Suggested changes in sports culture to prevent head injuries and concussions

Concussions have plagued North American football and NHL for decades now and as the sports have kept their physical nature, the amount of head injuries are not showing signs of decreasing. This has caused concern between athletes, teams, fans and even sponsors as well (1). With an estimated 1.6-3.8 million sports-related concussions annually in the United States alone (2), the amount of concussions in sports has put pressure on professional and youth leagues to overcome the issue and make the game safer. Often times the heads turn towards doctors or the developers of protective gear for answers. However, there is only so much that protective gear can do for the safety of athletes. What really needs to change is the culture inside the game.

Sports are not more violent than before

It is important to understand that there has been no significant change in the amount of concussions in professional leagues in the past few seasons. While an open discussion on player safety is crucial, you must remember that sports are not growing more violent. Of course, in some sports you are more prone to suffer injuries. This should be considered a ongoing issue that you can always improve upon.

”While head injuries are a real issue, it is vital to understand that they are not any more common than before”

Concussions and head injuries can cause a broad variety of symptoms on an athlete

Concussions are the most common type of brain injury and can be caused by impacts to the head, neck or body etc. Additionally, a number of studies have shown that repeated impact has a very detrimental effect on the brain. These may happen even when there are no visible symptoms of a concussion. What’s worse is that repeated impacts may cause a variety of neurological problems such as dementia later in life. (3, 4.)

concussions in sports
Not all concussions can be prevented, but there is a way to reduce their occurrence through proper coaching and education

 

What makes concussion treatment so difficult is that it does not have a specific set of symptoms. They can range from uncosciousness, memory loss, drowsiness, behavioral changes, loss of balance, headaches and nausea all the way to loss of motor functions. (345, 6). The symptoms may also be any combination of these and can even affect your normal everyday life. For a more in-depth look, check out the infographic above.

Most athletes return to play within two weeks

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Most concussions in OHL and NHL occur from player to player contact

While rest is the best medicine for concussion treatment (especially for the first 24-48 hours) there is no bullet-proof evidence that being completely stagnant would be beneficial in the long run (3). Usually these symptoms disappear within the first week of the injury and the athlete is able to return in 10 to 14 days after concussion (3, 6). However, in some rare cases concussion-related symptoms can last for a prolonged period of time. No matter how long it takes, the general opinion is that athletes should slowly return to their sport once their symptoms have completely subsided (23).

While there is a certain protocol on how to treat these symptoms, the difficult part is to personalize the treatment towards the needs of the patient. Concussion treatment is definitely not a “one-size-fits-all” procedure and it might even take a full season to recover from. Just ask players like Sidney Crosby, who’s dominated the NHL rinks for years. He also suffered a back-to-back concussions between the 2010-2011 and 2011-2012 seasons that kept him off the ice for nearly 10 months. Nonetheless, his comeback has been nothing short of impressive.

What makes concussions so difficult to define and measure?

It is important to understand that a concussion is an evolving injury in its acute phase and the symptoms may change very suddenly (3). Their effects can vary immensely from short term to long term symptoms. Additionally, studying them is extremely challenging because there is no way to research it in a clinical setting. The variables in force, direction, location (4), alertness and differences in the athletes’ physical attributes cause difficulties for researchers to measure them (3).

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While helmets can protect from direct impacts, they don’t do much when it comes to rotational forces towards the head. These often occur in sports that have plenty of physical contact.

Concussions don’t have a specific set of symptoms

According to three separate studies, athletes show up to three times higher (3.4x 7, 2.5x 8, 2.2x 2) risk of sustaining another injury after a concussion. Whether this is a matter of the lack of proper medical attention or a prolonged state of lowered motor control is anybody’s guess. One explanation could be that the athlete is more likely to show injury prone behavior after returning from concussion. At any rate, these numbers clearly indicate that concussions and their treatment are not to be taken lightly.

Three different leagues share striking similarities in concussion occurrence

The NCAA (9), OHL and the NHL (1) statistics show that a vast majority (65%) of concussions are caused by player to player contact. However, in the NHL a third of those occurred after an illegal play which resulted in penalties and/or suspensions. These numbers hint that bodychecking rules are not enough to regulate the incidence of concussions among athletes (1).

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A third of all concussions in the NHL occurred after an illegal play which resulted in penalties and/or suspensions.

According to The National Collegiate Association (NCAA), there is an estimated 10,350 sports-related concussions annually. In men’s leagues wrestling, football and ice hockey were the most concussion-inducing sports. However, on the women’s side, ice hockey and soccer were the most hazardous sports for head injuries. Females also showed a higher risk in obtaining a head injury across all sports and age groups. One explanation for this could be that women may be more willing to report their symptoms. (6.)

