Archive for the ‘Dangers of Concussions’ Category

DANGERS OF CONCUSSIONS: Will New Guidelines for Youth Football Make A Difference?

Ken Belson of the NY Times did a wonderful article this past week about a new initiative from U.S.A. Football, the nation’s governing body when it comes to amateur football, to do something to stop the dropping numbers of HS students who are deciding not to play football. Belson reports that since 2009, HS football numbers have declined by as much as 20%.

That’s a significant percentage, and of course, most of it can be attributed to rising concerns about concussions. Despite a tremendous upsurge in research on how to prevent or diagnose concussions, the hard truth is:

o There is still no football helmet on the market today that will prevent a concussion. True, the more advanced helmets can do a lot to soften the blow to the head, but no helmet can claim to prevent concussions from happening.

o And while there are medical protocols in place for a suspected concussion, there is still no definitive method to determine if a football player has suffered a serious hit to the head. Doctors can only determine real damage to one’s brain only in an autopsy.

NEW GUIDELINES FROM U.S.A. FOOTBALL

U.S.A. Football, in an attempt to do what is can to modify and make the sport safer for kids who want to play tackle football between the ages of 6-12, have announced the following changes:

Reduce the number of kids on each team during the game to no more than 6 to 9.

Have the kids play on a smaller field.

No more run backs on kick offs or punt returns.

All players must start each play from a crouch position, not a three-point stance.

Will any of this help? Or more directly, will parents feel more assured about letting their kids plays tackle football? If today’s callers were any indication, the answer is a resounding no.

Most of today’s debate centered on whether kids would be better suited to simply bypass tackle football and opt for flag football instead – at least until they are 13 or 14. By that age, their brain is close to being fully developed, and their head has more strength and support from their neck and shoulder muscles.

Dr. Robert Cantu, the Boston University neurosurgeon,has long advocated this approach, and I must say, I agree. If young football players want to play the sport, they are much better served to play touch football or flag football in elementary and middle school. Then, when they reach high school, not only can they turn to tackling, but more importantly, they can learn the safe and fundamental way of how to execute a tackle properly without risking harm to their head.  At the HS level, there are plenty of well-qualified football coaches who can teach these essential basics to football players.

To me, in light of the reality that we are in this transition phase where we are still waiting for medical science to catch up with more insights on how to prevent concussions, as well as how to treat them, Dr. Cantu’s approach makes a lot of sense. And by the way, for more information, there’s an enlightening article in Bloomberg BusinessWeek  that ran this week about what’s happening regarding the latest research in this area, much of which is being sponsored by the NFL.

Sad to say, the medical experts still say there is no effective way to prevent  a concussion, and even worse, we are still 4-5 years away from having a simple blood test to determine whether a football player has had a concussion. In other words, we are still in the dark.

 

 

 

DANGERS OF CONCUSSIONS: HS Guidelines Should Be Mandatory, Not Just Voluntary

Two Steps Forward, One Step Back:

Michigan’s New Guidelines on Full-Contact High School Football Practices

By Doug Abrams

In an article by Ted Roelofs last week, Bridge Magazine reported about the Michigan High School Athletic Association’s new concussions guidelines concerning the permissible length of football teams’ full-contact drills. The new MHSAA guidelines maximum is 90 minutes per week.

The problem, noted by Mr. Roelofs, is that the guidelines are just that – guidelines. That is, they are voluntary. Remaining in place is the mandatory state rule, which sets a maximum of six hours of full-contact drills per week (an average of more than one hour a day in any week when a team practices daily before Friday night).

The article reports that Michigan remains out-of-step with several other states that mandate 90-minute weekly maximums, and even with a few states that mandate lower weekly maximums. These other states have reputations as high school football hotbeds, but their statewide activities associations doubtlessly recognize that adolescent concussions, and even repeated sub-concussive head hits, can leave student-athletes with irreversible short-term and long-term damage. Last year, a study published in JAMA [Journal of the American Medical Association] Pediatrics found that repetitive head trauma occurs more often in youth football practice sessions than in games.

Coaching Integrity

A MHSAA spokesperson told Mr. Roelofs that he does not foresee problems with the new guidelines because, he says, coaches understand the risks of head trauma and no Michigan high school comes close to conducting six hours of weekly full-contact drills. Writing in USA TODAY, however, Ben Rohrbach asks the obvious question: “When the Michigan High School Athletic Association recommends 90 minutes of full-contact football practice per week, but doesn’t actually restrict coaches from using all six allotted hours of full-contact drills in a week, you can’t help but wonder if teams will actually take their governing body’s suggestion seriously.”

In my years of coaching, I never met a coach who ever wanted to see any of his players suffer injury or ill health. But voluntary full-contact guidelines nonetheless leave the door ajar for coaches who might feel tempted to exceed them. A coach, for example, might feel frustrated during a losing streak, or overzealous in the days before a big game or the playoffs. When word gets around that one or more teams have exceeded the 90-minute guideline, the temptation for other teams also to inch toward excess might not be far behind.

Strength From the Top

In interscholastic sports and youth leagues alike, strength and wisdom must begin at the top, and not at the middle or bottom. In the absence of state legislative action, the “top” here is MHSAA, which could level the playing field with a weekly full-contact maximum of 90 minutes or less, mandatory for all school districts and all football teams in the state.

Player safety should not depend on self-restraint by individual local school boards, principals, athletic directors, or coaches. Nor should player safety depend on individual parents who demand more protective concussion standards for their own children. In a high profile sport such as high school football, taking an individual stand risks arousing the sort of local criticism that can make silence seem the easier path.

Ongoing medical research informs us that the stakes for young athletes are simply too high to forego meaningful safety measures that maintain the essential character of the game. The MomsTEAM Institute of Youth Sports Safety, for example, maintains a web-based Youth Sports Concussion Safety Center that for years has collected a downloadable treasure trove of informative articles and commentary written by leading experts in a variety of disciplines. Accumulated learning means putting the players first.

