Concussions in School Sports: Is Culture Change Possible?

About a month ago, I stumbled across a news story in the Chicago Tribune about Drew Williams, a Lane Tech High School football player collapsing unexpectedly on the football field during a game. Ever since, he has been in a coma. Drew had no apparent collision during the game and that shocked and troubled bystanders. After the incident, a father of another boy on the team told his son that it was just fine if he didn’t want to play in the last few games this year.

Drew was taken away on a stretcher and brought to the hospital by ambulance. He was hospitalized until this week, when a transfer to a rehabilitation facility was authorized. However, shortly after his transfer, he suffered a setback and was rushed to a hospital because of a serious infection. His family asks for prayers and hopes to raise funds for him to pull through on a Facebook page dedicated to “this marathon we call recovery.

Could Drew’s injury have been prevented?  I don’t know. I certainly don’t feel comfortable bothering his family for an interview now, in what is clearly a very difficult time. But I read the story shortly after I attended a meeting on concussion prevention in school sports.  I am glad that concussion outcomes and prevention are getting the attention that they deserve.

For boys, the most worrisome sports are football, ice hockey, lacrosse, wrestling, and soccer. For girls, soccer, lacrosse, and basketball account for the most head injuries.

Recent reports of suicide, traumatic brain encephalopathy, and violence in NFL players and other athletes are troubling. In the report commissioned by the Institute of Medicine and National Research Council released Oct. 30, the authors call attention to “changing the culture.” The authors write:

“Too many times the committee read or heard first-person accounts of young athletes being encouraged by coaches or peers to “play through it.” This attitude is an insidious influence that can cause athletes to feel that they should jeopardize their own individual health as a sign of commitment to their teams.”–     p.6, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, National Academy of Sciences, Oct. 2013, prepublication copy.

Why is There Not More of a Public Outcry?

When you take a look at reports like the Institute of Medicine/National Research Council and recent peer-reviewed publications on outcomes of concussion, a huge knowledge gap is evident, but what is known is not comforting. Some of the more disconcerting issues to think about are as follows:

  1. Head injuries are invisible to observers beyond perhaps watching initial impact. Brain swelling and bleeding won’t be obvious without medical evaluations.  Problems with memory and processing speed may only be evident if objective testing is done.
  2. Research into the effects on the brain after concussions in youth, and differences between boys and girls, and different ages have only recently begun. So play continues with incomplete knowledge.
  3. After one concussion, athletes may be at greater risk for more severe concussions and take longer to recover. Not recovering from a concussion may be a key risk factor for another concussion, and increased severity of subsequent concussions.
  4. No sports figure has emerged yet that could serve as a role model for safety in sports. We have had suicides and violence in NFL active and retired players. This has propelled a research infrastructure, legislative changes, and some outreach.
  5. Only recently have we begun to track the course of recovery. Historically, questions about malingering unfairly stigmatized kids who were not recovering.
  6. Information on the race, ethnic background, or socioeconomic status of youth who sustain sports related concussions is not reported in studies, so we cannot determine if disparities exist. However, given that about 2/3 of NFL players are African-Americans and football injuries are the leading cause of head injuries for males, one wonders if a similar proportion of African-American youth is at increased risk of concussions.

There are some positive signs. In a subsequent post, I will point to legislative changes, research, and educational programs that could help reduce concussions.