William Levine, MD, believes in teamwork — both for the athletes he treats and to answer big questions about concussion
“Traumatic brain injury. Period. End of story.” That’s how Dr. William Levine describes “concussion” to the student-athletes he treats as Head Team Physician at Columbia University, in order to help them understand the gravity of the situation. And as one of the first members of the Scientific Advisory Board of the International Concussion Society, Dr. Levine is working to bring the potential long-term impact and real-life effects of concussions on athletes into focus. Below, he discusses how he has seen the conversation shift since he started at Columbia 20 years ago, and what questions remain.
How have your experiences changed your perception of concussion?
We have about 700 student-athletes at Columbia, and I have personally treated every athlete with a concussion during my tenure. It is safe to say that much was unknown regarding the impact of repetitive brain trauma when I began my career at Columbia. Now, concussion protocols, unbiased neurological consultants, medical retirement due to concussion, and the fear of chronic traumatic encephalopathy (CTE) are all prevalent factors of any sports medicine program and team.
In your opinion, why is it so important to educate your field about concussions?
The more information and research the better to treat athletes and educate our society about the significant impact of concussions. Part of the problem is that there is so much more information today than ever before, but there remain as many — if not more — unanswered questions as there are answers. What is the true pathway to development of CTE? Is there a specific phenotype that makes an athlete more susceptible to concussions? Do we have a clear understanding of the best return-to-play criteria in counseling athletes as they prepare to return to the playing field?
Continuing to change the culture has been what I would consider the first phase in the war on concussion: getting athletes, parents, and coaches aware and involved. My observation is that this has definitely occurred and there has been a paradigm shift over the past decade, for sure. Whereas underreporting used to be the norm, now, we see young athletes coming in reporting every single event. And CTE is not talked about just in the medical circles — all of a sudden, you see sportscasters on ESPN talking about CTE.
The second phase is much trickier: What can we do to decrease the incidence and prevalence? Are there biomarkers that can help us identify at-risk athletes for recurrent concussion? For CTE? What can we do better to rehabilitate athletes to minimize the likelihood of recurrent concussion?
If you could share one piece of information about concussion, what would it be?
Concussion is a serious problem that requires thoughtful, non-sensationalized investigation to comprehend the diagnosis, the symptoms, the consequences, the treatment and the ultimate outcomes more fully. Knee-jerk reaction, anecdotal evidence and sensationalized reports will not help us get any closer to answering these critically important questions. We need all constituents — neurologists, orthopedic surgeons, neurosurgeons, sports medicine physicians, athletic trainers, physical therapists, neurodiagnostic experts and vestibular rehabilitation experts — to engage fully in this problem to understand traumatic brain injury better and ultimately treat and hopefully prevent lifelong debilitating consequences.
William Levine, MD, is a member of the Scientific Advisory Board of the International Concussion Society. The International Concussion Society sponsored website Concussion.org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury.