Headfirst: A Concussion Podcast

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Note: This episode is for educational purposes only and is not medical advice. While I’ve done my best to accurately interpret the cited journal articles, please read the original sources yourself for full context before drawing conclusions.
This episode picks up where last week's left off — not questioning the "probable CTE" label itself, but asking what to do given the uncertainty around it. We dig into why a child's developing brain (myelination, the hippocampus) may respond to repeated heading differently than an adult's, then lay out the strongest evidence for restricting heading in kids under 12, including real-world results from youth hockey's body-checking bans. We give equal time to the case for caution, including genuine peer-reviewed findings that complicate the picture. We also break down an angle rarely covered: the physics of the ball itself, using a Guinness World Record Premier League shot to show why "the ball got lighter" doesn't necessarily mean heading got safer. Finally, we look at what happens when rule changes are actually tried, and the kind of resistance to change that has nothing to do with the science at all.
 
02:45 - Segment One: Why a Child’s Brain Is Different
07:15 - Segment Two: The Case For Changing the Rules
15:40 - Segment Three: The Case Against — Or At Least, For Caution
21:25 - Segment Four: The Ball Itself — Why “It’s Not Heavy and Wet Anymore” Doesn’t Settle It
27:30 - Segment Five: What’s Already Been Tried
31:30 - Segment Six: The Old Guard — Resistance That Isn’t About the Science
 34:30 - Segment Seven: Where This Leaves Us
 
* Dr Julie Stamm Episode 28: Kids, Youth Sport and Concussion with Dr Julie Stamm
* Dr Julie Stamm Episode 66: The Brain on Youth Sports, Athletic Trainers and Concussion Research with Dr Julie Stamm
* Dr Robert Cantu Episode 81: Concussion, CTE and Repetitive Head Impacts with Dr Robert Cantu
 
 
Twitter: @first concussion
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Episode — Reference List
1. Stamm, J.M. The Brain on Youth Sports: The Science, the Myths, and the Future. Rowman & Littlefield, 2021.
2. Mackay, D.F., Russell, E.R., Stewart, K., MacLean, J.A., Pell, J.P., Stewart, W. Neurodegenerative disease mortality among former professional soccer players. New England Journal of Medicine. 2019;381(19):1801–1808.
3. Russell, E.R., Mackay, D.F., Stewart, K., et al. Association of field position and career length with risk of neurodegenerative disease in male former professional soccer players. JAMA Neurology. 2021.
4. Cantu, R.C. Concussion and Our Kids: America’s Leading Expert on How to Protect Young Athletes and Keep Sports Safe. Houghton Mifflin Harcourt.
5. Emery, C.A., et al. Body checking and injury rates in youth ice hockey: comparison of Alberta and Quebec leagues. JAMA. 2010.
6. Black, A.M., Macpherson, A.K., Hagel, B.E., et al. Policy change eliminating body checking in non-elite ice hockey leads to a threefold reduction in injury and concussion risk in 11- and 12-year-old players. British Journal of Sports Medicine / cited via PubMed. 2016.
7. Krolikowski, M.P., Black, A.M., Palacios-Derflingher, L., et al. The effect of the zero tolerance for head contact rule change on the risk of concussions in youth ice hockey players. American Journal of Sports Medicine. 2016.
8. Reduction of high school ice hockey injuries with implementation of new checking/boarding rules. PubMed-indexed study, referenced 2021.
9. Hutchison, M.G., et al. Concussion characteristics in the National Hockey League before and after the introduction of Rule 48. JAMA Network Open. 2023.
10. The impact of body checking on youth ice hockey injuries (Pee Wee/Bantam age-group analysis). Referenced in Orthopaedic Journal of Sports Medicine, via SAGE Journals.
11. Rodrigues, A.C., Lima, M.D.M., de Souza, L.C., Furtado, C., Marques, C.E., Gonçalves, L., Lima, M.V., Lasmar, R.P., Caramelli, P. No Evidence of Association Between Soccer Heading and Cognitive Performance in Professional Soccer Players: Cross-Sectional Results. Frontiers in Neurology. 2019;10:209.
12. Auger, J., Markel, J., Pecoski, D.D., Leiva-Molano, N., Talavage, T.M., Leverenz, L., Shen, F., Nauman, E.A. Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries. PLOS ONE. 2020;15(10):e0240162.
13. Koizumi, A., Hong, S., Sakamoto, K., Sasaki, R., Asai, T. A Study of Impact Force on Modern Soccer Balls. Procedia Engineering. 2014;72:423–428.
14. Kirkendall, D.T., Garrett, W.E., et al. Heading in Soccer: Integral Skill or Grounds for Cognitive Dysfunction? (Review discussing ball physics, F = ma, and leather-vs-synthetic ball history.)
15. Guinness World Records. Fastest shot on goal in English top division football (soccer) — David Hirst, Sheffield Wednesday, 183 km/h, 16 September 1996.
16. The Ringer. What happens when soccer bans heading? 2017. (Twellman, Barker.)
17. WBUR Only A Game. (Don’t) use your head. 2015. (Comstock.)
18. BBC coverage of grassroots English heading-ban trials and the Raúl Jiménez injury, 2020.
19. Scottish Football Association public statement on proposed under-12 heading ban, following Mackay et al. 2019.