Lawsuits

Concussions damage actions are expensive, and they happen. I also wonder whether, by not joining several other states that have mandated 90-minute weekly maximums (or less), MHSAA unnecessarily weakens its position in any future negligence lawsuit that names the association as a defendant.

What if a concussed football player and his parents allege that the player’s team routinely exceeded the 90-minute voluntary guidelines while remaining within the association’s six-hour mandate? If I were MHSAA’s defense lawyer, I would much rather argue that the statewide association mandated best practices – the nationally emerging 90-minute mandated weekly maximum, or less — and not that the association condoned the team’s exceeding these maximums.

In damage actions, defendants tend to fare better when the judge or jury perceives them as acting within the mainstream. Perceptions help influence settlement negotiations, where most lawsuits terminate short of trial.

Some voices warn that concussion risks in contact and collision youth sports such as football may jeopardize the ability of high school programs and youth leagues to maintain affordable insurance, not only for players, but also for adults who conduct the competition. If the MHSAA spokesperson is right that none of the state’s high school football teams currently approaches the six-hour mandatory maximum, the voluntary guidelines bring jeopardy that seems avoidable and counter-productive – and dangerous.

 

Sources: Ted Roelofs, Bridge Magazine, June 16, 2016, http://bridgemi.com/2016/06/michigan-balks-at-rule-shortening-full-contact-practice-for-high-school-football/  Thomas P. Dompier et al., Incidence of Concussion During Practice and Games in Youth, High School, and Collegiate American Football Players, JAMA Pediatrics, http://archpedi.jamanetwork.com/article.aspx?articleid=2281575  (May 4, 2015); Ben Rohrbach, Michigan Recommends Less Full-Contact Football Practice, But Won’t Require It, USA TODAY High School Sports, June 17, 2016 (emphasis in original); MomsTEAM Institute of Youth Sports Safety, Youth Sports Concussion Safety Center, http://momsteam.com/health-safety/concussion-safety

DANGERS OF CONCUSSIONS: One HS Player’s Personal Story

The Life of The Concussed: One High School Players Account

By Elijah Rechler

“One Family, One Goal!” That was my high school football team’s motto. We were a tightknit group of brothers, and our goal was to achieve the highest caliber team both on and off the field. Each individual player felt an unwavering loyalty toward the rest of our unit. I did not care how many hits to the head I took or how confusing the play calls became: this was my team, my family and I would not abandon them.

Those were the thoughts that crossed my mind in the huddle right before the play that would end my eleven year football career. Three plays earlier I received the first out of many devastating hits that sent my brain flying into the front of my skull.

I played fullback on offense which meant my job was to block for the quarterback as he dropped back to throw the ball. Our quarterback’s name was Corey Goldglit, and although I gave him trouble for being a year younger than me, he was a member of our team and one of my best friends. As long as I was in that backfield and breathing, no one would touch him.

Corey snapped the ball from the center and dropped back, I was at his left hip and immediately saw a defender coming from the right side, head first, trying to spear my quarterback and possibly injuring him. Since I was on the opposite side of the defender, I would have been too late if I attempted a standard blocking approach, one that would have protected my head. Instead I made the quick decision to dive head first to the defender before he could spear

Corey. I felt a harsh vibration that rattled my helmet. My eyes lost focus and my entire body tensed up. My teeth clenched so hard that my molars bite right through the ends of my mouth piece.

After I landed, I distinctly remember hearing my helmet vibrating even as I lay motionless on the ground. The play was over, and Corey got the throw off. I did my job. One must understand that football players are not dumb. We know when we get hit in the head; we know when we should stop. We just don’t care. The team is more important. I had to keep going.

Play after play I received the same hit from the same defender in order to protect our quarterback. My coach screamed something to me from the sideline. I hear noises but not words.

Right as I came out of the huddle to what could have been a devastating event for my mind and body, I was saved by halftime. I waddled off the field and my coaches immediately noticed something was wrong. At first they thought I was overheating which led them to remove my pads. I then went on to tell them that I felt like I was going to throw up. My coaches and our trainer then understood that I had suffered a head injury. I was done for the day but my experience with brain trauma was just beginning.

As soon as I got home I developed a worsening headache. Within a few hours the presence of any light sent me into hysterics. I knew I had a concussion, but it felt like something much worse. With sunglasses taped over my eyes and my mom walking me hand in hand like an infant, I finally made it to the doctor the next afternoon. He took off my glasses and shined a light in my eye. It felt as if I stared directly into the sun. The doctor told me that I had suffered a serious concussion and should consider giving up football in order to prevent permanent damage.      Give up football for good? Absolutely not, I was going to play the following weekend. He told my mom and me that the more concussions one sustains, the less impact it takes for them to occur and the longer lasting the effects of the brain damage become. I didn’t know it then, but my doctor was describing the signs of Chronic Traumatic Encephalopathy (CTE). Still, I begged him to give me another chance on the field. He eventually relented and told me that if I spend a couple weeks at home he would consider letting me return.

I spent a week at home in complete darkness with no one around me, no TV, no reading, and no exercise. I was losing my mind because I was now feeling absolutely fine! Even though I was supposed to spend another week at home I couldn’t take it anymore. I was going to school on Monday. My first day back I was welcomed by my coach. We had a meeting in which he told me he was hesitant to ever let me play again. As I started to break down, he began comforting me by saying that to get another concussion could permanently alter my intelligence and my ability to be the person I am. Just as I was with my doctor, I wasn’t having it. I didn’t understand the effects that CTE could have on me. I was worried about breaking a leg or tearing my ACL, not about what was going on in my brain because I just couldn’t see it.