The vast majority of concussions in sports are caused by player to player contact

Even with all of the daunting headlines about concussions and safety in sports, it should be pointed out that ”long-term effects of these sports do not show a statistical significance in heightened risk of brain damage” (10). In fact the same study stated, that football players showed less signs of depression after their athletic careers. So in a way, team sport and the social network it provides can help sustain mental health. (10)

Coaches need to make responsible decisions regarding player safety

In order to save the athlete from further injury he/she should be taken off the playing field after the first signs of a concussion (loss of balance, unconsciousness etc.) to a space free of distractions (3). This season we saw Tom Savage of the Houston Texans clearly suffering a concussion after a tackle. However, the worst part of it was that he stayed on the field and continued the game. From a competitive standpoint this decision is quite easy to understand. The coach wants to keep their starting quarterback in the game, whereas the athlete himself is eager to play. The athlete may also be discouraged to seek help to keep his status inside the pecking order within the team. Instead of staying silent, players should be encouraged to report their symptoms without the fear of being portrayed as weak (11).

From a coach’s standpoint, showing concern of an athlete’s safety is a great sign of respect. It may even build up mutual understanding and team spirit. However, this also requires coaches to be able to recognize concussion symptoms and act accordingly (11).

Sustaining an even worse injury is not worth the risk – even when fighting until the very last second 

The fact is that no matter how strong and skilled a player is, if there are any signs of a concussion the athlete’s physical performance is most likely  compromised as well. Additionally, since physical differences in professional sports are so marginal, you will likely benefit from substituting a player that is not playing on their absolute highest level. There is plenty of skill on the bench too, and teams should be able to compete without putting one individual in harms way.

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Striving for victory should never happen at the expense of athlete safety

Leagues are looking into the rulebook to prevent head injuries

While professional leagues have made efforts to improve player safety with new rules and additions, they are still not enough to make a lasting impact on the issue (1). For example, NHL has shown great effort with rule 48 in the 2010-2011 season to penalize bodychecks to the head. On a positive note, the league has been able to stay true to their roots. The traditional physical game of ice hockey is still there.

What really needs to change is the attitude and respect for your fellow player

Instead of going too deep into proposing new rules, demanding inquiries or surveillance programs, I’d like to see proper education within the team as well as a change in culture in high-risk sports. This is the only way to make a real impact in player safety before an injury even occurs.

Accidents happen and they are a part of the game. However, sports entertainment should never come at the expense of someone’s health. No matter how modern our protective gear becomes, it is still just a precautionary measure against possible head injuries. While product development is definitely playing its part in injury prevention and making sports safer, perhaps we should not concentrate on longer suspensions or concussion treatment. The focus should be coaching the next generation of athletes to not go for those late challenges. This way we could possibly see a decrease in the amount of concussions in sports.

Educating coaches, athletes and parents of how to deal with head injuries

In order to have a lasting impact on player safety, there has to be proper education of what to do if an athlete shows any signs of a concussion. This education has to reach everyone involved in the team and provide both information and skills to make the right decisions when needed.

A great example of head injury education is North Carolina’s Gfeller-Waller Concussion Awareness Act that aimed to teach how to detect and manage the symptoms of head injuries (6).

Free educational materials for coaches, athletes and parents can be found here.

What direction should the culture within the sport go towards?

Concussion education is not the only factor that needs to change in order to improve player safety. To have a lasting effect on player safety, there needs to be a change in culture. This, on the other hand, is nearly impossible to achieve without years of collaboration between leagues and teams.

Sportsmanship in every situation

Coaches should be teaching young athletes to “respect the game” as well as their opponents. Hasty or aggressive decisions should never be done even if you happen to be on the losing side. Playing hard and being physical and competitive is of course a part of the game. Still, showing example and teaching kids about the difference between sportsmanlike and unsportsmanlike behavior could have a significant impact in the future characteristics on the ice or field. One problem is that a physically aggressive play is often portrayed as a selling point in top-tier leagues (1) which is easily picked up by younger players.

Concussions
Coaches need to teach young players about good sportsmanship

It is important to teach up-and-coming players to recognize situations where they are most likely to get hurt. More importantly, there is a need to educate them on how to deal with difficult situations before going head first into a potentially dangerous play. For example, a defender going to pick up a puck from the corner while the opponent is chasing you. The defender has to be aware of the situation and not turn their back on the attacker. A lot of injuries could be avoided by your own decisions during the game. Sometimes players put themselves or others in danger without even knowing it.

Do not be afraid to let your children participate in team sports

While the aforementioned results do not have a direct connection to youth leagues, they do show where the sports are going. Top flight leagues are industry leaders and, in many ways, what younger players look up to and strive towards. Thus, the idea of NHL of NFL leading by example is not too far-fetched.

