This article was recently brought to my attention via the Korey Stringer Institute Twitter page (https://twitter.com/K_S_Institute). A 15 year old student-athlete from Georgia, Terrell Coleman, highly touted for his physical presence and athletic prowess on the basketball court, suddenly and tragically passed away on Sunday, October 27th, following an All-Star basketball game. While the official cause of death has yet to be discovered, a local news outlet reported that the student-athlete was diagnosed with a heart murmur prior to playing basketball. It was reported that Coleman received medical clearance to participate, but as we know, it is impossible to predict what tragic circumstances may befall an individual at any time. Little information was given regarding the immediate response to the student-athlete's collapse following the game, however this video suggests the first responders were fellow teammates and the team coach. The news video goes on to state that Coleman was taken to the hospital, where he was pronounced dead.
There was no mention of any healthcare providers (such as certified athletic trainers) at the scene, nor was there mention of an automated external defibrillator (AED). The immediate implementation of an AED can profoundly increase the chances of survival for an individual in cardiac arrest (American Red Cross). Immediate and appropriate care by a qualified, trained medical professional such as a certified athletic trainer can, irrefutably, help reduce and prevent the overwhelming numbers of young student-athlete deaths we are seeing increasingly in the secondary school setting. Terrell Coleman was the victim of a tragic turn of fate, but his story should serve as an example of not only the need and importance of AEDs at all athletic venues across every level of athletics, but also the critical need for certified athletic trainers to be utilized, especially in the secondary school setting. We may not be able to prevent outright the loss of young student-athletes like Terrell Coleman, but we can certainly give them a fighting chance... and I think that is all anyone would ask for...
Terrell Coleman and his family, friends, and teammates will be in my thoughts.
Tuesday, November 5, 2013
Wednesday, October 16, 2013
Athletic Training is a Profession, Not a Hobby
I recently came across this article posted not too long ago on the USA Today website. The author posted this article around the same time as the National Athletic Trainers' Association (NATA) annual professional conference was held in Las Vegas, NV. This article does a great job at describing both the internal and external struggles faced by the certified athletic trainer. Struggles that involve not only the health and well-being of patient populations, but those faced through skewed public perception of what athletic training actually is. The oft-used saying in athletic training education is that "we are certified athletic trainers who are qualified, licensed healthcare professionals who are responsible for a wide array of medical, administrative, preventative, educational, rehabilitative, and now even some psychological duties and interventions. We are not 'trainers'. 'Trainer' implies someone who works with horses, or someone who passed an online course to receive a certification in personal training. Someone who maybe works with your pet to ensure they are obedient." Athletic trainers are not 'trainers'. Please, do not get me wrong, the individuals listed above are all highly qualified to be performing their respective jobs and all have valuable roles in society. Most people utilize the services provided by these individuals. However, athletic trainers have a specific skill set that has been honed through many years of didactic and clinical education and applies to certain patient populations in the human healthcare arena. Skills that are governed by higher bodies, such as the local and federal government, and professional organizations such as the NATA.
The issue surrounding the confusion of what athletic trainers actually do seems to be directly correlated with the name of the profession. It is a name that has long been attached to the profession since its infancy, and has long been a source of frustration for those who practice it. There has been much debate as of late regarding a potential name change, where professional committees have been formed, market research has been done, and feedback from professionals in the field has been received. Ultimately, it does not appear a name change for the profession of athletic training is imminent. As a future certified athletic trainer, someone who will carry on the struggle of promoting the profession and clarifying public perception of its nature, do I agree with not changing the name? As it happens, I do agree with keeping the name "Certified Athletic Trainer". This is due in part to the history and tradition of the field. As previously mentioned, the heart and soul of this profession is deeply connected to the name it was given so many years ago. But also, as put by NATA president Jim Thornton, "...'athletic trainer' isn't a very good description of what we do. To tell you the truth, our scope is so wide and so broad ... there isn't a name out there really that does a very good job of it at all."
Ultimately, I think it is crucial for athletic trainers and anyone familiar with the profession to continue promoting the profession and clarifying skewed public perceptions of what we do by any and all means possible. Certified athletic trainers play a vital role in the sports medicine team. As I have mentioned in my previous blogs, and as quoted in this article, "...[athletic trainers] have been thrust into more specialized duties in front lines of sports medicine." There it is again: "front lines of sports medicine".
The issue surrounding the confusion of what athletic trainers actually do seems to be directly correlated with the name of the profession. It is a name that has long been attached to the profession since its infancy, and has long been a source of frustration for those who practice it. There has been much debate as of late regarding a potential name change, where professional committees have been formed, market research has been done, and feedback from professionals in the field has been received. Ultimately, it does not appear a name change for the profession of athletic training is imminent. As a future certified athletic trainer, someone who will carry on the struggle of promoting the profession and clarifying public perception of its nature, do I agree with not changing the name? As it happens, I do agree with keeping the name "Certified Athletic Trainer". This is due in part to the history and tradition of the field. As previously mentioned, the heart and soul of this profession is deeply connected to the name it was given so many years ago. But also, as put by NATA president Jim Thornton, "...'athletic trainer' isn't a very good description of what we do. To tell you the truth, our scope is so wide and so broad ... there isn't a name out there really that does a very good job of it at all."
Ultimately, I think it is crucial for athletic trainers and anyone familiar with the profession to continue promoting the profession and clarifying skewed public perceptions of what we do by any and all means possible. Certified athletic trainers play a vital role in the sports medicine team. As I have mentioned in my previous blogs, and as quoted in this article, "...[athletic trainers] have been thrust into more specialized duties in front lines of sports medicine." There it is again: "front lines of sports medicine".
Wednesday, October 2, 2013
Moral and Legal Crossroads
I recently came across this article written for the Boston Herald website regarding high school sports and athletic trainers. In the article, a local Massachusetts high school athletic director claims that during a women's basketball game, an "overzealous" athletic trainer from the opposing high school purposely removed an athlete for a "possible concussion". The athletic director's claim goes on to suggest that the athletic trainer in question acted in a manner consistent with intent to sabotage the school's chances of advancing to post-season competition. The accusing athletic director went so far as to write letters to the MIAA (Massachusetts Interscholastic Athletics Association) and Boston City League addressing concerns surrounding the athletic trainer's decision to withhold the athlete from competition.
As an athletic training student, I am acutely aware of the professional concerns surrounding ethics, morality, and legality, as they pertain to most levels of athletic competition. The key word here is competition. As athletic trainers and clinicians, we hold ourselves to a high standard of providing care that is ethical, that is moral, and most importantly, that is legal. While the details of this circumstance are not entirely clear, it is common practice in this field to handle potential concussions sensitively and conservatively. Especially in a high school population. As mentioned in previous posts and via information that has been brought to light by many experts, the youth brain is still undergoing critical physical and cognitive development. To subject this forming brain to mild trauma, and still yet risk further damage by not acting conservatively, we are setting children and young adults up for a lifetime of physical and emotional detriments. Making return to play decisions during crucial games is difficult. Like I said, the key word is competition. Teams are physically fighting for the right to be called champions. So naturally, when a decision is made that could influence the outcome of the competition, someone is held responsible and there is generally some polarizing opinions as to how the situation was handled. That being said, the individual (who I do not know personally and cannot attest to professionalism or morality) that made this critical decision was an athletic trainer. An athletic trainer who is keenly aware of the signs and symptoms of concussions, and who is trained not only didactically, but also clinically, to make the proper decisions. An athletic trainer who took an oath to do no harm and practice by a professional Code of Ethics. Why, then, is there such outrage for a decision that was not only necessary, but made by a qualified, trained medical professional?
As it turned out, the athlete was taken to the hospital and had a concussion ruled out by physicians. However, we know in the field of athletic training that concussions are not observable on medical imaging, and are often difficult to diagnose given the overlap of signs and symptoms with many other conditions. Perhaps the outrage stems from the diagnosis of a corneal abrasion (and not a concussion). Regardless, the athletic trainer acted within the professional scope by administering concussion testing, gathering a history where the mechanism of injury could be indicative of a concussion, and making a conservative decision for the benefit and long-term well-being of the injured athlete. Had this athlete been diagnosed with a concussion by physicians, would there still be such outrage over how the athletic trainer responded? Are we no longer to be conservative for the health and well-being of our youth athletes? Without knowing the athletic trainer in question and operating solely off the information provided in the article, my inclination would be to stand by the clinical decisions made by this individual. If a there is a valid mechanism, positive tests, and no clear differential diagnosis, then one must act on what they know, within their scope, in an ethical, moral, and legal manner.
Interestingly, there was a follow-up article regarding the response of the MIAA and Boston City League to the accusing athletic director's letter. In it, the spokesman of the MIAA is quoted as saying: "We're not about to question the judgment of a qualified trainer on the scene at the time... As far as we are concerned, the game is over." The article can be found here.
As an athletic training student, I am acutely aware of the professional concerns surrounding ethics, morality, and legality, as they pertain to most levels of athletic competition. The key word here is competition. As athletic trainers and clinicians, we hold ourselves to a high standard of providing care that is ethical, that is moral, and most importantly, that is legal. While the details of this circumstance are not entirely clear, it is common practice in this field to handle potential concussions sensitively and conservatively. Especially in a high school population. As mentioned in previous posts and via information that has been brought to light by many experts, the youth brain is still undergoing critical physical and cognitive development. To subject this forming brain to mild trauma, and still yet risk further damage by not acting conservatively, we are setting children and young adults up for a lifetime of physical and emotional detriments. Making return to play decisions during crucial games is difficult. Like I said, the key word is competition. Teams are physically fighting for the right to be called champions. So naturally, when a decision is made that could influence the outcome of the competition, someone is held responsible and there is generally some polarizing opinions as to how the situation was handled. That being said, the individual (who I do not know personally and cannot attest to professionalism or morality) that made this critical decision was an athletic trainer. An athletic trainer who is keenly aware of the signs and symptoms of concussions, and who is trained not only didactically, but also clinically, to make the proper decisions. An athletic trainer who took an oath to do no harm and practice by a professional Code of Ethics. Why, then, is there such outrage for a decision that was not only necessary, but made by a qualified, trained medical professional?
As it turned out, the athlete was taken to the hospital and had a concussion ruled out by physicians. However, we know in the field of athletic training that concussions are not observable on medical imaging, and are often difficult to diagnose given the overlap of signs and symptoms with many other conditions. Perhaps the outrage stems from the diagnosis of a corneal abrasion (and not a concussion). Regardless, the athletic trainer acted within the professional scope by administering concussion testing, gathering a history where the mechanism of injury could be indicative of a concussion, and making a conservative decision for the benefit and long-term well-being of the injured athlete. Had this athlete been diagnosed with a concussion by physicians, would there still be such outrage over how the athletic trainer responded? Are we no longer to be conservative for the health and well-being of our youth athletes? Without knowing the athletic trainer in question and operating solely off the information provided in the article, my inclination would be to stand by the clinical decisions made by this individual. If a there is a valid mechanism, positive tests, and no clear differential diagnosis, then one must act on what they know, within their scope, in an ethical, moral, and legal manner.
Interestingly, there was a follow-up article regarding the response of the MIAA and Boston City League to the accusing athletic director's letter. In it, the spokesman of the MIAA is quoted as saying: "We're not about to question the judgment of a qualified trainer on the scene at the time... As far as we are concerned, the game is over." The article can be found here.
“We’re
not about to question the judgment of a qualified trainer on the scene
at the time,” Wetzel said. “As far as we are concerned, the game is
over.” - See more at:
http://bostonherald.com/sports/high_school/2013/03/new_mission_flap_over_bad_concussion_call_wins_no_sympathy_from_miaa#sthash.XgU4pZ3S.dpuf
“We’re
not about to question the judgment of a qualified trainer on the scene
at the time,” Wetzel said. “As far as we are concerned, the game is
over.” - See more at:
http://bostonherald.com/sports/high_school/2013/03/new_mission_flap_over_bad_concussion_call_wins_no_sympathy_from_miaa#sthash.XgU4pZ3S.dpuf
“We’re
not about to question the judgment of a qualified trainer on the scene
at the time,” Wetzel said. “As far as we are concerned, the game is
over.” - See more at:
http://bostonherald.com/sports/high_school/2013/03/new_mission_flap_over_bad_concussion_call_wins_no_sympathy_from_miaa#sthash.XgU4pZ3S.dpuf
Wednesday, September 25, 2013
My Philosophy of Athletic Training
Athletic training is a profession that continues to be under recognized, under appreciated, and truly misunderstood by many individuals. As a current athletic training student, and future athletic training professional, I set out to develop a philosophy that would help me to not only become a successful clinician, but also improve the profession of athletic training as a whole.
First and foremost, it is important to understand that athletic training as a profession is comprised of many complex facets that are constantly impacted by varying patient populations and current trends in healthcare. Athletic trainers are well-qualified and well-suited to handle and perform the multi-faceted tasks associated with the profession because we are certified and licensed healthcare providers. While many athletic trainers hold advanced degrees in a myriad of disciplines, including kinesiology, sports nutrition, and sports psychology, it is the traditional athletic training education program that helps mold aspiring athletic trainers into the adaptable clinicians needed in the field. Athletic training education programs provide the knowledge necessary to become certified, licensed, and to fulfill the skills outlined by the Role Delineation Study. However, I think that to become a truly successful athletic training professional, outside of the traditional physical skills and promise to be bound by the Hippocratic Oath whereby you will do no harm, prospective athletic trainers must possess additional qualities innate and unique to them.
Athletic training is not for everyone, but those who are successful, I feel, possess many similar qualities that I also look to embody in my everyday work and experiences. First, athletic trainers must be both passionate and compassionate. In this profession, there are many long hours filled with arduous tasks and paperwork. You are on the "front line" of the "war" on sports injury, and as such, you must be prepared for the unexpected and truly love what you do. Without passion, it is easy to get lost and lose interest in accomplishing your goals. Without compassion, it is easy to forget how much your actions and words affect other individuals. I firmly believe that compassion is a mainstay in athletic training, because we set out with the purpose of helping active individuals get healthy and stay healthy. Athletic training is a profession where you spend just as much time, if not more, educating individuals on how to essentially avoid employing you in the future. This is done out of a desire to help individuals and see them flourish. Compassion will allow us as clinicians to connect with our patients/athletes/clients on a deeper, interpersonal level, whereby we can achieve a greater knowledge and appreciation of views, beliefs, culture, and backgrounds. These often ignored factors undoubtedly play a significant role in the quality of healthcare we provide. I believe that I can provide the highest quality of care by establishing these working relationships with my patient population and allowing them to see that as a clinician, I am motivated by compassion, and not money, rings, statistics, or anything else.
Motivations are key to this line of work. Staying motivated and pushing both yourself and the profession forward correlates positively with overall self-fulfillment and professional development. I believe in order for the profession to become recognized, appreciated, and understood, we must strive as clinicians to maintain the utmost level of professionalism and desire to be life-long learners and teachers. Through strict adherence to the Code of Ethics set forth by the National Athletic Trainers' Association (NATA), it is evident in my interactions with patients that I want to be viewed as an educated, qualified, professional healthcare provider, and integral member of the sports medicine team. I am currently pursuing a Master's degree in athletic training, mainly because of my desire to push the limits of what I know, and what I can know. Athletic training is not a hard science, it is a field where the latest evidence-based practices and clinical diagnoses undergo constant evolution and change. It is imperative to seek out educational opportunities to stay abreast of this information. It is critical to incorporate this education and evidence-based knowledge into everyday practice, as it improves the quality of care we provide to our patients. It is also critical to recognize the importance of our role as educators in the sports medicine team. As I mentioned before, we are on the "front line", and we desire to help individuals avoid injury and stay healthy. This is accomplished only through engaging education of the individuals. Being on the "front line", the task of educating individuals falls on the shoulders of the athletic trainer. Through my experience as a member of the NATA and as a student, I am confident in my abilities to actively engage and educate individuals, thereby profoundly impacting their lives, while also making my job down the road just a little easier.
As an athletic training student and prospective certified, licensed professional, I intend to bring an exceptional level of professionalism and exceedingly high quality of care to the field of athletic training. Through self-understanding, self-motivation, an undying passion, compassion for those I treat, and an unwavering desire to remain at the forefront of my profession through education and awareness, I hope to one day become a successful, certified athletic trainer.
First and foremost, it is important to understand that athletic training as a profession is comprised of many complex facets that are constantly impacted by varying patient populations and current trends in healthcare. Athletic trainers are well-qualified and well-suited to handle and perform the multi-faceted tasks associated with the profession because we are certified and licensed healthcare providers. While many athletic trainers hold advanced degrees in a myriad of disciplines, including kinesiology, sports nutrition, and sports psychology, it is the traditional athletic training education program that helps mold aspiring athletic trainers into the adaptable clinicians needed in the field. Athletic training education programs provide the knowledge necessary to become certified, licensed, and to fulfill the skills outlined by the Role Delineation Study. However, I think that to become a truly successful athletic training professional, outside of the traditional physical skills and promise to be bound by the Hippocratic Oath whereby you will do no harm, prospective athletic trainers must possess additional qualities innate and unique to them.
Athletic training is not for everyone, but those who are successful, I feel, possess many similar qualities that I also look to embody in my everyday work and experiences. First, athletic trainers must be both passionate and compassionate. In this profession, there are many long hours filled with arduous tasks and paperwork. You are on the "front line" of the "war" on sports injury, and as such, you must be prepared for the unexpected and truly love what you do. Without passion, it is easy to get lost and lose interest in accomplishing your goals. Without compassion, it is easy to forget how much your actions and words affect other individuals. I firmly believe that compassion is a mainstay in athletic training, because we set out with the purpose of helping active individuals get healthy and stay healthy. Athletic training is a profession where you spend just as much time, if not more, educating individuals on how to essentially avoid employing you in the future. This is done out of a desire to help individuals and see them flourish. Compassion will allow us as clinicians to connect with our patients/athletes/clients on a deeper, interpersonal level, whereby we can achieve a greater knowledge and appreciation of views, beliefs, culture, and backgrounds. These often ignored factors undoubtedly play a significant role in the quality of healthcare we provide. I believe that I can provide the highest quality of care by establishing these working relationships with my patient population and allowing them to see that as a clinician, I am motivated by compassion, and not money, rings, statistics, or anything else.
Motivations are key to this line of work. Staying motivated and pushing both yourself and the profession forward correlates positively with overall self-fulfillment and professional development. I believe in order for the profession to become recognized, appreciated, and understood, we must strive as clinicians to maintain the utmost level of professionalism and desire to be life-long learners and teachers. Through strict adherence to the Code of Ethics set forth by the National Athletic Trainers' Association (NATA), it is evident in my interactions with patients that I want to be viewed as an educated, qualified, professional healthcare provider, and integral member of the sports medicine team. I am currently pursuing a Master's degree in athletic training, mainly because of my desire to push the limits of what I know, and what I can know. Athletic training is not a hard science, it is a field where the latest evidence-based practices and clinical diagnoses undergo constant evolution and change. It is imperative to seek out educational opportunities to stay abreast of this information. It is critical to incorporate this education and evidence-based knowledge into everyday practice, as it improves the quality of care we provide to our patients. It is also critical to recognize the importance of our role as educators in the sports medicine team. As I mentioned before, we are on the "front line", and we desire to help individuals avoid injury and stay healthy. This is accomplished only through engaging education of the individuals. Being on the "front line", the task of educating individuals falls on the shoulders of the athletic trainer. Through my experience as a member of the NATA and as a student, I am confident in my abilities to actively engage and educate individuals, thereby profoundly impacting their lives, while also making my job down the road just a little easier.
As an athletic training student and prospective certified, licensed professional, I intend to bring an exceptional level of professionalism and exceedingly high quality of care to the field of athletic training. Through self-understanding, self-motivation, an undying passion, compassion for those I treat, and an unwavering desire to remain at the forefront of my profession through education and awareness, I hope to one day become a successful, certified athletic trainer.
Wednesday, September 18, 2013
When Do Words Become Actions?
What is more of a hot topic right now in secondary school athletics, professional athletics, and sports medicine professions than concussions...? The "concussion crisis" has gripped the nation's parents, children, and sports fans whose children may, in fact, be the fantasy football teams they drafted not too long ago.
It seems to me that in today's society, there is a profound rift between those who feel that the "concussion crisis" is overstated, and those who feel that collision sports at all levels should be banned. Words are thrown around, statistics and values stacked up in front of the individuals who remain firmly entrenched in the belief that concussions are merely a "ding to the head". Yet, we still see an obstinacy regarding concussion awareness. Despite unexpected events, such as the death of a 16-year-old high school football player in New York this past Friday, people are still unaware or worse, unappreciative, of the gravity and severity of the so-called "concussion crisis". At what point do we stop throwing words around; stop stacking up statistics and values?
The National Athletic Trainers' Association (NATA) has made great strides in trying to improve national awareness of concussions and the mechanisms that cause them, especially in the secondary school setting (See NATA Official Statement on Calling Crown of the Helmet Violations). But when do we stand up and say that perhaps we must hold ourselves, as a society, at least partially responsible for the crisis we are encountering? We know that concussions are "bad". We know what chronic traumatic encephalopathy is now thanks to The Sports Legacy Institute. We know this stuff is not new, and we know it is reaching epidemic proportions in collision sports, most especially football.
Junior Seau's high profile and tragic death last year was not the first, and it will certainly not be the last. The research is clear: chronic concussive and sub-concussive hits result in long-term physical and cognitive consequences. But what is the NFL to do? And on a broader scale, should the sport of football even be played?
I contend that the issue must be addressed at all levels of athletic competition, not solely in the NFL. A typical, starting high school linebacker can average over 1000 hits to the head over the course of one season. If that athlete starts all four years of high school and continues on to play four years in college, you are talking about a young athlete still undergoing critical brain development enduring close to 8000 measurable hits to the head, withstanding hundreds of thousands of cumulative G's of force across an 8 year span (See my literature review on concussion prevalence).
New helmet designs are introduced every year, and no doubt companies like Riddell and Schutt are putting their engineers to the test to try and develop the first concussion prevention system. But the fact remains that helmets hardly protect against concussions. Rather, they protect primarily from superficial injuries (i.e., lacerations) and skull fractures. In some way they provide minimal protection against concussions by introducing foam padding or air-filled pockets to reduce the biomechanical impacts of hitting in football (i.e., reducing g-force transferal to the brain and absorbing some of the force produced through impact). But there are multiple aspects that lead to concussions and brain injury. Newer research (referenced here) has shed light on a rotational component, whereby the impacts sustained in sports like football cause the head not only to jerk laterally, but also spin. This causes a great deal of internal, physiological damage. A great analogy is to think of an egg in an egg carton. The carton protects the egg (to some degree) from cracking. But as the carton jostles around in the trunk of your car, the yolk and whites are constantly being sloshed around within the egg, beneath the shell. In football, the helmet protects your skull and absorbs some of the force, but regardless of that the head is still experiencing rapid linear and rotational accelerations and translations, causing the brain to smash around inside of the skull.
Education, early detection, and proper medical care/maintenance are going to be key to cutting down on chronic traumatic brain injuries in sports. Obviously more research needs to be done and will be done, but ultimately the only way to truly resolve this issue is some undiscovered space-age technology or broad spectrum rule changes that will essentially take all forms of hitting out of football. Football (and all the major sports) is one of the largest entertainment industries in the United States, with an overbearing media presence, viewership and fan base of well over 1/3rd the population of the US, and an annual GDP in the billions. The moral debate of whether football should even be played aside, the more important question is at what cost are we letting our children and young athletes recklessly play collision sports and aspire to be like their favorite professionals? The same older cohort of professionals who are just now bringing the issue of sports-related concussions, brain injuries, and chronic traumatic encephalopathy to the forefront of our media-driven society through the tragic results of years of playing.
Football is an inherently dangerous sport and the culture surrounding it will be very hard to change because of the role it has played in the evolution of the sport. It is a hegemonic masculine sport and subsequently athletes are forced to fit the ideal perpetuated through the hegemony. This means getting back in the game and "sucking it up". I mean think about what we're saying here... Should we only take you out if you lose your vision and your hearing? Wouldn't one be enough? Wouldn't just having a bad headache and sensitivity to light be enough? Why do you need to lose your senses? At what cost are we pushing our young athletes to be competitive for the trophy or the championship. This is why we say education and awareness and proper medical attention are key. Many high schools do not have certified athletic trainers who go through rigorous schooling to know the signs and symptoms of these serious conditions, never mind a physician or neurologist like they often have at the Division I collegiate level. Parents, coaches, athletic trainers, EMTs, administration, physicians, and even athletes need to learn about the issues at hand and learn to effectively identify signs and symptoms, in addition to taking the appropriate measures. The athletes' and coaches' perspectives are just as important as the researcher's, the biomechanist's, and the engineer's. I feel the perspective of fans and the general public are also equally important when addressing the "concussion crisis". Ultimately, the culture surrounding the sport of football and concussions in general must adapt to this epidemic. The question remains: when do all these words become actions?
It seems to me that in today's society, there is a profound rift between those who feel that the "concussion crisis" is overstated, and those who feel that collision sports at all levels should be banned. Words are thrown around, statistics and values stacked up in front of the individuals who remain firmly entrenched in the belief that concussions are merely a "ding to the head". Yet, we still see an obstinacy regarding concussion awareness. Despite unexpected events, such as the death of a 16-year-old high school football player in New York this past Friday, people are still unaware or worse, unappreciative, of the gravity and severity of the so-called "concussion crisis". At what point do we stop throwing words around; stop stacking up statistics and values?
