Matt Munjoy has been hearing “the story” for years.
“If you talked to anyone over 40 who played football, they’ll tell you about how they got knocked out and went back in the game later,” said Munjoy, Decatur Memorial Hospital’s Athletic Training Outreach Coordinator.
St. Mary’s Hospital Athletic Trainer Dustin Fink said he doesn’t have to go back that far to remember a time when head injuries in football at every level were treated much different than they are now.
“Ten years ago, if as athletic trainers we saw you stumble around and you were dizzy and had a headache, we would sit you on a bench, then walk back to you 15 minutes later and ask if you were OK,” said Fink, who is the athletic trainer for Mount Zion High School. “If you said yes, we would put you back in the game. That’s what we were taught. We thought that was OK.
“But what we’ve come to find out is that’s the worst thing you can do. Nothing in sports medicine has changed more than how we treat brain injury.”
Scientific discoveries the last few years have shined a light on the effects of brain trauma, particularly second-impact syndrome and chronic traumatic encephalopathy, causing changes to be made to the game to make it safer. But more change may be necessary to keep the game alive at the high school level.
Through the efforts of the National Federation of High Schools (NFHS) and Illinois High School Association (IHSA), there are more rules to help limit contact. Fink is part of the IHSA Player Safety Council and said he does feel the organization cares about player safety.
“The game is safer and the advances have helped,” Fink said. “It’s about limiting exposure. We’ve gotten away from the old Tex Schramm days of banging heads for two hours a day in double days, and we don’t do Oklahoma drills at Mount Zion.”
Both Munjoy and Finck have been impressed at the way most coaches have went along with new rules for less contact, though both also said it probably had a lot to do with the fact that having healthy players leads to more wins.
“I think football practices now compared to 10 years ago, we’re seeing coaches take player safety much more seriously,” said Munjoy, who is the athletic trainer at Maroa-Forsyth High School. “And that includes during the season. Kids aren’t hitting all practice long like they used to. There’s a lot more concern about trying to get through the season with fewer injuries.”
But, Fink said, there’s still more that could be done at the higher levels to make the game safer.
“Are they doing enough? The answer is no, they’re not,” Fink said. “They’re behind. They’re slow. They’re afraid.”
Fink said he’d like to see high schools follow the Ivy League, which has banned contact at practice during the season.
“Once the season starts, how much are kids really learning about tackling?” Fink said. “From what I’ve seen through the years, kids don’t pick up and learn technique once the season starts; it’s about self-preservation and survival at that point. You might learn new plays during the season, but you’re not learning how to tackle. That’s done in the preseason.”
Many are on board for something new when it comes to tackling. USA Football has endorsed Heads Up tackling, as has the IHSA. But Fink said not only does the Heads Up method not prevent head injuries, it isn’t a realistic expectation for players.
“It’s a horrible way to teach the proper way to tackle because kids will never remove their heads out of tackling,” Fink said. “For it to work, you have to have a willing participant carrying the ball, because if I go in with my head up and my chest out, what is the running back going to do? He’s going to put his head and shoulder into my chest and steamroll me.”
What many coaches are leaning toward is rugby-sytle tackling, or what some football coaches are calling, “Seahawk tackling.” Instead of putting the head in front of the opponent’s body and using the shoulders to drive in a way that puts the head at risk, the tackler’s head is behind the opponent’s body, wrapping up their legs and “gator rolling” the player. It doesn’t eliminate risk of head injury, but it does give a player more control of their upper body as they go to the ground.
MacArthur High School football coach Derek Spates is one who has embraced teaching Seahawk tackling.
“With the concussion stuff, I think us coaches and football as a whole have to check out some of these new techniques and get the information out there,” Spates said.
But as long as the game includes tackling, the participants are going to hit their heads. And while helmets protect skull fractures, they do nothing to protect the brain.
There is a new helmet on the market, much more expensive than a regular helmet, that promises relief. The Vicis Zero1 has a soft outer shell with a harder plastic core inside. It uses the same technology as a car bumper, giving a little when struck and slowing the impact of the hit.
“I could see that helping with some of the lower-impact repetitive stuff on the offensive line, and I’d say that’s where most of the effort needs focused,” Fink said.
But the bottom line is that keeping the brain from bouncing around during collisions is nearly impossible.
“They’d have to figure out how to stop jello from shaking in a pan, that’s the answer,” Munjoy said. “I’m not sure you can make that happen. The question is how do you make changes but still keep it football. Helmet technology has come a long way, but the brain is still going to shake.”
There’s plenty of motivation for companies to come up with something: millions of dollars. The problem is, some companies are preying on parents looking to protect their children with products that they claim help, but do little to actually prevent damage.
“There’s a lot of that out there, companies trying to make money on the fear of concussions,” Munjoy said. “I’ve seen parents spend a lot of money on headbands and helmets that were supposed to prevent things.”
Fink, who runs The Concussion Blog – the Twitter account has more than 11,000 followers – said he receives multiple emails a day about supplements and other pieces of equipment that claim to solve the problem.
“Brain trauma is an industry,” Fink said. “And there’s a lot of snake oil out there.”
There’s yet to be any definitive evidence that all the news coming out about brain injury and football has damaged participation. But there is reason to think high schools may eventually be forced out of the business.
The sport won’t go down easy. High school football is a way of life for many all over the country, including Central Illinois. Programs like Maroa-Forsyth and Sullivan have more than 70 kids out for the team annually. Fathers who relished their high school football days want the same for their sons. And they want the game to be played like it was in their day as well.
“Things are happening so fast and people are just naturally resistant to change,” Fink said. “Like a buddy of mine says, nostalgia has never lost.”
But, Fink said, football can’t survive with that mindset.
“I have a doomsday view, which I hope can be avoided. And I have a utopic view,” Fink said. “My doomsday view is that we don’t do enough and we have enough lawsuits and people get hurt that it won’t be the IHSA or the NFHS that takes the game away, it’ll be the insurance companies. They’ll make it too expensive for high schools to participate.
“Kids will still find a place to play, club teams and things like that, but high schools won’t be able to justify having it anymore because of the expense to protect themselves from lawsuits.
“At one time my timeline for that was about 25 years from now. But it’s been accelerated. I can see it happening in 15 to 20 years.
“My utopic view is that we still have football and it continues to be the pipeline for the college and professional games. But for that to happen, the higher-ups in these leagues and sports are going to have to enact changes and find ways to make it safer.
“Right now we’re at a fork in the road.”
A few key policy changes can reduce sudden deaths during middle school and high school sports activities, according to a best practices statement in the Journal of Athletic training.
More than 90 percent of sudden deaths in sport are due to sudden cardiac arrest, exertional heat stroke, head injuries and exertional sickling, the dangerous decrease in blood flow that can occur in athletes who carry the sickle cell trait, the authors write.
Evidence based safety policies like heat acclimatization, sickle cell trait testing, the “Heads Up Football” program and requiring that automated external defibrillators (AEDs) be available can reduce the risk of all four events.
“These efforts are really starting to pay off,” said Dr. Barry P. Boden, a sports medicine specialist at The Orthopaedic Center in Rockville, Maryland, who was not part of the new statement.
“A lot of them are really just education, not much more than that,” Boden told Reuters Health by phone. “It still takes some time and effort but there’s really no excuse.”
Heat acclimatization policies mandate that in the hottest months of the year, athletes only gradually return to sports practices and exertion. The Korey Stringer Institute recommends no more than one practice per day in the first five days and no more than three hours of practice per day, with athletes wearing only a helmet, if appropriate, and no other extra equipment on day one and two of practice. All protective equipment can be worn and full contact can begin on day six.
In the second week of practice, two-a-day sessions should alternate with one-a-day sessions. For two-a-day practices, the two sessions should be separated by at least three hours in a cool environment.
The National Collegiate Athletic Association implemented heat acclimatization guidelines like these in 2003, and since then heatstroke-related deaths have dropped from one or two deaths each August before the policy to only one August death since 2003.
The policy saved an estimated 20 lives among college football players, the authors write.
“Heat acclimatization costs absolutely no money,” said coauthor Douglas J. Casa, CEO of the Korey Stringer Institute at the University of Connecticut in Storrs.
“Simple Steps Help Prevent Deaths during Youth Sports | Fox News.” Fox News. FOX News Network, 29 Mar. 2016. Web. 19 Apr. 2016.
A federal judge granted preliminary approval Tuesday to an amended settlement between the NCAA and a group of college athletes who sued how the association handled concussions.
U.S. District Judge John Z. Lee’s approval came with one significant change that in part has delayed resolving the case. The athletes could still sue their university and the NCAA as a class under certain terms, meaning the NCAA and schools don’t have the blanket immunity moving forward they sought.
The settlement would release all class-wide claims relating to concussions, subconcussive hits or contact. Current and former college athletes could still sue for personal injuries and “class claims that do not relate in any way to medical monitoring or medical treatment of concussions or sub-concussive hits or contact.”
Both parties must still agree to amendments in the settlement. First submitted in July 2014, the agreement would create a $70 million fund to test thousands of current and former athletes for brain trauma and put aside $5 million for research. In addition, NCAA guidelines for medical care by universities would change moving forward.
“While we are pleased the court has provided a preliminary pathway to provide significant resources for the medical monitoring of student-athletes who may suffer concussions, we are still examining the conditions placed on preliminary approval,” NCAA chief legal officer Donald Remy said in a statement.
Jay Edelson, a Chicago attorney who intervened in the case, said he loves the decision and will start filing lawsuits against schools within the next couple weeks.
“We think there’s nothing stopping them now,” Edelson said. “It’s going to be the large schools that have had systematic issues. It’s not going to be a surprise who they are when we first start filing.”
Edelson’s interpretation of the ammended settlement is that class-action suits can be filed on a school-by-school basis — not a national class-action — and as long as they don’t involve medical monitoring.
