brain injuries Dave Mirra

The diagnosis of Mirra (above) has raised questions about how we view action sports. Photo: Courtesy of The Triumph Project.

On Tuesday, the news dropped like a sledgehammer on the world of action sports: A neuropathological examination of the brain of the late BMX icon Dave Mirra, who died in February of a self-inflicted gunshot wound, found evidence of chronic traumatic encephalopathy (CTE), the degenerative brain disease most commonly associated with football players and boxers. He was the first action sports star to ever be diagnosed with the disease.

The discovery of CTE in Mirra’s brain was a landmark moment in action sports. Now that they have officially claimed the life of a BMX legend, it’s time to ask: Are brain injuries becoming the elephant in the room in the world of action sports?

RELATED: Dave Mirra had CTE when he committed suicide

CTE is most commonly found in people who have sustained repeated blows to the head. Given the nature of football, where athletes are often running headfirst into each other multiple times each game, it makes sense that studies have found it present in the brains of as many as 96 percent of former NFL players.

But while there is a widespread national discussion about how to make football safer — and whether it’s even responsible to play football at all — that discussion has been largely absent for action sports.

“BMX is totally different than football or boxing,” Mat Hoffman, one of the most influential riders in BMX, told GrindTV. “Those sports are specifically designed around constantly hitting your head all day long. When you ride and you crash, the reasons why it’s not as dangerous is because, once you hit your head, you take off however long you need to take off. There’s no coach yelling at you to get back into the game.”

brain injuries mat hoffman

Hoffman still competes despite his countless concussions and says he is not worried about CTE. Photo: Courtesy of Mat Hoffman

For the 44-year-old Hoffman, brain injuries are potentially the only thing in life he is as familiar with as riding his bike: In 2012, Hoffman told the Los Angeles Times he estimates that he has suffered over 100 concussions throughout his career. Hoffman is casual when he mentions that he has suffered from memory loss on multiple occasions and once had amnesia for eight months.

RELATED: BMX icon Dave Mirra dead of apparent suicide

One story Hoffman is quick to recall is when he came-to after being knocked out in a competition years ago to see that his wife was pregnant. It came as a complete shock to Hoffman, even though she had been pregnant for months at the time.

“That was one of the more beautiful memories to come back to,” Hoffman told GrindTV. “That’s a joyful memory coming back and seeing that you’re having a baby. I’ve had memory loss many times, and the most traumatic memories tend to be the ones that come back first.”

Still, despite his long history with brain injuries, Hoffman curiously insists that he isn’t worried about developing CTE.

brain injuries mat hoffman

Hoffman thinks that having longer recovery times differentiates BMX from football. Photo: Courtesy of ESPN Images

“When Dave died, the CTE stuff was brought up by a bunch of people, but I think that was just the media hyping it up trying to make it part of the story,” Hoffman told GrindTV in a phone interview weeks before Mirra’s diagnosis. “I think Dave’s situation was complex and didn’t have to do with head injuries. But I don’t worry about CTE at all right now.

“Watching how football is, where people are running their heads into each other constantly, it’s a gladiator thing, and that’s why the world loves it so much. But that’s not what bike riding is. You do hit your head and get knocked out, but you can take months to heal yourself. You can be patient, that’s the beauty of our sport.”

But medical professionals aren’t exactly in agreement with Hoffman.

“When the story about Dave came out, a lot of people tried to differentiate action sports from contact sports like football and hockey,” Dr. Lili-Naz Hazrati, the neuropathologist who examined Mirra’s brain and diagnosed the CTE, told GrindTV.

“I just don’t think there is a difference. The common thing is that they all have concussions, and they all have an increased risk of concussions. That's the main link. It doesn’t matter how you get the concussions whether it’s action sports or football: If a sport is causing you to have multiple concussions, it’s all the same.”

The neuropathologist from the University of Toronto has been performing brain examinations at the Canadian Concussion Center on the brains of former hockey players and football players in the hopes of helping to further the public knowledge about the prevalence of brain injuries.

For Hazrati, the brains she examines don’t come with personal profiles. They’re simply the brains of the deceased, so when she sees a brain riddled with CTE, it doesn’t matter if it comes from a hockey player or a skateboarder; to her it’s all the same.

