Concussions, other brain injuries and ‘CTE’: How are they different? And is there any link to mental illness?
A physiatrist from TRIA Orthopaedic Center explains
There’s a good chance you’ve heard talk about sports-related brain injuries. There has been a lot of recent news coverage on these injuries in professional football players. Some of the stories have involved players displaying mental health symptoms. And some of those players have even taken their own lives. Understandably, I get many concerned parents and coaches wanting to know what is happening, and how it can be prevented.
This is a complicated topic. I often hear concussions, other head and brain injuries and CTE (which I’ll further explain later in this blog post) being lumped together as one issue among pro athletes. But I want to stress that they are all very distinct conditions.
What happens to your brain when you hit your head
When you hit your head, a flow of chemical changes react in response to the forces applied. How much change depends on the severity of forces that impacted the central nervous system. This causes an energy shortage that can cause different symptoms. This could be a headache, amnesia, dizziness and many more. These are the symptoms of a concussion. But there are also other types of head and brain injuries aside from concussions.
What we know about CTE
Chronic traumatic encephalopathy, or CTE, is considered a degenerative brain disease. This means it will progressively get worse over time.
In CTE, a protein called tau forms in the brain and kills cells. As the protein does more damage, the patient, or their loved ones, will start to notice the effects. The person with CTE might have memory loss, mood swings or personality changes. They could start to be more aggressive, or show signs of depression or paranoia.
The challenging part about CTE is the diagnosis. While the symptoms can be obvious, CTE cannot be confirmed until after death. And because of that, there is no treatment or cure. It is only after death that the brain can be more closely observed for tau proteins.
CTE is a condition that is being found in pro athletes more often. And because of that, people are often linking it to concussions and other head or brain injuries. The reality is, however, that CTE has not been proven to relate to or be caused by any head injuries. There is only correlation and we cannot definitively link the two. Plus, studies have not expanded much outside of football players. With only this limited research, we can’t be sure that CTE isn’t related to other activities or professions. As for now, it’s important to understand them as two separate conditions.
CTE is not a mental illness
While we are still learning about its impacts, we do know that CTE does not operate like a mental illness. This can be challenging to understand as we aren’t used to degenerative disease in the brain.
So while its symptoms sometimes mimic those of mental illnesses, CTE is not a mental illness in and of itself. Nor can we assume that CTE causes mental illnesses. Many symptoms do not follow just one disease. Having the sniffles could be related to allergies, or they could come from a cold. So showing signs of depression (like fatigue or irritability) doesn’t always mean someone has depression. Rather, a person who shows these signs could have any number of different conditions.
You have probably read about pro athletes who have taken their own life. In 2016, researchers found that among football players who were in the NFL for at least 5 seasons between 1959 and 1988, 12 died by suicide. And autopsies found that some of those players did have CTE. That has made it seem like CTE is connected to mental illness or suicide. However, the researchers also found that that suicide rate among pro football players is actually lower than the rate for the general population. That means players are not at higher risk for suicide, as many have assumed. Instead, the misconception has stemmed from the fact that the deaths of pro athletes, especially when caused by suicide, are highly publicized.
The silver lining in the confusion between concussions and CTE
Much of my work as a physician at TRIA is helping patients rehabilitate from sports injuries. But unlike a broken arm, a cast won’t fix a brain injury. Even more challenging: a patient may not even know they have done damage.
There are more people than ever before playing sports. Think about how many women’s sports have been added to school athletics programs. And think about how much younger kids are when they join their first team. Then pile on the increasing demand for athletes to be bigger and stronger, and how that has translated into more time being dedicated to practices and games. It all adds up to more people putting themselves at risk for sports-related injuries, and doing it more often.
Because of this, I have actually seen some positives come from the confusion between concussions, other head and brain injuries and CTE. Now that the general population is more aware of CTE, there has been a gradual culture change. People are finding more concern in injuries suffered to the head than they used to. More players are self-reporting these injuries. And more coaches are taking players out of the game after hits. It’s because of this attention that we can work with a patient early on and before their injury could potentially get worse.
Head injuries aren’t something to be feared – but they do need to be addressed and treated properly
Concussions, other head and brain injuries and CTE can be scary, confusing and nerve-racking for parents. But I assure you that you can keep your child active in sports and still safe. Here’s what is key to remember:
- There is no “safe” number of concussions. Even one incident should be evaluated.
- All ages can be at risk. A peewee flag football game can have some hard falls. And more experienced players shouldn’t just be “used to it.”
- Head injuries are not just a guy thing. Girls are just as likely to get injured. At TRIA we’ve actually seen an increase in the number of female athletes getting concussions.
- Parents and coaches are the first line of defense to helping out your athlete. Make sure to always pull a player from the game if you sense even a mild head injury. Then take time to observe them. If they are showing signs of a concussion, take them to see a professional.
Our HealthPartners team offers a wide range of treatment and research facilities that can help your athlete. Our Neuroscience Center works with brain care and research. And at TRIA, where I practice, we offer a comprehensive Sport Concussion Program. Our goal is to provide appropriate evaluation of head injuries and return athletes to their sports and physical activity. Doctors, neuropsychologists, physical therapists and athletic trainers are all involved and work together to create each patient’s treatment plan.
About Matthew Hofkens, DO
Dr. Matthew Hofkens is a physician who specializes in physical medicine and rehabilitation. He practices at the Woodbury location of TRIA Orthopaedic Center. His focus is on the non-operative care of musculoskeletal injuries as well as the non-musculoskeletal aspects of sports medicine. This includes return-to-play decisions, concussions, nutrition and injury prevention. When Dr. Hofkens is not working, he enjoys a variety of sports. He is active in the community and enjoys spending time raising service dogs for patients with disabilities.