One Step at a Time

As knowledge of the detrimental effects of head trauma grows, so too have calls for sports teams at all levels to address them. In collegiate athletics, those calls have been answered in relatively disjointed ways – an NCAA rules change here, a research project by an athletic conference there.

And while some advocates for athlete safety are pushing for more uniform change, many officials say the lack of data on concussions (in both how often they occur and what the long-term effects are) makes it too soon to tell what should be done to address head trauma in more preventative – as opposed to responsive – ways.

Concern is only rising with each headline-grabbing incident, including the suicide of professional football player Junior Seau, who many have speculated suffered from head trauma, and the plight of a Tulane University athlete whose spine was fractured after a head-to-head collision in a football game last month.

But for now, at least at the collegiate level, the focus is largely on gathering that data. This summer, the Big Ten and Ivy League Conferences joined forces to research and share data on head trauma, in hopes of figuring out such issues as how to minimize the effects of concussions and when it’s safe for a concussed athlete to rejoin a game. And the Southeastern Conference formed a working group to review the available research, practices and guidelines, and then make recommendations to the SEC as to how to proceed.

“We are in a fact-finding mode, and doing our best to provide information for our member schools so that they can do the best job possible to provide a safe and healthy environment,” said Dan Jones, chancellor of the University of Mississippi and chair of the SEC working group. “One of the challenges you face in this kind of issue, when the information is evolving, is when it’s clear that some new information is a certainty and when it’s not.”

But others say, why wait? The Ivy League last year limited the number of full-contact practices football teams may hold, under the logic that, the fewer opportunities for traumatic hits, the fewer concussions will occur.

“I think it would be beneficial to the other leagues to follow suit, and I think it would be great if the NCAA as a whole would take a look,” said Robin Harris, executive director of the Ivy League. “It’s complicated, though, and I’ll recognize that. What we hear in criticism from some people is, well, we don’t know what you’re doing is reducing concussions…. Intuitively, it makes sense. And our presidents have decided we can’t wait around for data – we have to try and do things.”

But Jones, for one, isn’t ready to make that call just yet.

“I think there’s room for individual universities to make decisions, there’s room for conferences to make decisions, whether that’s advice or otherwise, and there’s certainly opportunities for the NCAA to make decisions,” Jones said. “I’m confident that if the evidence for [limiting contact] becomes compelling…. and it’s clear that it will reduce injuries, then you’ll see conferences, schools, perhaps the NCAA, adopting changes.”

However, the SEC and other conferences are facing pressure from some player safety advocates pushing for immediate action. The National College Players Association is in the process of approaching all the conferences with its Concussion Awareness and Reduction Emergency Plan, which calls for NCAA-wide reforms without actually relying on the NCAA itself to make them.

In addition to data collection and warning and education of athletes about head trauma (while acknowledging there's more research to be done, it's not too soon to act, the NCPA says), the plan includes reducing contact during practices and freezing the maximum number of regular-season games (which in 15 years has grown from a maximum of 10 to 15, depending whether a team makes post-season conference championship and bowl games). It also demands support for former athletes suffering from degenerative brain conditions associated with their participation in college sports.

“As the NCAA and the conferences procrastinate, players are subject to unnecessary risks,” said Ramogi Huma, president of the NCPA. “They can voluntarily come together and agree to limit contact in practices. It doesn’t cost money, it just takes will, it takes prioritizing, and until now their priority has been on realignment and contract money.”

Huma argues that for the parts of his plan that do require funding, the conferences have a wealth of money available: the imminent financial windfall from the forthcoming playoff system. The playoffs are expected to net as much as $400 million to be divvied up between the conferences.

Since sending the plan to all the conferences about a month ago, Huma has had limited success; the Big Ten responded to his query in a letter, not agreeing to the proposals but corresponding about what the conference is already doing. The Pacific-12 Conference seems receptive, Huma said, but hasn’t discussed the idea with its members. The other conferences haven’t responded, he said.

Last month, the NCAA announced that despite some rules changes and legislation that created new rules discouraging hits to the head in games, the frequency of concussions among athletes in football and other fall sports, including soccer, field hockey and volleyball, has remained steady throughout the past seven years.

Huma wasn’t surprised.

“There’s no reason to believe that these statistics should have changed because there’s been no intervention,” he said. “Where is college football on this? They’re asleep at the wheel.”

While pointing out that any legislative changes would have to be brought forward by membership (aka, the college presidents) the NCAA points to a few developments since 2001, when it first put football rules in place to deter hits on defenseless players. Subsequent rules have focused on reducing hits and elbows to the head. This season, it mandated that any player who loses his helmet in a game must sit out for at least one play and be cleared by medical personnel before returning to the field.

“Our member schools and conferences can implement rules above and beyond what the NCAA has,” said Dave Klossner, director of health and safety at the NCAA. Lots of programs, he and Harris agreed, don’t always hold the maximum number of full-contact practices allowed each week under NCAA rules.

The NCAA just hired a chief medical officer who will create a “Center of Excellence” to provide safety, health and medical expertise and research, part of which will focus on head trauma. It also funded a $400,000 grant to the National Sport Concussion Outcomes Study Consortium – comprising the Medical College of Wisconsin and the Universities of Michigan, North Carolina at Chapel Hill, and California at Los Angeles – to track athletes after they graduate and study the long-term effects of brain impacts. (Similar to what the Ivy League and Big Ten are doing.)

The NCAA’s Committee on Safeguards and Medical Aspects of Sports, which meets twice annually, will likely evaluate the Ivy League policy at its December meeting, Klossner said. He also noted that concussion rates are much lower in practices than games – although the frequency of practices is higher.

“I think the really important piece is making data-driven decisions, and so the Ivy League is out in front and hopefully we’ll be able to gather the data and work in partnership,” Klossner said. “Whenever you can have data to back up those policies, that always carries a lot of weight in those discussions.”

In 2010, the NCAA mandated that all athletic programs develop a concussion management plan, to include a clear procedure for determining whether a player might have a concussion, specific return-to-play guidelines, and documentation of the concussion treatment from start to finish. If an athlete is determined to have a concussion, the NCAA said, he or she should be held out of practice or play for at least the rest of the day.

But Huma thinks the plans don’t go far enough in addressing the issue.

“The concussion management plan doesn’t do much to prevent concussions. It gives players a chance to receive better post-concussion care,” he said. “In terms of significant intervention, I don’t think suggesting to your schools to write up a plan would do anything to change whether concussions happen or not.”

In a survey of about 1/3 of all Division I institutions last year, Devin Fratarcangeli, a LEADS Fellow at Amherst College athletics, found that most institutions that had plans in place – about 90 percent – were following the NCAA guidelines “very well.”

“They do find this to be a really important issue that they want to be looking at, and the things that the NCAA highlighted already seem to be on their radar…. The plan is effective in that it’s forcing people to think a little bit more about the injuries to the student-athletes,” Fratarcangeli said. “The plan itself isn’t going to be the thing that fixes all the concussion scenarios, because really the only way you can solve it and decrease the numbers is to stop playing contact sports.”

That, of course, is unlikely. But incremental change will continue.

"In football, there's been a greater emphasis this year, nationally," Harris said. "I think people are paying attention. I think the culture is starting to change."