Tyler Joy
Brother John F Tyron, C.S.C
English 101-2
10 May 2011
Sports Concussions and Prevention
One of the most talked about topics in all of sports is concussions. Concussions have
recently become a large problem in both amateur and professional sports. It may be a little
suspect that these issues of head contact and concussions are only recently being made out to be
such a big deal. Sports containing regular body contact, a leading cause of concussions, such as
football and hockey haven’t undergone any drastic rule changes or equipment changes leading to
more concussions. If anything, the advancements in equipment would help to lessen the
likelihood of head injuries in contact sports. Many experts and former professional athletes
argue how the technique for tackling, hitting, and checking resulting in direct head contact leads
to concussion. The protocol for diagnosing a concussion occurring during a game or practice has
been changed numerous times. There is a great deal of mystery when it comes to diagnosing a
concussion and how they occur. With so many points of view and arguments the base question
still lingers. Are professional and amateur sports doing enough to protect their athletes from
concussions?
A good place to start on this issue is the definition of a concussion. A concussion is a
brain injury caused by a sudden blow to the head or body that shakes the brain inside the skull
which temporarily prevents the brain from working correctly (1177 Collins 2002). The brain is a
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soft organ surrounded by spinal fluid inside of a hard skull. This spinal fluid acts like a cushion
that normally prevents the brain from banging against the skull. In certain situations where
either the body or head is hit hard enough, the brain will crash into the skull resulting in a
concussion. Symptoms of a concussion are classified into categories from mild to severe.
Common symptoms include passing out, memory loss, grogginess, loss of balance and nausea.
Typically, these symptoms subside anywhere from a few days to a few weeks depending on the
severity.
Recently, the term concussion has been replaced by a broader term. Mild traumatic brain
injury (MTBI) is the dominant term that has been implemented by the scientific community in
recent years (3 McCrea 2008). The scientific community has had a great deal of trouble coming
up with a concrete definition of mild head injuries, but as of late, MTBI is interchangeable with
concussion and other mild head injuries. Much confusion and inconsistences exist when talking
about MTBI. “MTBI has long been considered the most perplexing and challenging encounters
clinicians throughout the neurosciences” (McCrea 2008). Neurologists are extremely frustrated
by how cases of MTBI don’t fit into any one reasonable, neurological explanation. Research has
shown most people who have suffered from MTBI reach full recovery within three months. In
some cases, a more severe set of symptoms presents themselves in the form of post-concussion
syndrome. There is much controversy when defining what post-concussion syndrome entails
and its symptoms. Post-concussion Syndrome (PCS) is a neurophysiological disorder caused by
traumatic brain injury such as a concussion. PCS is generally classified as symptoms of a
concussion lasting longer than three months (89 Fisher 2008).
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Most of the controversy surrounding concussions stems from professional and amateur
sports. One of the most talked about issues in the National Football League is the viscous hits
leading to players missing playing time due to concussions. With the 24/7 media coverage of
nearly all professional sports, it is safe to say most people have heard something about the
concussion problem in the NFL over the 2010/2011 season. From September to February,
newspapers, radio stations, magazines and television made it almost impossible to miss this issue
in the NFL. Even if all of those media outlets were avoided, the sports media juggernaut EPSN
had enough coverage to make up for all the other media markets. This allowed the viscous hits
from the previous Sunday to be played over and over again. The analyst as well as the viewer
had numerous views in real time and slow motion to dissect the hit. The hits the National
Football League deemed “viscous” were ones that targeted the head of defenseless players. An
argument might be presented that this influx of media coverage might blow the whole issue out
of proportion. While this may be true, concussions were more frequent in the 2010 season.
According to the NFL and the Associated Press, 154 concussions were reported in practices and
games from the first preseason game to week eight of the regular season. This is a 21% increase
from the same time period in the 2009 season and a 34% increase from the 2008 season
(Schwarz 2010).
