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LISA:
Welcome to Brainwaves, a podcast about big ideas, produced at the °µÍø½ûÇø.

I’m Lisa Marshall.

This week: football season is right around the corner. And with it, no doubt, will come more discussions about concussions.

How has our understanding of concussions changed? What’s being done to make athletes safer? And how is football changing as a result?

We’ll talk to a leading researcher, a coach, and an athletic director charged with protecting the health of student athletes, about the changing face of America’s most popular sport.

First, recent research by CU’s Center for Sports Governance shows high school football participation has taken a tumble in recent years, at least in part because of concerns about head injuries.

Would you let your kid play football?

VOICE 1:
I haven’t thought about it a whole lot. I grew up playing football, didn’t like myself. So, I’d be curious to see if they want to.Ìý

VOICE 2:
I definitely would not let them play football, probably something a lot safer.

VOICE 3:
Well, I don’t have a child, but I would probably let them do it in high school. I'm not sure what rules the NFL have, but I think probably in school they're probably taking more precautions and not hitting so hard.

VOICE 4:
My son played for a little bit, and I worried all the time. So, yeah, I would.

VOICE 5:Ìý
Never, ever, ever just because of the risks with the concussions.
LISA:

Each year in the United States, as many as 3.8 million people will sustain a sports-related concussion.

In a single day, about 670 high school athletes will report one, according to a recent CU Anschutz study, and among college football players specifically, about 8 percent of all injuries are concussions.

What exactly happens to the brains of those athletes?

And what can be done in the minutes, days and months post-injury to help them heal?
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Brainwaves’ Paul Beique sat down with Matt McQueen to get some answers.

He’s an associate professor in CU Boulder’s integrative physiology department, and a key player in a new NCAA-led effort to learn more about the science behind concussions.

PAUL:Ìý
Matt McQueen, welcome to Brainwaves.
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MATT:Ìý
Thank you, I’m glad to be here.
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PAUL:Ìý
Let’s begin with the very basics: what is a concussion and what does it look like externally and on a brain scan?
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MATT: Yeah, that’s a great question, and part of the research that we’re doing and others are doing across the world is to try to understand, you know, what does a concussion look like? Clinicians will say often that if you’ve seen one concussion, you’ve seen one concussion.Ìý

They can look quite differently in terms of how they present clinically in the same individual, if an individual has repeated concussions, and certainly will look different clinically from person to person.Ìý

All types of people, athletes, anybody who's active who sustains a concussion, you know, it can involve, you know, initial confusion immediately following an impact.Ìý

You can have issues related to memory, some sleep problems as well.Ìý

These symptoms typically, on average, we think, last about seven to 10 days before they resolve, but again some may have longer-term issues that may involve the vestibular system, they may have some balance dizziness as part of that as well.Ìý

But a big active area of research now is trying to understand whether there are subtypes of concussions that can be accurately diagnosed within individuals.Ìý

So, typically, based on what we have, our current technology that you would see standard in a hospital, you can't actually see a concussion on a CAT scan or an MRI.Ìý

There are more sensitive research tools that are coming online that would look at functional capacity of the brain, for example, through different imaging techniques that might be sensitive to certain changes, but those are still very much in development.
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PAUL:Ìý
So, really it's external behavior, whether someone is suffering memory loss or something like that.
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MATT:Ìý
That’s right, it’s very much driven by the symptoms that a person is experiencing.
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PAUL:Ìý
What is new in concussion research, and how is the way we're thinking about them changing?
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MATT:Ìý
What we’ve learned is, again, a concussion presents in many different ways.Ìý

It's also very important that athletes and individuals who’ve sustained a concussion are allowed proper recovery.Ìý

We didn’t quite understand the extent of which recovery time was important, and that's really taken off in the last decade or so, an awareness and understanding about the importance of rest and recovery in the process of concussion injury.
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PAUL:Ìý
Is it possible, do you think, to play football without concussions? Can we concussion-proof this sport?
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MATT:Ìý
So, what we have to do, whether it's football or soccer or lacrosse or mountain biking, right, are take steps to essentially, you know, improve the safety as it relates to concussion and to all injuries, but improve the safety of the sport.Ìý

