Alligators and water polo don’t normally cross paths – except in James Hicks’ lab. The UCI professor of ecology & evolutionary biology, best known for studying reptile hearts, recently turned his attention to another amphibious creature: the human water polo player.

Joined by an intriguing cadre of UCI scientists – including a former Boston Red Sox team doctor and a neurologist who once probed violinist brains – Hicks is among the first to investigate aquatic sport concussions. The multidisciplinary project, which now encompasses four studies, could also benefit soldiers and has drawn military funding.

The research comes amid a flurry of concern over head injuries in athletes. Football has been the main focus, but Hicks hopes to change that. He got interested in water polo concussions while watching his three sons play the sport. “People who’ve never seen a game may not realize how physical it is,” he says. “Head-butts and elbows. Balls flying up to 50 mph. I’ve witnessed players get dragged out of the pool in a daze after a blow to the head, and I’ve sat in an emergency room while my kid received stitches from being struck in the face. I began to wonder what the concussion rate was.”

He couldn’t find an answer. Although the NCAA Injury Surveillance Program compiles reams of statistics (“I can check how many linebackers get knee injuries,” Hicks says), water sport mishaps are largely a mystery. In 2012, the NCAA began tracking water polo concussions, but so far only a handful of teams have signed up to supply data, officials say, and the results haven’t been made public.

Dummies and Radar

To fill the gap, Hicks enlisted help from UCI’s Exercise Medicine & Sport Sciences Initiative, a health research arm he directs, and Huntington Beach-based USA Water Polo, a national governing body for the sport.

Head shots. David Reinkensmeyer, a professor of anatomy & neurobiology and biomedical engineering who specializes in robotics, contributed a crash test dummy head and radar gun to measure the impact of balls thrown at different speeds and inflation levels. Result: Underinflated balls reduced the risk of head injury. Engineering students also experimented with a padded skull cap, discovering that it softened the intensity of hits by at least 20 percent. But the slightly larger headgear isn’t allowed by the NCAA, on grounds that it creates a competitive advantage.

Player input. Neurology chair Dr. Steven Small, who has used MRI machines to analyze the brain waves of violinists and baseball sluggers, helped draft an online survey to gauge the prevalence of “seeing stars” among USA Water Polo members. Overall, 36 percent reported at least one concussion. That rose to nearly 50 percent for goalies, who are particularly vulnerable during practice, when balls are repeatedly hurled at them in drills.

Live tracking. Anteater men’s water polo coach Marc Hunt, who admits to having had his “bell rung” a few times as a player for UCI, let researchers stick electronic sensors in his team’s caps to monitor how often the athletes suffered blows to the skull. “I was surprised to see how frequently our goalies were getting hit,” Hunt says.

Something in the Blood?

One of the newest recruits to UCI’s water polo project is Dr. Massimo Fiandaca, an Italian-born associate professor of neurology and neurological surgery who once worked as a team physician for the Red Sox and co-invented a blood test that predicts Alzheimer’s disease. In collaboration with researchers at Georgetown University, the University of Rochester and UCI, he is now devising a blood screening method that could revolutionize concussion diagnosis.

Currently, athletes who don’t want to be pulled out of games can subvert field tests designed to detect mild concussions, he says. Players often underperform on preseason baseline exams so they won’t appear impaired after getting clocked during a game, he explains. An objective measurement would solve that problem.

Fiandaca’s group believes it has discovered a blood component – or biomarker – that changes in reaction to traumatic brain injury. UCI hopes to run trials with its soccer and water polo players this summer to determine how soon after impact the indicator shows up.

“concussions are not really the issue. It’s more about cumulative hits. We know boxers exhibit neurological symptoms as they age. But we don’t know the effects on water polo players.”

Helping Soldiers in Combat

Military officials are also interested in Fiandaca’s research, which could be used to identify concussions in howitzer operators, demolition crews and other troops who encounter explosion-related pressure waves. Soldiers on the battlefield are like athletes in a game, the doctor says: “The individual doesn’t want to let his teammates down and will often deny injury to stay in the contest.”

His group recently secured Department of Defense funding to see if repeated concussions increase a soldier’s risk for Parkinson’s disease or other problems later in life.

Several mysteries remain. Why, for example, can some people “take a punch” but others can’t? The answer might be a combination of brain wiring and physical strength, Fiandaca says. There’s also anecdotal evidence that injury risk is reduced if a player sees a blow coming.

In the end, Hicks explains, “concussions are not really the issue. It’s more about cumulative hits. We know boxers exhibit neurological symptoms as they age. But we don’t know the effects on water polo players.”

Originally published in the Spring 2016 issue of UCI Magazine