For years, the National Football League and National Hockey League have popularized and glamorized "big hits" in professional sports. Now, after five years of research, and some startling discoveries regarding the frequency and long-term effects of concussions, the NFL and NHL -- as well as the governing bodies at all levels of sport -- are starting to re-consider their policies on such punishing blows.
"The game has changed -- players play at a higher speed and faster pace than they've ever played before," Scott Bertoli, Interim Athletic Director and head coach of the Princeton Day School varsity boys ice hockey team, said. "[Athletes' bodies] are evolving as 'off-the-field' conditioning becomes more intense. As athletes get bigger, stronger and faster, hits and collisions get bigger -- these factors lead to more injuries and concussions...it's clear that we need to protect these athletes at every level, in every way possible," the former East Coast Hockey League All-Star added.
Among the leaders in research designed to educate and protect those involved in athletics (and the military) are the Sports Legacy Institute -- founded in 2007 "to advance the study, treatment and prevention of the effects of brain trauma in athletes and other at risk groups" -- and the Boston University School of Medicine's Center for the Study of Traumatic Encephalopathy -- founded as a collaborative venture between the Sports Legacy Institute and the Boston University School of Medicine in 2008.
Although both the Boston University School of Medicine and the Sports Legacy Institute declined to comment on the state of their current concussion studies, a review of the Sports Legacy Institute's most recent Form 990 (filed with the IRS in 2008) revealed that the non-profit spent $25,316 that year to help fund the Boston University Center for the Study of Traumatic Encephalopathy and secure the post-mortem donation of 107 brain, hosted a "coaches concussion clinic" in an attempt to educate 120 New Hampshire Pop Warner coaches on the diagnosis and management of concussions, and spent $29,724 to "raise awareness of the dangers of concussion[s]" (through pieces featured on CNN, ESPN, the New York Times and the Boston Globe).
A catalyst for the flurry of research being done at institutions across the nation appears to be an article by Dr. Bennet Omalu in the July 2005 issue of Neurosurgery, Dr. Steven DeKosky reported in the New England Journal of Medicine. Dr. Omalu's article, "Chronic Traumatic Encephalopathy in a National Football League Player," represented the first autopsy report of a professional football player with distinct symptoms of cognitive and neurological decline (Chronic Traumatic Encephalopathy).
According to the Boston University Center for the Study of Traumatic Encephalopathy's website, Chronic Traumatic Encephalopathy (CTE) is caused by repetitive blows (or trauma) to the brain. Early symptoms of CTE -- which causes impaired function, and eventual death, of brain cells -- include memory impairment, emotional instability, erratic behavior, depression and problems with impulse control. In some cases, the website said, "CTE may eventually progress to full-blown dementia."
In the wake of Dr. Omalu's breakthrough article, numerous studies dealing with the effects of brain trauma in sport have been published in medical journals -- including Dr. DeKosky's "Traumatic Brain Injury -- Football, Warfare, and Long-Term Effects", and Dr. Kevin Guskiewicz's Journal of the American Medical Association article "Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players." In his article, Dr. Guskiewicz asserts that, "approximately 300,000 sport-related concussions occur annually in the United States." His review of the data also revealed that players with a history of concussions are more likely to suffer repeated instances of concussions (possibly in the same season -- 6.5 percent of the sample studied suffered two or more concussions in the same season).
Such findings have left the governing bodies at all levels of sport, and the manufacturers of protective sporting equipment, searching for solutions to this growing neurological crisis.
The New Jersey State Interscholastic Athletic Association, made up of 433 "accredited public, private and parochial high schools in the state," implemented a formal policy mandating that coaches remove any players suspected of suffering a head injury or concussion. Coaches are to closely observe the player over the next "several hours," and cannot allow the athlete to return to action until he or she has been evaluated (and cleared to play) by a medical professional.
Policies in collegiate and professional sports -- where teams often have athletic trainer(s) on staff -- are not so cut-and-dried, Luke Hensel, head athletic trainer for the Princeton Day School, said. And, while some head coaches may rush their "star players" back into action before their head injuries have sufficiently healed, Princeton University head football coach Bob Surace said that his priority has been -- and will continue to be -- the long-term well being of his players.
"It is so important to protect the player's safety," Surace, who also served as an assistant with the Cincinnati Bengals for eight years, said. "Sometimes, these players try to be 'macho' -- it's important to make sure that the right decisions are being made regarding their health. I will never sacrifice a player's health -- I will do anything to make this game [football] safer...If studies show that there are better ways to [treat players], then we will do what needs to be done to make things better."
Helmet companies, like Easton-Bell Sports, Inc. (parent company of Riddell, Inc.), are also trying to stay ahead of the game by patenting new technologies to protect players against concussions (a review of Easton-Bell Sports, Inc.'s latest 8-K filing with the Securities and Exchange Commission reveals that the company experienced a 14% growth in sales of football equipment).
Helmet manufacturers and medical experts agree, however, that even the most technologically advanced helmet will not prevent concussions and head injuries 100 percent of the time.
"I think that [helmet companies] really are trying to make a difference with new designs...but, no helmet can ever guarantee that it will prevent brain traumas," Hensel said in an e-mail. "Helmets certainly protect [you] from soft tissue and skull damage, but a concussion occurs when [the] brain strikes the insides of [the skull], which can be caused by whiplash, or other types of indirect contact -- things that a helmet cannot protect against," he added, noting that new helmet designs will only be helpful if professional (and non-professional) athletes are willing to adopt them.
While Hensel acknowledged that helmet technology and clinical research have continued to move forward, he's also noticed a startlingly negative trend that he would like to see reversed as soon as possible.
According to Hensel, many doctors who review athletes' post-injury CT scans (CT scans visualize the brain, checking for blockages and other severe problems in the blood vessels) and find no abnormalities suggest that these athletes rest and return to action when they feel most ready. But, Hensel noted, CT scans do not tell the whole story. In order to effectively diagnose, and treat, concussions in the long-term, doctors must also learn to utilize such resources as baseline testing results (baseline tests compare current -- often post-concussive -- brain functioning to the individual's "normal" brain functioning).
Research and regulations aside, Hensel admitted, injury is -- and always has been -- a part of every sport.
"Every sport carries an inherent risk of some level of injury," Hensel said in an e-mail. "And, while we try to make them as safe as possible, if you make [things] too safe, you're taking away from the game itself. Some people in my profession, or in the medical community, might call me crazy, but I think that you need to realize that if you [over-regulate], athletes and fans are not going to find it fun anymore...I think that prevention is certainly key, but we can also have a positive effect by managing injuries better when they occur, so that athletes make full recoveries before returning to play."
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