The effect of repetitive subconcussive head impacts on observed physiological, biochemical, and functional perturbances in the brain in high school and collegiate football players: a systematic literature review


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In this review, we investigated the effects of repetitive subconcussive helmeted head impacts (RSHI) in high school and collegiate athletes. We performed a literature review of all English-language medical literature from 2009 to current. Hippocampal volume changes, white matter diffusion changes, neurocognitive and neurophysiological performance, serum brain marker, diffusion-weighted tensor imaging changes, and head impact telemetry were outcomes of interest. Our initial search strategy identified 564 articles. After restricting to articles focused on subjects aged 13 to 24 years, 151 articles remained. Finally, articles were limited to the past five years of publication (2009 – current). We evaluated preseason, in-session, and postseason outcomes in the study groups and their controls. Studies that used neuroimaging reported that RSHI accrued during football play altered brain physiology to some degree. Studies that used clinical neuroperformance measures, however, did not reach such consensus. Football league regulators, coaches, and players should be cognizant of RSHI and continue to use caution.



subconcussive head injury, repetitive head trauma