Sports concussions continue to be big news.
As visitors to this site and readers of my countless blogs, articles, and editorials on the subject of concussions already know, however, concussions have been important to me and MomsTeam for a lot longer.
It is thus with a certain amount of pride and satisfaction that I have watched as Congress and the national media in recent weeks have joined me on the sports concussion bandwagon and called the N.F.L. out for its lack of leadership on this critical public health issue. Editorials in newspapers have joined me in criticizing the NFL for its foot dragging. In a November 1, 2009 editorial, for instance, the Las Vegas Sun faulted the league for "repeatedly downplay[ing] research linking concussions to long-term brain injuries", despite what MomsTeam's concussion expert emeritus, Dr. Robert Cantu, told Congress was "growing and convincing evidence" of such a link. It concluded that "the NFL's current stance is putting players at all levels at serious risk" because "college, high school and youth football leagues often follow its lead on safety issues."
MomsTeam has long recommended that a certified athletic trainer (AT) be on the sidelines of every high school football game. In my view, and many others, it is simply a disgrace that less than half of the nation's high school have an AT on staff. It is unfortunate that we, as a nation, seem so penny-wise but pound-foolish when it comes to health care that scarce resources are devoted to hiring assistant coaches so our high school teams can win more games when the money could be better spent hiring trained professionals to keep our athletes - the vast of majority of whom are not going to become professional athletes - safe.
We pay to have nurses in our schools (although, as the H1N1 flu epidemic has shown, there are fewer and fewer of them, too, and they are often spread way too thin); but considering the overall health risk to students, why don't we pay to protect more of our high school athletes, especially those contact sports at greatest risk of long-term or catastrophic injury or death?
Teaching proper tackling
A recent NATA study shows that high school players are at greater risk for concussive events in part because they haven't learned proper tackling techniques. Youth Sports Parents has consistently promoted the efforts of coaches like Bobby Hosea to teach players to use what he calls "Dip n' Rip" (a tackling technique in which a football defender stops the ball carrier with an upward thrust across the chest and shoulders, not by leading with his helmet).
Proper tackling technique needs to be taught at every level, from Pop Warner to high school. At least one concussion expert thinks it might eliminate up to half of football concussions at the youth and high school levels. Not surprisingly, witnesses at the Congressional hearings also emphasized the need for teaching better tackling techniques.
For the last several years I have also been urging a change in the culture of football, which, from the NFL on down and since the earliest days of the sport, is for players to walk off the pain, take a hit like a man, be a warrior and gladiator, and to keep concussion symptoms to themselves, sometimes with tragic consequences.
As the keynote speaker at a national sports concussion conference in April 2008, and in articles on this site I have proposed that coaches actively, consistently and repeatedly encourage honest self-reporting by athletes of concussion symptoms (and reporting by teammates of symptoms shared with them by other players) and suggested that they make the failure to do so a violation of team rules. Just such a team approach to concussions was suggested by one of the witnesses at the Congressional hearing.
Once again, though, efforts to change the culture of football (and all contact sports, for that matter) have been and continue to be complicated by the NFL's attitude towards head injuries, which still, in my view, sends the wrong message to youth athletes. "Walking off the pain in an N.F.L. game turns into walking it off in a Little League game - the trickle-down effects on high school and college players are very real and can be fatal," warned Representative Hank Johnson, Democrat of Georgia, at the recent Congressional hearings.
I have been working hard the past ten years to educate parents about the risks concussive events pose to their children. As the national concussion conference in April 2008 - a conference attended by representatives of the N.F.L. - I called on the league to do more to educate youth and high school players about the dangers of concussion (especially from failing to report them). I specifically called on the N.F.L. to sponsor a public service advertising campaign on the subject.
So I was happy to hear, more than a year and a half later, N.F.L. Commissioner Roger Goodell grudgingly agree, under pressure from lawmakers, to create public-service announcements to educate the public about the seriousness of concussions.
Kids' brains are different
Hopefully, such PSA's won't reflect the NFL's position before Congress that the same standards for concussion management and return to play should apply from youth football to the pros. The N.F.L.'s one-size-fits-all position flies in the face of research showing that youth, middle school and high school players recover from concussive events much more slowly than professionals. And it appears to completely ignores the consensus of concussion experts, expressed as recently as this past March, "strongly endorsing" a "more conservative return to play approach" for children and adolescents than for the pros, including an outright ban on a same-day return to practice or play.
We know we have a long way to go in concussion education and management when, according to a recent study by researchers at Nationwide Children's Hospital in Columbus, Ohio, as many as 4 out of 10 concussed high school athletes are allowed to return to the practice and playing field in violation of current guidelines, including an astounding 16 percent who are allowed to return to the same game after being hard enough to cause a loss of consciousness. How many more Zack Lystedts and Ryne Doughertys will it take before the message gets through that permitting a player to return to the field before his brain has healed from a concussive event (whether involving a loss of consciousness or not) puts them at unacceptable risk of a second, catastrophic or sometimes fatal, head injury.
Reasons to be more cautious
The Congressional hearings and recent stories in magazines like The New Yorker give parents more reasons than ever to be cautious about letting their sons play football. Based on a 2005 North Carolina study of retired pro players founds those with three or more concussions had increased risk of mild cognitive impairment after age 50, the lead author, Kevin Guskiewicz, recently told the Baltimore Sun that it was reasonable to "assume that a high school player who likewise had three or more [concussive events] during his high school years would potentially be predisposed to some of these same long-term neurodegenerative conditions that NFL players are," but there's no evidence - at least yet - for that.
A telephone survey of over 1,000 former NFL players conducted by the University of Michigan's Institute for Social Research and commissioned by the N.F.L. found, alarmingly, that former players were being diagnosed with Alzheimer's or similar memory-related diseases at a rate 19 times higher than the normal rate for men aged 30 through 49
Most troubling, perhaps, is recent evidence, highlighted in The New Yorker article, that playing football may be dangerous even to those who don't ever experience a concussive event; that players in the so-called trenches (on the offensive and defensive line), may be at risk of early dementia (in the form of a condition called chronic traumatic encephalopathy or C.T.E.) from the cumulative effect of the sub-concussive blows they sustain over the course of their careers every time the ball is snapped. We simply don't know whether all those hits are, as a former N.F.L. lineman characterized them in a recent posting on Deadspin.com, tiny "time bombs planted in our brains with fuses of indeterminate length."
Tough choices for parents
Given the increased focus on head injuries in football, parents have naturally become more and more concerned about what playing football will mean to their child's long-term health. Recent news stories have recounted how parents of football players have been torn about whether they should let their kids continue playing and describe the prospect of long-term injury if they keep playing as "kind of scary." Some report having decided not to let their kids play football based on the new evidence.
Again, this is something I faced ten years ago. As I have recounted on these pages, I ultimately decided to end my son Spencer's football career after his sophomore year in high school because to continue playing, given his history of concussions and learning disabilities, posed, in my view, an unacceptable risk of long-term injury. And this was long before studies began coming out showing just how potentially dangerous football was to a player's long-term mental health.
I am not now and have never suggested that parents simply refuse to let their children play football. But parents do need to make the decision based on complete information; information which they still do not have. Concussion experts candidly acknowledge that little is currently known exactly about long-term health risks of concussion for N.F.L. players, much less players whose football careers end in high school or college.
More research is needed over a longer period of time before we will know - if we will ever know - just how dangerous football is to the human brain - particularly the developing brain of a youth, middle school or high school player. There is not now and never will be a one-size-fits-all answer. It is likely that the American obsession with football will continue for decades to come. But at the very least we - and the NFL - need to continue to provide the very best information.