Repeated subconcussive head impacts compromise white matter integrity: A longitudinal DTI and NODDI study in collegiate football players

ObjectivesTo determine whether repetitive subconcussive impacts in collegiate football are associated with altered white matter microstructure, motor control deficits, and changes in concussion symptoms across a single season. DesignCohort study with non-contact controls and stratification of contact athletes by head-impact exposure. MethodTwenty-two male varsity football players and 27 non-contact controls underwent pre-season diffusion tensor imaging. Tract-specific fractional anisotropy (FA) and mean diffusivity (MD) were derived from commissural and association tracts using probabilistic tractography. Helmet-mounted accelerometers quantified head-impact frequency and gForce over the season, classifying athletes into high (HE) and low-exposure (LE) groups. Football players completed the Kinarm Ball-on-Bar bimanual coordination task and SCAT3 symptom checklist pre- and post-season. ResultsAt pre-season, contact athletes showed altered white matter microstructure versus controls, with higher FA and predominantly lower MD across most tracts. Over the season, HE athletes sustained more total impacts and gForce than LE athletes and showed declining bimanual coordination on the Ball-on-Bar motor task. SCAT3 symptom and severity scores were low and showed no differences in change. ConclusionsRepetitive subconcussive exposure in collegiate football is associated with persisting white matter differences and subtle bimanual motor coordination deficits that are not detected by routine symptom-based tools, supporting the use of advanced neuroimaging and robotic motor assessment to monitor athlete brain health.