Our Brain is the Key to Longevity: Sub-concussive Force and Chronic Trauma

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By Desi Rotenberg, MS,  LAT, ATC

The human brain is one of the most studied aspects in existence today, and yet, we are only able to scratch the surface of how it really works.  With its overwhelming complexity, researchers are constantly on the lookout for methods to understand, treat and predict the various symptoms that can be associated with disruption of normal cerebral and neurological functioning.  What we do know is the human brain is vulnerable and fragile.  While the brain may hold the secrets to our existence and can take a lifetime to develop into its full potential, it only takes a momentary physical trauma for everything to change.

Concussions and traumatic brain injuries continue to be a hot topic amidst the athletic population and will continue to be on the forefront of research and medicine, as long as human beings strive to test the limits and durability of the human body.  The ugly truth about athletics and sports as a whole is the risk of altered cognitive functioning following a hit to the head. While most athletes will tell you the consequences of brain damage are unlikely, as a professional, I believe is it our responsibility to educate and prepare for these unlikely events.

I am reminded of the story of Pat Grange, a professional soccer player who was diagnosed with Chronic Traumatic Encephalopathy (CTE) at age 29, and subsequently lost his life to amyotrophic lateral sclerosis (ALS).  His brain was later donated to the Boston University VA.  Analysis revealed stage 2 (out of 4) on the CTE Severity Scale.  Up until his death, no one really considered soccer a high-risk sport when it came to chronic brain injuries.  From this examination and that of the countless others who donated their brains to science, medical research continues to raise the understanding that the human brain can only handle a certain amount of trauma on a day-to-day basis before it begins to degenerate from the inside out.

Occasionally, a player will suffer a concussion from knocking into an opponent’s head while going up for a ball.  However, what we seem to overlook is the number of times soccer players may use their heads during a single practice.  Is it possible that sub-concussive, low-force hits to the head may cause CTE?

A soccer player practicing headers through the course of a single season may have knocked their head over a thousand times.  Similarly, an offensive lineman who undergoes sub-concussive hits to the head for 4 straight months may not understand the damage that is occurring.  While these blows to the head may not produce clinically positive concussive symptoms, further research may reveal sub-clinical, chronic trauma to the head that could elicit long-term breakdown and scarring of brain tissue.  While correlation does not equal causation, we cannot overlook the fact that the human brain may be susceptible to long-term, low-force trauma.

As Athletic Trainers working at the high school level, we simply cannot take any chances when it comes to the developing brain.  Student athletes have their whole lives ahead of them, and while athletic competition is important, we must always remember the future of our athletes should never be sacrificed for a single practice or game.

Source: Johna Register-Mihalik, PhD, ATC, LAT

Instead, when it comes to head injuries, we must take into account the aspects of life that are going to be affected by the injury.  While the academic and extracurricular effects are obvious, we must not overlook the social and behavioral changes that also can occur.

Behavioral changes can affect interactions with family and friends and can often affect an individual’s ability to feel connected at home, at school and in the locker room.  Additionally, if an individual has any type of anxiety disorder or cognitive disorder, the individual’s recovery time may be slowed, or even negatively affected.

As medical professionals on the front lines, we are the first line of defense when it comes to protecting the futures of young athletes.  If a student athlete were to come to me in the middle of a game and say, “I was hit in the head and I have a headache,” concussion protocol states  the athlete should be removed from play.  However, I would continue to hold the athlete out of the game, regardless if the athlete were to tell me that their headache has remitted.

The brain is malleable and delicate, and we must do our part to ensure young athletes are not being exposed to chronic, sub-concussive blows to the head at a time when the brain is still developing.  As we saw in the case of Pat Grange and many other individuals before him, long term, low-force trauma to the head may prove to be disastrous later in life.


Branche, J. (2014, February 26). Brain Trauma Extends to the Soccer Field. The New York Times. Retrieved from

McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., ... & Stern, R. A. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury. Journal of neuropathology and experimental neurology, 68(7), 709.

Register-Mihalik, J., Guskiewicz, K. M., Mann, J. D., & Shields, E. W. (2007). The effects of headache on clinical measures of neurocognitive function. Clinical Journal of Sport Medicine, 17(4), 282-288.

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