How to Fix Sports' Concussion Crisis

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An interview with Linda Carroll and David Rosner, authors of a book on the brain injury epidemic

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Once considered nothing more than boo-boos to spittle-spewing coaches everywhere, concussions are finally being acknowledged for what they are: contact sports' nastiest byproducts. The long-term effects of head injuries, particularly in retired football players , are proving to be absolutely terrifying.

Linda Carroll and David Rosner, co-authors of The Concussion Crisis: Anatomy of a Silent Epidemic, are well versed in the subject. The recently-released book includes eye-opening stories of athletes, soldiers and everyday men and women who have struggled with concussions.

The authors have written about health, sports and science for a variety of publications, including MSNBC and Newsday. In this Q & A—conducted via email—the authors discuss concussions and their impact on sports, especially football.

Note: In her email, Carroll said she and Rosner "attacked all of [the questions] (with the obvious exception of the last) together."


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Simon & Schuster

In the early 1900s, college football players were literally dying on the field. Theodore Roosevelt had to step and demand rule changes that would make the game safer. In 2011, do we need a similar reformer? And if so, who would you like to see fill that role?

Not to diminish Teddy Roosevelt's role in reforming what was then an embryonic sport, but he simply urged college football's leading coaches to make changes before their own administrations chose to ban it (as indeed was already happening on some campuses). To now reform a mature sport that's grown into a national obsession at all levels of play—from the NFL on down to Pop Warner—will take constant pressure not from just one reformer but from all sides: parents, legislators, doctors, brain scientists, and so on. Change can come at the student-athlete level if there is a groundswell from parents who want to see their kids play a safer game.

Why is there still some reticence among former players, even ones who've struggled with concussions like Troy Aikman and Steve Young, to speak up about what they've gone through?

One of the reasons that concussions are called a "silent epidemic" is that most people who've suffered a traumatic brain injury prefer to keep quiet and to keep hidden any cognitive symptoms they may have struggled with. No one wants to be perceived—and perhaps stigmatized—as being brain-damaged or cognitively impaired. That's why it was important for us to also tell the stories of those Hall of Famers who are willing not only to speak up about what they've experienced but also to become outspoken advocates for concussion safety, such as football's Harry Carson and hockey's Pat LaFontaine. And that's why we're in awe of those everyday people who were willing to share their stories and struggles with us in hopes of helping other sufferers and of bringing this hidden epidemic out of the shadows.

Youth and high school football are incredibly popular. But after researching concussions and writing this book, do you think ANY kids should be playing football?

The dean of concussion specialists, Dr. Robert Cantu, recently advocated that no kid be allowed to play collision sports before age 14 because developing young brains are more vulnerable to concussion—and we agree with his bold proposal. For those who do play a collision sport like football, we offer these suggestions to keep players safer: No high school or middle school should field a team without a certified athletic trainer educated in concussion recognition and management, without a physician or EMT present at every game, without strict protocols requiring return-to-play clearance from a neurologist or other specialist, and without a neuropsychological testing program in place to help determine when it's safe to resume activity after a concussion.

Do you expect participation numbers to drop over the next decade?

Without a crystal ball, no one can predict what will happen as information about the dangers of concussions becomes more widely known. Some have expressed concern over how recent concussion stories might impact grassroots growth of football. We expect—and hope—that sports participation continues to rise. In a nation with obesity on the rise among its children, the benefits of sports are undeniable. We just hope that sports will continue to grow in a safer way and that people will follow the emerging science as they make their individual decisions about whether they want their kids to play collision sports like football.

You describe the outbreak of concussions an "exploding epidemic." But because we know that 20, 30, 40 years ago, concussions weren't reported as frequently as they are now, is it possible the problem was just as great back then?

The sad reality is that a perfect storm of factors has fueled what is indeed an exploding epidemic: With the participation boom more than tripling over the past two decades to 44 million Americans playing sports from youth leagues through high school, the raw numbers alone continue to feed this burgeoning public health crisis. What's more, those athletes have grown increasingly bigger, stronger, and faster while the laws of physics have remained constant—making head-rattling collisions less avoidable and more destructive. And beyond that, style of play has become ever more intense and violent in both boys' and girls' sports: In football, for example, the advent of high-tech helmets has made players feel more invincible and enabled tackling techniques that have stressed using the head as a battering ram; in soccer and basketball, the competition since Title IX has been intensifying among girls, who are now suffering concussions at rates far greater than their male counterparts.

The NFL seems to be trying to legislate the most violent tackles—head shots, hits on "defenseless" receivers—out of the sport. Is that a step in the right direction? And even if it is, is that kind of missing the point that the routine grind of football —the repeated collisions, even ones that seem small— can accumulate and cause serious damage?

The NFL has been taking baby steps in right direction ever since the 2009 congressional hearings criticizing its denial of the mounting evidence on concussion dangers. Those include the rules changes you mentioned. But just as significant, as you noted, is the issue of repeated hits that don't necessarily manifest in obvious concussion symptoms but can eventually add up to brain damage as evidenced in the dementia suffered by too many retired players. The NFL attempted to deal with that issue this summer in its new collective bargaining agreement, now limiting the number and intensity of full-contact practices during training camp, the regular season, and the offseason. We're happy to see this strategy also turning up at the college level, and we applaud the Ivy League's recent rule limiting full-contact practices to less than half what the NCAA allows.

You mention NFL commissioner Roger Goodell sending letters to the governors of the 44 states without concussion laws. Do you think the NFL is truly committed to better preventing/treating concussions?

We can only judge by what NFL has done in the two years since its stunning reversal on the concussion issue under pressure from the media, the medical community, and Congress: The leading impediment to change has become the leading voice for that change. But the NFL still has a long way to go when it comes to curing its own concussion crisis. Only time will tell whether its new policies, revised rules, and stricter protocols make the game safe enough for its own players and whether that will trickle down to all levels.

Not to be morbid, but a few years back, Bengals quarterback Carson Palmer said this : "The truth of the matter is ... somebody is going to die here in the NFL. It's going to happen.'" Is it going to take a fatal head injury in football for people to truly wake up to the problem of concussions?

Over the past three seasons, eight high school football players died as a result of injuries to the brain. Those deaths should have been enough to wake everyone up to the danger of concussions. And yet...

Are you both still football fans? With what you know now about concussions, is it difficult to even watch football these days?

We'll have to answer this one separately.

Carroll: I wasn't a big football fan to start out with and this does make me even less likely to watch. I find it difficult to watch any sport where there is a serious risk of severe injury. One sport I do follow, three-day eventing, I watch in spite of the prospect of witnessing wrecks on the course. I wince every time I see a horse and rider team collide with an obstacle. I'd be a lot happier watching the sport if its rule makers chose to make it safer by constructing fences in the cross-country portion that come apart upon collision. Their reasoning for not making the change is very much like what you hear from football fans—they think it will change the sport too dramatically.

Rosner: A onetime NFL season-ticket holder, I do still watch football—just not the same way I once did. What I've learned in writing this book has made it impossible for me to enjoy watching another sport I used to avidly follow: boxing. I still consider the first Ali-Frazier fight the greatest sporting event I will ever attend in person. But now, whenever I try watching a tape of that epic title bout in hopes of rekindling the magic memory of that night at Madison Square Garden, I can't help feeling pangs of guilt.

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Alan Siegel is a freelance writer in the Washington, D.C. area. His work has appeared in Slate, Deadspin, and several other publications around his native Boston.

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