Vital Sings: Concussions

Airdate: July 13th, 2020.

Dr. Gupta: 00:23

Getting your bell rung or seeing stars. Call it what you want, but concussions are brain injuries, and it’s time to start treating them that way. This is Vital Signs. I’m Dr. Sanjay Gupta.

Dr. Gupta: 00:34

Concussion comes from the Latin word “concutere” which means to violently shake. It’s exactly what happens to the brain inside the skull after a blow to the head, neck or body. The brain bounces off the skull bruising and tearing membranes, sometimes resulting in irreversible damage. And when it comes to sports with high concussion risks, a few come to mind right away. American football and of course boxing or ice hockey, but what about the world’s most popular game? It might be time to start including soccer on that list.

Announcer: 01:08

Two players are down. [inaudible 00:01:12].

Announcer 2: 01:12

I think they hit heads.

Dr. Gupta: 01:14

And he just dropped.

Cindy Parlow : 01:16

Yeah. I think I was out in midair.

Announcer 2: 01:20

The ball’s in the air. They’re both trying to head it. No question about it. They absolutely clocked each other.

Cindy Parlow : 01:25

It’s scary because in an instant, in that instant, my life changed.

Dr. Gupta: 01:34

Cindy Parlow Cone made a career out of heading the soccer ball. At nearly six feet tall, she was a target in the air, scoring countless goals with her head. For Cindy, the physical side of the game was one of the things she loved most about it.

Cindy Parlow : 01:51

Growing up with two brothers was a very physical childhood, and brothers are wrestling around and all the time, so I was used to that, and then going out onto the soccer field I love the combative nature of it. I was fearless.

Dr. Gupta: 02:05

And that fearlessness was an asset on the field. At the age of 16, she found herself called up for a scrimmage with the US Women’s National Team, playing alongside stars like Mia Hamm, Julie Foudy, Kristine Lilly.

Cindy Parlow : 02:19

It was pretty surreal. I mean, I had a poster of all these players on my wall at home still, and here I am playing with them an mixing it up in a scrimmage.

Dr. Gupta: 02:29

By the time she was 18 years old, Cindy was a full member of the team, and an Olympian. At the 1996 Summer Games in Atlanta, she and her teammates took home the gold medal. So when the ’99 World Cup came around, the pressure was on.

Cindy Parlow : 02:45

That was a pressure that we put on ourselves because we knew the impact that this would have, not only on women’s soccer, but women’s sports in general.

Dr. Gupta: 02:54

You were on the team for nine years and then in 2006, you left. What was going on?

Cindy Parlow : 02:59

I think the first time I thought about leaving the team was in 2004. My concussion symptoms were just continuing to get worse, and it was kind of the first time that I realised that something was wrong.

Dr. Gupta: 03:18

In soccer, heading is a big part of the game, but that very act is responsible for nearly a third of all concussions reported in youth soccer. Dr. Robert Cantu is a neurosurgeon who has spent over 30 years studying concussions in sports.

Dr. Cantu: 03:34

Of the sports at high risk for concussion, soccer is right up there, and for girls it’s right up at the top. If you focus on the head, it’s not greatly safer in terms of concussion than football.

Cindy Parlow : 03:49

Yeah, not enough movement off of the ball, right?

Dr. Gupta: 03:51

Cindy had two diagnoses concussions in her playing career, though she says there have probably been more. Her first diagnoses injury came in 2001.

Cindy Parlow : 04:03

My own teammate actually hit me in the side of the head, and I was knocked out before I hit the ground.

Male Announcer: 04:09

She’s woozy though, you can see it.

Cindy Parlow : 04:11

I continued to play, and then I remember running up and down the field and like my fingers didn’t feel right, and they were like tingly.

Dr. Gupta: 04:19

That’s a brain injury. You had injuries to your brain.

Cindy Parlow : 04:22

Correct.

Dr. Cantu: 04:23

The brain has some natural protection for sure. The obvious protection is the scalp and then the skull, the bone underneath it, but underneath that is a membrane and then a water bath, spinal fluid, before you get to the brain. So the brain, when you put it in motion, the head, actually sloshes back and forth in this water bath but if you violently shake it, it bounces off parts of our inner surface of the skull.

Cindy Parlow : 04:55

I mean, I think I was just like a typical athlete. I had an injury and we know injuries are a part of the game. Just tell me how long I need to sit out, and what rehab I need to do before I can get back on the field.

Dr. Gupta: 05:06

Cindy’s second diagnosed concussion came two years later in the 2003 World Cup consolation match. Again, she collided with other players and was briefly knocked unconscious, but it would be a scare a year later in 2004, that made Cindy realise these concussions were jeopardising more than just her career.

Cindy Parlow : 05:27

Good. Set it up.

Cindy Parlow : 05:29

I remember trying to tie my shoes and my fingers weren’t working right, and that’s the last thing I remember until waking up in the MRI machine, and I had just been diagnosed with a TIA or mini-stroke.

Dr. Gupta: 05:42

I mean, you think about strokes in older people.

Cindy Parlow : 05:45

Right.

Dr. Gupta: 05:45

You’re an athlete, 24 years old.

Cindy Parlow : 05:48

I mean, that was a really scary time for myself, my family and of course, my teammates. Just as quickly as things happened, I went through all the stress tests and everything and was released to rejoin the exact training camp a few days later.

Cindy Parlow : 06:02 [inaudible 00:06:02], stretch them.

Dr. Gupta: 06:02

In the end, doctors weren’t sure that Cindy had had a mini-stroke, but they were confident that whatever it was, was related to repeated concussions.

Dr. Gupta: 06:12

Did someone say at that point to you, “Look, maybe it’s time to stop playing?”

Cindy Parlow : 06:17

Never. I mean, I think back now because I’ve educated myself so much more on the topic, it’s scary of what could have happened because I never have fully recovered from that concussion. I still have the exact same symptoms.

Dr. Gupta: 06:34

14 years later.

Cindy Parlow : 06:35

Yeah. I have symptoms every day. I have pretty much daily headaches. I have extreme fatigue that’s not related to normal things like working out and then feeling tired. That’s why I have a part of this campaign called Safer Soccer to take heading out of the game up to the age of 14.

Dr. Gupta: 06:55

Safer Soccer is an initiative started by the Concussion Legacy Foundation and Santa Clara Institute of Sports Law and Ethics. Cindy joined World Cup teammate Brandi Chastain as another face of the campaign last year. The aim is simple. Change the minimum age of heading the ball in youth soccer from 10 years old to 14. Dr. Cantu is one of the co-founders.

Dr. Cantu: 07:20

The young brain especially under the age of 12 or 13 is particularly vulnerable to trauma compared with the adult brain, and then the other really important one is that mostly between the ages of 10 and 12, the connectivity and the pruning of circuitry within the brain is at its highest amount.

Dr. Gupta: 07:43

Because of her post-concussion symptoms that continue to this day, Cindy Parlow Cone is no longer allowed to play soccer, but the sport is still a big part of her life.

Cindy Parlow : 07:53

Natalie, where do you need to be? Okay, Tiana, look around.

Dr. Gupta: 07:58

She now coaches young girls, and you’ll notice no heading practise here.

Cindy Parlow : 08:04

Well, I think a lot of the concern comes with the number of repetitions that a lot of coaches have their kids do in practise. I mean, it’s not uncommon for someone to go to a heading practise and to do 100 headers in a matter of 25, 30 minutes.

Dr. Gupta: 08:21

Cindy Parlow Cone retired after a successful career at the game’s highest level, but there are some who won’t get that chance, whose careers are over before they barely began. According to a study by the High School Reporting Index Online, concussions have become the most common injury in American high school sports, rising from nine percent in 2005 to more than 24 percent in 2015, partly because of increased awareness. They’ve also found that in the 2013-14 school year, only football and boy’s ice hockey reported more concussion in competition than girl’s soccer. In fact, concussions are nearly twice as likely to happen to a girl soccer player as compared to a boy.

Dr. Gupta: 09:04

One possible reason is neck strength. Typically young girls necks are going to be thinner and weaker, less able to absorb the impact of a hit to the head. While many players make a full recovery, others are not as lucky.

Dr. Gupta: 09:23

Wednesday morning in Memphis, TN. 16 year old Gracie Hussey and her older sister Katie are headed to school.

Teacher: 09:33

So take a look at the sign of this H …

Dr. Gupta: 09:36

First up for Gracie is algebra class. What used to come easy for this straight A student is now more challenging. Two severe diagnosed concussions on the soccer field in the span of five years have left Gracie reeling. Along with her two older sisters, Gracie started playing soccer at a very young age.

Gracie: 09:59

I remember I played for a team called the Blue Butterflies. We played against a boy’s team, and I made all the boys cry because I was so competitive and I didn’t back down to them.

Dr. Gupta: 10:10

On the soccer field she was tough, consistently playing on teams above her age level against girls who were bigger and stronger. Gracie was never afraid to challenge them for the ball, especially in the air.

Gracie: 10:23

Well, right off the bat when I was introduced to heading I loved it immediately, thought it was cool, and every practise I would say, once a week a practise was dedicated to headers.

Dr. Gupta: 10:34

With much of the concussion conversation dominated by football, soccer seemed like a safer option. Gracie’s mom Beth and her father Richard didn’t see it as an inherently dangerous sport. But all that would change with Gracie. Her first diagnoses concussion came when she was just seven years old.

Beth: 10:53

Gracie went up for a ball to head the ball and the girl’s elbow just cut her right in the forehead, and I saw it, and Gracie fell to the ground and jumped right back up and acted like it didn’t happen. So, Gracie finished the game. After the game she came up to me and said she couldn’t really see and her head hurt, and so then we proceeded from there.

Dr. Gupta: 11:14

Gracie just wanted to get back on the field as soon as possible. It wasn’t long before doctors cleared her to return.

Gracie: 11:21

I thought it was just like breaking a bone, and it was going to heal and that you could laugh about it later, but now what I know about it, I wish I would have changed everything I did back then.

Beth: 11:32

As a parent, this is why I guess I’m so passionate about getting the word out now is because thinking back, it just kills me remembering situations and thinking that everything was okay.

Dr. Gupta: 11:45

This video is from 2011. Gracie is the goalkeeper in the orange jersey. You can see her colliding with another player and getting kicked in the face. She’s disoriented and in tears, but she stays in the game. Most likely another brain injury, undiagnosed.

Beth: 12:04

I think a lot of people who suffer concussions and who suffer the worst concussions over and over are the athletes that can fight through pain and don’t want to admit that they’re hurt. I think it’s also hard to communicate it as a child when no one can see it.

Dr. Gupta: 12:21

Gracie continued playing soccer and excelling at it. She was one of the stars of her club team, winning regional tournaments around the Southern United States, but in 2012 that would all end.

Gracie: 12:34

My main concussion that changed my whole life was September 25th.

Beth: 12:40

And Gracie was playing defender and she had cleared the ball, and when she cleared the ball, she was off balance and someone came and just hit her, and she fell back and she fell back on her head, leaned on her shoulder and she hit the turf really hard.

Gracie: 12:54

And then I stood up and the whole field was spinning around me and everybody was like, “Are you okay?” And I remember that I was feeling so confused and I just stayed in the game because there was about 30 seconds left. I was like, “I’m fine.” And then I could barely make it to the bench, and after that I really don’t remember much.

Gracie: 13:12

Come on, Murph. Come on. Come on, Murph. 

Dr. Gupta: 13:15

Gracie was diagnosed with another concussion, whiplash and a sprained neck. Doctors sent her home from the emergency room with a neck brace.

Beth: 13:24

We went home but I just had a feeling, and by the weekend, it was, her symptoms had gotten worse, and Gracie was repeating herself.

Dr. Gupta: 13:34

Gracie went to see a neurologist who diagnosed her with post-concussion syndrome. She missed a lot of school, and as the winter basketball season approached, Gracie became restless. She told her parents she finally felt better, but she was hiding a secret.

Gracie: 13:50

I was lying to myself and my parents. I really had a headache, but I was just so determined to get back to my sports that I lied, and I shouldn’t have, but then finally in about March or February I was like, “Mom, I’m still having headaches.”

