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Every athlete wants to keep playing. For those who love their sport, nothing short of a broken bone sticking through the skin is going to keep them off the field or court.
There is a famous — and true — story about former San Francisco 49ers Hall of Fame defensive back Ronnie Lott. Faced with missing a wild-card playoff game a week after breaking his pinkie in the final game of the regular season, Lott had doctors cut it off — a decision he later regretted.
Lott told Sports Illustrated: “We’re becoming gladiators. If I ever become a coach, I hope I never lose sight of the fact that players are people. They feel. They have emotions. I could have all of Eddie DeBartolo’s (then 49ers owner) corporations, and it isn’t going to buy me a new finger. It has given me a new perspective on life.”
Lott lost a finger, but there is a much bigger danger in the world of contact sports that also thrives on athletes’ determination to continue playing no matter the circumstances. Concussions are a silent injury that, over time, cannot only end a career but also a life.
Locally, a notable case is that of the late DuQuan Myers, who, in 2017 at only 26 years old, took his own life just two months shy of graduating from Texas State University with a degree in criminal justice — which would have been his third college degree. He also spoke several languages and, in general, was known to be a very intelligent young man.
But researchers at Boston University determined he had chronic traumatic encephalopathy, also known as CTE, an injury caused by repeated head injuries. His mother sued Riddell, the football helmet company, to no avail, but arguments such as hers have prompted many trainers, doctors, and coaches across the nation to take a much closer look at concussions and their long-term effects.
Myers, by the way, only played football from sixth grade through high school. That’s a relatively short time for many players in Texas and certainly much less than athletes who go on to take poundings throughout college and even into professional careers.
“SMU takes concussions very seriously and encourages our student-athletes to take them seriously as well,” said Brad Sutton, senior associate athletic director/external affairs.
Sutton said the athletics department provides concussion education training twice for incoming freshman student-athletes during their first year. This training includes:
1. Review what a concussion is and how they occur
2. Common symptoms of concussions
3. Importance of early reporting
4. Understanding their role in concussion management — self-report and be a good teammate and report concern
5. Review baseline testing
6. Review management plan (initial injury, recovery, RTP, and academics)
7. Opportunity to ask questions
He added that the topic of concussions is also covered with each team at the start of every season, so all athletes get fresh education on the topic annually.
Likewise, TCU Associate Athletics Director for Communications Mark Cohen said annual concussion education training is held with student-athletes and all staff who work directly with them.
Small College Taking Giant Steps
But it’s not only large universities that are tackling the subject of concussions and long-term effects with student-athletes. Texas Wesleyan University has emerged among the leaders in educating participants in sports to recognize and self-report when they believe they have a concussion.
Every year prior to the beginning of the season, head athletic trainer Ritchy Hitoto gives a 45-minute review of the signs and symptoms of concussion. Athletes are taught how to recognize their own symptoms (what are they experiencing) and how to recognize signs of concussion in one another. The coaching staff also participates in this activity as a refresher.
Faculty are, likewise, trained to know how to look for a possible concussion in student-athletes even as they sit in class.
“As the concussion return-to-learn case manager, I provide an annual review to our faculty, informing them on the signs to look for in class or in academic performance so that they can report suspected concussion,” said Pamela Rast, professor/chair of kinesiology at Texas Wesleyan.
“As we gradually return concussed student-athletes back to class, the brain is stressed, and symptoms can return. We need to know these things so that we do not return an athlete to play before their brain is healed. I believe our process works to protect our athletes because we have smaller classes and faculty can actually get to know their students.”
Return-to-learn protocol references the effects of a concussion on a student’s cognitive ability, which may require educators to provide classroom and school accommodations for a student until he/she is fully recovered.
And while CTE isn’t detectable until after a person’s death, Rast said any and all education student-athletes can receive about the dangers of concussions is important — now and in the future.
“The training and discussions don’t really revolve around CTE, although it might be mentioned. The key is to get our athletes treated as soon as possible,” she said. “So, we focus on those things that the athlete can see as more immediate issues. But by doing that, we may be helping to reduce that repetitive trauma associated with CTE.”
Texas Wesleyan Rams head football coach Joe Prud’homme is a huge advocate of concussion education.
“The whole goal is so the athlete can recognize symptoms, signs, when to self-report, and that way we can encourage them to report if they feel like something’s wrong,” Prud’homme said.
“We have a lot of kids that we’ve gotten at an earlier stage. Sometimes kids think it was just a headache, or they just shake it off and you have a second impact syndrome. But we’ve had a lot of guys who have been able to self-report, and it’s really helped fend off potentially worse situations.”
Prud’homme also noted that, unlike other injuries, such as ankles, knees, or joints, which are all noticeable, concussions often show no immediate signs. Often, only the athlete themselves know there is a problem, and that might not be until practice or the game is over.
“That’s why it’s so important for athletes to self-report and have an awareness of it — and going forward, protect themselves long term,” Prud’homme said.
Don’t Blame It All on Football
So much of the blame for concussions is automatically directed at football. And while that sport certainly has its share, statistics show that it is not the top sport in which concussions are seen.
A study recently published in the American Journal of Sports Medicine analyzed the NCAA Injury Surveillance Program data from Fall 2014 to Spring 2019 and over 8.4 million athlete exposures for sports-related concussion counts and rates. What they found was that men’s ice hockey and women’s soccer actually had higher rates of concussion than football.
Other sports noted in the top 10 (listed from most to least) were women’s ice hockey, women’s gymnastics, men’s wrestling, women’s field hockey, women’s basketball, women’s volleyball, and men’s soccer.
Whatever the sport, Rast said there are several reputable internet resources for information on concussion and other sports-related conditions to help athletes while they are in school and beyond. They include the CDC HEADS UP Resource Center, which has some strong resources for school and club coaches, and the Korey Stringer Institute has a lot of important information about heat illness and concussions.
Stringer was a former Minnesota Vikings defensive lineman who died from heat stroke.
This information is for more than the athletes themselves, Rast stressed.
“It is important to educate not just the athlete and the coach but also parents (of minors) and teachers,” she said.
A Doctor’s Take
Recent studies have shown that many people who are concussed do not go on to develop CTE, but evidence suggests a pattern of repeated minor head injuries increases the risk.
Renowned neurologist Dr. George Cravens of the Center for Neurological Disorders noted that “Concussion rates for kids under 19 —especially those who play football — it’s doubled in recent years. But football is a major part of our heritage.”
That said, several former NFL athletes such as Emmitt Smith and Brett Favre have come out in favor of more consistency of the league’s enforcement of concussion protocol. Favre has even said that, while he’s not certain he has CTE (again, no way to know until after death), he is experiencing memory loss that he’s sure is connected to his playing days.
Cravens said it is important for young athletes to be aware of what could be awaiting them years down the road. He said ultimately it is up to them to learn all they can.
“I think athletes should take interest in his or her own health care and to be aware of the possible long-term consequences. Make the athlete aware of what can happen, and they can take ownership,” he said.
Cravens strongly suggested learning the laws in your state concerning concussions.
“I think it’s important for parents, coaches, kids, everyone connected to be aware of the laws. They differ from state to state,” he said.
Texas has “Natasha’s Law.” It requires school districts to create concussion oversight teams that must include at least one physician and to establish return-to-play protocols that involve evaluation of the athlete by a physician.
The law was named after former Allen High School and Texas State University soccer player Natasha Helmick, who suffered so many concussions she had to give up the sport and her dream of playing in the Olympics.
Cravens also stressed that, in addition to looking out for concussions during the season, he would like to see impact testing to get a baseline on where an athlete is at the beginning of a season and again at the end. If things change, take note and do something, even if it means not playing.
After all, it is possible for an athlete to not experience a concussion but still suffer from repetitive impact.
“If you don’t let it recover, it’s only going to get worse,” he said. “I love football. I played football, and honestly, I remember some times when I probably had a concussion.
“Of course, you do start getting into that privacy thing, but I’d want to know if I were an athlete. You test at the beginning of the season and if, at the end, you’re worse, you’ve got to do something.”
Some folks have gone as far as suggesting all football becomes no-contact, such as in flag football. And while that is something Cravens sees as a possibility, though far from a probability, there’s also bumping, falling, and collisions in that sport like others.
So, when you break it all down, he said it’s really not that complicated. Try to prevent concussions, of course, but if you do suffer one, treat it as you would any injury and give yourself proper time to heal. He said that’s at least a week to 10 days, longer for younger players.
Just like trying to make a sharp turn on a knee or twisting a back that hasn’t healed properly risks further and even permanent damage, it’s the same with the brain. Many athletes hobble later in life because they pushed their knees too far, or they can’t bend over because of a permanent back injury.
You definitely do not want to permanently damage the brain, Cravens said.
“If you bruise the brain and do it again, the bruise gets bigger, bleeds, and then you’ve got something really bad going on,” he said. “Today’s players are faster, heavier, they hit harder. Maybe you can reduce contact in practice, but you’re still gonna have the game.
“If you don’t take the proper precautions, it will come back and haunt you.”
