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Comment by mikeh1010 | Hacker News Reader

I want to push back on the "every sport is dangerous" argument I'm seeing in here.

There's a difference between "you might die right in the middle of this very fun activity" and "you might die slowly and horribly years from now when you're retired and in the midst of raising a family."

I ski pretty aggressively, and of course I might die doing that. But every day I go home and know, "well it wasn't today! Today was just great clean fun." If I had a nagging thought of "but today might give me a mental disorder in 20 years" then I'd be much less inclined to participate in the sport.

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There's also a big difference between "you might die right in the middle of this very fun activity, here are the fatality stats from the past 30 years, here are the things you can do which are proven to reduce your risk" versus "this sport is Totally Safe, and to prove it we're going to resist every attempt to investigate long-term injuries so that you'll never really know."

Sports, as a fun hobby is one thing, but the article discusses the NFL; big business in and for the USA. Rather than say hey, this is hurting people, maybe we could change the rules some, the NFL is doubling down and is the one pushing the "all sports are dangerous" emotional narrative to mother's of children, in order to get them to play, all so they can pad their bottom line.

http://highline.huffingtonpost.com/articles/en/nfl-football-...

The study is about NFL players, but the harm starts in high school and college. Wait for more studies...

But you have absolutely no idea if aggressive skiing is giving you CTE because no one has ever looked to investigate it.

In football, as in boxing, the original investigation began because head trauma is obvious, but as the study broadened some of the worst cases of CTE were actually offensive linesmen. These are generally not the players who dish or receive hard hits, and many had never had a suspected concussion in their career. That led to the dominant theory that it isn't concussions -- the big hits -- that are the main cause of CTE, but instead many small traumas (in that case the o-line engaging with the d-line) that add up to CTE.

There is every reason to suspect that many other sports yield these sorts of recurring sub trauma, and aggressive skiing seems a probable candidate [edit - note that it does not require that you hit your head, have an accident, etc. If enough of a high-G event is transmitted to the brain, that can be a subconcussion]. It just isn't terribly common to do an intensive brain study of people after death to find these correlations.

I don't know about GP, but I'm an aggressive skier and very, very rarely hit my head. I have maybe a dozen falls a season, wear a helmet and am not colliding with anything. This is a silly comparison.

Maybe the aggressive compressions of slalom cause the brain to bounce around a bit? In any case, I'm sure it's much less than the sudden stops caused by running into a 300 pound lineman.

The Earth weighs a good deal more than a 300lb lineman, and it's the Earth that skiiers are repeatedly running into while carrying an enormous amount of inertia.

Have you ever been skiing? It's your feet that are running into the earth, and hardly even that - they're skating smoothly over it unless you really mess up. On good mogul run,your head hardly moves off a straight line while your legs and hips adjust to keep your skis moving smoothly. In a similar comparison, walking does not produce head trauma.

I've been skiing plenty of times. Runs where I'm at a high rate of speed and hitting countless variation changes (not moguls, just normal skiing) and my head is shaking so much that my vision is blurry. Landing a jump at best (when you absorb with your legs) is a 19G+ event. Every minor mistake in absorbing can tenfold increase that. Walking is not a relevant comparison.

We evolved to walk with a limited brain suspension that just wasn't adapted for 100kph wax shoe runs.

That's the forward component of the velocity vs the component that's normal to the ground, though - the collision with the Earth is much lower speed than the lateral motion (sliding along the surface after the fall). If you're skiing aggressively, you're frequently quite close to the ground, and a fall is frequently where you end up grazing it because you lean further than the centripital force can maintain. You fall a much shorter distance toward the Earth than a timid skier does.

If you're skiing at the level I'm talking about, falls are probably not that frequent, though.

In my earlier comment I was talking more about the explosive vertical compression-expansion cycle that characterizes skiing really hard with very tight turns on short radius skis. Those are much less violent than hitting a lineman though.

A sub-concussion doesn't require that you hit your head. It simply requires a g-force event -- like skiing quickly over rough terrain -- that shakes the brain around, building up the scar tissue that we know as CTE. Offensive linesmen engage with the opponent via their body/arms, seldom hitting with their head, but that rapid g-force of the body stopping is enough.

Again, someone studied football players because the impact is obvious. As it reaches out, players in even relatively low-g sports like soccer are being found with CTE.

Having played the game for years, I can assure you the impact being generated on the line is very real. These folks do interact with their body/arms, but head on head contact is a very real part of the game, and that is the part that really affects the brain.

And the part of soccer that seems to cause concern is heading the ball, not the running around part.

Comparing helmet to helmet impacts to skiing over rough terrain feels like a real stretch here.

And the part of soccer that seems to cause concern is heading the ball

But we don't know what the concern is in soccer. Heading is immediately looked at because it's an impact, but the actual cause may be something altogether different.

I mentioned the g forces measured in skiing elsewhere. They are absolutely in the range of subconcussion.

