The 2015 movie Concussion was the solidifying factor in completely turning concussions in to a mainstream topic. Before that, the subject of concussions was swept away like dust, a taboo concept relegated to back doctor’s offices and old files collecting dust in administrative file cabinets. But the genie has now completely, albeit slowly been let out of the bottle. With increasing pressure from medical professionals, families of suffering retired athletes, and former professional football players themselves, the NFL is slowly but increasingly admitting the obvious link between contact sports and degenerative brain disease. Most recently in late March, the NFL made its most straightforward acknowledgement of the link to date when its senior vice-president for health and safety policy indicated that he was certain of the connection between contact sports and subsequent neural malfunctions.
Now that the proverbial cat is out of the bag, even though many were aware of said cat for years before the NFL would acknowledge it, concussions are just an addition to the bevy of silent threats that infiltrate the medical world. You can’t see them, but the effects can become glaringly obvious if these injuries aren’t handled correctly.
“Concussions have come in and out of the public eye for over 130 years” said Katherine “Price” Snedaker, a Connecticut-based concussion advocate and founder of SportsCAPP, a concussion awareness program for those involved in youth sports leagues. “But there are no hard, fast numbers for anything or any one age group when it comes to a concussion because all facts are based on ‘reported concussions.”’
It is clear that collegiate programs are lacking in their establishment of effective concussion protocol. In a 2014 survey of 1066 collegiate institutions completed by the American Journal of Sports Medicine, researchers found that while a large majority of collegiate athletic programs have protocol for when an athlete sustains a concussion, the guidelines need many improvements. Of 2,081 participants in college athletics in 2012-2013, 206 of those students (roughly 9 percent) sustained a total of 211 concussions.
Weaknesses within collegiate athletic training programs are called in to question as the dark shadow cast over the NFL gains more acknowledgement. This has resulted in a bottom-up approach in concussion prevention and treatment in sports. The foundation for advocacy and proper ways to deal with concussions has been established within youth sports programs and high school sports programs. The effectiveness of many different youth programs has served as a framework for many collegiate programs.
Concussions in Montgomery County Public Schools (MCPS)
MCPS concussion specialist Jeffrey Sullivan considers MCPS policy as one of the top in the country; way ahead of the mainstream when it comes to the education and treatment of brain injuries that are the result of athletics.
“We are at the forefront of medical changes in high school sports; we had many of these protocols in place before a lot of the state concussion laws were enacted” Sullivan said in an April 18 telephone discussion.
The concussion policies within MCPS athletics are based on education. The priority for administrators is to educate students, parents, trainers and coaches. At the beginning of each athletic season, the county presents student-athletes with an Athlete Healthy & Safety PowerPoint that highlights the most common symptoms of concussions, what one should do if he or she believes a he has suffered a concussion, and how a student’s return to play should be handled. In recent years, athletic trainers have been a priority in MCPS.
“This is the first year that all 25 MCPS high schools have athletic trainers for sports,” Sullivan said. “Trainers attend all home games on-site and treat both competing teams when an injury is sustained.”
The pool of trainers employed by MCPS is picked from four local vendors that the county has entered in to a three-year contract with: Adventist Healthcare, MedStar Health, Pivot Physical Therapy and Maryland Orthopedic specialist.
In an article published in the Washington Post in 2015, MCPS director of athletics William “Duke” Beattie said the county pays roughly $20,000 per trainer that it employs.
MCPS, like many other counties, also uses ImPACT testing for its student-athletes. Every two years, all athletes are required to undergo ImPACT baseline testing. The test measure brain functioning in students under normal circumstances and is taken again post-concussion when a student is injured. The two tests are then compared to measure an athlete’s brain functioning. However, while the test is mandatory within the county, it is an optional resource that can be used by a student-athlete’s personal doctor.
“MCPS as a whole is very in-tune with what’s going on with concussions and our students,” Sullivan said. “The county as a whole has a five-step concussion plan established whereby we use education, baseline testing, trainers, procedures, and a step-by-step return to play procedure that we are confident is effective.”
