The death of 22-year-old Derek Sheely, starting fullback for the Frostburg State University Bobcats in West Maryland, has once again hoisted concussions in contact sport to the fore.
Sheely died Sunday at the University of Maryland's R. Adams Cowley Shock Trauma Center in Baltimore less than a week after he collapsed at football practice between routine drills. The cause of Sheely's death is unclear, but his father Kenneth suspects a brain injury was to blame.
"It doesn't really matter how it happened, personally. It's not going to change the situation with Derek. But I want to let it be known that he didn't have some kind of heart condition or other kind of condition. It was severe head trauma," Kenneth Sheely told the New York Times.
Sheely had uncontrollable brain swelling, the Times reported, which may have been caused by successive concussions leading to second impact syndrome.
"It's very rare, but when it occurs it can be deadly," said Dr. Steven Flanagan, professor of rehabilitation medicine and chairman of NYU Langone Medical Center's Rusk Institute of Rehabilitation Medicine. "Someone returns to play too soon after a concussion and sustains another, seemingly mild concussion. But the response the brain has is to have this uncontrollable, malignant swelling."
Second impact syndrome is especially rare in adults, Flanagan said, and more common in children and teens. It is unclear whether Sheely sustained multiple head injuries leading to second impact syndrome.
Brain injuries in contact sport, particularly football, have garnered much attention in recent months. A class action lawsuit filed in July by seven former National Football League players claims the league failed to treat concussions and tried to conceal the link between football and brain injuries.
"Because of what's happening in the NFL, people are becoming much more aware of concussions and their consequences," said Flanagan. "Head injuries in sport are very common, and it hasn't been until recently that people realized just how common they are."
An estimated 1.7 million people sustain a traumatic brain injury each year in the U.S., according to the Centers for Disease and Prevention, and about 75 percent of those injuries are considered "mild," or concussions. But so-called mild brain injuries are brain injuries, nonetheless.
"When we talk about concussion and mild traumatic brain injury, the 'mild' only refers to someone being very unlikely to die," said Flanagan. "But the consequences can be much more severe, with chronic problems -- physical, emotional and cognitive issues."
Evidence to support the cumulative effects of repeated mild brain injuries is mounting. One study found that professional football players and boxers had features of Alzheimer's and Lou Gehrig's disease -- chronic, debilitating neurological diseases.
As the NFL takes action to limit the risk of concussions and their long-term consequences, college, high school and little leagues are following suit.
"Most of these players are going to have careers in something else -- long lives of working and using their brains," said Dr. Alan Hoffer, assistant professor of neurological surgery and neurocritical care at University Hospitals Case Medical Center in Cleveland. "We really should be trying to make sure there are no brain injuries."
In July, Ivy League football teams announced plans to limit contact during practices to cut back collision time. And more schools are using concussion screening programs to compare players' brain function after a hit to baseline measurements taken pre-season.
"A brain injury is not like an ankle or knee injury; you can't tape it up," said Dr. Allen Sills, a neurologist at Vanderbilt University Medical Center's Sports Concussion Center. "Really, you can't play with a partial brain injury."
Only 10 percent of concussions lead to a loss of consciousness, according to Dr. Sills. And competitive players often feel compelled to play through the commoner, subtler symptoms like fatigue, headache and nausea.
"That's where other, more objective measures of brain function really come in handy," said Sills. "If you suffered an injury and you're not being forthcoming about your symptoms, we can measure your performance and compare it to baseline. Then we know that regardless of what you're telling us, your brain's not ready for play."
Improvements in equipment can reduce concussion risk, but will never eliminate it.
"Certainly we know that these are important factors," said Sills. "But helmets are never going to prevent concussions any more than seatbelts are going to prevent car accidents."
Similarly, stricter return-to-play guidelines and limitations on contact during practices will make sports safer, but not completely safe.
"So long as there are contact sports, there will always be concussions," said Flanagan. "There's no way around it other than to not participate."
Sheely was a senior history and political science major and two-year All-Atlantic Central Football Conference all-academic honoree, according to a Frostburg State spokeswoman. He will be posthumously awarded a Bachelor of Science degree in Liberal Studies, cum laude.