Dr. Gregory Myer of the Cincinnati Children's Hospital made news this week when his group's study that equated stadium elevation with concussions in the NFL was published in the Journal of Orthopaedic and Sports Physical Therapy. The two-year study said it found the nine teams that play at 644-feet elevation or greater had 28 percent lower concussion rate than the other 23 teams. The study followed the group's similar findings with high school football concussions.
Myer, who has been with the Children's Hospital since 2001 and helped to create its sports medicine division, said the research is based on the fact that the brain swells at higher elevations causing it to fit tighter in the skull. That leaves less room for "brain slosh," which at normal elevations provides the gap for the brain to impact with the skull during concussive hits.
Myer, who is a devote Cincinnati Bengals fan and a member of and lecturer to the American College of Sports Medicine, the National Strength and Conditioning Association and National Athletic Training Association, talked with NFL Evolution contributing editor Bill Bradley on Thursday about the study's origins, what woodpeckers and big horn sheep mean to the research and how the findings can apply to football players.
What made you look at the correlation between elevations and concussions?
I wish these were all my ideas, but I have to give the credit to Dr. David Smith, who is the pioneer of a lot of them. He was charged five years ago with finding out why concussions were occurring. Someone told him to also find out why a woodpecker doesn't have a concussion. That's what he did and he's been studying woodpeckers for the last five years. What he's determined is that these animals have an amazing tongue that wraps around their head and they throw it out right before the concussive impact. That tongue is attached is a highway muscle that is attached to the jugular vein. ... It slows the blood coming to the brain. ... It basically creates a bubble wrap for the brain right before the concussive impact. That's an important theory that we have to look back on. We're looking at concussions from the inside out. We're trying to create that packaging for the brain and make it safer. The brain has an amazing vascular tree if you utilize it. ... If we can bring it to those levels, we can have a snugger fit brain inside our cranium.
Your study also mentions comparisons to big horn sheep and football. How does that apply to concussions for football players?
They do something very similar (to the woodpecker), but they do it at higher altitudes. That's what took us down the pathway of altitudes. If you look at the migratory patterns of big horn sheep, they're all at higher altitudes, a lot of them at 5,000 feet above sea level or higher. (Dr. Smith) said if my theories are correct, then you should be able to look at football players at higher elevations and see reduced concussions. So we did the first study looking at all the high schools in the United States. We did a large epidemiologic study, like 21 million athletic exposures and we had 6,000 reported concussions. We split them at higher and lower altitude, just like we did on the NFL study. We found that there was about a 28 percent reduction in concussions at those schools that are at higher altitude. So we said, "That was really interesting, but let's do it in a more confined environment." That's when we picked the NFL, where we know the level of play is very consistent. We just looked at ... the games played at each stadium (for the past two years) and we found a 32 percent decrease reduction in concussions (at higher altitudes). We thought this was pretty exciting because there have been a lot of smart people who have been looking at preventing concussions via helmets and they haven't shown any real reductions with their strategies. Yet here's a potential pathway looking at the higher dynamics of the brain and the skull. Maybe we can go down that path.
One part of the study showed that Denver, which is known to have a mile-high elevation, didn't have the lowest concussion rate. Is that because the propensity of players to use supplemental oxygen at games there?
That's very interesting to us. We were saying "why wouldn't that happen?"... The idea behind why elevation has an affect is that there's less oxygen in the air so that the brain chemistry responds by trying to bring more blood to the brain. Again, that creates that effect like the woodpecker. When people go to the sidelines and essentially deflate their air bags (by breathing oxygen from tanks), then go out and play, that's potentially why we're not seeing the largest reduction (in cities like Denver). Again, we were surprised as you about Denver. But that was one of our conclusions. Maybe it's the oxygen use on the sidelines.
What's the next step for this study? What will you do with this information?
That's what I'm most excited about. Again, David Smith is coming up with some pretty innovative ideas. I can't give you all the details, but we're on the pathway to something that's very proactive. It's not going to look like a helmet. Our solution is going to look much different. We're going to try to mimic the physiology that occurs at higher altitude and what the woodpecker does. We've done some very early trials on rat models and we found an 83 percent reduction in concussion biomarkers using these techniques. We are on the forefront of starting our human clinical trials to see if we can actually reduce this. What's exciting about these studies is ... if we can reproduce this with our technologies, then I think we're going to have something really special here. I'd be happy to talk to you more about it when it's a little further down the line, but right now I can't give you all the details.
You seem very excited about the study. Is there a key fact we should take from your findings so far?
Maybe we shouldn't focus so much on the reactive research, looking how to manage or how to diagnose concussions. There's hardly any funding that is focused on preventing concussions and I think we can start to create a paradigm shift. Let's get researchers focusing on prevention. Maybe that will be the solution that will save our game. I don't think the solutions are going to look like a helmet. I don't think they're going to look like rule changes. That's the pathway I'm going down.