Jul 24, 2013; Kansas City, MO, USA; Kansas City Royals manager Ned Yost (3) looks in on catcher Salvador Perez (13), as a trainer takes care of a cut on Perez

Head trauma is not neatly understood. Identifiable symptoms do not always accurately reflect the extent of damage. A bash to the head causes a cellular quagmire of chemical reactions, synaptic misfires and microscopic tissue fissures that compromise the body’s entire immune system.

It is sometimes easier to define the type of brain injury by the cause of it. A massive singular blow can literally twist the brain inside one’s skull. This can knock someone unconscious, render them incoherent and cause memory loss. That is a concussion.

More common, more difficult to immediately identify and possibly more dangerous in the long-term is injury caused by minor but frequent blows to the head. This type of trauma is called “sub-concussive” mild traumatic brain injury (MTBI). Baseball crowds frequently see evidence of it when a catcher takes two foul tips to the mask in short succession. The catcher will often remove his mask, take a moment to compose himself, blink a few times and maybe shake his head before resuming play. This is what usually lands catchers on the concussion disabled list.

Those successive blows to nerve centers in the forehead, chin or jaw destabilize the natural chemical mixture in synapses, causing neurons to malfunction. As Popular Mechanics explains it:

Potassium leaves the cell and calcium rushes in, destabilizing the electrolyte balance, while the brain does all it can to keep these levels in balance. With each successive blow, the balance becomes harder and harder to maintain, and more and more energy must be spent in the process.

If the heart cannot pump enough blood to repair the injured neurons quickly enough, the concussed individual loses coordination and eventually consciousness.

That is just the immediate effect…

Repeated blows to the head can cause chronic ailments due, in part, to a protein called S100B. Under ordinary circumstances, this particular protein is only found in the brain. A study of college football players found that the higher the number of hits to the head, the higher level of S100B that leaks into the bloodstream, indicating damage to the blood-brain barrier.

Because the S100B protein is a foreign substance in the bloodstream, it is attacked by the body’s autoimmune system. The antibodies seep back through the damaged blood-brain barrier and start attacking brain tissue.

According to an article by Cleveland WKYC’s Monica Robins:

Brain scans (using diffusion tensor imaging) confirmed that the presence of S100B antibodies in the player’s blood correlated with brain tissue damage, comparable to what one typically observes in the scan of a whiplash victim.

The effects of S100B seeping into the bloodstream can cause “long-term brain damage.” The more blows to the head, the higher concentration of S100B in the bloodstream, increasing the efficiency of autoimmune antibodies tasked with attacking it, thus compounding the brain damage.

Perhaps this auto-immune response is what causes (at the very least correlates with) the now well-known “Chronic Traumatic Encephalopathy,” a degenerative neurological condition found only in people who have suffered repetitive brain trauma. It is the same disease that most likely prompted the suicide of former Kansas City utility player Ryan Freel.

Modern catcher’s masks have prevented untold thousands of concussions by absorbing a considerable amount of energy from foul tips, about 85%, but it is still not enough to stop MTBI and long-term brain damage. It is an unnerving situation for ballplayers behind the plate.

Currently, two primary styles of catcher’s mask exist: the traditional steel cage & helmet combo and the “hockey style” mask. Some catchers have substituted steel masks for lighter weight titanium masks to reduce strain on the neck. It’s easy to believe that the reduction of 2 1/2 pounds from the face would relieve some neck strain. However, it certainly hasn’t reduced the number of concussions.

In 2007, multiple foul tips to the face ended the career of San Francisco Giants catcher Mike Matheny and spawned a brief flurry of catcher equipment research. The Giants performed their own study and determined that no specific type of mask provides advantageous protection over any other. The Giants did not publish their results and did not return calls for additional information.

Students at Kettering University administered their own low-tech study, which indicated that traditional masks may be more protective to frontal impacts than hockey-style masks, while hockey-style masks protect better against bat back-swings to the temple. The manufacturer of both masks, All Star Labs, objected to the results, claiming that their extensive internal research did not support the Kettering students’ conclusions. Of course, that is easy to say when they do not divulge their testing methods or provide any research of their own.

The path to eliminating sports brain injuries is as obvious as it is impossible. Don’t get hit in the head. Short of that, the continuing improvement of protective headgear is the only realistic avenue to reducing sports-related brain injuries.

MLB is taking steps to avoid collision-induced brain injuries, which have plagued the NFL for decades, by banning home plate collisions. It makes sense politically. They do not want to be the subject of an exposé as damning as League of Denial. The reason for ending collisions at the plate may not come from a genuine desire to protect players as much as reputations, but it will protect players nonetheless. The next step should be for MLB to spearhead research for the development of headgear that successfully reduces the brain injury of catchers and umpires from foul tips to the face.

The Royals have a good reason to want better catcher’s gear. Salvador Perez is a franchise player who missed a week of the 2013 season with a concussion. In regards to plate collisions, Ned Yost has stated, “Now I’ve got an All-Star Gold Glove catcher I want to protect,” but Perez hit the disabled list due to foul tips, not collisions.

Since his concussion, Salvy has shown subsequent signs of MTBI after taking additional foul tips off his mask (confusion, rapid blinking). The Royals would do well to pressure MLB to fund concussion and catcher gear research. If recent trends are any indication, when 15% of catchers can hit the DL simultaneously with concussions, so should every other team.