SPORTS MEDICINE: Concussion concerns must be on forefront as football season returns (opinion)

John Doherty Sep 7, 2020 Updated Sep 8, 2020

After a handful of games at the end of August, the college football season officially kicked off on Saturday. The NFL season follows right behind with one game on Thursday, followed by a full day of contests a week from now. High school football and soccer teams in Indiana are already into Week 4.

Consequently, concussion-related concerns cannot be far from the forefront despite ongoing COVID-19 worries.

The NBA demonstrated late last month that, despite its expert administration of shielding its personnel from the pandemic, the league still has a long way to go in how it handles head trauma.

Worse, if professional players and those caring for them continue to display a cavalier attitude towards concussion’s dangers, it should be no surprise that similar attitudes are found among too many athletes, coaches, and parents at the high school and youth levels.

Nationwide Children’s Hospital in Columbus, Ohio, published a study last November in the Journal of Adolescent Health that looked at the barriers — some self-imposed — to reporting concussion for coaches, parents, and players.

The press release from Nationwide Children’s regarding the study initially noted, “All 50 U.S. states enacted concussion laws between 2009 and 2014 to mitigate the consequences of concussion. While details of the laws vary from state to state, all state laws address three main factors: concussion education; removal from play after suspected concussion; and return-to-play requirements.”

The study consisted of a telephone survey of 64 athletic trainers from 26 states and the District of Columbia. According to the press release, those athletic trainers complained that the education materials for coaches, parents and players often used complex medical terms, did not require active learning and were frequently unavailable in needed languages.

A study published in August 2018 in the journal Health Promotions Practice, examining the “Availability of Concussion Information in Spanish for Parents of Youth Athletes," agreed. That study determined, “Only one quarter of (state high school association) websites examined contained any concussion information in Spanish, and none of these websites offered a mirrored Spanish-language translation. Spanish information was also difficult to access, with the search process requiring English-language ability. Our findings suggest that non-English-speaking parents may be inadequately informed about concussion because translation of concussion educational materials is absent, incomplete, or hard to access.”

Still, even if state high school association websites lack concussion-related resources in Spanish, they are easily accessed at the Centers for Disease Control’s website.

Aside from language barriers, according to the Nationwide Children’s press release, “Athletic trainers noted a lack of buy-in to state law requirements from both coaches and parents, who may not understand the potential severity of these injuries, which, in turn, made scheduling a time for this training and full compliance with school concussion policies challenging.

“The barriers to removal from play were associated with athletes’ attitudes towards concussion and concussion reporting as well as their unwillingness to disclose concussion symptoms, and resistance from coaches and parents. Sports culture and ‘old school’ mentality of parents and coaches that encourage athletes to ‘play through it’ and ‘toughen up’ can create an environment that is not conducive to athletes reporting symptoms.”

Dr. Michael Owens, the medical director of Community Healthcare System’s Concussion Clinic, with offices in Schererville and Valparaiso, explained why it is so important for concussions to be reported and treated as soon as possible.

“There is a real concern with athletes who experience symptoms which might indicate that they sustained a concussion, yet continue to participate in play or practice, without bringing their symptoms to the attention of their coach or athletic trainer,” he said. “It is well-accepted that the concussed brain is in a vulnerable state. That is to say that when you have a concussion, less trauma is required to injure your brain further. Athletes need to understand that a later hit might cause their injury to change from one that might keep them out for days to weeks to one that may keep them out for the entire season. Another more serious concern is the rare but catastrophic Second Impact Syndrome. In those cases, the later hit results in brain swelling and other changes which can lead to death.”

Once a concussion was diagnosed, though, the athletic trainers surveyed by Nationwide Children’s also lamented the barriers they encountered when it comes to returning to play. They listed high cost, limited access to medical treatment, and lack of clarity in state laws regarding which medical professionals should be making return-to-play decisions.

The athletic trainers preferred their athletes to be managed by a medical professional with the most modern concussion-specific medical training. However, they reported such professionals were not always available.

As a result of their findings, the Nationwide Children’s researchers urged state and local policymakers to update concussion laws, clarify return-to-play language, and improve access to care for athletes who face socio-cultural or economic barriers in order that they may safely return to play.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion.