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?