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This episode unpacks what "probable CTE" actually means — where the term comes from, what the science can and can't currently tell us, and why a single case (former Socceroos captain Paul Wade) has reignited debate about diagnosing a disease that's only ever been confirmed after death. It walks through the genuine case for and against using this label in living patients, and why the language we use around it matters.
Note: This episode is for educational purposes only and is not medical advice or a diagnostic tool. While I've done my best to accurately interpret the cited journal articles, please read the original sources yourself for full context before drawing conclusions.
 
06:00 - Segment One: What Chronic Traumatic Encephalopathy Actually Is
 
09:45 - Segment Two: Why You Can't Diagnose It in the Living — Yet
 
12:00 - Segment Three: "Probable CTE" — Where the Term Actually Comes From
 
17:09 - Segment Four: Why This Topic Divides Even the Experts — The Dose-Response Problem
 
21:30 - Segment Five: The Case For Diagnosing Probable CTE in Living Patients
 
24:00 - Segment Six: The Case Against — Or At Least, the Case for Caution
 
29:27 - Segment Seven: Why the Words We Use Actually Matter
 
32:50 - Segment Eight: Where This Leaves Us
 
 
Episode — Reference List
1. Martland, H.S. Punch drunk. Journal of the American Medical Association. 1928;91(15):1103–1107.
2. McKee, A.C., Cairns, N.J., Dickson, D.W., et al. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathologica. 2016;131(1):75–86.
3. Bieniek, K.F., Cairns, N.J., Crary, J.F., et al. The second NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Journal of Neuropathology & Experimental Neurology. 2021;80(3):210–219.
4. Mez, J., Daneshvar, D.H., Kiernan, P.T., et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318(4):360–370.
5. Montenigro, P.H., Baugh, C.M., Daneshvar, D.H., et al. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome. Alzheimer's Research & Therapy. 2014;6(5):68.
6. Cantu, R.C., Budson, A.E. Management of chronic traumatic encephalopathy. Expert Review of Neurotherapeutics. 2019;19(10):1015–1023.
7. Katz, D.I., Bernick, C., Dodick, D.W., et al. National Institute of Neurological Disorders and Stroke consensus diagnostic criteria for traumatic encephalopathy syndrome. Neurology. 2021;96(18):848–863.
8. Dickstein, D.L., Pullman, M.Y., Fernandez, C., et al. Cerebral [18F]T807/AV1451 retention pattern in clinically probable CTE resembles pathognomonic distribution of CTE tauopathy. Translational Psychiatry. 2016;6(9):e900.
9. Arena, J.D., Stewart, W., Schneider, A.L.C., et al. Performance of traumatic encephalopathy syndrome criteria in identifying individuals with chronic traumatic encephalopathy. Nature Medicine. 2026;32:2037–2046.
10. Iverson, G.L., Gardner, A.J. Risk for misdiagnosing chronic traumatic encephalopathy in men with anger control problems. Frontiers in Neurology. 2020;11:739.
11. Iverson, G.L., Gardner, A.J. Risk of misdiagnosing chronic traumatic encephalopathy in men with depression. Journal of Neuropsychiatry and Clinical Neurosciences. 2020;32(2):139–146.
12. Iverson, G.L., Gardner, A.J. Symptoms of traumatic encephalopathy syndrome are common in the United States general population. Brain Communications. 2021;3(1):fcab001.
13. Grashow, R., Weisskopf, M.G., Baggish, A., et al. Premortem chronic traumatic encephalopathy diagnoses in professional football. Annals of Neurology. 2020;88(1):106–112.
14. Eagle, S.R., et al. Interaction of medical conditions and football exposures associated with premortem chronic traumatic encephalopathy diagnosis in former professional American football players. Sports Medicine. 2024;54:743–752.
15. Stewart, W., Buckland, M.E., McInnes, K., et al. Primum non nocere: a call for balance when reporting on CTE. Lancet Neurology. 2019;18(3):231–233.
16. Hazrati, L-N., Schwab, N. Embracing the unknown in the diagnosis of traumatic encephalopathy syndrome. Neurology. 2021;96(18):835–836.
17. McKee, A.C., et al. Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts. Acta Neuropathologica. 2023;145(4):371–394.
18. Atherton, K., Han, X., Chung, J., et al. Association of APOE genotypes and chronic traumatic encephalopathy. JAMA Neurology. 2022;79(8):787–796.
19. SBS News. Former Socceroo becomes first Australian footballer to share probable CTE diagnosis. July 2026.
20. beIN SPORTS. Former Socceroos captain reveals probable CTE diagnosis. July 22, 2026.
21. The Washington Post. Ex-Socceroos captain Paul Wade says he has probable CTE, urges no heading for junior players. July 22, 2026.