Just like every other football player in the world, all that mattered to me in that moment was getting on the field. Once again I was exceedingly persistent. Although my coach would not let me play the next weekend, if my symptoms remained dormant he would let me play in the game a week later. Unfortunately, the happiness did not last long. By the end of first period, I was laying on the floor of my 10 person English class with my backpack over my head, writhing in agony.

It was, of course, too early for me to return to school or football. I spent another week at home wondering how a headache could last so long. What I didn’t know then was that my brain was trying to heal, and every time I betrayed the process by going outside or to school I made the initial damage worse. Fortunately for me, I had people in my life telling me to slow down and let myself recover. Sadly, NFL players tend to have people telling them to do the opposite. When millions of dollars are at stake, football players will play every down no matter how damaged their brains are. The constant hits that they experience with no time for healing is what leads them to contract CTE, a deadly disease that causes aggression, confusion, memory loss, and destroys lives. I, however, am not an NFL player. I was forced to stay home for weeks until the headaches were unquestionably gone. Finally, the day came where I received both my doctor’s and coach’s approval to play in my last ever home game at night under the lights. It was time to rejoin my football family.

I was always nervous before games, but this time I wasn’t only nervous about messing a play or letting my team down. I was worried about the way my brain works, how I work through problems in a way that allows me to excel at my passions. What if another hit took that away from me? Is playing in this last game really worth giving up everything my brain has to offer? I stuffed the thoughts of concussions and CTE deep into the back of my mind. By the time the opening kickoff came around I was hyper focused on only one thing: I needed to win my last home game ever. As the rest of the team captains were injured, I was the last one left to be a designated leader in this game. It was up to me to take charge, to lead by example, and to be the person my coach believed me to be. I started the game on fire by scoring a touchdown, running for a hundred yards, keeping our defense alive and focused, and most importantly making sure my brothers had their heads in the game. Although we were losing, I was confident that we would be able to pull off the win.

Toward the beginning of the third quarter, Corey threw a high pass over the middle to one of our star players, Jalijah Daniels. If you follow football, you know that a high pass in that area of the field is extremely dangerous for a receiver. As Jalijah jumped up to catch the ball he was hit head on in the air by a defender. As Jalijah was slow to get up I turned to Corey and said, “Don’t you dare throw it high over the middle to me like that, you hear?” He gave his nod of consent to me. Unfortunately, things in football do not always work out as planned. About eight minutes later Corey had no choice but to throw me the same type of dangerous pass that had ended the game for Jalijah. As I jumped up in the middle of the field, I knew what was coming. Once again I did not care about the impending impact because I needed to catch this ball for the first down. Smack! I’m lifted by a defender and dropped. I knew it was a big hit because I could hear the home crowd yell in fear. As I got up I did not feel any pain. Yet,I was still horrified. I did not know whether or not I was hit in the head.

I went to the sideline and saw the look on my coach’s face. It was over. I was done. That was the last time I would ever play tackle football again. I started crying on my coach’s shoulder, and he began crying on mine. I was sad and angry but the truth is he saved my life in one way or the other. I never would have stopped if he hadn’t stopped me. That was the end of my story on the field. However, my interest in concussions and CTE has not relented ever since that first hit early in the season. Even today I often wonder if I am mentally slower than I was pre-concussion. I am for sure not slower in any way that is noticeable to the outside world, but only in a way that I only could notice.

Sometimes it is hard for me to remember names or dates. I feel like I can’t recall events or solve problems as quickly as I did in the past. It may just be because I am a busy college student filling my brain with facts and theories. However, there will always be a part of me that wonders if I had permanently hurt my brain for the game that I love. There is another part of me that is forever thankful to the people in my life that did not let me make it any worse.

Elijah Rechler is currently finishing his first year of college. He still loves tackle football, but no longer plays the game.

DANGERS OF CONCUSSIONS: Parents Sue School District So Their Injured Son Can Play in Championship Game

Every so often, something happens in the course of amateur and youth sports that makes one pause….and makes one think about whether we as sports parent really do have our priorities in order.

Let ask you this: if your son, a HS football player, had been diagnosed with a possible concussion, would you allow him to go back and play in next week’s game?

Would it make any difference that the next game was for the state championship? That your son was the star running back on an undefeated team? That your son has assured you repeatedly that he’s absolutely fine?

I want you to think about that dilemma. Because we all know for a lot of parents, especially when it comes to the fuzzy world of concussions, this is a very, very difficult situation to find oneself in.

Now, let me give you more of the details>

Shawn Nieto is a top running back at Cleveland HS in Rio Rancho, NM. He’s a junior there. He’s also 5 foot 5, and weighs 140 pounds. That being said, he rushed for more than 900 yards this season and 18 TD’s.

A couple of weeks ago, in a state semifinal game, he was tackled hard, and there was direct and solid contact from a defensive player to Shawn’s helmet. As the play came to an end, everybody got up except Nieto. The Cleveland HS trainers ran onto the field and Shawn’s parents in the stands held their breath.

The trainers determined that Shawn was unconscious – that he blacked for 20-30 seconds before coming around. He was helped to his feet, and walked off under his own power to the sidelines.

Shawn says he never lost consciousness — that he had simply had the wind knocked out of him, and he was taking his time catching his breath.

On the sidelines, the team trainers administered a memory test, and Shawn correctly recalled two of the three words he was given. He also passed a balance test.  In other words, as far as he was concerned,he was ready to go.

But from the school’s perspective, especially in light of the new state laws regarding athletes and concussions, not only was Shawn prohibited from playing any more that day, but under New Mexico law, he now fell under the state mandated concussion protocol, which meant that he had to sit out for at least seven days before practicing or playing again.

That meant, of course, that Shawn would miss the state championship football game, which was to be played in 7 days.

WOULD YOU LET YOUR SON PLAY?

