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  • Writer's pictureRyan Allen

Protecting against head injuries in sports and life

It’s one of my favorite days of the year, because football is officially back. The NFL season kicks off today, signifying the start of my annual 18-week spell of disappointment in the Raiders, poor Fantasy Football coaching decisions, and Sundays preoccupied with “seven hours of commercial free football,” featuring every scoring play from every game regardless of my interest in the competing teams. Jokes aside, these are some of the stereotypical things we all love about football, and so many of us would never want to trade that away.

One looming football stereotype, though, is that of head injuries and concussion risk. The observation of this sport’s harm to player’s lives, in the sense of both their physical and mental health, is so clear that at times its poor management, efforts at prevention, and prevalence of chronic traumatic encephalopathy (CTE) have almost become a sick joke in broader society. This may be justifiable, as we see study after frightening study emerge, such as this one last month in JAMA Neurology, which found CTE in 41% of deceased amateur contact sport athletes under 30. Nevertheless, could all of this concern actually originate from our taking the wrong approach?

We all seem to have an instinctive sense of how to address the concerns around head injuries, and these intuitive solutions are generally two-fold: prevent players from being in collisions that cause head injuries, or improve protection for their heads. An article from earlier this year in Scientific American explores these two possibilities and then some, beginning by addressing the latter. It is worth noting the substantial progress that has been made over the last century in engineering helmets and other protective gear to lessen the impact of head trauma. While innovation will continue in this space, it is reasonable to assume that we are reaching a bit of a plateau in the capabilities of such equipment. Though advances continue to be made, it must be considered if players would be willing to adopt such technology if it presented any possible hindrance to their performance. The answer is likely to be no, particularly given that the players are already comfortable engaging in the sport with the current level of risk posed.

What about prevention? Well, it seems clear what must be done here, and the solution is not to bring an end to the sport of football (which I would argue may do more harm than good due to the social and economic benefits this industry provides so many). Those who watch football do not need studies to know that the vast majority of head injuries result from improper tackling technique. Now, the NFL has made a bit of an effort to crack down on this, establishing a rule against “targeting” in 2008. This typically refers to a situation in which one player lowers his head to initiate contact on a defenseless player using the crown of his helmet. Ironically, this can sometimes be even more dangerous to the tackling player than the player being hit. Education of this risk, combined with the rule’s reasonably harsh punishment of a personal foul penalty and ejection from the game, appear to be slowly leading less players to intentionally make such plays.

However, particularly at the youth level, many head injuries result from involuntary use of improper tackling technique. Teenagers are often not taught proper wrap-up technique, usually due to either neglect or a lack of experience on behalf of the coach. Ideas have been proposed such as a brief certification course, where all kids starting tackle football must demonstrate proper technique (on a dummy or perhaps an adult) before an evaluator before they receive permission to participate full-contact with others.

While we always advocate that prevention is the key in life (and for the purposes of head injuries, we still do strongly recommend you exercise great caution, avoid hazardous situations, and use protective equipment when necessary), with this topic, I am actually more interested in the possibilities that exist for improvement on the post-injury and treatment side of things.

The first is that there is ample room for progress in creating a culture of awareness and acceptance around concussions and other head injuries. In our current paradigm for football and many sports, there is seemingly a pride in rushing back from any injury. This especially appears to be the case for head injuries, which are somehow viewed as distinct from orthopedic issues, or not recognized as posing physical hindrances. You may recall the concerning sequence of events with Miami Dolphins quarterback Tua Tagavailoa during the 2022 NFL season, in which he suffered two confirmed concussions and one suspected concussion within the span of a few weeks, continuing to play despite evident, televised on-field demonstration of symptoms. In fact, how long one ignores a concussion and delays treatment is the single biggest factor influencing recovery. For example, one alarming study suggested that every minute one resumes play following a concussion equates to 7-8 days of additional recovery time needed. In another paper, the best predictor of recovery time was the duration of time it took from injury to arrival in a concussion treatment clinic (as one would expect, the shorter the better).

Change is required not only for coaches and players (in addition to medical professionals) to better recognize symptoms of concussion (headache, nausea, loss of consciousness, and–most predictive of poor outcomes–dizziness and fogginess), but also to empower players to truly return to play when they are ready. For this to take place, the decision on the return-to-play timeframe must be taken out of the player’s hands as their judgment may be impaired as a result of injury, or they may feel a sense of pride pertaining to the timing of their return. Additionally, the decision should likely be left entirely to medical professionals without the influence of coaches, as this is the only way to ensure the actions taken are in the patient’s best interest, without conflicts such as team performance.

Lastly, awareness of proper recovery and treatment is very much lacking. As many of us probably have heard, I always thought the most important principle for concussion recovery was rest. It turns out, it is the exact opposite. Depending on the type of neurological damage that has occurred–and concussions are quite variable in presentation–specific retraining is needed corresponding to that loss of function. If one had, say, a certain vestibular reflex issue resulting from a concussion, they may be prescribed physical therapy and particular exercises that utilize that reflex. The key is to prevent further atrophy of the disrupted neuromuscular pathways, which can be accomplished by keeping them active and reinforcing them as opposed to resting them.

This by no means poses any comprehensive solutions for concussions and head injuries, but hopefully it at least provides a framework from which we can start to alleviate consequences of such incidents. In complete transparency, I have often expressed hesitancy over allowing my future child to participate in high-risk sports or activities, largely due to my pessimism in our capacity for change or progress in the area of head injuries. While I am admittedly still unsure of where I stand on this decision, after conducting all the research for this post, I do feel increasingly comfortable in our ability to prevent long-term consequences of head injuries, should we adopt these principles.


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