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Dr. Schmidt is the Georgia Athletic Association Endowed Professor at the University of Georgia and Co-Director of the UGA Concussion Research Center. Her research program focuses on the continuum of concussion management, including injury assessment, clinical recovery, rehabilitation strategies, and evidence-based return-to-activity protocols. She is particularly recognised for advancing the evidence surrounding post-concussion return-to-drive decision-making, an emerging area of clinical importance given the cognitive, visual, and motor demands of driving following mild traumatic brain injury. Her sustained contributions to concussion science were recognised in 2025 with her induction as a Fellow of the National Athletic Trainers' Association (NATA), one of the profession's highest distinctions. With more than 3,500 citations in the scientific literature, Dr. Schmidt's work has substantially influenced contemporary concussion research, clinical guidelines, and interdisciplinary approaches to patient care.
 
01:10 - Journey into Concussion and Return-to-Driving
05: 15 -What is a concussion?
06:50 - Why Don’t We Really Think of Concussion and Return-to-Drive?
09:00 – Drink Driving Paradox and Concussion
11:30 – Messaging Around Return-to-Drive
15:10 – What Does Return-to-Drive Protocols 
21:00 – Development of Protocols 
28:00 – Heavy Machinery 
34:00 - Where to Find and Help Dr Julianne Schmidt’s Work
  
Twitter: @first concussion
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Email: headfirstconcussion@gmail.com

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Dr. Allyssa Memmini, PhD, LAT, ATC, is an Assistant Professor in the Department of Health, Exercise and Sports Sciences at the University of New Mexico and an internationally recognised researcher in concussion management. Her work has focused on improving recovery pathways for individuals with concussion, particularly university students and performing artists—groups that have historically lacked evidence-based return-to-activity guidelines. During her doctoral studies at the University of Michigan Concussion Center, she developed one of the first structured Return-to-Learn protocols specifically designed for post-secondary students, helping universities better support students' safe return to academic participation following concussion.

01:22 – Journey into Athletic Training and Concussion Research 
04:40 - What is a concussion?
6:45 - Difficulties in assessing and diagnosing concussion in collegiate/ university athletes
07:50 – Barriers & Difficulties in Assessing Students and Athletes for Concussion
12:10 - What’s the Return-to-Learn Process Look Like 
21:20 – Concussion in Preforming Arts 
24:50 – Concussion in Sport
29:40 – Return-to-Learn in Preforming Arts
33:20 – Favourite Moments in Sport/ Work
35:45 – Where to Find and Support Dr Memmini
 
Assistant Professor Allyssa Memmini 
https://coehs.unm.edu/faculty-staff/profiles/memmini-allyssa.html
 
Google Scholar: https://scholar.google.com/citations?user=m1a6H_QAAAAJ&hl=en
 
Twitter: @first concussion
Facebook: Headfirst: A concussion podcast
Instagram: Headfirst_ Concussion  
Email: headfirstconcussion@gmail.com

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Dr. John J. Leddy is a primary care sports medicine physician with UBMD Orthopaedics & Sports Medicine and Professor of Clinical Orthopaedics at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. He serves as the Medical Director of the University at Buffalo Concussion Management Clinic, where he has played a leading role in advancing the clinical assessment and management of concussion. In collaboration with Dr. Barry Willer, Dr. Leddy co-developed the Buffalo Concussion Treadmill Test (BCTT), a validated exercise tolerance assessment that has become an internationally recognised tool for guiding safe, individualised return-to-activity protocols following concussion. His work has significantly influenced contemporary concussion rehabilitation by challenging the traditional recommendation of prolonged rest and supporting the use of carefully prescribed sub-symptom threshold aerobic exercise as an evidence-based treatment strategy.
Dr. Leddy's contributions to sports medicine and concussion research have been recognised through numerous prestigious awards, including the American Medical Society for Sports Medicine's Best Overall Research Award and the 2022 Stockton Kimball Award for Outstanding Scientific Achievement and Service from the University at Buffalo. He has authored more than 200 peer-reviewed publications, with his research receiving over 20,000 citations, reflecting his substantial impact on the scientific understanding and clinical management of concussion worldwide. His body of work continues to inform international clinical guidelines and best-practice approaches to concussion diagnosis, rehabilitation, and return-to-sport decision-making.
 
 
 
01:30 - Journey into Medicine, Concussion research and Introduction to Buffalo Concussion Treadmill Test
11:20 – Shifting From ‘Cocooning to Exercise’ Induced Recovery 
19:25 - Differences Between the Treadmill and Bike Test
25:30 – Completing Exertion Testing Without Heart Rate Monitor 
30:25 – Full Return-to-Play 
35:50 – ‘Myth Around Concussion/ Evolving Research’
40:20 – Supporting and Where to Find Professor John Leddy

Professor John Leddy 
https://www.buffalo.edu/news/experts/john-leddy-faculty-expert-concussions.html
https://www.researchgate.net/profile/John-Leddy-3
 
 
Twitter: @first concussion
Facebook: Headfirst: A concussion podcast
Instagram: Headfirst_ Concussion  
Email: headfirstconcussion@gmail.com