And that’s what she wants to stress to people.

“Some people want to say that because, maybe, concussions aren’t as common in action sports as they are in football, that the sports are inherently safe,” said Hazrati. “But concussions vary from person to person. There’s no concrete number on how many concussions, or how severe of concussions it takes to cause CTE. We just know that multiple concussions raises your risk.”

While it’s impossible to say what specific number of concussions will lead to CTE, Hazrati says that as more concussions start to pile up in a person’s medical history, it becomes somewhat like a game of Russian roulette in regards to the probability of CTE showing up in later years.

She also says that someone, like Hoffman, who claims to have had 100 concussions, is clearly at risk of developing the disease.

brain injuries dave mirra

The image on the left is a healthy brain. The one on the right is a brain suffering from advanced CTE after multiple concussions. Photo: Courtesy of Wikimedia Commons

“I think in the upcoming years, we’ll start to see CTE showing up in the brains of more and more extreme sports athletes,” said Dr. Hazrati. “Action sports are flourishing and attracting a lot of people.”

Hazrati’s assessment that action sports are as dangerous as contact sports raises concerns for Kevin Pearce, a former professional snowboarder who nearly died after suffering a traumatic brain injury (TBI) in 2009 while training for the 2010 Winter Olympics.

“I don’t think that action sports are anywhere close to being in the same league as football,” the 28-year-old Pearce told GrindTV. “Our athletes aren't going out and getting concussions everyday like in football. The goal of action sports is not to hit your head like football. Our athletes fall, they make mistakes, shit happens. But you can’t compare falling after hitting a jump to repeatedly hitting your head as hard as you can.”

Pearce has spent the six years since his injury in a constant state of recovery, and as he continues to heal, has started the nonprofit group Love Your Brain in the hopes of spreading awareness to people about brain health. The organization promotes healthy habits to the general population in the hopes of mitigating the risks others put themselves at for suffering a traumatic brain injury.

The organization encourages people to refrain from drinking too much, to engage in meditation and yoga, and to carry out a host of other practices it says will help maintain brain health.

While he isn’t ready to say that skiing or snowboarding is as dangerous as football, he does think the action sports industry has hit a tipping point and needs a wake-up call.

A photo posted by @kevinpearce on

“I don't know how much further snowboarding can be pushed and still be considered safe,” said Pearce. “Maybe guys shouldn’t be trying to throw triple corks in the halfpipe. I mean I don't think there’s a point where you say, ‘This is how far you can go and no further.’ I think people should know about TBI’s and what they do and make the choices they want, but I don’t think we need to push it further. I don’t want to see 24 or 25-foot halfpipes, because at that point, I’m not sure you can do it safely.”

Pearce says there needs to be widespread reform in how brain injuries are handled in action sports. He wants concussion protocols and physician examinations to be mandatory if there are suspected head injuries at contests, and he wants people to realize the danger they’re putting themselves in.

brain injuries kevin pearce

Pearce is hoping that he can help convince people to take up yoga and meditation, and to not engage in activities that can hurt their brains. Photo: Courtesy of Miles Clark

And that is something science can get behind.

“We’re not trying to regulate these sports, but we want to allow people to make informed decisions,” Dr. Steve Thygerson, a professor of injury prevention at Brigham Young University, told GrindTV.

Thygerson commissioned a six-year study on the prevalence of traumatic brain injuries in both skateboarding and longboarding (of the skateboarding variety) and came away with two major conclusions. The first was that participants in skateboarding and longboarding are at a significantly higher risk of suffering multiple concussions than the general population (at a risk level pretty relative to football).

The second conclusion is that the safety precautions within the action sports communities are woefully lacking in relation to other sports.

“The mechanism of injury, whether it’s tackling a guy or slamming your head onto concrete, is the exact same,” said Thygerson. “We need to advance helmet technology and safety product engineering in our space, and more specifically we need to get people who are doing these sports recreationally, not professionally, to take better care of themselves. Otherwise, we’ll just see more and more traumatic brain injuries in action sports.”

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