Industry executives say the spotlight being placed on health and safety has made student-athletes safer now than at any time in history.
By Curtis Eichelberger, NFF Correspondent
It was only about five years ago that football fans feared the onslaught of concussion claims and that early stage dementia in a small subset of former players might doom the sport. But the initial feelings of panic and cynicism have begun to fade, as the voices of doctors and athletic trainers have emerged, calming the public and appropriately refocusing the conversation on the science of concussion and broader health issues of student-athletes in all sports. The game isn’t going to go away, they declared, but it must be made safer.
“The entire football community has developed a laser focus to address the concerns about the long-term effects of concussions,” said Steven Hatchell
, president and chief executive officer of The National Football Foundation & College Hall of Fame, Inc. “Sports will never be totally injury free, but we are taking significant steps to err on the side of safety in protecting the long-term health of our student-athletes.”
The result of this concern has been a plethora of recent studies involving tens of thousands of student-athletes, millions of dollars in funding, new coaching guidelines for safety and unprecedented community awareness of the dangers of concussion and other health and safety concerns.
Industry executives say the spotlight being placed on health and safety has made student-athletes safer now than at any time in history.
For most, the subject centers on concussions and brain injury. But that’s not the only, or even the primary, concern for coaches and athletic trainers. Mental health and overuse injuries are of equal concern, they say. Student-athletes who play one sport year-round stress their bodies and are subject to repetitive use injuries. Meanwhile, stress, depression, and anxiety are problems that don’t show up on an injury report, yet can be just as debilitating, and in some cases, deadly.
These concerns used to be relegated to men’s sports, but that’s changing, too. Women suffer a higher incidence of concussion in comparable sports like soccer, lacrosse and basketball, and often require more time to recover. It’s not just a football injury issue, doctors say. A knee to the side of the head in soccer or a hard tag in softball can send women to the hospital just as easily as a goal line tackle. And funding for the biggest research projects in the country now require that women’s sports be given appropriate and equal attention.
U.S. President Barack Obama
echoed the fears of many parents last year when he expressed concern over the potential long-term impact of injuries in college sports. The movement to step up research and create new rules and guidelines to protect student-athletes was well on its way when the president, a father of two young daughters, shared his worry, but it struck a chord with the general public.
The games that teach so many important life lessons about leadership, team work and respect for others were under fire, yet many still believe the benefits outweigh the risks.
There are no guarantees for the young men and women who take the field, sports executives say, but one thing is for sure: thousands of doctors, scientists, government agencies, athletic associations, equipment makers, and moms and dads have heard the call and are doing everything in their power to make sports safer for every kid in America.
Football is compared to war far too often, but in a number of cases the analogy is fitting.
The NCAA and Department of Defense have partnered on a three-year, $30 million research project on concussion and head impacts that is being described as the most comprehensive study ever undertaken.
Starting this fall, more than 37,000 student-athletes in men’s and women’s contact sports will be given physical exams for balance and other brain functions that will be used as a baseline for those who later suffer concussions.
The goal is to use this data to establish a history of concussion, including the risks and treatment. The research will benefit athletes, but also soldiers who are injured in real combat, which is why the Department of Defense is so keen on the research.
“I believe this project will be the game changer,” said Dr. Brian Hainline
, who became the NCAA’s first chief medical officer in 2013. “It will become the basis for discussion … not based on hype.”
The research, which includes head sensors, magnetic resonance imaging (MRI) studies and biogenetic markers, will start with 15 schools, including the four service academies, the five biggest football conferences, and the Ivy League.
Experts say that concussion can no longer be viewed as an inconvenient timeout.
“We need to treat (concussion) like an ACL injury,” Hainline said.
Research Grants, Donations Focus on Concussions
While the DOD study is certain to draw the attention of mainstream media, it’s hardly the only medical research taking place around the country. Hospitals and universities all over the U.S. are performing studies that will contribute to treatment in the coming years.
Princeton University researchers used advanced imaging techniques to show differences in the brain function and structure of concussed athletes. Doctors think these techniques, combined with the usual subjective tests could make a concussion diagnosis more definitive.
Researchers at the University of North Carolina and Medical College of Wisconsin received a $399,999 grant from the NCAA last year to study the long-term effects of head injuries in college athletics. There has been a lot of research on what happens to an athlete immediately after suffering a concussion, but there is little data on the long-term effects.
Researchers will survey 2,000 former athletes before whittling the list to 120 who will undergo physical assessments of balance, genetic testing, psychological surveys and neuroimaging studies.
