Put Me in Doc, I'm Ready to Play

Steven Zuckerman, MD

Repeated head injuries such as those sustained during boxing matches or a football career can lead to chronic traumatic encephalopathy.

Really- I’m not going to need my brain ten years from now

One area in which neurology gets a good deal of public attention is in head injuries. This is particularly true when it comes to the sports arena, especially in football and boxing. Of course, our official body, the AAN, has called for a ban on the latter sport because it is the only athletic competition in which the intent is to induce a traumatic head injury… blah, blah, blah. Well, despite organized neurology’s attempt at eliminating “the gentleman’s sport,” it is mostly internal corruption and lack of exciting heavyweight contenders that has reduced the popularity of boxing. In fact, the American Boxing Association’s call for the ban of the American Academy of Neurology as the only organization with the “intent of banning boxing” is more likely to be successful.

The astute and attentive reader may perceive that I am not opposed to boxing or football (especially if LSU and the Giants win). This propensity dates back to my boyhood in New Jersey when my father and I attended the local boxing matches. The highlights of these outings were: 1) a full scale riot when an Irish boxer from Boston got a raw decision- with my father cackling in delight in the chaos and 2) seeing Ruben” Hurricane” Carter fight (subject of the song, book, and subsequent Denzel Washington portrayal in “Hurricane”). We were from Paterson, NJ, and would occasionally pass the bar where Carter had been accused of shooting up several patrons.

However, the highlight of my entire neurology career was to take place later, in 1984, when I was a neurology intern at the Neurological Institute of New York. While slaving away in an otherwise dreary call night, I received a page about my next patient: Muhammad Ali. (Since HIPPA laws did not exist at the time, and this is public information, I can hopefully avoid a 50K hit). Sure enough, around 9:00 PM, perhaps the most readily recognized individual on planet Earth came walking down the hall. Mr. Ali had been my idol for many years, and I cannot convey the absolute pleasure and delight our interactions provided.

Since then, I have been involved locally as the “fight doctor” for amateur bouts held in Baton Rouge, LA. These have included the annual fundraiser dubbed “Guns and Hoses.” In this event, the firemen would fight policemen for three rounds. I was on hand to ensure the safety of the participants. I remember one bout in which one of the combatants was not faring well. I went to his corner in between rounds to determine whether he was neurologically fit to continue the bout. When I inquired how he was doing, he said “fine,” but that the fight was over because he was “getting the s#!* beat out of me.” That was probably the most intelligent decision ever made by any of the participants.

Of course, repeated head injuries such as those sustained during boxing matches or a football career can lead to chronic traumatic encephalopathy (ie, dementia pugilistica). The hallmarks of this entity include both cognitive and extrapyramidal dysfunction. Recently, an article in the Journal of Neuropathology and Experimental Neurology reported that there was an association between repeated head trauma and the development of a syndrome indistinguishable from amyotrophic lateral sclerosis. The New York Timespicked up on the story with the hook that Lou Gehrig, due to possible minor head injuries sustained in his baseball career, may have had this newly described form of the disease which subsequently bears his name. In Neurology News(September 16, 2010; Vol 10 Issue 18), several ALS experts reject the entity of head trauma-induced ALS. The report described a pre-selected cohort of only three patients, and the experts conclude that the conclusions drawn from the original study cannot be substantiated from the presented evidence.

In the world of football, another physician was put on the hot seat when he kept a star running back from returning to the game after sustaining a concussion. Since it entailed a loss of consciousness and was therefore a grade 3 concussion, guidelines clearly specify that the player could not return to competition on that day. However, the physician was pressured by the coach to abandon his medical responsibilities and allow the patient/player to return to the game. This exchange and other attempts at influencing medical decisions in the competitive sports universe are well described in the above article. Coaches, players, and even player’s parents may not have the long-term interests of the injured players in mind, since they are focused on winning and possibly advancing a sports career. The pressures brought to bear on the team physicians are certainly not trivial, given the high stakes involved at the professional, collegiate, and even high school levels. I am sure that being a physician associated with big time, successful athletes is extremely exciting and rewarding; I just cannot imagine the potential for conflicts and influence that may be brought to bear.