Urgent plea for greater football safety measures amid rising concerns over concussion injuries
Warped Turf: The Hidden Danger Lurking in America's Sports Fields
Young athletes across the U.S. face a steadily growing threat from head injuries, particularly concussions. Over the past decade, there has been a staggering 200% increase in both emergency room visits and reported concussions for 8-13-year-olds and 14-19-year-olds, respectively. In 2012 alone, over 325,000 teens sought medical attention for concussions, amounting to almost 40 cases an hour.
One heavy blow may set the stage for disaster, but repeated blows significantly heighten the risk of catastrophic head injury, long-term neurological disability, and irreversible brain damage. Undetected and untreated, concussions and other forms of traumatic brain injury (TBI) can be fatal.
Since 2003, the Centers for Disease Control and Prevention (CDC) has led the charge to raise awareness and educate coaches through the "Heads Up" initiative, distributing over a million copies of training materials and reaching over 1.5 million online coaches. Yet, concerns persist.
Concussion: A Hidden Epidemic in Sports
Concussion can stem from a direct blow to the head or an indirect blow to the body, striking the delicate neural pathways within the brain, and causing problems with memory, judgment, reflexes, speech, balance, and muscle coordination.
- Approximately 1 in 3 concussions occur during practice, and 1 in 5 high school athletes will suffer a concussion during the season.
- About 5.3 million people live with TBI-related disabilities in the U.S.
- A staggering 9 out of 10 concussions do not result in loss of consciousness.
The American Association of Neurological Surgeons (AANS) defines concussion as "A clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma."
Long-Term Consequences: A Cause for Alarm
Research has linked hazards surrounding concussions and TBIs to increased risks of dying from subsequent unintentional injuries, suicides, and altered cognition and balance. In mouse studies, young women who have experienced concussions have shown a higher susceptibility to alcohol abuse later in life.
Recovery is typically possible without intervention, but a second concussion increases the risk of permanent damage by 39%. football is the sport in which concussions occur most frequently, accounting for 47% of sports-related concussions during high school activities.
Football's Brutal Toll: Statistics Speak Louder Than Words
Incidence rates of concussion in football are 64-76.8 per 100,000 participants. Boys' ice hockey has a slightly lower rate of 54 per 100,000, while girls are most at risk when playing soccer, with 33 cases per 100,000. Cheerleading is relatively safer, with a rate of 11.5-14 per 100,000.
The sheer number of participants in football means it accounts for a colossal number of significant injuries, compared to boxing. Dr. Paul Auerbach, formerly a team doctor and currently of the Department of Emergency Medicine at Stanford University School of Medicine, aptly sums it up as "a more significant cause of significant injuries than boxing."
Signs and Symptoms: Recognizing the Warning Signs
Symptoms of concussion in football players may include, but are not limited to:
- Headache or pressure in the head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light or noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems
- Confusion
- Indifferent or down mood
To others, a player may appear:
- Dazed or stunned
- Confused about an assignment or position
- Forgetful about an instruction
- Unsure of the game, score, or opponent
- Clumsy in movement
- Slow to answer questions
- Lose consciousness, even momentarily
- Show mood, behavior, or personality changes
- Be unable to remember what happened before or after the hit or fall
Should concussion be suspected, immediate action must be taken, such as:
- Removing the athlete from play
- Keeping them out of play for the rest of the day
- Obtaining written clearance from a trained healthcare provider before allowing them to return to play
According to Dr. Auerbach, athletes often return to the field before they have fully recovered, typically within 7-10 days. This can expose them to the risk of serious, lifelong damage.
The Unfinished Battle: Navigating the Future of Football
Since 2009, Return-to-Play (RTP) laws have been implemented in all 50 states and the District of Columbia, aiming to provide athletes with ample time to recover before putting themselves at further risk. These laws require schools and activities institutions to develop concussion guidelines and educational programs, secure the informed consent of parents and players through an annual concussion information sheet, immediately remove athletes exhibiting signs of concussion from play, and only allow their return once they have received clearance from a trained healthcare provider.
However, some experts believe these RTP laws do not offer adequate protection. In an opinion article published in JAMA earlier this year, Dr. Auerbach and co-authors called for more proactive measures to prevent concussions in football before they occur.
Dr. Auerbach emphasizes that returning to play after a concussion, even when symptoms seem to have abated, may not be safe. Instead, he advocates for a more conservative approach involving rest, recovery, and rule changes within the game itself.
Suggested changes include:
- Eliminating down linemen in direct opposition at the line of scrimmage
- Banning tackling or intentionally striking an opponent's body with the top part of the helmet
- Prohibiting forearm blows, or "shivers," to the head during blocking or tackling
- Imposing a maximum of 2 days of full-contact practice per calendar week, with each practice session involving a maximum of 20 plays per player with full contact
- Mandating a minimum recovery period of 4 weeks for players who exhibit symptoms or test positive for concussion before returning to full play
- Suspending coaches for three games if they knowingly allow an athlete with suspected concussion to participate
Other proposals include a ban on tackling or intentional head blows at the youth level. Dr. Auerbach attributes the lack of action on these issues to a lack of awareness, conflicting interests, or both.
As competitions resume, sales of paraphernalia related to colleges and professional teams continue to surge. Concerns about the long-term health implications arising from repeated concussions go unaddressed. As Dr. Auerbach posits, these changes might not be popular, but they can potentially pave the way for a safer, faster, and more nimble football experience.
While caution and regulations have become more commonplace, there is still a long way to go before football and other sports can effectively safeguard the physical well-being of their athletes. The clock is ticking. It's time to heed the call, make a stand, and demand change. The future of football lies in our hands.
- Scientists and medical professionals are gaining increasing concern about the impact of sports, particularly football, on health and wellness, with a focus on concussions and other forms of traumatic brain injury (TBI).
- A more conservative approach to football may help prevent catastrophic head injuries and long-term neurological complications, with potential changes such as eliminating down linemen, banning certain tackling techniques, and limiting full-contact practices.
- Further advancements in science and awareness, such as those brought by initiatives like the CDC's "Heads Up", could lead to a safer sports environment for athletes of all ages, and highlight the importance of health-and-wellness education in sports and sports-analysis.