“This study represents the most comprehensive investigation of long-range neurologic health outcomes in former NCAA athletes,” the researchers wrote in their study proposal. “Our study will advance the science on the chronic effects of concussion and head impact exposure.”
Athletic departments are playing a role in research, too.
Virginia Tech football players have worn sensors in their helmets to measure the number and severity of collisions during games since 2003. Especially hard hits trigger a sideline computer, alerting athletic trainers to check the student-athlete for concussion.
At Stanford University, the Cardinal has installed high speed cameras at their practice facility so researchers can study collisions at hundreds of frames a second.
And colleges are upgrading their medical equipment beyond the old whirlpools and taping tables, too. These rooms are now being built as mini-medical clinics that focus on physical therapy, rehabilitation and general medical care, said Scott Anderson
, head athletic trainer at the University of Oklahoma and president of the College Athletic Trainers’ Society.
All this research is expensive and relies on donations from sources outside big government agencies like the Depart of Defense or associations like the NCAA. New York Giants co-owner Steve Tisch
donated $10 million to UCLA’s department of neurosurgery at the David Geffen School of Medicine this past May to develop an age-appropriate concussion evaluation tool.
UCLA will use the money to establish the world’s most advanced diagnostic and treatment program for athletes who have suffered concussions. Tisch’s donation was the largest an individual has ever given to a medical center for concussion research.
“Currently, young athletes are assessed with adult tests – but kids aren’t little adults,” said Dr. Christopher Giza
, an associate professor of neurosurgery and pediatric neurology at the David Geffen School of Medicine at UCLA and Mattel Children's Hospital UCLA.
Always a 10 Percent Risk of Injury
It’s important to show how much research, money and time are being spent to prevent concussions. But it’s even more important to note that all of the man hours and millions of dollars combined haven’t resulted in a concussion cure or piece of equipment that can unequivocally prevent the injury.
Every time a football player makes a goal line tackle, a soccer player bumps heads going for the ball or a diver backflips off a concrete platform, he or she risks concussion, head trauma or another injury.
“There is always going to be a 10 percent risk of concussion or other injury. Sport has inherent risks. That’s the bottom line,” Hainline said.
At an NCAA meeting this June in Salt Lake City, the committee on Competitive Safeguards and Medical Aspects of Sports tried to reduce that risk by requesting that health and safety be considered in every on-field rules change – even when the primary reason is to ensure fairness or adapt to changes in playing styles.
An update is expected at the committee’s meeting in December.
Greater Focus on Women’s Health
The national discussion on concussion has focused primarily on men’s sports, particularly football, but researchers say women suffer more concussions in comparable sports like basketball, soccer and baseball/softball.
Symptoms for both genders include confusion, headaches, distorted vision, lack of balance and amnesia, and they can affect the student-athlete immediately, hours or even days later, doctors said.
Concussions are usually caused by a hard hit that rotates the head from side to side, causing the brain to move inside the skull. A male's neck is generally bigger and stronger than a female's, which helps protect him. In addition to having less strength, women have a natural ability to rotate their heads faster from side to side, making them more vulnerable.
Researchers say males get concussions when they collide with other athletes during tackles, take-downs or checks, while women tend to get them falling to the ground, getting hit in the head with a ball or running into equipment.
Male and Female Concussion Rates Per 1,000 Games in Comparable Sports
Sport Women Men
Soccer 2.10 0.96
Basketball 1.03 0.47
Lacrosse 1.24 0.98
Ice Hockey 1.69 2.38
Softball/Baseball 0.59 0.11
Source: NCAA concussion data for the period 2004-2013 from Datalys Center for Sports Injury Research and Prevention in Indianapolis.
Research in the treatment of men’s and women’s concussions is important, but it comes a little late for the athlete.
The College Athletic Trainers’ Society and NCAA Sport Science Institute hosted a summit in January where they formulated guidelines on how many full-contact football practices should be allowed, what role doctors and athletic trainers should play in student-athlete healthcare, and the steps for treating concussions.
While the recommendations can’t be forced on schools or conferences, those who fall out of line put their student-athletes at greater risk of injury, and in the longer-term, may lose an advantage in recruiting the best student-athletes.
Their guidelines for Division 1 limit spring training full-contact practices to no more than two a week and none on consecutive days; never more than one contact practice in a day during preseason two-a-days; no more than two live contact practices per week during the regular season; and teams participating in a bowl game should be limited to two full-contact practices per week out of a maximum 15 workouts.
There are currently no NCAA rules limiting the number of full-contact practices during the regular season, postseason and bowl workouts.