NFL commissioner Roger Goodell has been working alongside the federal government,
state legislatures, and football helmets regulatory body on concussion prevention. In December
of 2010, the NFL’s head, neck and spine committee joined helmet manufactures, physicists, and
military biochemists at a meeting in New York to discuss helmets in football and their relevance
to the frequency of concussions (Schwarz 2010). Between these high caliber groups, many ideas
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filled the room. Since so many parts of a concussion are still unknown, all of these ideas will be
part of a continual search for safety. Dr. Joe Maroon, neurosurgeon for the Pittsburgh Steelers
said, “The problem is there is still more questions than answers.” The most obvious solution for
concussion prevention in contact sports would be the helmet. After all, the helmet is there for
the sole reason to protect the head. The problem in the helmets being worn now is they protect
against skull fractures and not concussions. There is one huge reason for this. There is not
enough understanding about how concussions happen. It would be impossible to design a helmet
around unknown parameters.
The National Hockey League (NHL) is having its own issues with concussions and
player safety. Similar to the NFL, there has been an increased focus on head shots and
concussion care. Two of the league’s premier players in Sidney Crosby and Marc Savard have
missed a combine 98 games this season due to concussions resulting from hits to the head.
Sidney Crosby is arguably the best player in the NHL and is widely considered the face of the
league. Crosby received a blind-side hit in the 2011 Winter Classic played annually on New
Year’s Day. Crosby was visually distressed as he slowly made his way off the playing surface.
He ended up finishing the game despite the potentially head injury. On January 5, 2011, Crosby
received another hard check and he hasn’t been seen in a game since. The official report from
team doctors of the Pittsburgh Penguins is Crosby is suffering from post-concussion syndrome
(Allen 2011). While this is Crosby’s first incident, Marc Savard has battled concussion related
problems for the last two seasons. Savard suffered his first concussion on March 7, 2010 when
he received an elbow to the back of his head. He missed the last eighteen games of the regular
season and the first two rounds of the Boston Bruins playoff run. He returned for the
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seven games of the Eastern Conference finals of that year. During the offseason, Savard
complained of memory problems and said, “Everything seemed to moving slower” (Lebrun
2011). Savard’s post-concussion syndrome also included a bout with depression. He then
missed the first twenty-three games of the 2010-2011 before returning to the lineup, but he
wasn’t the same player. Savard sustained his second concussion in less than a year on January
22, 2011 on a legal hit. Since this latest concussion, Savard has been placed on long-term
injured reserve and isn’t sure if he will ever return to professional hockey (Lebrun 2011).
While Savard and Crosby are just two high-profile players, the NHL is on pace for over
80 concussion reports amongst its players during the 2010/2011 season (Klein 2011). The
NHL’s concussion-prevention program has been in place since 1997 and is recognized as the
earliest and most advanced in professional sports (Klein 2011). Having said that, hockey is
second in concussion frequency in team sports trailing only football. With a plethora of illegal
checks to the head, the league and Commissioner Gary Bettman have recognized the threat to the
health of their players. Illegal checks have been called tighter and stiffer suspensions handed out
for repeat offenders. The NHL general managers’ meetings in Boca Raton, FL were the first
major step towards a revised policy on concussions. The weeklong event addressed many issues,
but concussion prevention was at the top of the list.
Bettman introduced at these meetings a five point plan to reduce concussions in the NHL.
The first part of the plan involves the NHL Vice President of Hockey and Business Development
and hall of famer Brendan Shanahan. Shanahan and the Players Association have the task of
focusing on player equipment. The league would like to see the size of the equipment reduced
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without compromising its protective qualities. The idea behind this is the size of the shoulder
pads and elbow pads are contributing to the increased frequency of concussions. The second
point Bettman made dealt with the rinks in all thirty arenas home to NHL teams. A safety
engineering firm will be consulted to evaluate the rinks to see if any changes can be made to
improve player safety. Currently, some of the NHL rinks use seamless glass to enclose the
playing surface. Plans are in motion to replace the seamless glass with plexiglass for the
2011/2012 season. According to a panel of current players, seamless glass is much harder and
doesn’t have as much cushion or give as the plexiglass (nhlpa.com 2011). The final three points
are revisions to the current NHL Protocol for Concussion Evaluation and Management: 1)
Mandatory removal from play of a player reports any listed symptoms or problems; Slow to get
up following a hit to the head, loss of consciousness, balance problems, blank or vacant look,
unaware of his surroundings, clutching the head after a hit, and visible facial injury in
combination with any of listed symptoms. 2) Examination by team physician (not a team trainer)
in a quiet room free from distraction. 3) Team physician is to use an acute evaluation tool such
as the NHL SCAT 2. NHL SCAT 2 stands for Sports Concussion Assessment Tool (Nhl.com
2011). The NHLPA Executive Director Don Fehr released this statement in concurrence with
Bettmans plan. “This is a significant step to improve player safety, and concussion protocol is an
area where we will continue to work with the league through the joint NHL/NHLPA Concussion
Working Group” (nhlpa.com 2011).
