Mind

Winter Olympians Face Same Brain Injury Risks as Boxers and Football Players

Boxing and football have been increasingly scrutinized for risks of brain trauma — winter sports, not so much.

Alberto Maffei of Italy wipes blood from his nose after he crashed during the Men's Big Air Qualification on day 12 of the PyeongChang 2018 Winter Olympic Games at Alpensia Ski Jumping Centre on February 21, 2018 in Pyeongchang-gun, South Korea. | Ryan Pierse/Getty Images
Alberto Maffei of Italy wipes blood from his nose after he crashed during the Men's Big Air Qualification on day 12 of the PyeongChang 2018 Winter Olympic Games at Alpensia Ski Jumping Centre on February 21, 2018 in Pyeongchang-gun, South Korea. | Ryan Pierse/Getty Images

Athletes and physicians have increasingly raised concerns about concussions and Chronic Traumatic Encephalopathy (CTE) in some sports. But for many years, winter athletes were less cautious about a knock to the head than they are now.

Take snowboarder Kevin Pearce. At 22 years old in 2009, he was an upstart who had become the only man to win two air and style rings in one season and earned four medals at the X Games. Training before the Olympics, Pearce crashed trying a new trick, an incident that would rob him not only of a potential trip to the Olympics, but left him fighting for his life.

But the crash that ended his career may have been due to a concussion he got the week before.

“I was already brain injured,” Pearce told Seeker. “Unfortunately the brain is unlike any other piece of our body. It doesn’t necessarily tell you when it’s hurt.”

American football and boxing has brought the conversation about brain trauma into sharp relief. Dozens of athlete autopsies have illuminated how lives lived between flurries of subconcussive blows and punctuated by the occasional KO concussion result in CTE.

According to Mayo Clinic researcher Kevin Bieniek, consecutive blows are thought to shear blood vessels around sulfi, folds in the brain, releasing proteins and instigating an inflammatory response. Normally this aids recovery. Ad nauseum, it toxifies the brain.

“You start to get this aggregation of this protein called tau. It’s a protein that’s found in everybody’s brain. It normally functions to stabilize these processes,” Bieniek told Seeker. But with regular hits, “it builds up, forming aggregates, and it eventually leads to neurodegeneration.”

In advanced stages, CTE is akin to dementia, causing memory loss, aggression, impulsivity, depression, and motor impairment.

Attention to CTE has helped elucidate the dangers boxers and football players face. Yet, when it comes to winter sports, where athletes rocket atop compressed snow in excess of highway speeds — often in severe weather like last week’s high winds at the Olympics, which blew skiers and snowboarders sideways while flipping and twisting 20-plus feet in the air.

Overall, head injuries are more common and consecutive for football players and boxers, who average around 0.8 concussions for every 10 rounds, than winter athletes. Concussions account for a greater percentage of injuries faced by snowboarders and skiers, though, than they do for football players, according to the NCAA’s reported rates and research on NFL injuries. during the last winter Olympics, 11 percent of injuries were concussions — compared to pro footballer’s 5-7 percent of injuries.

The exception to that rule is ice hockey, in which players not only sustain repeated subconcussive blows, but they also have one of the highest rates of concussions among winter sports. Nine of sixteen hockey players’ brains studied by Boston University CTE Center were diagnosed with CTE — which likely contributed to several of the athletes’ suicides.

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On paper, snowboarders and skiers have more time to recover from head trauma. But the cultures surrounding them, particularly snowboarding, often breeds cavalier attitudes about head injuries.

“The mentality is ‘Are you all good? Are you alright?’ Okay, you’re fine. I’m not gonna stop snowboarding on this perfect day just cuz you hit your head,’” Pearce said.

It doesn’t take concussions to put one at risk for CTE. “About 20 percent of our CTE cases do not have any recognized history of concussion,” Boston University’s Dr. Robert Cantu told Seeker. Repeated subconcussive blows like the thousands taken by boxers and football players, with the occasional hard knock, correlate more strongly with CTE, he said.

If scientists’ understanding of CTE’s development in football players, boxers, and hockey players remains nascent, their insights on the risk to winter athletes is even more rudimentary.

Many studies have attempted to nail down how common head injuries are for winter athletes. Estimates for skiers range from just 1 every 100,000 days on the slopes to 1 per 1,000 outings. Snowboarders are pegged as having between 40 to 600 percent more head injuries than skiers. For hockey players, there are 0.72 to 1.81 concussions per 1,000 games.

But that doesn’t tell the whole story. Scores of subconcussive blows likely go unreported. Estimates of snowboarding and skiing injuries are observations of injuries of visitors to ski parks and resorts, athletes and casual skaters alike — a far cry from a concrete measurement of how prevalent concussions are among professional winter athletes.

Many use different metrics to define head injuries, often focusing just on injuries like concussions and fractures, or report head and neck injuries together. There have been actual studies of head injuries at the Winter Olympics that report higher rates. Injury studies, however, tend to report higher rates during competitions than practices. So Olympic studies may be misrepresentative. Researchers — and athletes — have no clear picture of how regularly subconcussive and concussive blows to the head occur.

Head trauma is the leading cause of death among skiers and snowboarders, according to a study published in 2000. In 2012, X-Games snowboarder and Olympic pioneer Sarah Burke died from a head injury — a decade after world champion Regine Cavagnoud’s death. Ahead of the 2014 winter games, snowboarders Jenny Jones and Jackie Hernandez suffered high profile head injuries. And snowboarder Iouri Podladtchikov announced that he wouldn’t be competing in the Olympics after a nasty knock several weeks ago at the X-Games. Yet, the only action sport athlete investigated for long-term damage from brain trauma is BMX biker Dave Mirra, who committed suicide and was later diagnosed with CTE.

“Right now it’s still pretty hard to determine at what window you’re most susceptible [to CTE], how much trauma you need, how frequently you need it, at what point you’re brain is at developmentally when you receive this trauma,” says Bieniek.

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Pearce is confident that helmets are getting better. Head trauma researchers are less optimistic about their protection. Helmets are great at reducing fractures, breaks, internal bleeding, and a host of other injuries — and are underused.

Concussions, however come courtesy of the head’s rapid deceleration making the brain ricochet off the skull.

“If you’re dealing with an athlete who’s got a helmet on, and something’s gonna hit that head that weighs 200 pounds, the head is going to be accelerated very rapidly,” said Cantu. “On the other hand, if the object that’s going to hit the helmet is light, say a puck or a baseball, and the object is not going to move the head very much, it’s going to prevent concussion.”

So from the rare concussive puck, hockey players will get some reprieve. In football, helmets that take advantage of magnetic repulsion have been devised to slow down concussion-causing deceleration. Engineering fixes for winter sports are a more challenging and cash-strapped affair.

Nevertheless, since 2006, one research team with Columbus Children's Research Institute has held a patent that could reduce concussions in ice skating: a wrist guard that’s uniquely designed not to slip when people try to catch themselves, keeping their head from snapping into the ice.

While tech fixes for concussions may be far-off, something can be done to help illuminate what risks there are for winter Olympians that put their lives on the line. Since his career-ending fall, Pearce has headed an advocacy organization called Love Your Brain that educates people about the dangers of concussions. He also encourages athletes to donate their bodies to science.

“I think that the issue with that is that these action sports are too new,” he said. “The guys who are the very best, and who’ve pioneered to sport, they’re still alive. I’m so excited. One hundred and ten percent I want my brain to go to research.”