And also, obviously, it’s not just trying to prevent the initial concussion from happening, but also providing optimal care and giving athletes time to recover from that injury that they’ve sustained.
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PAUL:
You are the director of the PAC-12 concussion coordinating unit. Can you tell us a little bit about that work and where it's going?
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MATT:Ìý
Yeah, so, my team here at CU Boulder is directing the NCAA, Department of Defense care- affiliated program, which is a partnership between the PAC-12 conference, the NCAA and the Department of Defense. And so, the entire PAC-12 conference has joined into this initiative to collect important clinical information at constant time points throughout an athlete's time at the university.Ìý

So, this will involve baseline testing on the same assessments, and then following a concussion in any sport, men and women’s sport, we will follow them over time with the same assessments across the PAC-12 to try to understand, unpack, the natural history of concussion.Ìý

What's the average recovery time?Ìý

What strategies may seem to be more effective at athlete recovery and so on?Ìý

And so, our role here as the coordinating unit is to literally coordinate the 12 sites across the PAC-12 for data collection.Ìý

And eventually, we’re starting to write some papers now on the data, data curation and analysis of the data in publication.
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PAUL:Ìý
Well, good luck with your work. We’ll be interested to see what your results are
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MATT:Ìý
Great, thank you very much.
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PAUL:Ìý
All right, Matt McQueen, thank you very much for joining us on Brainwaves.Ìý

LISA:
Knowing what we know about head injuries and concussions… can we make football safer?

Coach Mel Tucker is one person who’s trying.

Brainwaves’ Cole Hemstreet has the story.

COLE:
Mel tucker has lived a football life.Ìý

Before becoming the head coach for CU Boulder this offseason, he played football for the University of Wisconsin in the early 1990s, was a defensive coordinator for the Chicago Bears as well as the University of Georgia last season, he was even the head coach of the Jacksonville Jaguars for part of the 2011 season. Ìý

Now standing on the sideline of CU’s practice field, he sees some changes from when he started more than 20 years ago.

MEL:
Well, the players are bigger and faster and stronger, but in terms of the way we teach football and the techniques that we use for blow delivery and tackling, I think the game is safer than it’s ever been, just in teaching players to keep their head out of the game. That’s been a big point of emphasis for quite some time. you know, really a lot of the rule changes that we’ve had, starting in the NFL years ago. I mean, I’m thinking 2005, 6, 7. When I was in the NFL, there was a real strong push to eliminate a lot of the, a lot of concussions.Ìý

COLE:
Concussions aren’t just a problem for the NFL.
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MEL:Ìý
It's the same thing for us. You know, we all talk to our players about taking a head out of the game. And tackling, always having your eyes up. See what you hit. Delivering a blow with a shoulder and a forearm and not leading with the head. And that's somewhat different than maybe what we, what we heard growing up as kids playing the game. So a lot of those hits, you know, years ago that were a highlight type of hits, those hits now will result in a penalty and ejection.
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COLE:
Tucker says as the game changes, so does the way he coaches.Ìý
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MEL:
I always make sure that our coaches are saying the same thing that I am saying. So, we never refer to, You know tell a player to stick his face in there, or put your face in the fan or, or knock his head off, or anything that has to do with the head. We don't, we don't reference that. And so, it starts with me. I watch every single drill that we do every single day, because my number one job is to make sure that our players are safe.Ìý
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COLE:
And that responsibility is on everyone else’s shoulders, too.
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MEL:
If a coach sees a player or a teammate sees a player that he thinks may be a little banged up one of our doctors or trainers, and we also have spotters in the booth, immediately go and see the doctor and get analyzed and evaluated. ÌýAnd there’s protocol for that. And that player will not return to the game unless he's cleared to go.Ìý

COLE:
Catch Mel Tucker and the Buffs playing their first game at the end of this month. For Brainwaves, I’m Cole Hemstreet.

