New Study Provides Insight Into Chronic Traumatic Encephalopathy

Back in February a tremendous piece on dementia pugilistica ran on Sherdog. Just to rehash a bit of the good bits from it here's an excerpt:

Research on Dementia Pugilistica has brought two primary things to light. First, although the disease was long thought to be an acceleration of normal aging, perhaps a form of Alzheimer's disease brought on by trauma, the evidence proves otherwise. Alzheimer's disease produces scarring diffusely throughout the brain, but autopsy studies of ex-boxer's brains show a very different pattern of injury. In boxers' brains the scarring is predominantly along the surfaces of the brain, most commonly along the frontal and temporal lobes where punches have led to repeated contact between the bony prominences of the inner skull and the delicate surface of the brain.

The second important modern discovery regarding boxers' dementia is that it is not limited to boxers. Former rugby players, football players and wrestlers such as Chris Benoit have all been known to suffer from neuro-psychiatric diseases similar to boxers.

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The disease is now known as Chronic Traumatic Encephalopathy (CTE).

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It’s well known that the NFL has recently taken an active interest in CTE. Less well known is that the science behind the NFL’s new concern comes primarily from fighters. The NFL’s appropriation of boxing’s brain damage data is well founded; skull accelerations in head punches are similar to football collisions -- 50-80 g's. That bears repeating: These athletes’ brains endure jolts 50 to 60 times the acceleration of gravity.

Football has been under the microscope for several years now as the more research that is done, the more data is compiled pointing to a very scary link between concussions and long term health problems. Now a new study has come out of Purdue University that confirms some very major fears among fans, athletes and scientists. The main conclusion is that a football player does not need to experience a diagnosed concussion to see significant brain changes. The researchers studied a high school football team whose helmets were outfitted with accelerometers and players were studied throughout the season. The LA Times with more:

Of 21 high school players monitored for a full season by a team of researchers from Purdue University, four players who were never diagnosed with concussions were found to have suffered brain impairment that was at least as bad as that of other players who had been deemed concussed and removed from play.

"They're not exhibiting any outward sign and they're continuing to play," said Thomas Talavage, an associate professor at the Weldon School of Biomedical Engineering at Purdue and the lead researcher on the study. "The cognitive impairment that we observed with them is actually worse than the one observed with the concussed players."

And another scary excerpt from Indy Star:

Because these sub-clinical concussions -- injuries that can't be diagnosed as concussions but have similar effects -- are not recognized, the athletes are potentially at risk for additional, more serious concussions and other brain illnesses such as early-onset Alzheimer's disease, chronic depression and chronic traumatic encephalopathy, which affects the normal function of the brain as scar tissue replaces neurons, according to the study.

These kinds of studies caused former Dallas Cowboys quarterback Troy Aikman to make news last week when he said that if he had a ten year old son he would not encourage him to participate in football. And it's leading some to think that football will drastically decrease in participation among youth from the middle class as data becomes available that children and teenagers are running much more long term risk than was known even just a few years ago.

Of course, this is an MMA website so I'm not just writing this because I also love the game of football.

What we're learning as more and more data is collected on head injuries is that it's not just the obvious blows to the head that cause clear concussions that are going to do long term damage to athletes. There are solid measures in place in regulated states to examine fighters for obvious symptoms of brain injury before and after fights but there are not, nor are there likely to ever be, measures in place to constantly check on fighters as they participate in standard fight training where a boxer or mixed martial artist will receive the majority of blows to the head throughout their career.

The headgear and big gloves used in training do nothing to lessen the amount of trauma the brain takes and if anything, much like football helmets, create a false sense of safety. Headgear does a fine job of preventing superficial damage like cutting and bruising but there is no way to deal with the fact that when the head is hit it moves and the brain travels in the cranial fluid directly into the skull. That is where the scarring and other damage occurs. Much as football players are more likely to use their head in tackling and blocking when it is "protected" by a helmet, fighters tend to be somewhat less careful of protecting their head when wearing headgear.

Also, it is customary in training for fighters who are not "knocked out" but are wobbled or "have their bell rung" to sit out for a few minutes before jumping right back in to training. This, of course, puts a recently damaged brain right back in the line of fire. The Purdue study backs up the idea that every time a fighter steps into a sparring session or a fight they run the risk of suffering major brain trauma that could lead to conditions such as dementia pugilistica even if they are not knocked out or diagnosed with an obvious injury such as a concussion.

As many steps as have been taken to help with the safety of mixed martial arts we still have a long way to go before we're doing everything in our power to look out for athletes. I'm aware, as I'm sure are many others, of fighters who have been medically suspended following bouts in which they were knocked out who were back training well before being cleared by a doctor regardless of what the orders in the suspension were. The vast majority of trainers also have no training in recognizing any symptoms of obvious brain trauma or how to handle those situations let alone having knowledge of medical studies where smaller scale trauma has been recognized to have a tangible effect on brain function. I've been in gyms before where a guy is wobbled and knocked down and encouraged to get back up and continue, it's great to see young men who are so driven to prove themselves that they'd be willing to do it, but tragic to see trainers that would request such dangerous behavior.

Adding to the safety issues in MMA are promotions avoiding professional regulations by holding "amateur" events. Here in Southwest Michigan I've seen events where guys with over forty professional bouts are suddenly fighting on amateur cards where the only medical personnel in the building is a guy described as a "diet doctor."

Obviously there are no easy answers to what to do about brain injuries suffered in training or promotions disguising themselves as amateur events despite having professional fighters on the card. But fans and participants in the sport need to be fully aware of the risks involved in MMA. Just like any sport where athletes take repeated blows to the head we run a high risk of seeing men and women suffer from CTE later in life. Being aware of the risks only makes it more possible for us to look at the way things are currently set up throughout the sport from the biggest stage to the dankest gyms and figure out ways to constantly work to make the sport as safe as possible. It's not alarmist, it's responsible.