Monday, December 14, 2015

Concussion Movie & Coaching Ethos

There is no bigger issue the sport of football is facing today than the cloud of anxiety associated with long-term affects of head trauma. We have addressed this previously, but not to the extent we will be exposed today. This season we are presented with a social impetus that will move this issue into the minds of a wider audience than just football players and coaches. The movie, Concussion, amplifies the wake started with HBO's "Head Games" (2010) and Frontline's "League of Denial" (2013) with narratives too strong to ignore. The movie is a profitable venue because it is something on everyone's mind; everyone wants to learn more about this issue. 

Understand that a movie is an over-dramatization of life stories, but can serve as an effective means to illustrate a perspective (The Insider, Thank You For Smoking, Erin Brockovich, The Informant!, etc). Both the sport of football, as an institution, and the harrowing stories of NFL veterans suffering from diminished mental capacity evoke powerful emotions. With so much at play in these discussions, I feel it is important to clearly define a path of constructive dialogue. For the betterment of the sport, coaches should serve as vanguards of this dialogue, improving the sport and protecting the trust parents and our communities have in our programs. Teaming with our training staff is job number one so that we can have a better appreciation for the monitoring and treatment of at-risk athletes. In addition, educating ourselves on the physical impact of the game has to be as important as learning how to run Power against an Under front.


 To start, it will be easier to find the root issue by declaring what this conversation should NOT be about: 

  • NFL as a business: This isn't about defining liability or benefits between worker and employer. 
  • NFL as entertainment: This isn't about how players should be framed/viewed in the media. 
  • NFL as an embodiment of football: Football is a platform to deliver the entertainment product. The conditions this entertainment industry fosters leads to an increased risk/exposure to these variables. Recognize the emotions behind this product association (also exists in NCAA). Emotions are real, but not fact. 
  • The value of team sports: We are not weighing the benefits of organized competition against risk of injury. 
  • Value of mental toughness: Don't frame the risk of brain damage as if it were any other physical obstacle. Physical rehab (muscle/ligament repair) is an entirely different animal compared with brain tissue. 
  • Solely about concussions: The answers we are seeking are the origins and scope of degenerative brain conditions, known as CTE. While concussions are an issue and cited as a precursor to the condition, what we are really after is how to better understand how to better protect the brain against all effects, not just those that produce "knockouts". An oft-sited study , "Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes (2010)", provides a wealth of data that set the ground work for concussion protocols. 

How we address the next questions in light of the new information presented, will shape participation in the game of football for 14 - 24 year old males in the coming generations. I would encourage coaches this off-season to spend some time reading or viewing material presented by physicians on the long-term impact of brain trauma. While there are no absolutes at this stage in discovery, there is plenty of information available so that we can provide intelligent feedback to those with concerns. From an educated foundation, we can participate in discussions with medical professionals to find solutions. 

The sport of football has faced these challenges before. In the 70's, it was serious ligament damage (coming back from an ACL tear was unheard of 40 years ago), then it was spinal injuries, then it was dehydration, then it was heat stroke, then it was concussions, now it is long-term degenerative brain condition. I am not suggesting these are equal injuries, but its not like this is anything the sport cannot overcome. 

Moving forward, the questions, as I see it, we need to find answers for are as follows: 

What can this age group tolerate? What is the likelihood of risk / frequency? 

  • I reserve the right to be absolutely wrong later, but there is a world of difference between the hits a 15 year old takes in a game takes, a 23 year old kid takes in DIII ball, and a career in the NFL. This is really like comparing a prop plane pilot vs a jet pilot vs an astronaut. They all are flyers, but are not subjected to the same stimulus / environment. Just because they advance in the field based on an increasing set of criteria, doesn't mean the parallels remain consistent (a collision with a player of equal size does not produce the same relative force to the body). The mass/force generated by high school athletes is largely within the realm that the human body can adapt itself to.  The mass/force and frequency that can be generated in an arena played with (super) humans is easily beyond which the fragile human body can ever account for.

How do you determine the scope of injury? What factors are needed to produce a long-term degenerative situation? 

  • Products like Shockbox are a step in the right direction, but is not the panacea. It provides quantitative data that is needed to better define what transpires on the field. The next step will be to scientifically provide the conclusions of how the brain responds. Keep in mind, proper equipment and fit is important to protect the physical body, but will not prevent brain trauma caused by explosive movements. Helmets will prevent head injuries and can reduce the force inflicted on the head, but the brain is a free-floating organ (like dropping an egg within a container). With free market solutions, we have to temper our expectations because not all these products intent on selling parents on piece of mind will offer real solutions. With such a willing market (and incentives from the DoD), business will fill this void with anything to make a buck.


Temper against the risk of rushing absolute answers creates a false security in an uncertain environment. 

  •  Thankfully we are rapidly advancing technology to better understand the brain and CNS that just wasn't possible 30 years ago. Embrace this tide of innovation and knowledge. We simply did not have the technology until very recently to accurately study evidence of brain trauma outside of an autopsy. The brain trauma (onset disease) is a precursor to CTE. Of a representative sample of HS players, we need to understand how pervasive the evidence of the disease is. This is what we need to determine the scope of risk to give everyone an actionable decision. These studies help us better understand human physiology in the ever-evolving science of neurology and will benefit not only football but all contact sports (Hockey, wrestling, soccer, rugby, etc).

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