- Action on concussions comes from all sides, but lack uniformity
- Culture, ignorance, biases all obstacles to preventing head trauma
- Big Ten and Ivy League to study head trauma in college sports
- Experts work to address concussions in all sports, not just football
- NCAA publishes guidelines on concussions and player safety
The Ivy League’s new restrictions on the frequency with which football teams hold full-contact practices, designed to reduce player concussions, are unprecedented at the collegiate level. Given the lack of research on the topic, it’s difficult to say whether the league did too much, too little or just enough -- let alone to predict the effect the rules will have in the upcoming season. But league officials and some experts on brain injuries say the Ivy policy could have one clear effect: encouraging other college leagues or even the National Collegiate Athletic Association to follow suit.
As head trauma has become a more visible issue at all levels of football, the NCAA, the chief governing body in intercollegiate sports, has taken some steps to address it. Last year it began requiring all institutions to develop a concussion management plan (which, among other things, takes athletes who exhibit symptoms off the field for at least a day), and in 2009 it mandated that conferences conduct post-game video reviews of helmet-to-helmet or above-the-shoulder hits that draw fouls but not ejection, and consider sanctions for the offending players.
But when Ivy League presidents who had been following the issue kept hearing about how concussions were affecting football players -- in the short term with dizziness, headache, disorientation and nausea; in the long term with memory problems, poor concentration and depression -- they determined they needed to move to protect their players’ safety, said Robin Harris, executive director of the Ivy League.
While the Ivy League had already allowed for fewer full-contact practices than the NCAA permits, the difference between the two will now be as high as 60 percent during some parts of the year. (For instance, the Ivy League now permits no more than two full-contact practice days a week during the fall, compared to the NCAA’s limit of five.)
The Ivy officials who made the call -- coaches, trainers and athletic directors -- also reduced to seven from eight the number of spring practices with any contact (the National Collegiate Athletic Association permits up to 12); and limited to one the number of days both sessions in pre-season two-a-day practices can include full padding (after the fifth day of practice, there's no such restriction from the NCAA).
But they also acknowledge, as does the group’s report, that beyond these rules alone, “It is also important to evaluate the culture of football and ensure [that] the welfare of student-athletes is emphasized.” That means that limiting practices won't be enough. It means addressing the misconceptions of many stakeholders: perhaps most important for students, the idea that it’s OK to play through a concussion; for teams and the public, that easing up on contact in practices signifies weakness; and for coaches, that to do so would lessen the team’s performance come game day.
Christopher Nowinski, who co-founded of the Sports Legacy Institute and works with groups in sports, medicine and higher education to combat concussions, has seen all these ideas firsthand -- and he's certain they're misguided. (After playing football at Harvard University, Nowinski became a wrestler before retiring in 2004 because of post-concussion syndrome.) But he hoped that by serving as a consultant to the Ivy League group as it developed its policy, he could help set in motion a real culture change.
“When you think of Division I football, most programs don’t want to touch this issue still. The NCAA was not on the forefront of this issue, they just kind of followed the lead of the NFL, which I think is a shame. There’s a lot to be done and there’s a lot to be desired in terms of the status of football at the college level,” Nowinski said, adding that while he believes more radical changes are necessary to make the game safer, every conference should adopt the Ivy League rules. “What we’ve discovered so far about the true ramifications of the old way of playing football should make us rethink what the future of football is.”
In Nowinski’s mind, that not-too-distant future (he thinks other conferences will catch up in a year or two) looks a lot like what the Ivy League has done -- only more extreme. Gradually, he said, more rules changes will restrict hitting and boost player education. “Any football conference would be ill-advised not to follow these guidelines,” Nowinski said. “It’s lowering the opportunity for harm.”
Harris said the presidents who chaired the group -- Jim Yong Kim of Dartmouth College and David J. Skorton of Cornell University -- first considered appealing to the NCAA for an association-wide rules change. But because that process would have made it impossible to get the rules in place by this fall, they opted to keep it inside the league.
The next NCAA proposals will be submitted in spring 2012, Harris said, giving the league time to "assess the reaction" to its rules and see whether others would consider something similar. “We certainly would be thrilled if other conferences wanted to follow our lead or the NCAA as a whole wanted to follow our league, and do what’s right for our students,” she said. “There’s a further conversation that could be happening.”