Shawn was crushed. He insisted he was fine. He insisted that he didn’t suffer a concussion. He pointed out that after the semi-final game, he drove back with the team on a three-hour bus ride home, and then drove his car home from the school. Plus no headaches.

So, what did his parents do?

They of course sued the school district to let their son play in the championship game!

Among other preparations for their day in court, the family had their son see a doctor the very next day, who examined him and said he showed normal cognitive function.  The parents then took that medical evaluation, and got their day in court in front of a state district judge, just a day before the big game.

The judge heard the case, and read the doctor’s evaluation. Plus he could see for himself that Shawn wasn’t outwardly injured. Even more, the school district didn’t bother sending anyone to present their side of the case. That’s to understand why, but I guess as far as they were concerned, they were just following the law of New Mexico.

The judge made his decision. He lifted the ban on the kid playing.

The next day, Shawn Nieto suited up and was ready to play in Cleveland High’s state championship game and to defend their undefeated season.

But in the intervening hours, the physician who examined Shawn that week heard about the case, and she was flabbergasted. She wrote in a letter that the parents had never told her that Shawn had been ruled unconscious the week before. If she had known that crucial fact, the doctor claimed, she would have never cleared him to play!

THE COACHES TO THE RESCUE

And now, here’s the curious twist in this case.

Shawn’s coaches who clearly had been watching all of this  – said to Shawn that he hadn’t practiced all week, and as such,  decided not to start him, or for that matter, to play him. He got in the game on one play, a kickoff late in the 4th quarter. It would seem that all of his legal wrangling had really not gotten him to where he wanted to go.

Meanwhile, his team won 48-35. And in addition, Shawn’s replacement ran for 200 yards on the day and scored a touchdown.

Law professor Doug Abrams discussed this case at length on WFAN this morning, and made it clear that this lawsuit, which was decided in favor of the athlete, should not be viewed as a legal precedent for other parents to follow. It was hard to understand why the school district didn’t bother to even defend their actions, and because of that, the judge really didn’t have much but to allow the kid to play.

But Professor Abrams made it clear that it would be difficult to think that other Moms and Dads, eager for their son or daughter to play when told not to, could use this case as legal doctrine.

But more than that, both Doug and I salute the coaching staff at Cleveland HS for having the common sense to realize that yes, kids do get hurt playing sports, and especially with concussions in football, it’s always much smarter to be on the side of caution. Nieto might indeed have been perfectly fine to play in the next game, but the trainers felt he had been knocked cold. That was their professional opinion. And the state law made it clear that an athletes can not play again for another 7 days.

So the coaches can up with the right solution. Yes, Shawn Nieto could suit up for the game, but even though it was a championship game and he was the starting halfback, the coaches made the right call: they kept him out of the game except for one play. After all, just suppose Nieto had been hit again during that game, and had suffered a concussion again. Then, he would be looking at his HS career coming to an end (remember, he’s only a junior).

Bottom line? The coaches should be saluted for having the right approach here, even when the athlete and his parents may have lost their vision as to what’s the right and safe thing to do.

DANGERS OF CONCUSSIONS: A Closer Look at Prevention in Youth Soccer

A New Safety Study Sheds New Light on Heading the Ball in Youth Soccer

By Doug Abrams

In Montreal’s Olympic Stadium and on television, soccer fans winced when United States midfielder Morgan Brian and German forward Alexandra Popp struck heads as each went airborne trying to head the ball in the World Cup semifinals on June 30. The dramatic moment and its aftermath added fuel to a debate that dominates discussion about youth soccer concussions.  At least for players under 14, should youth leagues ban heading (using the head to redirect the ball, sometimes as it travels at significant speeds)?

As Rick Wolff discussed last week, a new study published in the journal JAMA Pediatrics suggests that the question may be more easily asked than answered. The study’s research team examined reported soccer concussions at 100 public and private high schools from 2005 to 2014. Heading the ball figured in about 30% of boys’ concussions and about 25% of girls’ concussions during that nine-year period.

These are hefty percentages, but most of the concussions did not result from head-on-ball contact. Most resulted from contact between the opposing players as each attempted heading. The research team concluded that “[s]occer has been allowed to become a more physical sport over time because more athlete-athlete contact is occurring, without a concurrent increase in the frequency of fouls or sanctions awarded by referees.”

Dr. Dawn Comstock, University of Colorado School of Public Health epidemiologist and the study’s lead researcher, drew a fundamental lesson about player safety. She told the New York Times that soccer concussion rates would fall “if referees, coaches and players would enforce the existing rules” against rough play. “There will always be some athlete-athlete contact while soccer is played,” she explained to the Los Angeles Times, “but a large amount of the athlete-athlete contact . . . is technically against the rules of the game.”

“A Risk Control Measure”

The relationship between rules enforcement and player safety transcends youth soccer. Dr. Comstock also participated in a 2008 study by the Center for Injury Research and Policy at Nationwide Children’s Hospital (citation below), which concerned nine high school sports (boys’ football, soccer, basketball, wrestling and baseball; and girls’ soccer, volleyball, basketball and softball). Researchers estimated that between 2005 and 2007, more than 98,000 injuries in these sports were directly related to an act that a referee or disciplinary committee ruled illegal. Thirty-two percent of these injuries were to the head or face, and 25% were concussions.

The Children’s Hospital study was unequivocal: “Reducing the number of injuries attributable to illegal activity in general among US high school athletes can specifically reduce the number of injuries to the head/face and concussions.”

“Each sport has . . . rules developed to promote fair competition and protect participants from injury,” the Children’s Hospital researchers explained. “[E]nforcing rules and punishing illegal activity is a risk control measure that may reduce injury rates by modifying players’ behavior.”

Rules and Referees

The JAMA Pediatrics study reminds us that a youth sport’s playing rules are merely words on pieces of paper. Achieving the rules’ protective purpose depends on enforcement by parents, coaches, and referees at the local level, but the adults often do not live up to their responsibilities. In prior columns, I have written about how misconduct by parents and coaches during heated games can compromise player safety, regardless of what the rulebook says. http://www.askcoachwolff.com/2012/03/22/all-safety-is-local-part-i/ ; http://www.askcoachwolff.com/2012/03/29/all-safety-is-local-part-ii/ . In the last few paragraphs here, I will discuss how that misconduct can endanger player safety by weakening rules enforcement by referees and other game officials.

The American Academy of Pediatrics reports agreement among sports medicine professionals that “[o]fficials controlling the physicality of the game . . . can . . . play significant roles in reducing contact injuries.”  Many communities, however, suffer a steady exodus of experienced officials who grow disgusted with the verbal, and sometimes physical, abuse inflicted on them from coaches on the benches and parents in the stands.

Rules enforcement, and thus player safety, suffers when so many veteran officials hang up their whistles before their time. Many replacement officials are inexperienced, unprepared for responsibilities thrust on them, and frequently not ready to control fast-paced games. But for the veteran officials’ premature departures, many replacements would not be on the field.

Conclusion

The new JAMA Pediatrics study deserves the youth soccer community’s careful attention for shedding new light on risks posed by heading the ball. By emphasizing a central role for rules enforcement, the research team poses continuing challenges for soccer parents, coaches and officials who seek a healthy mix of safety and skills development.

 

Sources:  R. Dawn Comstock et al., An Evidence-Based Discussion of Heading the Ball and Concussions in High School Soccer, JAMA Pediatrics (July 13, 2015); Gretchen Reynolds, Heading Ban for Youth Soccer Won’t End Head Injuries, Int’l N.Y. Times, July 15, 2015; Sasha Harris-Lovett, Study: Even Without Heading, High School Soccer players Face Concussion Risk, Study Finds, L.A. Times, July 14, 2015; Christy Collins et al., When the Rules of the Game Are Broken: What Proportion of High School Sports-Related Injuries Are Related to Illegal Activity?, Injury Prevention, vol. 14, p. 34 (2008); Chris G. Koutures & Andrew J. M. Gregory, Injuries in Youth Soccer, Pediatrics, vol. 125, pp. 410, 412 (2010).

 

DANGERS OF CONCUSSIONS: Focusing on The Often Overlooked Concerns During Practice

New Medical Study Spotlights Football Concussion Rates

During Practice Sessions

 By Doug Abrams

In early May, National Public Radio aired a story about a new study on the prevalence of concussions in football. The study, published in JAMA Pediatrics, found that at the high school and collegiate levels, players are more susceptible to concussions in practice sessions than in games.

The JAMA Pediatrics study found that in high schools and colleges, 58% of football concussions occurred in practices and 42% occurred during games. Fifty-eight percent is quite a bulk. A political candidate who wins election by 58%-42% celebrates a landslide, and the study’s 58% finding demonstrates a “concussions landslide.”

The study also found that in youth leagues, 54% of football concussions occurred during games. That number means that a hefty 46% occurred during practices. When a political candidate receives 46% of the vote, the campaign’s message resonated with voters, even without gaining a majority. The study’s hefty 46% “concussions minority” should resonate with parents and coaches who are concerned about youth leaguers’ safety.

Two Strategies for Safer Practices

The JAMA Pediatrics study concerned only one sport and only one type of injury, but the findings should stimulate closer attention to what happens generally in practice sessions – and not just in football. Football holds no monopoly on injury or risk, and the way that coaches plan and conduct practices vitally affects the health and well-being of the athletes and their families. Well-attended games sometimes attract the lion’s share of attention while practice sessions, without onlookers in the stands, escape under the radar.  But an injury is an injury, and the resulting short-term or long-term disability does not depend on whether the damage occurred with the scoreboard running.

Safety in practice sessions is the subject of this column. I am neither a medical researcher nor a physician, but the new JAMA Pediatrics findings do not surprise me. As a high school and collegiate hockey player in the mid-1960s and early 1970s, and as a youth hockey coach since then, I understand why practice sessions can carry higher injury rates than games.  But I also understand that coaches can lower these rates significantly with prudent, commonsense measures that enhance safety without changing the essential character of the game.

The potential for higher injury rates in practice sessions almost stands to reason. A winning hockey goalie who makes 30 saves, for example, is usually the game’s star; but in a practice, the goalie may face 30 shots in one repetitive drill that lasts only a few minutes, and may face a hundred or more shots in an hour-long session. And many teams schedule more practice sessions than games throughout the season. It would not surprise me to learn that goalies get hit in the face with shots more often in practices than in games. More repetitive shots on net in more sessions = more chances of hits to the head.

Two commonsense measures can help coaches reduce the likelihood of practice session injuries: (1) reasonably reducing repetitive risks, and (2) eliminating unreasonably dangerous drills in favor of effective drills that teach skills more safely. Both measures deserve discussion here.

Reducing Repetitive Risks

First, reasonably reducing repetitive risks in practice sessions. . . . Last month, the executive committee of the Georgia High School Association, the state’s governing body for interscholastic sports, voted unanimously to limit full-contact drills in football practices. The new limits, which take effect August 1, apply during both the preseason and the regular season. Georgia becomes the latest state to adopt limits designed to prevent concussions and other traumatic brain injuries in interscholastic football without changing the essential character of the game.

The GHSA says that its new rules resemble existing National Collegiate Athletic Association and National Football League rules, which many Georgia high schools were already following. The Macon Telegraph reports that during the preseason, full-contact drills will now be limited to 135 minutes each week, but not on more than two consecutive days. When a team holds two-a-day practices, contact may take place during only one session.

The newspaper reports that in practice sessions during the season, full contact is now limited to “90 minutes per week, or 30 minutes per practice spread across three practices. Full contact on back-to-back days will be permitted, but three straight full-contact practices will be prohibited.”

Eliminating Unreasonably Dangerous Drills

Now, eliminating unreasonably dangerous drills . . . .  Some years ago, I was watching a hockey practice for young teens in another community. The two coaches had the players do a “Suicide Drill” (their name for it), which featured manufactured mayhem with two pucks. “Team one” of five players skated out of one end of the rink with its puck, while “Team two” of five players skated simultaneously out of the other end, also with a puck. Each team skating full speed passed its puck several times as it avoided the other team through center ice on its way to the opposing net to take a shot.

The Suicide Drill’s purpose was to train players to keep their heads up as they skated through center ice. Heads-up hockey is an important skill at all age levels, but that particular drill should never have found its way into the practice agenda. Within two minutes, a full-speed collision at center ice landed a player in the hospital with a broken jaw.

In any sport, the best drills combine realism with safety. The hockey team’s Suicide Drill failed on both counts because, without simulating real game conditions, the drill carried an unacceptably high risk of injury that should have been apparent as the coaches planned the practice agenda. The team would have been much better off if the coaches had asked themselves a simple question before practice: “If the players do this drill, what might happen?”

When coaches foresee that a drill carries an unacceptable risk of injury, they can usually choose a safer drill that teaches and develops the same skill. Few, if any, skills have only one drill known to the coaching world. Safety is the coach’s primary responsibility to the players, and anticipating unacceptable risk is key to fulfilling the responsibility. Hindsight may indeed be 20/20, but coaches protect their players best when they also rely on 20/20 foresight to anticipate avoidable danger in practice sessions.

 

Sources: Thomas P. Dompier et al., Incidence of Concussion During Practice and Games in Youth, High School, and Collegiate American Football Players, JAMA Pediatrics, http://archpedi.jamanetwork.com/article.aspx?articleid=2281575 (May 4, 2015); NPR, Concussions Can Be More Likely In Practices Than In Games, May 11, 2015; Ron Seibel, GHSA Votes To Limit Contact In Football Practice, The Telegraph of Macon, Apr. 13, 2015; Assoc. Press, GA Sports Officials Vote To Limit Football Drills, Apr. 14, 2015; Doug Abrams, 20/20 Foresight, USA Hockey Magazine, Sept. 2014.

 

 

DANGERS OF CONCUSSIONS: Florida Law for Girls’ HS Lax Met with Heavy Resistance

I don’t know if you have ever seen a girls’ HS lax game, or if you have a daughter who plays the sport, but my two daughters both played right through HS and loved the sport. They still do.

But that being said, when I used to watch them play, it struck me as a potentially very dangerous sport. I mean, although the girls wear goggles and mouth guards, they DO NOT wear helmets like their male counterparts do. And especially when my girls were playing the sport when they were in middle school or on the JV team, the number of accidents that occurred were staggering: kids being bumped in the head by opponents’ sticks, lax balls bouncing off noggins, and even the occasional scrum when one falls to the ground and suffers a concussion. In short, as a sports parent, it makes you hold your breath.

That’s why I was amazed when I heard that the state of Florida, where lax is still relatively new, had enacted a mandatory rule this spring where all female lax players at the HS level had to wear a protective headband during games. Now, in truth, the headband isn’t very big or thick, but it does offer a modicum of protection. It is definitely NOT a helmet, but it’s at least a start.

But the girls don’t want the headbands…

Yet there’s been a tremendous backlash to this seemingly innocent and well-intended measure. Women lax traditionalists have spoken universally of how there’s no need for this protective headband, that the sport is NOT like men’s lax, and that women’s lax is generally very safe — that it’s a game of speed and skills, NOT of physical contact. I even had my older daughter, Alyssa, who was a top scorer in HS in lax, come on the show, and she too didn’t see a need for this Florida law.

The callers, however – and especially the sports parents – all tended to share the same sentiments that I had – that this was a protective move, and from their perspective, it seemed to make a lot of sense. Recent statistics show that girls lax ranks fifth in terms of sports with concussions, right after football, ice hockey, girls soccer, XXX. In other words, why not do something to protect the girls, especially at the younger ages where their skills haven’t developed yet.

Here’s a suggested solution:

And as one caller suggested,”Why not make the protective head wear simply voluntary? That is, let the girl and her family decide whether they want to wear something to protect their head?”

That, to me, seems like a most practical and logical solution. Speaking as a sports parent, I might have urged my daughters to wear some sort of head protection when they played lax. I just don’t understand why there’s so much resistance to this Florida law.

DANGERS OF CONCUSSIONS: Sports Parents of Football Players Blindsided by Chris Borland’s Unexpected Retirement

Some years ago, in the mid-1990s, there was a famous psychological study reported in Sports Illustrated.

The study asked 198 top Olympic athletes the following choice: if you could take an illegal drug that would allow you to win every event you entered for the next five years – and you wouldn’t get caught – but at the end of five years, you would die….would you take the drug?

More than half said yes. Think about that…..these top athletes would have traded their chance for a long and healthy life for a short-term goal.

To me, that study has some real parallels to what’s happening with the NFL and concussions. In short, if you’re good enough to play in the NFL, and for five years or so you lead a glorious and well-paid life, would you still do it….even though you know that the odds are good your brain might be scrambled beyond repair for the rest of your life?

Now, keep that study in mind….

It was way back last year that I posted the question to you all….Is the sport of football now beginning to decline, and ultimately – thanks to the knotty problem of concussions in the sport – that we’re going to witness the end of this sport?

You already have heard and read about the former NFL players suing and winning about concussion issues. A federal judge is saying that the NFL needs to put up more money to cover future damages.

And now, this past week, one of the NFL’s top rising stars, Chris Borland, at the age of 24, has walked away. A Big Ten All-Star at the University of Wisconsin at 6 foot, 250, he quit due to concussion concerns, even though he hasn’t had a serious history of concussions in recent years. (Although I believe Borland said he had a couple of concussions from when he was younger, one from when he was in 9th grade, and one from playing youth soccer

Of all the things that the NFL DOES NOT want to have happen, it was this: Borland is a bright young star who, at age 24 and before he’s made tons of money, has walked away from the game he loves from a fear of concussions, and what that could mean to his life as he gets older.

He didn’t burn out on the game…or lose interest….or wasn’t good enough. After all, that’s why most NFL players walk away.

Rather, he’s read all the research and articles about former NFL players having serious brain issues as they get older, and Borland didn’t want to risk that.

Remember that even the NFL admits that at least a third of its former players have brain-related issues when they retire.

Some NFL front office people and medical personnel have pooh-poohed this. Eliot Wolf, director of player personnel with the Packers, was quoted as saying that he’s overwhelmed by how many calls and emails he receives from players who WANT to play in the NFL.  Another NFL doctor pointed out that more kids get hurt, statistically, each year from bike injuries than from concussions.

But these fellows are missing the point.

Nobody is suggesting that the NFL is going to shut down tomw. But the truth is, there are all sorts of surveys everywhere that reveal that more and more parents DO NOT want their kids to play football.

The numbers at the youth level are dropping. And also at the HS level. Within a few years, those numbers will begin to take their toll.

So from a football perspective, Chris Borland’s “retirement” at age 24 is very devastating…and if you’re a sports parent who has a son who plays football, or is thinking about playing football, I don’t know how you get around this.

I mean, if the kid had a real history of serious concussions — and he doesn’t want to risk any more — well, that makes sense.

Or if for some reason, he was warned by his doctor to quit because he was feeling depressed, well, that’s another reason. What I mean is, there have been recent cases of college football players who have taken their own lives, and autopsies have revealed serious build-of tau, the unwanted substance that comes from concussions.

But from all accounts, this is a very healthy star football player who seems very level-headed (no pun intended) and has thought it all through, and has decided to quit.

That is quite an indictment of the sport he clearly loves.

Sports Parents Need to Decide

So what does one do, if your son tells you that he wants to play football?

In truth, I’m not sure what I would suggest or do in this kind of situation. Obviously, you want your son to have a long and healthy life. So is the gamble to play a few years of football really worth it?

Here again, as I wrote in the Huffington Post last week, I sure wish the President’s Council on Physical Fitness would come up with guidelines here to help sports parents everywhere find a pathway through the maze. After all, for every doctor who says that concussions are terribly dangerous, there’s another top physician who will say that the concern is overblown. It all makes it very difficult for a sports parent to have to make a choice on this vitally important matter.

Meanwhile, it’s our kids who end up paying the price.

 

DANGERS OF CONCUSSIONS: More States Enacting Safety Precautions

Michigan Announces New Football Practice Session Policies

By Doug Abrams

Last week, the Michigan High School Athletic Association, the state’s governing body for interscholastic sports, announced new policies that limit helmet-to-helmet contact in football practice sessions during the preseason and the regular season. Michigan’s new policies (proposed by a Football Task Force comprised of coaches, administrators and MHSAA staff) are the latest initiative in nationwide efforts to reduce concussions and other traumatic brain injuries in football and other sports. This column discusses the major sources of these initiatives.

Sources of Regulation

Four of these sources exercise direct public authority, though distribution of that authority differs somewhat from state to state. In the typical state, youth sports safety measures may be mandated by the state legislature; the state education department; the state high school activities association; and local decision makers such as city councils, school districts, and parks and recreation departments.

Even without direct official action, coaches and parents on individual teams may implement safety measures that maintain the team’s competitiveness and preserve the essential character of the game.

The State Legislature

At the top of the official hierarchy sits the state legislature. Since 2009, all fifty states and the District of Columbia have enacted laws to improve prevention and treatment of concussions in youth sports. Most of these laws govern only interscholastic competition, but some states extend regulation to private youth sports organizations.

Most of the state concussions laws enact three core mandates.  First, leagues and teams must provide parents, coaches, administrators, and players with pre-season information and education about the dangers of concussions, how to recognize their symptoms, and how to help promote healthy recovery.  Second, coaches must immediately remove from a practice session or game a player who is suspected to have suffered a concussion.  Third, the player may not return to action until a physician or other licensed medical professional clears the player and affirms that return is medically appropriate.

State legislatures often act incrementally, addressing one aspect of a problem that seems most pressing, before weighing later amendments in light of experience. Several states have already amended their relatively new youth sports concussions laws to create regulation stricter than the three core mandates. My August 5 column discussed amendments that California enacted last month (“California Limits Full-Contact Football Practice Sessions”).

The State Education Department and the State Activities Association

In the typical state, official statewide regulation of interscholastic sports is not limited to the legislature. Because interscholastic sports are offered in the nation’s schools, the state education department may establish rules and regulations governing athletic competition. So too may the state high school athletic association, which is typically comprised of most or all public and private schools that compete in football and other interscholastic sports.

As last week’s Michigan policymaking demonstrates, the state association (or the state education department) may establish safety regulations binding on member schools. Indeed, several state associations have already announced concussion safety regulations, which apply only to interscholastic sports, and not to competitions conducted by private youth sports organizations.

Local Agencies

Local government agencies hold the so-called “power of the permit,” the legal authority to set terms under which private applicants may use public property, including public athletic facilities (fields, gymnasiums and the like). Most of these facilities are administered by two local agencies, the public school district and the parks and recreation department.

The school district, of course, may establish terms governing use of its facilities for interscholastic play. The power of the permit, however, also reaches use by private youth sports organizations such as Pop Warner and other youth football programs.