Dr. Gupta: 14:06

Among other symptoms like dizziness and nausea, Gracie had been suffering from a sever headache every day for months. At that point, the decision was made to stop playing all contact sports including soccer.

Gracie: 14:19

It was really tough. At first I didn’t want to accept it. I thought it was just going to be for a year, maybe, but then when I looked at it and realised that I was not going to be able to play for the rest of my life, I was so mad and frustrated because that’s my personality.

Dr. Gupta: 14:35

Gracie suffered from two diagnosed concussions on the soccer field, but she and her family now think there may have been as many as four or five more that went undetected.

Beth: 14:45

I didn’t realise at the time that if a child’s nauseous, has a headache, hits a ball and sees stars or things go black, the sky changes colours and those are symptoms and signs of a concussion. It’s not natural for the head to feel that way. Now, I’ve learned just being a part of this for so long with Gracie through her journey, I’ve learned and I understand more.

Dr. Gupta: 15:10

Understanding more. It’s what doctors and researchers are also trying to do when it comes to concussions and the brain. More and more, it appears technology will have a position on the playing field. Next, what tech is teaching us about brain injuries.

Dr. Gupta: 15:28

One of the trickiest aspects of concussion is that everyone experiences one differently, and you don’t always lose consciousness when suffering a concussion. That’s a myth. A concussion does however, change the way you perceive the world. Blurry vision, ringing in the ears, numbness in your arms, headaches, nausea, fatigue, those are all common physical symptoms. There can be cognitive issues such as difficulty with memory, concentration, even amnesia. There are also emotional symptoms, like irritability, depression, sleep disturbances. Complicating the diagnostics even further is the fact that there’s still so much we need to learn about the brain itself before we can fully understand what happens when it is injured.

Dr. Gupta: 16:11

That’s where technology can help, and it’s finding a home on the field of play. It happens in a split second. The impact of the soccer ball on the head or head-to-head contact. A quick blow is all it takes.

Chad: 16:31

I can generate some impact here.

Dr. Gupta: 16:34

Finding a way to measure that is what Chad Hollingsworth is working on.

Chad: 16:39

It’s a lot more people play soccer in this world than American football. So that was kind of the idea, let’s try to make a sensor that could work for non-helmet sports.

Dr. Gupta: 16:50

He’s the president of Connecticut-based Triax Technologies. The company has developed a sensor worn in a headband to measure impacts to the head.

Chad: 16:59

We made some pretty sophisticated algorithms that, even though this is on the back of the head, the sensor thinks it’s in the middle of your head, and this is not a diagnostic tool, but it does give you an objective measure of what’s going on a field in real time.

Dr. Gupta: 17:13

The data from the headbands is transmitted to a control box on the sideline or even to your phone. Coaches, parents, trainers can receive alerts when a particularly hard impact occurs.

Chad: 17:24

The most surprising thing I learned was I saw a 15 year old girl take a goal kick from half field off the head, and it registered at a level that I saw a Division I football player a week before hit a linebacker at.

Cindy Parlow : 17:40

So the real goal of it is to provide objective data to medical professionals to be able to better detect concussions.

Dr. Gupta: 17:49

Cindy Parlow Cone agrees that technology has a place in sports. She’s co-founded a company called ImVere to develop a detection device.

Cindy Parlow : 17:57

Our device actually goes inside the ear, so it sits on the bony part of the canal, so it actually measures skull motion which as you know is important in detecting impacts to the head and skull movement.

Dr. Gupta: 18:08

Cindy says she wonders what might have been if more had been known about concussions when she was playing.

Dr. Gupta: 18:14

So most people will never get to hold one of these, let alone have five of them.

Cindy Parlow : 18:21

It was just such a great time until probably I would make the divide about right here. So from then on, I was suffering pretty severely with concussion issues, and at that stage, and I had these doctors that said I was fine, I had to push through it, and so I was trying and it was every day was a battle.

Dr. Gupta: 18:47

What is your sentiment or your sort of emotional thinking about these headaches now?

Cindy Parlow : 18:49

I call it my new normal. I rationalise it that everyone has issues, and I’m no different.

