Football is an athletic chess match in which the pieces are combative giants. For that reason, the game is capable of providing us moments of great beauty: the acrobatic touchdown catch, the zig-zagging punt return, the muscular fourth quarter goal-line stand.
There are also moments of great ugliness. Consider the wide receiver who is blocked, falls to the ground, and gets up with a tilt-a-whirl gait before he’s helped to the sideline; or remember the quiet that falls when a human pile melts away to reveal a defensive lineman who just isn’t moving.
According to the University of Pittsburgh, 34 percent of college football players have suffered at least one concussion, and approximately 20 percent have suffered multiple concussions.
Meanwhile, the NCAA says the problem isn’t getting better. After a 21-year period of decline, the rate of football-related concussions has remained steady for the past eight years.
That’s why, as of August 10, 2010, NCAA rules have required its member institutions to have concussion management plans on file. These plans must include informational programs for the student-athletes and policies that prevent concussed athletes from returning to competition until cleared by appropriate medical personnel.
Some of the plans even go beyond that. Big Ten Schools, for instance, are required to keep medical records that accurately reflect an athlete’s history with head injuries. They must treat concussions the same regardless of whether they happen in practice, a game, or during an athlete’s downtime. They are even obligated to make accommodations so a concussed athlete does not suffer academically.
It’s more than just the NCAA and the conferences that are responsible for helping to deal with the issue of concussions, and some of those responsibilities overlap. Although it’s not an exhaustive list, here are some of the ways people are trying to make sure college football is headed in a safer direction.
In addition to requiring schools have a concussion management plan, the NCAA also has a competitive safeguards committee. The 20 members of this committee (including Ohio State assistant professor of internal medicine Kelsey Logan) serve the NCAA in an advisory capacity.
Earlier this month, the NCAA also named its first ever chief medical officer, Dr. Brian Hainline. He’ll be on the job as of January of 2013. Considering he has a background in neurology, he could play an active role in the NCAA’s endeavor to deal with concussions.
Finally, the NCAA has instituted several rule changes in football in an attempt to protect athletes. Moving touchbacks to the 25-yard line was part of this effort. New helmet rules were a part of it, too.
The rule book itself states: “Officials and coaches shall give special attention to players who exhibit signs of a concussion.” There’s an entire appendix of the rule book devoted to the subject, and you can read it here.
The NCAA's ground-level enforcers on game day are, of course, the officials. They have to make sure the game is played fairly and cleanly, which in and of itself helps to protect the athletes.
When these protections aren’t enough, officials are charged with recognizing the signs of a concussion and making sure the athlete is safely removed from the field.
Some specialized training can help. Big Ten Coordinator of Football Officials, Bill Carollo, says in his league, they’ve invited either doctors or trainers to their summer clinics the past few seasons to help teach what to look for when injuries occur in games.
In June 2010, the Big Ten was the first conference to develop a concussion management plan its schools could model their own protocols after. (You can see the plan the Big Ten uses as its baseline here.)
In June of this year, the Big Ten announced they were joining the Ivy League in an effort to research head injuries and compile data from a number of other exisiting research projects.
Some of these studies can seem quite space age. At Illinois, a review board is currently looking over a proposal to test cooling helmets. At Ohio State, small electronic sensors, so small they were once used to track the movements of bumblebees, have been monitoring the movements of Buckeye freshman.
Big Ten Associate Director of Compliance Kerry Kenny has more…
(And this is a link to the full interview with Kenny.)
Conducting vital research is obviously a function of the schools, but so too is making sure the information finds its way to the coaches, athletes and trainers.
Northwestern is one of many universities that, by rule, has an educational program designed to dispel the myths regarding concussions as well as teach athletes to recognize the symptoms.
Once an athlete is injured, the education continues. The Wildcats provide a set of take-home instructions to injured players that include recommendations on what to eat, what medicines to avoid, and the advice (to college students no less) that it’s best to keep from watching TV, texting or playing video games.
Based on his experience, Wisconsin’s head trainer Mike Moll told Fox Sports he estimates half of concussions occur in practice and the other half in games, so the medical staff always has to be on their toes.
Add to this the fact that concussions are not easy to diagnose. "Assessment and management of concussive injuries, and return-to-play decisions remain some of the most difficult responsibilities facing the sports medicine team," says the 2012-2013 NCAA Sports Medicine Handbook.
No two head injuries are the same. Symptoms differ from person to person and can show up minutes or hours after contact. A relatively minor force can lead to a major injury.
Whether the concussion is mild, moderate or severe, however, the trainers are the front line when it comes to ensuring the safety of the players.
The best thing coaches can do is create an atmosphere where trainers can make a diagnosis without pressure and players can report symptoms without stigma.
“Everybody is so nuts about it right now, which they should be,” says Ohio State’s coach Urban Meyer.
Like all Big Ten coaches, Meyer has had to sign a waiver acknowledging he knows the risks his players face. By signing, he promises to report any instance where he witnesses a player exhibiting symptoms of a head injury.
When former Buckeye Andrew Sweat called it a career because of recurring symptoms from a concussion, he was criticized. After all, when you’re not wearing a brace, a bandage or a cast, it can be easy for outsiders to question the severity of an injury.
For athletes, it is crucial to realize the risks are real. There are some things you just can’t "tough out."
"It is pretty hard," said Buckeye defensive back Christian Bryant when asked how difficult it is for a player to take himself out of a game. "You just can't let your pride get in the way, and I feel like as an athlete, you should know when you can go and when you can't go."
For all the attention, there are still some major challenges.
The fact is that with so many individuals sharing the responsibility to protect players, it’s easy for any one person to avoid feeling that theirs is the final responsibility.
Also, the risks are still being borne by the athletes alone. Teams are not punished; schools are not punished if a coach or trainer behaves recklessly.
Kerry Kenny of the Big Ten admits there is no established procedure for dealing with negligence when it comes to concussion management. “We have not had to deal with that in the two years since the NCAA mandate came out,” Kerry said.
There are also undoubtedly issues with the NCAA or the conferences legislating the way a team deals with an injury that doesn’t typically show up on an MRI or CT brain scan.
However, the NFL provides examples of a couple of steps that can be taken.
First, the NFL rules all players who lose consciousness must be removed from activity for the rest of the day. No such bright line exists in the college game. Michigan State's Mark Dantonio told reporters that is part of the reason William Gholston was allowed to return to play against Ohio State.
Second, the NFL requires a trainer to sit in the press box, monitoring both teams for players who may have sustained head injuries. One person dedicated to watching for potentially concussive hits reduces the chance such a play will be missed by a busy coach or a training staff already working on another player. It helps prevent a disoriented player from misleading the trainer about the nature of his injury.
In the end, there is no way to reduce the risk of concussion to zero, so what is a reasonable goal? What’s the best case scenario?
This is a question that needs answered, and these are challenges that need tackled for the game and its participants to remain healthy.