Yesterday in New York, the Sports Legacy Institute announced a certification program for head impact sensors to track the number of hits a player sustains above 20 g's of linear force.
It wasn't exactly what I had expected, but, nevertheless, a move that I wholeheartedly support.
When SLI first unveiled its Hit CountTM program two years ago, it expressed the belief that the "fastest and most effective path to safer youth sports is to regulate the amount of brain trauma that a child is allowed to incur in a season and a year," proposed that no athlete under age 18 be exposed to more than 1,000 hits to the head exceeding 10 g's of force in a season, and no more than 2,000 times a year, and if they exceeded these thresholds, not be allowed to finish a season. It said at the time that its goal was to have a Hit Count adopted by major youth sports organizations by 2013, which SLI hoped would include, among other things, guidelines for the minimum threshold to be considered a "hit," the maximum hits per day (with all counts stratified by age), maximum hits per week, and maximum hits per season.
Two years on, SLI announced four things: first, the guideline it had called for in 2012 for the minimum threshold to be considered a hit (20 g's of linear force); second, a program for certifying head impact sensors "to give consumer and research scientists ... confidence that the sensors are accurately measuring impacts, providing simple and actionable data" which it said could eliminate 500 million head impacts in football a year; third, the "beginning of a major research and public health effort to limit brain trauma in sports," and fourth, a "goal to eventually provide clear guidance for coaches and parents" about a Hit Count Threshold, which would be set by a committee of leading scientists. (emphasis supplied)
Hitting the reset button
Why the mid-course correction? Why no announcement of the Hit Count Threshold SLI promised in 2012?
In a word, science.
In 2012, SLI claimed that "scientific evidence exists to support Hit Count." In 2014, however, SLI acknowledged - correctly - that "current science does not provide a 'safe' or 'unsafe' Hit Count." In other words, SLI admitted that we had not in 2012, nor today, reached the point where there was a basis in the science for saying that athletes who sustain hits above any particular threshold are at significantly increased risk of long-term brain problems or neurodegenerative diseases such as chronic traumatic encephalopathy.
Admittedly, the research so far does suggest that repetitive sub-concussive hits may, in some individuals, be a factor in long-term brain damage, early dementia, and, in an unknown, but believed to be very small, percentage of cases, neurodegenerative diseases like CTE. Emerging research also suggests that a high number of high force impacts, can, at least short-term, effect on neurocognitive function equal to that resulting from concussions.
Thus, SLI's goal of reducing total head trauma in contact and collision sports, in the belief, as Dr. Robert Cantu often says, that "no brain trauma is good trauma" is certainly one that all of us in the youth sports community share, can get behind, and are working towards. So, rather than harp on the fact that SLI is now admitting that its goal in 2012 was perhaps, shall we say, a wee bit too ambitious, I choose to view the fact that SLI has essentially hit the reset button on Hit Counts as an important step in the direction (or perhaps it's more one step backward, two steps forward).
Now that SLI has admitted that the science has not reached the point where we can pick any particular number of hits, and say to a parent, coach, or athlete, that above that number an athlete is running an unreasonable risk of long-term brain injury (or, for that matter, that, up to that number, you are safe) and that, far from having a hit count threshold in our sights, we are at just the beginning of a major research and public health effort to bring such a threshold into view (I note in passing here that some in the media, including Will Carroll in a long article for Bleacher Report, somehow missed this point, and got the idea that an actual Hit Count threshold was announced yesterday!), we can focus our energies on doing what can be done, right now, to make contact and collision sports safer, in this case, by using sensor technology in three very important ways (all of which, by the way, we highlight in our PBS documentary, "The Smartest Team"):
First, as SLI mentions in its press release, albeit in passing, we are starting to see sensors used "to alert coaches, medical professionals, and parents when a potential concussive impact occurs." Based on my experience working with the high school football team and sensor manufacturers in Newcastle, Oklahoma the last two seasons (two in 2012, four last year), I continue to believe, as do such respected research scientists as Drs. Steven Broglio and Jeffrey Kutcher at the University of Michigan and Rick Greenwald at Dartmouth, that real-time monitoring of head impacts hold enormous promise in assisting athletic trainers and team doctors in identifying athletes for concussion screening on the sports sideline. As numerous recent studies have shown, athletes are reluctant to report concussions themselves, such that the percentage of concussions that go undetected is unacceptably high. Many of the Newcastle players, in a private conversations, told me quite frankly, that "we do not want to have the responsibility of reporting our concussions any longer. We want the sensors."
Second, I absolutely agree with SLI that sensors have value as a "teaching tool and a behavior modification tool for athletes," at least by programs that can afford them (and this is a major concern, of course, and will continue to be until the per unit cost drops, as it inevitably will over time, to the point that they are within reach of most, if not, all programs) and there is science to support that belief: A number of top concussion researchers also think that real-time monitoring of impacts could help reduce the total amount of brain trauma from repeated subconcussive blows by identifying athletes sustaining a large number of such hits due to improper blocking or tackling technique, and sensors are already being used in this way at both the college and high school level.
In a recent article on SI.com, Kevin Guskiewicz, PhD, ATC., Kenan Distinguished Professor and Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill, said sensors are helping coaches and other personnel at UNC identify athletes who are sustaining a high number of high force impacts, especially to the top front of their helmets that appear to be the most worrisome from a brain trauma standpoint, as a result of poor tackling or blocking technique. "If a player is observed repeatedly sustaining larger impacts to the crown of his head," he told SI, "coaches will work with him on adjusting his technique," said Guskiewicz.