The National Athletic Trainers' Association (NATA) has made great strides in trying to improve national awareness of concussions and the mechanisms that cause them, especially in the secondary school setting (See NATA Official Statement on Calling Crown of the Helmet Violations). But when do we stand up and say that perhaps we must hold ourselves, as a society, at least partially responsible for the crisis we are encountering? We know that concussions are "bad". We know what chronic traumatic encephalopathy is now thanks to The Sports Legacy Institute. We know this stuff is not new, and we know it is reaching epidemic proportions in collision sports, most especially football.
Junior Seau's high profile and tragic death last year was not the first, and it will certainly not be the last. The research is clear: chronic concussive and sub-concussive hits result in long-term physical and cognitive consequences. But what is the NFL to do? And on a broader scale, should the sport of football even be played?
I contend that the issue must be addressed at all levels of athletic competition, not solely in the NFL. A typical, starting high school linebacker can average over 1000 hits to the head over the course of one season. If that athlete starts all four years of high school and continues on to play four years in college, you are talking about a young athlete still undergoing critical brain development enduring close to 8000 measurable hits to the head, withstanding hundreds of thousands of cumulative G's of force across an 8 year span (See my literature review on concussion prevalence).
New helmet designs are introduced every year, and no doubt companies like Riddell and Schutt are putting their engineers to the test to try and develop the first concussion prevention system. But the fact remains that helmets hardly protect against concussions. Rather, they protect primarily from superficial injuries (i.e., lacerations) and skull fractures. In some way they provide minimal protection against concussions by introducing foam padding or air-filled pockets to reduce the biomechanical impacts of hitting in football (i.e., reducing g-force transferal to the brain and absorbing some of the force produced through impact). But there are multiple aspects that lead to concussions and brain injury. Newer research (referenced here) has shed light on a rotational component, whereby the impacts sustained in sports like football cause the head not only to jerk laterally, but also spin. This causes a great deal of internal, physiological damage. A great analogy is to think of an egg in an egg carton. The carton protects the egg (to some degree) from cracking. But as the carton jostles around in the trunk of your car, the yolk and whites are constantly being sloshed around within the egg, beneath the shell. In football, the helmet protects your skull and absorbs some of the force, but regardless of that the head is still experiencing rapid linear and rotational accelerations and translations, causing the brain to smash around inside of the skull.
Education, early detection, and proper medical care/maintenance are going to be key to cutting down on chronic traumatic brain injuries in sports. Obviously more research needs to be done and will be done, but ultimately the only way to truly resolve this issue is some undiscovered space-age technology or broad spectrum rule changes that will essentially take all forms of hitting out of football. Football (and all the major sports) is one of the largest entertainment industries in the United States, with an overbearing media presence, viewership and fan base of well over 1/3rd the population of the US, and an annual GDP in the billions. The moral debate of whether football should even be played aside, the more important question is at what cost are we letting our children and young athletes recklessly play collision sports and aspire to be like their favorite professionals? The same older cohort of professionals who are just now bringing the issue of sports-related concussions, brain injuries, and chronic traumatic encephalopathy to the forefront of our media-driven society through the tragic results of years of playing.
Football is an inherently dangerous sport and the culture surrounding it will be very hard to change because of the role it has played in the evolution of the sport. It is a hegemonic masculine sport and subsequently athletes are forced to fit the ideal perpetuated through the hegemony. This means getting back in the game and "sucking it up". I mean think about what we're saying here... Should we only take you out if you lose your vision and your hearing? Wouldn't one be enough? Wouldn't just having a bad headache and sensitivity to light be enough? Why do you need to lose your senses? At what cost are we pushing our young athletes to be competitive for the trophy or the championship. This is why we say education and awareness and proper medical attention are key. Many high schools do not have certified athletic trainers who go through rigorous schooling to know the signs and symptoms of these serious conditions, never mind a physician or neurologist like they often have at the Division I collegiate level. Parents, coaches, athletic trainers, EMTs, administration, physicians, and even athletes need to learn about the issues at hand and learn to effectively identify signs and symptoms, in addition to taking the appropriate measures. The athletes' and coaches' perspectives are just as important as the researcher's, the biomechanist's, and the engineer's. I feel the perspective of fans and the general public are also equally important when addressing the "concussion crisis". Ultimately, the culture surrounding the sport of football and concussions in general must adapt to this epidemic. The question remains: when do all these words become actions?
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