Most private youth sports organizations do not own facilities, but rather use public facilities pursuant to renewable agreements with local authorities. The power of the permit means that when a private youth sports organization applies to use a field, gymnasium or other public facility for the first time, the local agency may condition grant or denial on adherence to concussions protocols and other specified safety measures. The local decision maker may then determine future renewal or non-renewal based on the applicant’s prior performance.

The power of the permit hit the headlines on May 10, when the Vineland (N.J.) Daily Journal ran a story under the headline, “Midget Football May Be Banned.”   The Vineland City Council said that the Vineland Midget Football League, which enrolls players between five and fourteen, reported only two of at least eight players who suffered concussions the prior season. The private league also allegedly issued some older players helmets that were designed and recommended for younger, smaller and lighter players.  The city council threatened to close the fields to the midget football league because, according to the council’s vice president, “nobody followed any protocols” about concussions the prior season.

At a city council meeting, the council’s vice president said that unless the league commits itself to greater adherence to safety protocols, “we can suspend the league by telling them they can’t use” public fields.

Coaches and Parents

When the California legislature and the Michigan High School Athletic Association considered tightening concussions protocols, observers predicted that the protocols would likely not generate much controversy because they reflected precautions that most football coaches were already taking anyway.

“There’s really not a big uproar about this,” said a California Interscholastic Federation senior director, “because it really is nothing new for our coaches.” The MHSAA’s executive director said that in his state, “roughly 85 percent of coaches are already doing similar things”; the new policies were “for the 15 percent that weren’t doing it just yet. We wanted to get everyone on the same page.”

A little common sense can go a long way, though official mandates remain useful to offer players universal protection, and to assure that no team suffers a competitive disadvantage for putting its players’ safety and health first.

 

[Sources: Michigan High School Athletic Association, New Football Practice Policies Promote Safety as 14-15 Sports Year Begins (press release), Aug. 7, 2014, http://www.mhsaa.com/news/pressreleases/articletype/articleview/articleid/3093/new-football-practice-policies-promote-safety-as-14-15-sports-year-begins.aspx; California Law Restricts Full-Contact Youth Football Practices, http://sacramento.cbslocal.com/2014/07/21/california-law-restricts-full-contact-youth-football-practices/ (July 21, 2014); Mike Moore, MHSAA Alters Rules for Football Practice With Aim At Player Safety, Advertiser Times (Warren, Mich.), Aug. 6, 2014]

 

DANGERS OF CONCUSSIONS: New California Law Reflects National Support to Protect Young Athletes

 

California Limits Full-Contact Football Practice Sessions

By Doug Abrams

 On July 21, California Governor Jerry Brown signed bipartisan concussion-safety legislation limiting the number and length of full-contact football practices that high schools and middle schools may conduct beginning on January 1, 2015.  The bill also strengthens existing law concerning treatment of players who are suspected of suffering a concussion or other head injury.

Both houses of the state legislature overwhelmingly approved last month’s bill, which had drawn support from the American Academy of Pediatrics, the American Academy of Neurology, and the California Psychological Association. Also voicing support was the California Interscholastic Federation (CIF), the state’s governing body for interscholastic sports.

The new law (1) prohibits public, private and charter school football teams from conducting more than two full-contact practices each week during the preseason and regular season, (2) limits permitted full-contact portions of practices to no more than 90 minutes in a single day, and (3) prohibits full-contact practices during the off season. The CIF, or a league or school or other body, may adopt rules that enforce stricter standards.

The new California law also provides that where an athlete is suspected of suffering a concussion or head injury, the athlete must be removed from the game or other activity for the rest of the day, and may not resume play without evaluation, and written clearance, by a licensed health care provider. If the provider determines that the athlete has suffered the suspected concussion or head injury, the athlete must complete a graduated return-to-play protocol of no less than seven days under the provider’s supervision.

The new California legislation is a step in the right direction, the latest amendment to youth sports concussions-safety laws that all 50 states and the District of Columbia have enacted since 2009. The laws, similar in many key respects, are not limited to football because medical professionals warn that concussions can happen in almost any sport.

State “Laboratories”

The nationwide legislative flurry, completed in just the past five years, holds potential to help make life better for many youth athletes. Lawmakers, however, often take one step at a time, addressing aspects of a problem that seem most acute today, before weighing amendments in the light of experience. Last month’s amendment in California deserves attention from other states.

Justice Louis D. Brandeis once said that in our federal system, states frequently act as “laboratories” by individually confronting a common problem with similar but not identical legislation. Any state assessing its own performance and considering future amendments can learn from other states’ experiences, enacting perceived strengths and avoiding perceived weaknesses. The 50 states and the District of Columbia have each established a laboratory to experiment with remedies that enhance pediatric concussion safety.

The California legislature found that 19 other states have already banned off-season full-contact football practices. Several states have already limited full-contact practices during the preseason and regular season. The media reports that many schools follow similar concussions protocols, even without statewide legislation. Other states and schools should learn from California’s laboratory.

“As Safely As Possible”

In partisan times typically marked by red-state-blue-state divisions, getting all 50 states do almost anything in unison should draw public attention. State concussion legislation demonstrates how seriously Americans take youth sports traumatic brain injuries in football and other games.  “Sports is . . . fundamental to who we are as Americans and our culture,” President Obama told first White House Healthy Kids and Safe Sports Concussions Summit on May 29, 2014. “We’re competitive. We’re driven. And sports teach us about teamwork and hard work and what it takes to succeed not just on the field but in life.” “[S]ports are vital to this country,” he said, but the nation needs to assure that children “are able to participate as safely as possible.”

[Sources: Nat’l Conf. of State Legislatures, Traumatic Brain Injury Legislation (list and survey of statutes: Apr. 2014); Calif. Assembly Bill No. 2127, Legislative Counsel’s Digest and Bill Text]