Dr. Gupta: 18:58

Gracie Hussey feels the same way. Her playing career ended three years ago at the age of 13.

Gracie: 19:05

My morning pills are …

Dr. Gupta: 19:08

Now at 16 years old, she takes 11 pills a day to combat her symptoms. If I didn’t take my pills I think I might be fainting every other hour probably.

Beth: 19:19

To see a child every morning and every evening have to take medicine, it’s tough, and the goal is to get her off the medicine.

Dr. Gupta: 19:28

Another therapy for Gracie, her dog Murphy. When her symptoms were at their worst, doctors recommended a pet.

Gracie: 19:36

He just laid on me all day while I was in bed, and every time I got a really bad headache, he would know and he would just go lay on my pillow and just be there to support me.

Dr. Gupta: 19:47

In the back of both Gracie’s and Cindy’s minds, are questions about the future. More and more, chronic traumatic encephalopathy or CTE has been in the spotlight. It’s a degenerative cognitive disease that can only be diagnosed after death. In former NFL players, who had had concerns about CTE symptoms while still alive, it was found in 87 out of 91 examined brains, and it is also recently been found in soccer players.

Dr. Cantu: 20:17

The brain doesn’t know what rattles it. If it gets rattled enough, and you’re susceptible to CTE, you’re going to have it.

Cindy Parlow : 20:24

CC, you’re job’s to get out of her way.

Dr. Gupta: 20:26

Cindy has already agreed to donate her brain for CTE research.

Cindy Parlow : 20:31

That’s a point.

Dr. Gupta: 20:32

Do you think you have it? Do you think that you might have CTE?

Cindy Parlow : 20:35

I try not to think too much about it, but I mean, it is a concern that it’s something I may develop.

Cindy Parlow : 20:41

We need deception there, Cara.

Dr. Gupta: 20:42 To help cut down on the number of blows to the head. The Safer Soccer initiative hopes to raise the minimum age of heading the ball, but it is up to youth leagues to adopt the policy.

Cindy Parlow : 20:55

The main pushback that I’ve heard is that it changes the game, which is a legit pushback. It does change the game, but for me, I think it changes it actually for the better because now the balls on the ground more often. You’re working on skills …

Dr. Cantu: 21:08

Well, there’s no such thing as good head trauma, but let’s not get paranoid about it. We’re all going to take shots to the head, and as I mentioned to you, we’ve gotten some pretty good protection, but it’s not a good idea to seek it out.

Dr. Gupta: 21:22

In a statement to CNN, FIFA, soccer’s international governing body told us recent policy changes have led to a quote, “Significant decrease of concussions.” FIFA says in 2014, a new protocol was approved for FIFA competitions. One of the main elements of this protocol is that only the team doctor can allow a player to return to play after suffering a head injury.

Female: 21:44 [inaudible 00:21:44] okay?

Female 2: 21:45

Yeah.

Dr. Gupta: 21:46

Here in the US, Cindy Parlow Cone and Gracie Hussey continue to try and get the word out about concussion awareness in a sport typically considered safe.

Dr. Gupta: 21:57

When you come out here nowadays, and you’re standing on a soccer field like this, do you have any … Does it take you back? I mean, do you have any of the tough memories from years past where you got injured?

Cindy Parlow : 22:09

No, I really don’t. I mean, when I look back over my career, it’s with pride and joy.

Cindy Parlow : 22:15

Here we go. All you got to do is get a touch.

Cindy Parlow : 22:17

And now, through my coaching and through my involvement with the company that I’m starting, I take great pride in trying to help make the sport that I know and love as well other contact sports safer for kids.

Dr. Gupta: 22:32

Making sports safer while still maintaining the integrity of the game. That’s the challenge facing sport leagues all over the world. For parents and players, it’s about weighing the benefits and the risks. We’re not saying to never play football or soccer. There are big upsides to team sports like exercise, social engagement and valuable life lessons such as teamwork, but make sure it’s happening as safely as possible. Talk to the coaches, trainers, parents and players, so that everyone knows concussion awareness is a no-brainer. For Vital Signs, I’m Dr. Sanjay Gupta.

END