Following Börje Salming’s ALS diagnosis, experts say more research is needed on the dangers of head injuries

The news that Toronto Maple Leafs icon Börje Salming has ALS has emerged amid growing research into the prevalence of the condition in athletes as well as its potential link to the type of head injury from which many suffer during their careers.

It’s unclear at this point whether Salming’s two decades as a hockey star have anything to do with the diagnosis the 71-year-old has now shared publicly.

Still, researchers are increasingly studying the kind of impacts that cause concussions – and head injuries that may show no symptoms at the time. They say research must continue to ensure the safety of today’s athletes.

Salming announced on Wednesday that he had been diagnosed with ALS, which stands for amyotrophic lateral sclerosis. Salming played 16 seasons with the Maple Leafs from 1973 to 1989 and was inducted into the Hockey Hall of Fame in 1996.

ALS, also known as Lou Gehrig’s disease, is characterized by a loss of muscle control that eventually leads to complete paralysis. Life expectancy from the onset of symptoms is usually about two to five years. There is no cure, but there are treatments that aim to slow down the disease.

Dr. Daniel Daneshvar, a neuroscientist who is an assistant professor at Harvard Medical School and a brain injury physiatrist at the Massachusetts General Hospital Brigham Network, said that since 90% of ALS cases are considered “sporadic,” meaning that researchers don’t know their origin – it has been paramount for scientists to investigate the causes of ALS.

And one of the identified risk factors is traumatic brain injury, he said.

Serious head injuries causing a concussion are a factor, but so are repeated head injuries that may not have resulted in any symptoms, he explained.

“At this point, we’re still working to prove this relationship, but it’s pretty compelling that the underlying common denominator between those athletes at higher risk for ALS and those athletes who aren’t, is a story of repetitive impacts. to the head,” he said. .

Daneshvar said research on football players and the connection to ALS began to emerge in the early 2000s. Recent studies have also shown a link between head trauma and ALS in footballers and football players. .

A 2019 study published in the New England Journal of Medicine showed football players were four times more likely than a control group of non-players to have their cause of death as motor neuron disease – a disease category in which ALS is found.

Regarding football players, Daneshvar mentions an article he and several other scholars wrote that was published in 2021 in the Journal of the American Medical Association. It found that NFL players who debuted between 1960 and 2019 were four times more likely to be diagnosed with and die from ALS than members of the general population.

“The common denominator between soccer players and soccer players is that they both get these non-concussive blows to the head, so the kind of blows that don’t cause symptoms, but occur in the hundreds times in a season. ,” he said.

“It’s the blows that we believe are responsible for neurodegenerative processes,” he said.

The protein associated with the development of ALS, called TDP-43, is present in the brains of people with the disease who have suffered repeated head trauma, Daneshvar explained. “The thought process is that when this protein accumulates in the wrong place at the wrong time, it could lead to someone developing ALS.”

There isn’t enough research on hockey players yet, Daneshvar said. It is hoped that research will continue for athletes and groups such as survivors of domestic violence, where repetitive heat trauma continues to be a problem.

Tim Fleiszer, executive director of the Concussion Legacy Foundation, an organization that supports people, including athletes, who are affected by concussions and CTE – chronic traumatic encephalopathy, a life-threatening condition caused by repeated injuries to the brain – said it is unfortunate that so many former athletes are being diagnosed with a rare disease.

There are approximately 3,000 Canadians living with ALS. About 1,000 people die each year from the disease and another 1,000 are diagnosed each year, according to the ALS Society of Canada.

Fleiszer, who is also a former CFL player and multiple-time Gray Cup champion, said changing sports is crucial to preventing this type of injury, especially in children under 14.

“You know, not exposing kids to tackle in football, not exposing (them) to body checking in hockey, not exposing (them) to headbutting in football, you do that and you reduce greatly increases the risk of these diseases progressing later in life. ,” he said.

Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, a former WWE football player and professional wrestler who dealt with sports-related head trauma, said he and Fleiszer have seen teammates die recently from causes linked to head trauma and that the link between ALS and head trauma needs to be taken more seriously.

“It’s another reminder that this is preventable, repetitive impacts to the head are entirely preventable in sport.”


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