As a further safety measure, some junior leagues have made bodychecking illegal until a certain age. This has had positive results in concussion prevention, as head injuries are more common in youth leagues where body checking is not prohibited (1).

The bad reputation is unjustified

Sometimes it is easy to discredit physical sports as dangerous and unhealthy especially for younger athletes. For example, in 2009 nearly 65% of all sports-related concussions were sustained by young people aged 5-18 (4). It is only natural for parents to be worried about their children’s safety. No matter the sport they want to participate in, there is always room for improvement. For example, having at least some sort of medical staff in junior league games or tournaments.

However, what if these kids would not participate in sports or exercise at all? There are plenty of studies stating that exercise and social interaction have a tremendous positive impact regardless of your age. Being a part of something, staying active and surrounding yourself with other people helps maintain your physical, psychological and mental wellbeing.

Sure, it’s physically safe inside a bubble. But would it be worth it?

 

References:

  1. Donaldson, L., Ashbridge, M. & Cusimano, M. D. 2013. Bodychecking Rules and Concussion in Elite Hockey. PLoS ONE, Volume 8, Issue (7).
  2. Nordström A, Nordström P. & Ekstrand J. 2014. Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players. British Journal of Sports Medicine Volume 48, p.1447-1450.
  3. McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R.C., Cassidy, D., Echemendia, R. J., Castellani, R. J., Davis, G, A., Ellenbogen, R., Emery, C., Engebretsen, L., Feddermann-Demont, N., Giza, C. C., Guskiewicz, K.M., Herring, S., Iverson, G.L., Johnston, K.M., Kissick, J., Kutcher, J., Leddy, J.J., Maddocks, J., Makdissi, M., Manley, G.T., McCrea, M., Meehan, W.P., Nagahiro, S. Patricios, J., Putukian, M., Schneider, K.J., Sills, A., Tator, C.H.,  Turner, M., Vos, P. E. 2016. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, British Journal of Sports Medicine 2017. Issue (51): p.838-847. Cited on 13.11.2017. 
  4. Carman, A.J., Ferguson, R., Cantu, R., Comstock, R.D., Dacks, P. A., DeKosky, S.T., Gandy, S., Gilbert, J., Gilliland, C.,Gioia, G., Giza, C., Greicius, M., Hainline, B., Hayes, R.L., Hendrix, j., Jordan, B., Kovach, J., Lane, R.F., Mannix, R., Murray, T., Seifert, T., Williams, D.W., Warren, E., Wilde, E., Willard, H. & Fillit H.M. 2015. Expert consensus document: Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions. Nature Reviews Neurology, Issue 11, p.230–244.
  5. Burman, E., Lysholm, J., Shahim, P., Malm, C. & Tegner, Y. Concussed athletes are more prone to injury both before and after their index concussion: a data base analysis of 699 concussed contact sports athletes BMJ Open Sport & Exercise Medicine 2016;2.
  6. Conder, R.L. & Conder, A. A. 2015. Sports-Related Concussions. North Carolina Medical Journal. Volume 76, (2), p.89-95. 
  7. Herman, D.C., Jones, D., Moser, M., Tillman, S., Farmer, K., Pass, A., Clugston, J.R., Hernandez, J. & Chmielewski, T.L. 2017. Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes. Sports Medicine, May; Volume 47, Issue (5):
    p.1003-1010.
  8. Brooks, M.A., Peterson, K., Biese, K., Sanfilippo, J., Heiderscheit, B.C. & Bell, D.R. 2016. Concussion Increases the Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes. 2016. American Journal of Sports Medicine. March; Volume 44, Issue (3): p.742-747. https://www.ncbi.nlm.nih.gov/pubmed/26786903
  9. Zuckerman, S.L., Kerr, Z.Y., Yengo-Kahn A., Wasserman, E., Covassin, T. & Solomon, G.S. 2015. Epidemiology of Sport-Related Concussion in NCAA Athletes From 2010 to 2013-2014. American Journal of Sports Medicine. Vol 43, Issue 11. 
  10. Boyle, R. 2017. Concussions and Traumatic Brain Injury in Football: What We Know We Don’t Know. American Institute of Physics. Cited on 22.2.2018 
  11. Walter, K. D. 2014. Addressing concussion in Youth Sports. American Medical Association Journal of Ethics. Volume 17, (7), p.559-564. 

 

2 Replies to “Suggested changes in sports culture to prevent head injuries and concussions”

  1. High-impact team sports are not the only sports where concussions occur often. For example, extreme sports such as skateboarding, snowboarding and freestyle skiing have the highest occurrence in head injuries when it comes to individual sports.

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