“The medical monitoring was always the tail that wags the dog,” Edelson said. “That’s just about people getting a test to see if they can get a concussion. People who were badly injured know they have concussions. The key thing is this is not a done deal. (The plaintiffs’ attorney) Steve Berman will be happy going forward with this deal. The key question is whether the NCAA still wants to go forward. That’s not clear. They really want the class release. What the NCAA ends up instead of facing one big suit is they face dozens of moderate-size suits, which doesn’t sound like the biggest win for them.”
Berman said he has “no issues” with the judge’s new terms. “Hopefully we will get this before the judge in mid-February,” he said.
When asked how susceptible he thinks the settlement would make individual universities to class-action claims, Berman responded, “I don’t see a big risk. There just aren’t scores of concussed kids that would make up a class at each school.”
The litigation was originally filed in 2011 by former Eastern Illinois football player Adrian Arrington, who sustained several head injuries in college and argued the NCAA neglected concussions. Additional cases became consolidated with Arrington, who later opposed the settlement because individual athletes aren’t getting paid medical costs.
The settlement would create a 50-year medical monitoring program at $70 million to cover diagnostic medical expenses for athletes, not their actual treatment. The NFL’s settlement with players over concussions is for approximately $900 million and includes millions of dollars going to players who suffer from neurological diseases.
Back in 2010, the NCAA began requiring every school to have a concussion-management plan. Documents released in the Arrington case in 2013 showed the NCAA essentially had no oversight over these concussion management plans.
In a 53-page opinion, Lee wrote that he could not rule that the NCAA’s alleged conduct injured college athletes in “the same, unvarying” way as conclusions reached in the NFL case.
“Rather, the facts produced in discovery present a multitude of potential permutations regarding whether the NCAA breached a duty to protect its athletes and caused any particular plaintiff injury,” Lee wrote. “And the need to make individual, fact intensive determinations as to liability with respect to each class member eclipses any common issues as to whether the NCAA had a duty to protect players from concussion-related risks, breached that duty, and fraudulently concealed those risks.”
Lee outlined six changes the NCAA agreed to implement regarding concussion policies (some of which are already in place):
• Require all athletes to undergo preseason baseline testing for each sport prior to their first practice or competition.
• Revise the NCAA guidelines so an athlete diagnosed with a concussion will be prohibited from returning to play on the same day and must be cleared by a physician before coming back.
• Require medical personnel who are trained in concussions to attend all contact-sport games and practices for Divisions I, II and III. Contact sports are defined as football, lacrosse, wrestling, ice hockey, field hockey, soccer and basketball.
• Have the NCAA institute “a uniform process for schools to report diagnosed concussions and their resolution, and for concerned persons to report potential problems directly to the NCAA.”
• Require NCAA schools to provide approved concussion education and training to athletes, coaches and athletic trainers before each season.
• Have the NCAA provide education for faculty to accommodate students suffering from concussions.
Lee had previously said he needed to understand “the range of actions” the NCAA may take against a member for either intentionally or inadvertently failing to comply with settlement terms, and any sort of enforcement mechanism. NCAA members have wrestled with whether to adopt rules attached to concussion guidelines.
In Tuesday’s opinion, Lee wrote that the settlement “now encourages the schools to implement the concussion management protocols, by requiring that the schools provide written certification of compliance in order to be included as Released Parties under the agreement.”
Previously, Lee was concerned about how few locations would be available for medical monitoring tests. The number of locations has expanded to 33 across the country, with an assumption that 50 percent of class members would live within 50 miles of a location and 70 percent would be within 100 miles. Athletes who live more than 100 miles away could get reimbursed to travel to the closest location or request access to a closer medical provider.
The settlement requires a publicity campaign 10 years into the 50-year monitoring program. Lee recommends publicity campaigns every 10 years to ensure class members are aware of the testing.
Four former college athletes — Derek Owens, Angelica Palacios, Kyle Solomon and Arrington — are set to receive $5,000 each as named plaintiffs since they were deposed in the case. Additional plaintiffs who were not deposed will each get $2,500.
The NCAA agreed that it will not oppose plaintiffs’ request for an award of attorneys’ fees of up $15 million and out-of-pocket expenses up to $750,000. Attorney fees and costs must still be approved by Lee. A status hearing for the case is set for Thursday in Chicago.
We’ve always heard you must get a lot of rest if you’ve suffered from a concussion, but one study is taking the opposite approach to healing concussed athletes.
Researchers at the University of Buffalo received a $2 million, 5-year grant from the National Institutes of Health to study the effects low-impact exercise has on the recovery of teen athletes who’ve suffered concussions. The study is looking at the impact on the brain and the body.
University of Buffalo researchers from the Jacobs School of Medicine and Biomedical Sciences say they’ve realized that exercise is good for the brain, and if its controlled it can actually help concussed patients recover.
Clifton Herbert, one of Alabama A&M’s assistant football coaches, says as more research is done on this topic they make changes to the way they play the game. |
“I think it changes how we structure our practice,” Herbert said. “It changes how we tackle, our tackle drills to make sure we are tackling correctly and properly because of course we’re not trying to have any of the players or the kids get concussions.”
90 teen athletes are being recruited for the study led by doctors in the UBMD Orthopedics & Sports Medicine.