While Sullivan notes that the recent spotlight on concussions has not lead to a noticeable decrease in participation in contact sports, they county is already planning to usher in courses and training programs on how to properly block and tackle in football.
“Many members of the MCPS athletics administration are a parents too,” Sullivan said. “We are all very worried about our children and just want them to be safe and have their well-being placed in good hands.”
Concussions in D.C. Public Schools (DCPS)
While only a short drive or metro ride away from MCPS, DCPS’s athletic department takes a very different approach to concussions from their suburban-Maryland counterparts.
The DCPS administration does not have the rock solid foundation that has been a hallmark of MCPS for decades. DCPS Athletic Director Stephanie Evans has been on leave since late 2015 amidst reports of high turnover, inconsistent records, and a floundering budget.
When a DCPS student-athlete suffers a concussion, the athlete is removed from activity, and is not allowed to participate in athletics the next day. In order to begin the return-to-play process, the athlete must be asymptomatic for at least 48 hours. If an athlete sustains multiple concussions in one season, they need a doctor’s approval to return for the next season. DCPS began mandatory ImPACT testing for all student-athletes only five years ago.
According to DCPS Lead Athletic Trainer Jamila Watson, DCPS uses a return-to-play protocol that was created by the concussion department of Children’s National Medical Center
“We use [Children’s] as guidance for how we handle brain injuries, and their recommendations have been successful in effectively treating concussions” Watson said in an April 21 telephone conversation.
While not as in-depth as MCPS, concussion protocol and safety within DCPS has been a priority since before studies on concussions and their lasting impacts became in vogue.
“The way DCPS handles athletic injuries can really be considered a benchmark because we have had 12 full-time athletic trainers for 26 years, way before other schools had trainers on staff,” Watson said. “We were that benchmark and everyone followed suit.”
A testament to the dedication of athletic trainers within DCPS is that fact that some of these original athletic trainers are still on staff. These days, they focus on being present in practices and pushing coaches to modify student-athlete techniques in hopes of eliminating concussions in practice that could result from a poorly executed hit or tackle.
The policies DCPS currently has in place appear to be effective. According to the athletic administration, during the 2014-2015 academic year 61 our of 2,922-or two percent- of student athletes suffered a concussion.
While public schools work hard to create guidelines and reforms in order to decrease concussions in public schools, there has also been an increase in awareness programs throughout towns and sports leagues.
Snedaker’s program, SportsCAPP, is the primary program used to educate and evaluate concussions in all of Norwalk, Connecticut’s recreational sports leagues and athletic programs. The goal of SportsCAPP is to lower the liability for the city and its sports programs in the event that a major head injury is sustained.
“It is suspected that only less than half of the number in each age group actually report concussions,” Snedaker said. “Missed concussions are the first big issue because students keep playing and run the huge risk of getting hit a second time.”
Snedaker’s program aims to educate athletes and coaches on how to accurately evaluate a hit to the head and understand when it is really okay to return to play. SportsCAPP has been implemented in five baseball leagues, two soccer leagues, lacrosse leagues, basketball leagues, field hockey leagues and football leagues throughout the area. It has resulted in over 1,000 trained coaches for 6,000 youth players.
Through SportsCAPP, the city of Norwalk has established a concussion protocol that in some ways is similar to that of MCPS. Parents, coaches and athletes are informed through free online training sessions. Athletes are removed from play if they experience concussion-like symptoms. In order to begin the return-to-play process, athletes must wait 24 hours after the initial hit before getting permission from their doctor. All concussions sustained while playing in one of Norwalk’s recreational leagues must be recorded and submitted to Norwalk’s parks and & recreational facilities office.
“There is this misconception that athletes fake concussions in order to get out of practice but it’s just not true,” Snedaker said. “With all of the new lawsuits arising… that’s the push we need in our society right now.”
As for the future of concussions, many- like Snedaker- believe it is all about raising awareness, increasing education and eliminating the misconceptions that have been existent for years. The NFL’s full admittance of the danger of repetitive head injuries is a major step towards ushering in a new era of concussion management.