“The rationale for reducing practice contact is to decrease athlete exposure for concussion … and to decrease overall incidence of injury,” Summit co-chair Scott Anderson
The group’s guidelines also state that medical care and return-to-play decisions should be decided independent of coaches and administrators, and that the team doctor, rather than a coach or sports executive, should provide medical direction and supervision to the athletic trainer.
How Many Fingers Am I Holding Up?
One of the biggest problems for athletic trainers and doctors is that there isn’t a clear definition of what a concussion looks like. By some counts, there are as many as 42 definitions, with many determinations coming down to human judgment on the sideline.
Concussion symptoms can reveal themselves immediately, or with a delayed onset. Physical and mental examinations are often normal. And players underreport their symptoms to get back in the game, making it all the more difficult to diagnose concussion on the sideline.
“The natural history of concussion remains poorly defined and diagnosis can be difficult,” said Anderson. “There often remains a significant reliance on self-report of symptoms from the student-athlete.”
Health professionals meeting at the Summit developed important guidelines for concussion management that include preseason baseline assessments, diagnosis, and steps for managing concussion. And they also called for schools to assign a team of doctors, athletic trainers, neuropsychologists and faculty to manage the student-athlete’s return to class.
Surely, progress in health and safety has come slower than some would like, but progress is being made.
The first spearing rules were adopted in 1976 and decreased spine injuries dramatically. Preseason guidelines regarding hydration and breaks went into place in 2003 and reduced heat illnesses. Concussion might be the next milestone achievement.
“There is this extraordinary awareness that now is the time to come together,” Hainline said.
Mental Health and Overuse Injuries Are Problems, Too
While concussion has received most of the attention, student-athletes told administrators at the 2013 NCAA Convention that mental health issues are just as big a concern for them and their fellow athletes.
Hainline and a team of student-athletes, administrators and health experts, dubbed the NCAA Mental Health Task Force, have developed a list of issues faced in college programs.
- Adjusting to new coaches.
- A heavy athletic and academic schedule that can lead to a sense of being overwhelmed.
- Once removed from the field due to injury, student-athletes sometimes lose their sense of identity, which can lead to depression, anxiety and self-medication with drugs and alcohol. Few seek help out of fear they will be ostracized.
The task force said schools need to develop a plan to break down these barriers. They recommended that the athletic department create a point of contact for mental health problems. The task force, which convenes annually, is now developing educational programs for coaches.
“Concussion is the elephant in the room and we have to figure it out,” Hainline said. “But in terms of the prevalence of injuries, what is really hurting our athletes and needs addressed are overuse injuries, mental health and we have to get a better handle on cardiac issues, too.”
President Obama Echoes Public Concerns
In an interview with the New Republic in January of 2013, Obama was asked if he takes less pleasure watching football, knowing the impact the game has on its players.
“I'm a big football fan, but I have to tell you if I had a son, I'd have to think long and hard before I let him play football,” Obama said. “I think that those of us who love the sport are going to have to wrestle with the fact that it will probably change gradually to try to reduce some of the violence. In some cases, that may make it a little bit less exciting, but it will be a whole lot better for the players, and those of us who are fans maybe won't have to examine our consciences quite as much.
“The NFL players have a union, they're grown men, they can make some of these decisions on their own, and most of them are well-compensated for the violence they do to their bodies.
“You read some of these stories about college players who undergo some of these same problems with concussions and so forth and then have nothing to fall back on. That's something that I'd like to see the NCAA think about," Obama said.
Obama isn’t the first U.S. president to question the safety of college athletics.
The NCAA announced the formation of the NCAA Sports Science Institute to provide medical expertise and research to coaches, medical staffs and administrators the following day.
Violence was on the rise in college football when President Theodore Roosevelt
called for a meeting of representatives from Harvard, Yale and Princeton at the White House in 1905, and he told them to reform the game, or else. The result was an organization that later became the NCAA.
The new body created the forward pass and changed rules that made the game safer. College football’s popularity soared.
“I think concussions are what led to the paradigm shift where we are saying, 'What are we doing here?' It really was the media’s push over four years ago addressing the dangers of concussion and how we are not paying attention that led everyone into a frenzy,” Hainline said.
“The spin-off is that it got scientists thinking about concussions and coming together and saying, 'Let’s really solve this.' At the same time, a group of sports professionals came together and said, 'Maybe concussion issues are more of a metaphor for how we are not addressing health and safety from a global perspective.'
“We want to make the sports experience good because we believe in sports. If people can get beyond the bigger point of blaming the NCAA or football and see the extraordinary opportunity sports provides youth, that’s what we are after.”