While concussions in professional sports are something we see on a national scale, a less
talked about issue is of children receiving concussions in sports. This should be the largest
concern of any issue regarding concussions. Children start sports at a very young age, but
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it is easy to see why. Sports have become such a competitive area that it is almost necessary for
children to begin playing at a young age so they can make their varsity high school team in ten or
twelve years. A child can begin playing football at the age of five with full contact and virtually
the same rules as professional football. Hockey has a similar set of rules. While youth hockey
doesn’t permit body checking until the Peewee level (11-12 years old), young players can begin
as early as three years old. It is not the children in the five to thirteen year old range that need to
be worried about. A review of the national databases of emergency department(ED) visits states
there were 502,000 concussion related visits, and half of those visits were sports-related in
children from the ages of eight to nineteen during the time from 2001 through 2005 (Lifespan
2010). Findings of this study showed 65 percent of the sports related concussions were reports
from children ages fourteen to nineteen. Eight to thirteen year olds account for the other 35
percent. The researchers in this study also found ED visits relating to concussions in organized
team sports went up 200 percent in the 14-19 year old group in comparison to the previous five
years. This astounding increase occurred during the same time period where there was an overall
13 percent decrease in participation in organized sports. The senior author of this research is
James Linakis, MD, PhD. He is a pediatric emergency medicine physician with Hasbro
Children’s Hospital and its Injury Prevention Center. When referring to the study Linakis says,
“Our assessment highlights the need for further research and injury prevention strategies
into sport-related concussion. This is especially true for the young athlete, with
prevailing expert opinion suggesting that concussion in this age group can produce more
severe neurological after-effects, such as prolonged cognitive disturbances, disturbed
skill acquisition, and other long-term effects” (2,958 Linakis 2010).
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This study definitively shows how young athletes are at risk for long term injury. It may
be easy to understand why concussions are on the rise in this age group. There is surplus of
available sports activities whether they are organized or recreational. A drastic increase in the
competitiveness of youth sports and the length and intensity of practice time would be an
obvious catalyst for the increase in sports concussions. However, the spike in the numbers of
reported incidents might also be a result of better awareness of a concussion and its symptoms.
While all of this is understandable, it is outrageous with all of this information, there is still no
comprehensive return to play guidelines for young athletes who have experienced a concussion.
There are no specific guidelines for parents, coaches, or doctors on how to handle a concussion
in a child. There are also none for adults, but Dr. Linakis and other experts agree children and
adults should have separate guidelines for concussion treatment. The researchers of this study
also stick with the same story as nearly all other experts in the medical field. There are no
definitive, evidence-based guidelines for the treatment of concussions.
The current coaches of young adults will be the ones who dictate whether this rise in
concussions continues. In contact sports like hockey and football where hitting is an
irreplaceable part of the game the correct methods for tackling and checking must be taught.
Players must learn at a young age the appropriate ways to give and receive hits or checks.
