A newly released study by researchers at Boston University linked repetitive hits to the head rather than concussions to the onset of CTE. Dr. Lee Goldstein, an Associate Professor at Boston University School of Medicine and College of Engineering and one of the authors of the study said: “The concussion is really irrelevant for triggering CTE. It’s really the hit that counts.” The BU study focused on the brains of teenagers with head injuries and head-injured mice. The study found the link between head impact and TBI, independent of concussion. For the research team, the findings explained why approximately 20% of athletes with CTE were never diagnosed with a concussion. Goldstein referred to TBI “it is an injury, an event and involves damage to tissue. If you don’t have a concussion, you can absolutely have a brain injury and the converse is true.”
The study points to groups who may be at risk for repetitive head injury and CTE including: victims of domestic abuse, people who are incarcerated, the homeless, the military, amateur athletes and professional athletes. Dr. Goldstein and Dr. Ann McKee noted the repetitive effect on a 2012 paper on blast neurotrauma in the military. That effect, they noted, was “injury on top of injury.” In the most recent research the brains of four teenagers who sustained closed-head impact injuries ranging from one to 128 days before death and found the results alarming. Two were 18 and two were 17; two died by suicide, one died 10-days after a sports-related concussion and the fourth after sustaining three concussions 1 day to 26 days before his death. Of the four brains, one showed early signs of CTE and two with abnormal accumulation of tau protein, a CTE marker.
The study points to a gap in managing hits to the head without signs of concussion. These are the hits in which there are not signs of concussion and in most cases the person returns to activity without further examination or restriction. The only way to prevent these hits is to limit physical contact and educate players, coaches and others at risk. NeuroNotes has published several blogs on repetitive injuries in sports like soccer and lacrosse as risk activities associated with cumulative brain injuries. The recent study from Boston University and the ongoing work of researchers like Goldstein and McKee keep pointing in the direction of evaluating non-concussive injuries.