Following a cluster of terrible injuries on Washington football fields, the editorial board had a conversation with brain-injury experts and an NFL health and safety executive.
Editor’s note: A cluster of terrible injuries on Washington state high-school football fields over the last month adds urgency to the mission of the newly formed Sports Health and Safety Institute at the University of Washington.
With $2.5 million in startup funding from the NFL, the institute will draw on evolving knowledge of concussions and other injuries to educate players, coaches, schools and leagues on how to make sports safer.
The institute will also advocate for safety policies and rules, building on the Zackery Lystedt Law passed in Washington in 2009 and then extended to all 50 states.
Named for a Maple Valley teen disabled after a football concussion, the law requires that youths who appear to have receive a head injury be removed from play or practice. They can’t return until they’ve been cleared by a licensed health official.
More research and education is clearly needed. Concussions can be difficult to identify and doctors still don’t understand why they have such varied effects on people.
The NFL is right to support this work as long as it continues to allow the institute to operate autonomously and unconstrained.
Recently, The Seattle Times editorial board met with Jeff Miller, NFL senior vice president for health and safety policy, along with brain-injury experts leading the institute: Dr. Stanley Herring, medical director of the UW Medicine Sports, and the Spine and Orthopedic Health program, and Dr. Richard Ellenbogen, chairman of the UW Medicine’s Department of Neurological Surgery.
The following are excerpts from the discussion.
Q: When players get concussions, what’s known about the extent of injury and being vulnerable to more dramatic or even fatal outcome in a second concussion?
Ellenbogen: You’re asking the billion-dollar question that everybody wants to know. If you’re 7-years-old and you fall off your bicycle, does it mean that when you’re 77 that’s the reason you have Alzheimer’s? I tell people, life is a concussion sport. Forget about football. The majority of traumatic brain injuries, the mild ones, occur from running, walking, bicycling, cars, falling from the playground. What we know is that most people don’t have long-term side effects, but some do, so genetically what’s different? What is different about you versus me — if I hit my head in the car, what’s the long-term effect of that? We don’t have those studies.
Herring: There are unique risks for young people. Young kids seem to take a bit longer to recover. What happened to Zack (Lystedt) happens to young people; it doesn’t happen to adults. So there are unique vulnerabilities for young people — you can’t model youth concussion treatment off of what we do with professional athletes, you have to be a little more careful.
Q: You say each brain is different, but that’s not helpful for parents whose kids are playing now. Do you say “one concussion and you’re done,” “two concussions and you’re done,” or does it not make a difference? What do you tell parents?
Herring: You tell them that the great majority of people who are concussed, young people, recover and appear to do well throughout life. You say, listen, no two concussions are the same and everybody recovers differently. I ask them to please … make sure their child stays active 60 minutes a day, I don’t care what sport they do. Because the long-term consequences of not being in sports and not exercising are probably more dangerous than the risk of exercise. And you say: It’s very important that your daughter or son gets all the way over this episode, that’s very important, we do know that.
It’s never a number (of concussions). But trending — multiple concussions close together, concussions that occur with smaller blows, concussions that last longer — so you look for trending, and then you have to make an educated choice because we really don’t know how many are too many. This is a judgment call. The great majority will be fine, but you have to manage each one seriously and you have to make choices.
Q: Medical societies are taking a stand on activities from smoking to sugary drinks in schools. Where’s that line with football, that the risk is too much?
Herring: You haven’t seen medical organizations do that with football. There’s a reason for that — there’s just not enough data.
Q: Where does that research need to go?
Ellenbogen: More kids are dying of heart problems on the playing fields than they are of traumatic brain injury. They estimate between 4 million and 5 million kids played football last year — six catastrophic injuries last year. Put it in perspective — two people are dying every day on bike lanes, are we going to outlaw bikes?
I prefer, instead of telling my kids you can’t ski because there are so many kids that die, that go off the cliff, here are the railroad tracks you operate in. You’re going to ski, you’re going to wear a helmet.
It’s educating parents, it’s getting every parent out there making wise choices for your kids.
Q: What would be a better solution: helmets with sensors that indicate when you’ve received too much impact — measured by G-forces — or to have no helmets and reduce padding?
Herring: The sensor work is intriguing, I just wish we knew what it meant. The sensor work that has been done does not show any correlation between the size of the G-forces and clinical concussion.
Ellenbogen: We don’t want to get rid of helmets. Helmets work in catastrophic injury — it prevents skull fractures, it prevents hematomas in the head. Get the head out of hitting. Get kids, whether they’re skiers, football players or lacrosse players, to not lead with their heads. I yell at everybody on the Burke-Gilman Trail as they go by without their helmets, “Put a helmet on!” I usually get flashed the middle finger.
Herring: The helmet was never designed as a concussion-prevention tool, it was designed to prevent skull fractures. It’s worked pretty well for that.
Ellenbogen: That’s where we got in trouble, I think, in sports, is kids put on helmets and then thought they were invincible.
Q: Parents are worrying about injuries. What happens to the NFL in a generation if participation continues to decline?
Miller: It’s our responsibility to educate and to change the game where needed. We have large-scale programs to replace helmets, equipment, that kind of stuff, for (communities) that can’t afford it.
What makes that question particularly difficult is the premise of it isn’t as clear as many people think. Football participation over the last five years is down. But if you look at other sport participation — basketball, soccer and baseball — are all down well more than football over that same time frame. The only sports that are up, pre-high school, are rugby, lacrosse and ice hockey. So the questions that people have around health and safety of football and other sports aren’t reflected in the data necessarily. It’s a much broader conversation — what is going on in our culture that fewer kids are participating in team sports, football or otherwise? We can address the health and safety concerns and there’s lots of ways to do that.
Q: Where are you still running into pockets of non-education or resistance?
Herring: Coaches (at Washington high schools) have a very high knowledge of concussion — over 90 percent can answer questions about concussion correctly. The bigger challenge is now translating education into action — how do you now move knowledge into behavior change? But at the same time, our research shows coaches are not necessarily more likely to go looking for concussions. If they see one, they’re likely to treat it but they’re in the middle of the game. Everybody has to be educated — now the opportunity presents itself to find the best way to do that.
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Q: What changed with the NFL? Up until 2009, it was saying players weren’t getting long-term damage, there weren’t repetitive brain injuries. It seems like you might have been listening to the lawyers more than the doctors back then.
Miller: No, I think it’s fair to say that as the science evolved, that we’ve evolved. I think the fact the league has been really proactive over the last few years changing how the game is played and adding all these other safety elements are an indication of the level of seriousness with which they’re taking it.
Herring: We all learned. In 2008, the world consensus was that certain (concussed) professional athletes could go back and play in the same game. That’s what we did — that’s what everybody did. The recent change to “no same day return to play” has been the last few years.