Using impact sensors as a teaching tool has also been happening in high school football. After Purdue researchers found, in a landmark 2010 study, that high school football linemen who sustained a high number of high impact sub-concussive hits over the course of a season were the ones suffering impairment of their visual memory, the information led at least one player to change his blocking technique. As Tom Talavage, the lead author of the Purdue study, told Frontline in a 2011 interview, he estimated that at least 50 percent of the high impact hits linemen and linebackers were sustaining were due to poor technique.
"Some of the players that we have on our team have not very good technique, to be quite honest," Talavadge said. "And what you'll find is, they will launch into a play, and they will lead with their helmet. Other players will more correctly keep their head up, try to get their arms up as a blocking technique, or when they're rushing, they will try to get their arms up as a means to push the offensive lineman out of the way. Those technique differences lead to a very large difference in the total number of blows experienced and where those blows are experienced on the head."
Talavage said that when one of the offensive lineman who was found to have been functionally impaired after sustaining a high number of subconcussive blows - impairment that persisted beyond the season - decided to change his technique, he experienced a drastic reduction in the number of blows he experienced to the top front of his head and a moderate reduction in the total number of blows. The result was that, after the second season, "his neurocognitive testing never detected any deficits, and from an imaging perspective we saw substantially less change in his fMRI activity. There's still some, because he's still getting hit, but his technique changed the distribution."
Third, I support SLI's certification program for sensor products in order to standardize the collection of impact data on 20 g+ hits, with devices that have been certified as reliable, to be used by research scientists to look for the twin head injury "holy grails": an impact threshold above which an athlete is highly likely to have sustained a concussion and the number of hits above which the athlete runs an unreasonable risk of long-term brain injury.
Again, this is a use of sensors that is featured in "The Smartest Team," in particular, in some statements made by former i1 Biometrics' CEO, Lawrence Calcano: "Over time, every hit that you take gets recorded by the system and stored, and so people can keep track. Your mom, your dad, your coaches, your doctor can keep track of what's happening to your head, every impact that you receive. And that is really important to be able to understand what the cumulative number of impacts are that you receive during your playing career, whether it's that day, the season, over your high school career, and hopefully with you guys, when you play big time college football."
As Calcano noted, "The process of understanding what is happening to athletes when they compete is not a process that we're gonna end in the next three months or six months, or next football season. This is a multi-year activity that's gonna require the collection of a very significant amount of data. Over time, when you have millions of data points, then the medical community and the research community can begin to make sense of it and decide at what point, you know, is there injury?"
If I have a concern about the certification program it is that I hope that it not be used to stifle innovation in the field by imposing on companies, many of which are start-ups with limited capital, onerous fees, that all sensor companies have an equal voice in the development of Hit Counts going forward, are afforded equal consideration in any research studies that SLI funds with fees generated from the certification program, and equal access to the consumer market for their products, which, given NOCSAE's original and clarified rulings last year voiding the certification of helmets with third-party add-ons, is currently tilted in favor of products, such as MC10's Checklight skull cap and X1's earbuds, that do not physically attach to helmets, and discriminates against products. such as those of Impakt Protective, Gforce, Safe Brain and Brain Sentry, which attach to helmets.
As much as I support SLI's sensor certification initiative, it bears repeating here that the use of sensors in these three ways is just one part of what I see as a multi-pronged, all-of-the-above, approach to managing the risks concussions and repetitive sub-concussive impacts pose in contact and collision sports, one which we have dubbed the Six Pillars, which includes:
- Reducing total head trauma by establishing sensible limits on full-contact practices;
- Teaching athletes how to minimize helmet-to-helmet contact by teaching them "Heads Up" tackling;
- Better enforcement of rules against helmet-to-helmet and blind-side hits;
- Comprehensive head injury awareness education which focuses as much on creating an environment in which athletes feel safe in reporting experiencing concussion symptoms as it does on teaching them to recognize concussion signs and symptoms;
- Improved identification of concussed athletes on the sports sideline, through the use of impact sensors to alert sideline personnel to blows that might cause concussion, and by having more certified athletic trainers on the sideline, even at the youth level;
- Much more conservative management of concussions once they occur, including a period of cognitive and physical rest after concussion, a gradual return to the classroom, and return to play only after athletes are symptom-free, off all academic accommodations, and have completed a program of gradually increased exercise without symptoms returning; and
- Recommending retirement to athletes who are slow to recover from concussion and for whom continued participation poses an undue risk of long-term brain injury.
I look forward to working with Chris Nowinski and Sports Legacy, and all youth sports stakeholders, to reduce brain trauma in football and other contact and collision sports, to identify concussed athletes sooner, to manage their injuries more conservatively, and return them to the classroom and the field when it is safe to do so, and I thank SLI for its tireless work in increasing public awareness of this critical public health issue.
Brooke de Lench is Executive Director of MomsTEAM Institute, Founder and Publisher of MomsTEAM.com, author of Home Team Advantage: The Critical Role of Mothers In Youth Sports, and Producer/Director/Creator of "The Smartest Team: Making High School Football Safer." She can be reached by email (firstname.lastname@example.org) and you can follow her on Twitter @brookedelench.