It's sort of silly but it's sort of not. The evidence suggests that a few really big hits doesn't do it, it's repeated medium sized head traumas that does. (ie: it happens to line men more frequently out of footballers) Quantifying the size of that head trauma is really key. Does it have to be a "hit?" I mean repeatedly hitting mogul runs put shock on your whole body, you may not hit your head but you're absorbing that up and down shock and moving side to side fairly abruptly; more so that you do just running around and your brain absolutely experiences some amount of that. Age might have a factor too, age when this trauma or shock happen.

I ski and snowboard and I'm not planning on stopping, I think the benefits outweigh the risks. I'd say that about most sports but I'm not about to let either of my kids play football or box.

We need to study this stuff a lot more.

I don't think this comparison stands up, at least not for most reasonable interpretations of "aggressive skiing". It might not involve any crashes at all.

I think there's a fair distinction to be drawn between sports that might cause head trauma if you make a mistake, and sports in which head trauma is practically the defining characteristic (see also: boxing). I am three weeks away from having a son, and while I've got some years, I'll eventually have to make some decisions about what activities I want to encourage and discourage. It at least seems possible to learn to ski without repeatedly bashing your head. Not so for football.

> But you have absolutely no idea if aggressive skiing is giving you CTE

Where are you skiing that results in you receiving repeated blows to your head?

The comparison doesn't hold up at all, and OP's original point still stands against yours.

In an edit to the original comment -- an edit that shouldn't even be necessary -- I made it painfully clear quite some time ago that it has positively nothing to do with "blows to the head". Yet still people keeps rushing to post these noise replies.

... except "Blows to the head" has everything to do with this from the article to OP's point.

When you have a number of HN commenters correcting you, it's not them it's you.

Multiple people in one place can still be completely wrong. Concussive events are what matter when it comes to CTE; many of them occur without physical contact to the head just as impacts to the skull may not have concussive effects on the brain. What matters is sudden acceleration, not contact to the head.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995699/

[2] http://www.uwhealth.org/sports-medicine/clinic/concussion/11...

It's even worse when it's "you will die slowly and horribly years from now", which is what football is starting to look like. There's no "risk"; you're just storing up your consequences for later.

Hm, is it true that everyone with CTE dies "horribly"? I think that might be overstating things a bit.

Not every single person with CTE dies horribly. As I understand it, some simply live decades happily forgetting their children's names and what day of the week it is.

Is that really best-case scenario? So you're saying that among the retired football players who do TV today, Terry Bradshaw, Howie Long, Michael Strahan, Cris Collinsworth, etc. 90% of these players have CTE and will have decades-long dementia? So for the older players we should start seeing that very soon, no?

How do you know we aren't seeing the slow onset of dementia for some of these guys? Isn't the whole schtick with Bradshaw that he's a "little off in the head"?

I don't think that it's fair to look at these former players that go into broadcasting and "diagnose" them in anyway. We don't see inside the private lives of these guys and we don't know what struggles they may or may not live with everyday.

I think you are misinterpreting my posts. I'm just trying to make sense of all of this, myself. This report is eye opening to me and I just don't understand it. I understand and accept that the CTE rate for football players is quite high.

What I don't understand is what that means exactly. Are there degrees of CTE? Might some of these players have CTE but hardly ever show much of a symptom in their lives? Or is everyone, as the people who I was responding to suggested, doomed to some sort of dementia where they forget who they are their families are? And if that's the case, shouldn't we see this more often among ex-players who are still in the public? Or are the former players who take these jobs all in the 10% that don't get CTE? Just trying to make sense of the conflicting data here.

I'm being a little tongue-in-cheek, of course.

The article implies a selection bias -- that the actual number of football players with CTE could be as low as 9%. It also notes cases where CTE effects really become "horrible" much later in life, for men who are older than the guys you list.

Guys who self-select to be television personalities also might have a lower incidence of CTE. There's also a chance that some odd behavior on TV will be interpreted as "quirky" or "goofy" and not "experiencing brain damage."

At any rate... Of course the answer is: No, not everyone with CTE dies "horribly." But it's seeming increasingly likely that CTE can have major unexpected consequences on the later lives of football players. And the worst case scenario of CTE (Junior Seau, Jovan Belcher) is exceptionally horrible and exceptionally tragic.

> as low as 9%

Which is still disgustingly high.

Thanks for the reply. This is what I'm trying to understand myself. I didn't see the 9% number in the article. I did see the mention about selection bias. So I wonder what the true numbers are here. If it's 9% then that explains well enough why so many ex-players don't show strong signs of CTE (by strong I mean long-term memory loss or worse).

The 9% is assuming that 100% of unknown cases are in fact negative.

This study showed that 110 of 111 players tested had CTE. But many of their families consented because they suspected CTE already, so it's not a random sample and therefore you can't generalize that to the rest of the population. 110 is 9% of the population of 1300 deceased players for the given time period. CTE is normally extremely rare.

Why is the total population deceased players and not all players?

because you can't test the living ones

The only test for it requires dissection of the brain

This is currently happening to my grandfather. He played football most of his life and up through adulthood for the Philadelphia Eagles before leaving the sport to pursue his passion for flying (eventually becoming a captain for Delta).

