Although many fans will be sad that football won’t dominate their lives as it usually does in the months after Labor Day, the pandemic-related constriction, postponement, and cancellation of so many prep and collegiate sports may have an upside: It likely will add to declines in the need for urgent care for dangerous and damaging head injuries.
Public awareness has soared about the risks of such trauma, with preventive measures leading to a sharp dip in the emergency department visits for sports- and recreation-related injuries to children and adolescents, federal researchers have found.
Their study for the Centers for Disease Control and Prevention was based on data from the National Electronic Injury Surveillance System–All Injury Program from 2001 to 2018. Early in that time period, young people’s ED trips peaked at “411 per 100,000 youths aged 17 years or younger in 2012 before declining by 32% to 299 per 100,000 by 2018,” journalist Bridget M. Kuehn wrote in an online article for the Journal of the American Medical Association.
Incidents involving the head, including sharp and repeated blows that can result in concussion and traumatic brain injury, can occur, of course, in many different sports, including hockey, soccer, basketball, lacrosse, diving, gymnastics, and riding activities — both with mechanized devices like bikes and scooters but also horses. Still, emergency medical services most often are called on — and have declined — with one sport, as Kuehn reported of the CDC findings:
“Most of the decline was driven by a reduction in football-related brain injuries: participation in organized youth football programs has declined by 24% since 2010 and tackling and contact restrictions have been implemented to reduce concussion risk. Rates of non–contact sports–related visits for head injuries also declined between 2012 and 2018. Despite the declines, football was responsible for the highest rate of ED visits for traumatic brain injuries among children and teens of all contact sports in 2018.”
The NFL emulates Dartmouth?
Coronavirus protective-measures not only have led prep and collegiate programs to cut or postpone fall football, they may alter fundamental thinking about how even the pros prepare for competition — a move that may further reduce head trauma. The National Football League has limited its players’ close contact with each other during training camps, banning athletes from donning pads and full contact hitting until late in their preparation and just before games launch.
The league, in doing so, took a page from practices pioneered at Dartmouth, the Wall Street Journal reported.
The Ivy League “Big Green,” the newspaper said, faced a sad situation a decade ago in which its players were banged up and performing poorly. So, Coach Buddy Teevens decided on a counter-intuitive approach that shocked his staff, athletes, and initially got him reviled by “experts” in the game: He eliminated live contact outside of actual competitions, barring players from “tackling and mauling of each other.”
Teevens, who had coached under legends of the game, recalled for the Wall Street Journal what Steve Spurrier, one of his mentors and a collegiate king and a onetime NFL coach, had argued:
“’Why would you beat the crap out of our own team and players?’ Spurrier says. ‘I used to tell people: When the army’s preparing for battle, they don’t use live bullets against each other. So why use live collisions when we get ready for opponents?’”
The unorthodox training plan Teevens adopted has spread, and programs around the country at all levels now try to reduce the player collisions outside of competition, with good outcomes. If it works for the NFL and if it adopts the practice — along with gear modifications and improvements in which Dartmouth also has blazed new paths — this could be a good thing for the game, the Wall Street Journal reported, quoting Spurrier, again, as to why a big and rich league would want protective measures to succeed.
“It’s hogwash if people say the techniques that worked at Dartmouth won’t work in the NFL. ‘I don’t agree with that at all,’ Spurrier says. He added: ‘When you have injuries in practice, that’s really stupid.’”
The quest for a CTE test
While harm prevention and reduction may be showing signs of progress, the detection and subsequent treatment of sustained head harms lags — and the challenges of concussions and chronic traumatic encephalopathy, or CTE, a neurodegenerative disease linked to repeated blows to the head, persists as a significant issue, the Washington Post reported.
The newspaper’s magazine section has taken a deep dive into the complexity of diagnosing CTE in living and anxious athletes, and not, as is standard now, at autopsy. The story focuses on Sam Gandy, a neurologist at Mount Sinai Hospital in New York, and a former National Football League player named Sean Morey. As the article reported of the big problems that head injuries pose to the sport:
“A 2017 Boston University study of the brains of 202 deceased former football players found that 110 of the 111 who had played in the NFL had the disease, as did lower percentages of athletes who stopped playing in college (48 of 53) and high school (3 of 14). Linked to aggression, depression, suicidal thoughts, impaired judgment, impulse control problems and dementia, CTE was found in the brain of Tyler Hilinski, a 21-year-old Washington State University quarterback who died of suicide in 2018, and in the brain of Aaron Hernandez, a 27-year-old former NFL player who in 2017 hanged himself in prison while serving a life sentence for murder.
“The disease sparked thousands of individual lawsuits that led to the NFL’s settlement, which already has awarded nearly $790 million to retirees with cognitive impairment or conditions such as Parkinson’s or Alzheimer’s. CTE was a major factor in a similar settlement between former college athletes and the NCAA and is a key part of a second wave of football-related suits against the association and various athletic conferences and schools. Concerns about CTE also have contributed to a nationwide decline in high school and youth tackle football participation, local and state-level efforts to ban both activities, and a number of NFL and college players walking away from the game.”
The NFL’s problematic concussion settlement
The NFL faces continued legal action over its concussion settlement, with African American players filing the most recent action — a lawsuit contesting how the league uses race-based benchmarks in determining eligibility for payments. The black players say the league relies on discriminatory measures to determine their cognitive capacities and the onset of debilitating conditions like dementia due to football injury. As the newspaper reported:
“The allegations of systematic discrimination are the latest and perhaps most damning criticism of the settlement, which has been stung by delays, predatory lenders, accusations of fraud and a lack of transparency since players began filing claims four years ago. They come at a particularly awkward time for the NFL, which has battled the perception that it has dismissed the concerns of black players, who make up about 70% of the league’s active players.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by brain and spinal cord injuries, notably through concussion and other head hits in sports, especially if helmets and protective gear are defective and dangerous products.
It is good to see that public awareness has helped reduce emergency care for head traumas among the young. We still need to do more, remembering that studies have shown that patients can suffer significant damage not just by big, nasty knocks but also by milder blows to the head, too, especially if they are recurring. While young folks in the pandemic may not be participating in organized sports and getting hurt there, parents should be mindful about protecting vulnerable and developing brains and heads in casual activities around the house and the neighborhood. Be sure, for example, that the kids wear helmets while biking and skateboarding.
As for football, let us see if the NFL can play a season and manage not only its “usual” injuries, head harm-risks, and the coronavirus, too. The game certainly has its enthusiasts, and it is jarring to see rising campus Covid-19 infections, even as several of the big collegiate conferences race on toward traditional schedules of play.
Want to stir a little chatter in the next Zoom call with the football bros? At least one argument about keeping pro and collegiate football going — despite issues like the coronavirus and head harms — centers on the game’s potential to provide a lifetime lift for talented players, giving them entrée to lucrative pro careers. This is a much-promoted part of the multi-billion-dollar industry of collegiate athletics. Really? Send the pals to the NCCA stats, showing: an estimated 1 million youngsters play in high school football programs. That dwindles to ~74,000 players good enough to compete in college. And how many then get to the pros? ~16,000 are draft eligible. But 254 (!) become actual picks.