An NCAA spokesman, Christopher Radford, said the association can’t take that step unless it gets a legislative proposal from one of its committees, which comprise representatives from various institutions, or from a college or conference like the Ivy League. “But I think it’s fair to say that the membership will be interested in reviewing any such proposal if it is proposed,” Radford said.
Radford said he doesn’t know of other conferences taking similar action, but individual institutions might be. (Although the NCAA and conferences set standards for these things, coaches may work below those limitations, just not exceed them. For instance, John Gagliardi, head coach at Saint John’s University in Minnesota, allows no tackling whatsoever in practices -- and is the winningest college football coach in history. He has won multiple Division III championships, most recently in 2003, and makes it to the postseason almost every year.)
It may be hard to imagine the big-time sports programs imposing such limitations, but the University of South Carolina head coach Steve Spurrier told ESPN last week that the Ivy League rules would work for the Southeastern Conference -- and aren’t that different from how his practices work already.
The SEC sent Inside Higher Ed a statement in response to an inquiry about whether the Ivy League rules would be feasible for the conference (which, along with the Big 12 Conference, has been criticized by politicians for not adopting concussion policies stricter than those mandated by the NCAA). "The topic of student-athlete safety, especially concussions, is important in the SEC,” it said. “We have had discussions with our coaches, athletics directors, student-athletes and game officials. The league has made penalizing late hits and helmet-to-helmet contact a priority in our football contests. The league continues to monitor the issues surrounding student-athlete safety on a regular basis.”
These measures are important in trying to reduce not just concussions but “catastrophic” injuries generally, according to the most recent annual survey on the topic from the University of North Carolina at Chapel Hill's Department of Exercise and Sport Science. That report tracks football injuries resulting in brain or spinal cord injury or skull or spine fracture, from the youth to professional levels, but addresses concussions as well. It also recommends improved coaching techniques in teaching tackling and blocking fundamentals (as does the Ivy League), and preseason physical exams to identify athletes with a history of such injuries.
Over all, Harris believes the Ivy League went to appropriate lengths to address the issue of practices. As its report says, given the lack of data regarding how many or what kinds of hits induce long-term consequences -- making it difficult to determine where to draw the line -- the group tried simply to “minimize the likelihood and severity of hits to the head.”
The primary research of note in the Ivy League report came out of Brown and Virginia Tech Universities and Dartmouth College, where taken together, players in 2007 sustained an average of 6.3 head impacts per practice and 14.3 per game, and up to 1,444 throughout the season. But the frequency, location and severity of the hit varied by point of impact and the player’s position -- and the severity generally didn’t differ between games and practices.
Jason P. Mihalik, an assistant professor in exercise and sport science at UNC-Chapel Hill, where he studies head trauma, said it’s fair to say that the league did the best it could based on the information it has. “Simply by eliminating the opportunity for an athlete to suffer brain injury,” he said, “I think the athlete will be better for it. Not just from a concussion standpoint, but that takes its toll on your body.”
In addition to limiting the number of full-contact, full-pad practices in which blows to the head or helmet-to-helmet hits are likely to occur, the Ivy League also emphasized informing athletes about the long-term risks of concussions and the importance of reporting symptoms rather than trying to play through them.
Mihalik said he’ll have to see next year’s injury rates before speculating on the potential of the practice limitations to reduce concussions. But the other recommendations, if followed properly, would undoubtedly improve the situation, he said. “What I like most about the report is that there is a large emphasis placed on education. And education beyond simply letting coaches and athletes know about signs and symptoms,” he said, adding that teaching athletes to tackle safely is crucial. “If we can prevent the injury from occurring, then the injury isn’t such a bad thing anymore.”
Nowinski, for one, thinks that poor decision-making stems more from ignorance than stubbornness. Players spend ages learning about the nuances of the option offense, he said, and five minutes learning about concussions. "The players' mentality doesn't need to be changed so much as they need to be given the information for their health," Nowinski said. "It's not a crazy concept. A player injures their knee -- they don't run back on the field if they could tear their ACL on their next step." If the players knew a post-concussion hit could be equally debilitating, he said, they'd be less reluctant to sit out the rest of the game.
The report recommends that next, the league conduct similar reviews of men’s and women’s ice hockey, lacrosse and soccer (the three sports trailing football in frequency of concussions). It’s important to remember that head trauma occurs in all sports, Mihalik pointed out. “I think football gets a really bad rap for being a dangerous sport. Sure, head injuries occur, but they occur in any sport,” he said.
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