By Laird Harrison

Without even knowing it, you could have a sports brain injury.

The death of Kosta Karageorge has once again focused attention on concussions in U.S. football. And it should. But just because you don’t play football, or haven’t had a concussion, doesn’t mean you’re safe.

Sports Brain Injury Beyond Concussions

Abrupt movements of the head in soccer, hockey, basketball and other contact sports can cause brain injury. The injury can occur even without telltale symptoms like dizziness, confusion and vomiting.

Karageorge, an Ohio State University defensive lineman committed suicide last month after suffering multiple concussions. “Sorry if I am an embarrassment, but these concussions have my head all F—– up,” he reportedly wrote in a text to his mother.

But Karageorge had wrestled much more than he played football.

And in April, researchers reported that they had detected changes in the white matter of football players’ brains who had not had concussions.

The study implies that football could cause injuries that are never diagnosed or even noticed.

“We all kind of took a step back and said, ‘Wow,'” said Alexander Powers, MD. Powers is an assistant professor of neurosurgery at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

I reported the finding in Medscape on April, 9. TIME, the Washington Post. Others picked it up after the researchers held a press conference Dec. 1 at a meeting of the Radiology Society of North America.

Brain Injury in Soccer and Hockey

What none of us noted in these articles is that previous research has turned up similar problems in other sports. For example, in September 2013, researchers reported similar white matter changes in the brains of soccer players.

Even more disturbing, the brain changes were associated with poorer memory scores. The forgetfulness appeared to affect players who reported more than1,800 headings per year.

Hockey players brains underwent similar changes after concussions,  researchers reported in 2012.

In November, a study identified similar patterns in the brains of athletes who had concussions while playing a variety of contact sports. The sports included football, water polo, lacrosse, ice hockey, wrestling, basketball, rugby and soccer. Participants in crew, squash, track, cross country, swimming and volleyball did not show these possible signs of sports brain injury.

Researchers are still trying to understand whether these changes are signs of serious problems. Certainly they don’t mean that everyone who participates in contact sports is at risk for sports brain injury.

But they do suggest we should take more care. Several measures can help.

All Contact Sports

• Vigorously enforce rules limiting the type of contact allowed.
• Strengthen players necks.

The Moore clinic recommends these exercises
http://youtu.be/8Xf-cR5gW3A

Hockey

Avoid contacting the board or other players head-first, U.S. Hockey advises. For example, if sliding to the boards don’t duck; try to hit with the buttocks, arm or shoulder.

U.S. Football

• Reduce the amount of time spent in full-contact practice.
• Use the “Heads Up” technique for tackles. Evidence is lacking to prove this method reduces the risk of head injury. But it makes intuitive sense that it can reduce the risk of sports brain injury by shift the force from head and neck to arms and shoulders.

This U.S. Football video illustrates Heads Up

Soccer

• Use softer, under-inflated balls for heading practice, and avoid the use of over-inflated balls in games.
• Use proper heading technique.

This SoccerAcademy.com video illustrates proper heading technique:

The photo featured on this page is courtesy of the Radiology Society of North America.