He's had a charmed life. Lots of great experiences, like a real-life Tom Sawyer or Huck Finn, and the stories to go along with them.

Now's he battling (and losing) with the late-stage effects of dozens of concussions, which is manifesting itself as severe short-term memory loss, increasingly poor long-term recall, and eventually the inevitable situation where he doesn't recognize his own children, only grandchild, and only great grandchild. My father also played football most of his life (but not at the same level), and I'm concerned the same thing will eventually happen to him.

I'm very thankful to have had my grandfather in my life for so long (I'm now 37), and I have so many really wonderful memories and experiences that I can attribute to him (sitting in the cockpit of a 727 as a toddler, flying in the family little Piper Cub, countless lovely tailgate parties, a huge loving extended family of his long-time friends, etc), and I want to make sure that in the short window that's left where he's able to be at-least present in the moment that myself and my young son spend ample time with him.

It's difficult to watch the decline, but I can't imagine how difficult it must be for him to be living it.

I'm basically your age and my grandmother passed away from Alzheimers almost 10 years ago. It was another 5 before that when she last recognized anyone in our family. She neither played football nor had any history of concussion that any of us are aware of.

The point being, from what I've seen on the subject, there's no way to diagnose CTE until the patient has passed away and you can slice open their brain. It's possible that your grandfather's symptoms are related to his concussions, but it's also very possible that it would have happened anyways. CTE usually manifests 8-10 years after these brain injuries and has a lot of symptoms beyond the dementia you list, so it could be garden-variety Alzheimers.

Regardless, you have my sympathies. Alzheimers-type dementia is truly a terrible way to lose a loved one. The anti-climactic nature of it makes it really difficult to get closure in the way that you do when someone's death is more abrupt. Instead, they slowly fade away in the "boiled frog" fashion and you're left at whatever funeral you end up having realizing that they died a long time before their body expired and you never got to grieve. Be sure that you're intentional in remembering the person he used to be and don't let the empty shell of a person that exists now replace that in your memory. I didn't do that enough and it made grieving for my grandmother very difficult.

If there's a silver lining to my story, my mother is now past the age when her mother was diagnosed with Alzheimers and is, thus far, not showing signs of the disease. Given some of the research that's tying Alzheimers to particulate air pollution, I'm hopeful that the strides made by the EPA and others in reducing our air pollution will mean that she won't have to go through that ordeal and I won't have to lose her the way I lost my grandmother. If your dad is more than a decade past his football-playing days and symptoms haven't shown up, there's a good chance that he won't either.

In my opinion, the most horrible death is the one where someone else starts living in your body, and no one is even aware that you have gone.

Senile dementia, Alzheimers, brain cancers, and TBI frighten me even more than being flung 100m across the pavement in an automobile accident, or getting dragged into the gap by a commuter train. With those, you know you're dead, and so does everyone else. When you slowly lose your mind, no one can ever really be sure when you stopped being you, not even yourself.

Well, at least of nearly all the dead NFL players whose families suspected they had CTE, they did. As noted in the article, "there’s a tremendous selection bias".

Yes, this is why the "but many other things are dangerous and people do them knowing full well that [...]"

Of course the problem is that you can go half a life time doing this thing, and then it sneaks up on you and there's no reversing the damage. The danger isn't presented as clear or present as with anti-smoking messaging, or with something like solo free climbing which needs no warning.

It seems likely that some activities are orders of magnitude more dangerous than others for CTE.

Maybe you'd rather your kid play football or learn boxing than lay on the couch. If the risk is 10x that of baseball, and 50x that of track and field, however, you might steer them to different activities.

> I ski and snowboard and I'm not planning on stopping, I think the benefits outweigh the risks. I'd say that about most sports but I'm not about to let either of my kids play football or box.

That's interesting because the accidental insurance (that I took out during the football years) had separate premiums for skiers and snowboarders. The most serious concussion that I ever got was from snowboarding.

> There's a difference between "you might die right in the middle of this very fun activity" and "you might die slowly and horribly years from now when you're retired and in the midst of raising a family."

It's kinda arbitrary to draw these lines of "my dangerous sport is superior to your dangerous sport." It's all risks and benefits. Skiing/snowboarding is pretty dangerous for catastrophic accidents AND it still has a high concussion rate.

0.37 = American football concussion rate per 1,000 athletic exposures

0.2 = Skiing/snowboarding closed head injury rate per 1,000 mountain visits

You're not incredibly far behind football in terms of risk, my friend.

>"but today might give me a mental disorder in 20 years" then I'd be much less inclined to participate in the sport.

what if you were paid millions of dollars to do it and treated as a living god? i think a lot of people would still take that deal even knowing the risks.

Most serious football players never get paid millions of dollars, or are treated like a living god. They do get the injuries, though.

> "well it wasn't today! Today was just great clean fun."

Good clean fun that has erased quite a bit of usable life from your knees. Better than a brain injury, but not great.

>better than a brain injury, but not great.

brain injuries and knee injuries are not really comparable.

very well said

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