LISA:
Now we’ll turn to someone who’s responsible for helping all CU Boulder athletes, including women soccer players, who also have a higher concussion risk, do all they can to prevent them.

Brainwaves’ Dirk Martin sat down with Senior Athletic Director Miguel Rueda.Ìý
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DIRK:
Thanks for joining us, Miguel. In terms of health and safety, what are you doing to prevent concussions in our student-athletes?
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MIGUEL: Ìý
Well, I think the most important thing is to define it. Right? You'd be surprised how many people don't understand what a concussion really is. So what we try to do is explain to them what we understand to be the mechanism, the physiological mechanism of what concussion is, and what that means for them as they participate in sports and reasons why they would be pulled from competition and stress reasons why they would need to be honest and report symptoms to us.
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DIRK:
What changes have you seen over the years in trying to prevent concussions?
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MIGUEL: ÌýÌý
I think, you know, lately what we've seen is its changes coming from many different places at the same time. Looking at the number of contact practices. How many contact practices you’re allowed to have. How often your athletes may hit. The type of drills that they do. And, really, changes in tackling technique, all are being emphasized right now in addition to strengthening components. What we're finding is, you know, that female student-athletes have greater incidence of concussion than their male counterparts within the same sport. For example, women soccer players may sustain more concussions than men's soccer players. And so why is that? And we're getting to the root of that. But one thing that is - hypothesize is - that it could be a difference in neck strength. Maybe male athletes have a little bit more neck strength and female athletes don’t. So one thing that we emphasize in the weight room is proper strength and conditioning program to help with that. I think, the collegiate environment in terms of research that we're doing to try and identify best practices and ways to address concussions when they happen, and also look at different technologies that may exist to, perhaps, maybe prevent concussion, whether it's helmet design or some of these other biomarkers that we're looking at.

DIRK:
How difficult is it to diagnose severity of concussion and how many different levels are there to concussions?
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MIGUEL: ÌýÌý
We've gotten away from grading concussions. You never really know how severe one is until all the symptoms have subsided.Ìý

It used to be, you know, when I started in this profession that loss of consciousness kind of dictated what grade of concussion someone was.

But you may have a student-athlete that has no loss of consciousness, but has these persistent headaches, and some other minor - what would be considered minor symptoms that are long-term and, you know, persist for a period of months.Ìý

And in that may be more severe than the student athlete that has a major hit, has all these signs and symptoms early on but clear up relatively quickly.Ìý

So, we’ve taken a step back from gradingÌý
concussions and we just follow them and try to find the best opportunity in an environment for them to heal and get better.
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DIRK: Ìý
Also, how difficult is it to diagnose in terms of how long the recovery will be?
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MIGUEL: Ìý
There are some pretty robust databases is out there.Ìý

You know we do neurocognitive testing--computerized neurocognitive testing--on some of our student-athletes. And that data collection part has been around for a while. And then with the introduction of newer technology, what we're trying to do is look at all the different signs and symptoms and see if there's a way to predict how long something may last. But we're in the infancy of that right now. So, it is pretty difficult.
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DIRK: Ìý
At what point do you just tell an athlete that have to stop? That the concussions are too dangerous for them?
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MIGUEL:
You know, I think what we need to look for it if you're talking about an athlete ending their career because of concussion, number one: it's sort of that conversation with the athlete and what the athlete wants.Ìý

Some athletes, you know, their threshold in terms of desire is different than others.Ìý

And so, they may have sustained an injury that they're just not comfortable with participating and we support that. Right?Ìý

And then there's others who want to participate but maybe they have some of those long-term symptoms that persist for a while, and that we’re having a hard time getting them over that hump.Ìý

Then we may kind of step in provide advice. Right? Or make a medical decision.

LISA:
Thanks for listening to this episode of Brainwaves.

I’m Lisa Marshall.

Dirk Martin, Cole Hemstreet and Paul Beique produced today’s episode.

Andrew Sorensen is our executive producer.

Sam Linnerooth is our digital producer.

Cole and Andres Belton created our theme music.

See you next time on Brainwaves.
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