Coaches have to teach the fine line between playing physical and taking it too far. If a player
learns a dangerous or incorrect way of tackling at a young age, there is a very good chance he
will continue this way of hitting until his career is over. The gruesome and viscous hits are the
ones making Sportscenter the next day and in turn getting all the media attention. Experts and
analyst (most who have played professional sports) claim some of these hits are unavoidable
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because they happen too quickly. This is true, but there is a definite grey area when deciding
whether a hit is unavoidable or a dirty play. It is debatable whether some of these hits can be
removed from professional sports in the short term. Perhaps the reputation of contact sports can
be saved by coaches teaching the proper methods early in a player’s career.
A sports league can do all they want with guidelines, fines, suspensions, teaching, and
meetings, but accidents are still going to happen in any sport. Injuries can occur in a seemingly
harmless sport such as volleyball given the right circumstances. Accidents are going to happen.
Players run the risk of all types of injuries including concussions every time they strap on the
pads. With the increase in research and knowledge of concussions the risks are more out in the
open than ever before. Now-a-days, players and parents alike know the risks that accompany
contact sports and it is ultimately there decision to participate.
It is fairly obvious to see how concussions are going to be a part of contact sports at any
age as long as they’re played. With this in mind, the issue surrounding concussions should focus
on the protection of the players. Leagues like the NHL, NFL and NCAA would be non-existent
without the players since they are the brand. Almost any business group is out to make money
and having star players sidelined doesn’t help them make money. So there are realistically two
reasons for protecting players of all levels. The first and more sinister reason would be for
professional leagues to make the maximum profits. The second and more important of the two is
the short and long term health of players of all ages. Whether they are amateur or professional,
recreational or organized, a set of guidelines should be in place for concussions. Professional
leagues such as the NHL and NFL have begun to set the standard for concussion prevention and
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treatment. The NFL has recently instituted strict fines and suspensions for viscous hits in an
attempt to cut down on the likelihood of concussions. The NHL and Commissioner Gary
Bettman have laid out there five point plan for concussion prevention and treatment. Some of
the ground work has been set. The process has begun for the protection of athletes, but there is
still a long way to go. Young athletes in the eight to nineteen year old range are the ones who
are most susceptible to concussion yet they have the least amount of protection as far as
guidelines and protocol. The issue still remains that not enough is known about concussions to
make a concrete set of guidelines for treatment and prevention. This issue will continue until
there is a huge scientific breakthrough which provides a better understanding of brain injuries.
Until then, sports leagues and medical experts will have to do their best and provide a set of
universal guidelines for adults and a separate one for children. After all, the long term health of
all athletes should be the number one priority.
Works Cited
Nhl.com. (2011, March 14). Retrieved April 13, 2011 , from Bettman presents 5-point plan to
reduce concussions: http://www.nhl.com/ice/news.htm?id=555985
nhlpa.com. (2011, March 14). Retrieved April 13, 2011, from Statement from NHLPA executive
director Don Fehr initiatives announced at the GM meetings today in Boca Raton,
Florida: http://www.nhl.com/ice/news.htm?id=555985
Allen, K. (2011, January 21). Crosby Out for Allstar Game. USA Today.
Collins, M. W. (2002). Cumulative Effects of Concussions in High School. Neurosurgery, 11751181.
Fisher, J. D. (2008). Post Concussion Syndrome. Pediatric Emergency Medical Journal, 87-89.
Klein, J. Z. (2011, March 21). NHL Urges Uniformity on New Concussion Protocol. New York
TImes.
LeBrun, P. (2011, March 27). Memory Issues for Marc Savard. Retrieved April 5, 2011, from
ESPNBoston.com: http://sports.espn.go.com/boston/nhl/news/story?id=6262553
Lifespan. (2010, September 13). Concussions in Young Athletes on the Rise, Especially in
Hockey and Football Players. Retrieved May 9, 2011, from Science Daily:
http://www.sciencedaily.com/releases/2010/08/100830094924.htm
Linakis, J. (2010, August 30). Emergency Department Visits for Concussions in Young
Children. Pediatrics, 2009-3101.
McCrea, M. (2008). Mild Traumatic Brain Injury and Post Concussion Syndrome. Oxford, New
York: Oxford University Press.
Schwarz, A. (2010, December 8). NFL Invites Helmet Safety Ideas. The New York Times, p.
B16.