Lower the Risk of Head Injuries from Contact Sports
Head injuries are one of the most serious risks in sports, especially in collision and contact sports. A recent Columbia study found that soccer players who often head the ball showed physical changes in the brain that affected long-term cognitive performance. Even when head injuries don’t show up on scans, they can still be harmful—especially for young athletes whose brains are still developing.
Columbia sports medicine physicians Elan Goldwaser, DO, and Thomas Bottiglieri, DO, are former athletes who understand the value of sports and how to participate safely.
“Head injuries are common. Many are not serious, but it is extremely challenging to know which injuries are concerning and when athletes can safely return to play,” says Dr. Bottiglieri. “Always consult with an expert, because brain health should not be something we gamble with. Conversely, we are not made of glass, and we can be resilient in the face of injury if given the appropriate support and time to heal.”
With the fall sports season underway, Drs. Goldwaser and Bottiglieri share what to know about collision and contact sports, head injuries, and safe participation.
How athletes get head injuries
Contact and collision sports involve repeated impacts with objects, other players, or the ground, as seen in football, ice hockey, lacrosse, boxing, soccer, and basketball. These athletes are most at risk for head injuries no matter their age or skill level. However, children and young adults should take longer breaks when recovering from head injuries.
“Younger people are generally thought to have more complex injuries and need more time to heal, as the brain and its protective mechanisms are not fully developed yet,” says Dr. Bottiglieri.
What are the types of head injuries?
All head injuries are a kind of traumatic brain injury (TBI). Concussions are mild TBIs that produce temporary symptoms without visible brain damage on scans. Make an appointment with a sports medicine specialist or your primary care doctor if you or your child experiences any of the following concussion symptoms:
- Headache or neck pain
- Dizziness
- Drowsiness
- Sensitivity to light or sound
- Mood swings and irritability
Moderate and severe TBIs have similar symptoms to concussions, but the effects are more serious and last longer. Any of the below symptoms should be evaluated immediately at an emergency room or urgent care center:
- Slurred speech
- Seizures
- Loss of consciousness
- Loss of vision
It’s especially important for athletes with concussion symptoms to follow up with a sports medicine specialist. Severe or recurrent TBIs can cause long-term issues affecting memory, attention, mood, and executive function, even if the injury isn’t visible on a scan, Dr. Goldwaser says.
What is chronic traumatic encephalopathy?
Not all hits to the head result in TBIs. However, repeated hits to the head over many years can lead to chronic traumatic encephalopathy (CTE), a neurodegenerative disease caused by scar tissue buildup in the brain. CTE isn’t well understood because it can take years or decades to develop and isn’t visible on scans—it can only be diagnosed from an autopsy.
Symptoms initially overlap with TBIs and other conditions but get worse over time, eventually resembling Alzheimer’s and Parkinson’s diseases. Signs include:
- Memory loss
- Impulsive behavior, depression, and aggression
- Cognitive issues affecting thinking, planning, and reasoning
- Dementia
- Tremors, difficulty walking, and balance and coordination issues
- Speech and swallowing difficulties
“CTE is the most concerning negative outcome of repetitive brain injuries,” says Dr. Bottiglieri. “At this time, it is very challenging to predict when athletes will be at risk of CTE, but there is growing evidence that participating in collision sports for more than five years comes with an increased risk that continues to grow with each additional year of play.”
You don’t have to have been diagnosed with a concussion or other TBI to develop CTE. Similarly, being diagnosed with a concussion (or several) does not necessarily put you at higher risk of CTE. Researchers believe the main factor is the number of collisions experienced, which for athletes playing sports like football and hockey, can reach the hundreds or thousands.
How to stay safe playing contact sports
While head injuries can be serious, there are ways to lower the risk.
“The most important way to keep a child safe in contact sports is through proper training and technique,” Dr. Goldwaser says. Changes to rules have helped make games safer, he adds, but if a child isn’t properly educated in a sport, they’re likely to engage in more aggressive behaviors. “These behaviors result in a much higher likelihood of head injury, often without much competitive advantage. Being a student of the sport you’re playing will not only make you a better athlete but reduce your rate of injury as well.”
In addition, children should avoid collision or contact sports while they’re still growing, ideally until high school. And all athletes should always wear properly fitting gear to practices and games. Cleats that are the wrong size, helmets that are too loose, or mouthguards that fall out could result in preventable falls or more serious injuries.
“Although there is a risk of head injury in contact sports, when played the right way, that risk decreases, and the sports become more enjoyable. When head injuries do occur, they shouldn’t be ignored and should always be evaluated by a medical professional,” says Dr. Goldwaser.
Elan Goldwaser, DO, is an assistant professor of sports medicine at Columbia University Vagelos College of Physicians and Surgeons, specializing in caring for pediatric patients with concussions and acute and chronic musculoskeletal injuries.
Thomas Bottiglieri, DO, is an assistant professor of sports medicine at Columbia University Vagelos College of Physicians and Surgeons, specializing in treating and preventing orthopedic injuries and concussions