Intended Consequences Lead to Unintended Issues: NCAA Settlement

Sure the lede looks backwards, but the overwhelming point, in my opinion, of the NCAA recent settlement on concussions has to deal with my profession of athletic training.  The issue is athletic trainers; the need for more of them and what happens if you cannot find them or afford them?

Don’t get me wrong, the fact that attention is being paid to the need for athletic trainers — although the wording does not explicitly name our profession, rather “medical professional” — is tremendous and often overlooked.  Sure, you can have a doctor on the sidelines, but what is their cost?  Perhaps there are some semantics that would allow other medical professionals to be in attendance, but what would be their experience, education and knowledge about concussions?  And how cost/time effective would it be to have another “medical professional” that didn’t have the ability to assess, treat, manage, and rehab other injuries that occur on a sporting field?

In other words, this is an awesome advertisement and endorsement for athletic training.

But there is an issue, as stated in the Chronicle of Higher Education;

Colleges have their own concerns about the settlement, including a requirement that they have a medical professional on the sidelines for every practice and game in the highest-contact sports: basketball, field hockey, football, ice hockey, lacrosse, soccer, and wrestling.

While many big athletics programs already provide such coverage, lower-level NCAA institutions will be hard-pressed to afford it, several athletics officials said.

The requirement could lead colleges to use graduate assistants or others with little medical training, or to cut sports altogether over fears of liability.

“I’m worried about the financial fallout from this, and how it will impact Division II and Division III, and how it’s enforced,” said Tim Kelly, head athletic trainer at the U.S. Military Academy and a former member of the NCAA’s Football Rules Committee. “I’ve always wondered, Do too many schools provide too many sports at a level that’s not effective?”

If you have spent time in the “lower levels” of NCAA sports or even the NAIA you would note the very understaffed sports medicine team compared to the “big boys”.  This is no fault of the fine institutions, rather an economic issue.  From personal experience I can tell you that Continue reading

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10/17 Quick Hits

HockeyNow question and answer with Charles Tator (one of the best);

HN: What have we learned about concussions that maybe we didn’t know a decade or two or three ago?

CT: There are about 30 things that we didn’t know just 10 years ago. For example, the adolescent brain seems to be most susceptible to concussion and takes the longest to recover. It’s rather unfortunate because that age is when kids are now big enough and fast enough that they are getting concussions—it’s also the risk-taking age.

Also, women appear to concuss more easily than men; and that holds for sports like hockey and basketball. We’re not really sure why that is but that’s what the data is telling us.

Unfortunately, there are still a lot of unanswered questions about concussions. We still don’t know the exact mechanism—although, rotational acceleration is more important in producing concussions than linear acceleration. And also, we don’t know how to detect a concussion on imaging techniques; for example, there is no telltale sign on a CAT Scan. And the MRI (magnetic resonance imaging) is still not showing us the effects of concussion. We are hopeful that some newer sequences of MRI will be more informative.

A concussion is still a clinical diagnosis, meaning that it depends on a knowledgeable examiner, like a physician, as well as a compliant patient. And not all patients are compliant; there are still people who want to hide the symptoms and signs of a concussion.

HN: How important is recognition of a concussion?

CT: All you have to do is look at Sidney Crosby—the fact that he got his first concussion on a Monday and it wasn’t recognized; and then on the Wednesday, he got his second concussion and it took a year to recover. It’s important to sit out until you’ve fully recovered and follow the six-step process of gradually incorporating more physical activity, so that your brain is ready to take another hit. If you run around the block and get a headache and get dizzy, that means your brain is not ready for the next hit and then you’re subject to the serious consequences of another concussion because your brain has not recovered fully from the first one.

Ex-ESPN exec says “Stop denying brain damage“;  Continue reading

Old Coach Point of View

What I believe was at the same conference as the previous video by Dr. Jeffrey Kutcher; former coach Lloyd Carr speaks about concussions;

Coach Carr was the head football coach at the University of Michigan from 1995 – 2007, it is worth listening to this perspective.  Although coaches can be to blame for much of the “complaining” when it comes to the necessary changes in any sport as it relates to concussion, their input is very worthy.

We can sit in our offices and come up with “dream” ideas, but these are the men/women that must implement all the “bright” ideas.  There is something to be said for those that have “been-there-done-that”, so as long as it is both constructive and respectful.  I believe that Coach Carr did a good job of this.

A quick side note; this was in 2011 and he spoke of leading with the head, now the NCAA and NFL will possibly eject players for leading with the crown of the helmet (a very hot debate, and will be once the season begins).

SEC Beats NFL to Punch

The South Eastern Conference today suspended a player from one of its conference teams for a flagrant helmet-to-head hit.  Chris Hughes, a Mississippi State line backer was suspended for one game after a video review of the game by the conference.  The play itself was NOT flagged during live action. 

“Now I have to pay the price for my actions,” Hughes said. “Our coaches teach us and warn us about those types of plays, and I just need to learn from this and make sure it doesn’t happen in the future.”

The NCAA nor the SEC ever made an official statement that they too would be cracking down on these types of hits, as the NFL had done last week.  A surprising move and a proactive one at that.  Good for the SEC, and for Hughes understanding his mistake.

AP Story

Univ. of North Carolina Model

Under the direction of a leader in the sport concussion world, Kevin Guskiewitz, the University of North Carolina (Tar Heels) have put together a model for dealing with concussions that the NCAA is now recommending as the suggested protocol.

While the NFL has been out in the media promoting this issue and seeing players in the popular league on a weekly basis get hurt, the news is there.  But quietly and effectively the NCAA is also tackling this problem head on (pun intended).  Committees have been working on getting a solid concussion model in place as soon as possible.  Which with 500+ schools under their blanket can be tough.

There are a lot of egos and “what about our ideas” out there, Continue reading

Research

A diagram of the forces on the brain in concussion
Image via Wikipedia

This JAMA article is from 2003, but it does well to expose what we are currently seen with the concussion.  It is good to note that this study was with college aged individuals with a developed brain.  This study did not deal with the developing brain of adolescents.

Conclusions  Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.