Cullum: Are high school sports safe? Concussion registry can provide answers

Awareness about concussions has never been greater among high school athletes and coaches, thanks to the spotlight shone on some former NFL players who have experienced problems later in life. A downside to this heightened awareness is the fear it has sown among parents that their children who play contact sports like football may end up the same way.

I understand that fear. My son played soccer throughout high school and college and sustained several concussions. While I was obviously concerned at the time, he recovered quickly after each with proper rest and has had no lingering effects.

As a neuropsychologist, I applaud the increased attention that has led to improved protocols for diagnosing sports-related concussions and removing athletes from play until they have fully recovered. But I worry that the pendulum has swung too far. The reality is that we still don’t know who is most likely to suffer a concussion, who will take longer to recover, and who may be at risk of prolonged symptoms or developing cognitive problems later in life.

Scientists have made great strides in unlocking the mysteries of the brain in recent years, but much remains unknown. And while a number of studies have examined various aspects of sports concussions, the sample sizes have tended to be small and the findings disparate.

Some parents who decide that their kids should not play football out of fear that they may suffer life-changing brain trauma may have been influenced by media coverage of former professional football players who died after developing chronic traumatic encephalopathy (CTE).

One of the studies that generated the most headlines — and misperceptions, I contend — is a 2017 report in the Journal of the American Medical Association that showed CTE in 110 out of 111 brains of deceased former NFL players donated for analysis. While informative, this study covered only a highly select group of cases — namely professional players who had reportedly shown signs of mental decline before their deaths. Even the authors cautioned that the study was limited by ascertainment bias and lacked a comparison group representative of all individuals who played football.

In contrast, a report published just days later in JAMA Neurology made a very different point. The long-term study of 3,904 men who graduated from high school in Wisconsin in the 1950s showed no difference in cognitive function or decline between those who played football and those who didn’t.

And at UT Southwestern Medical Center in Dallas, where I work, a small study of former NFL players, age 50 and older, completed recently showed no significant association between the length of their career, the number of concussions sustained, and their cognitive function later in life.

How to account for these differences? Why does one former football player develop cognitive problems while another exhibits no cognitive decline? We simply don’t know.

Although many factors must be considered, I think it is premature to discourage teenagers from playing contact sports. What is needed now is more research to gain a deeper understanding of how concussions and hits to the head affect the brain.

Our team at UT Southwestern joined with the UIL, the governing body for high school sports in Texas, to launch the ConTex concussion registry in 2017. Although it began as a voluntary reporting program, beginning this fall the state’s largest school districts are now required to provide concussion data. We plan to use the data to begin examining how often concussions occur in high school athletic activities, examine regional and longitudinal trends, and investigate whether steps taken to make sports safer are actually reducing injuries.

Football and other sports are an integral part of American society and teach millions of kids invaluable lessons about teamwork and physical fitness. Rather than allowing fear to deprive children of the benefits of sports participation, let’s allow science to define the risks and help us make informed decisions.

— Dr. Munro Cullum is a neuropsychologist at UT Southwestern Medical Center’s Peter O’Donnell Jr. Brain Institute in Dallas.

Today's Bible verse

“In the beginning was the Word, and the Word was with God, and the Word was God. He was with God in the beginning. Through him all things were made; without him nothing was made that has been made.”

— John 1:1-3

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