Football: Heading for trouble?

1. Knockin' heads

2. A player is down!

3. Caution about concussion

4. The macho factor

5. Odd sports injuries

Heading in soccer has been blamed for memory loss, but the evidence is still inconclusive, as you can see from this discussion. Photo: Michael Forster Rothbart, copyright University of Wisconsin-Madison.

diagram of head with concussion area highlighted
5.3 million Americans have brain injuries caused by trauma, says the Brain Injury Association of America.

Mucho macho?
Two women hustle after soccer ball.If you've read this far, you realize the importance of recognizing and treating concussion conservatively. Once, coaches would simply get out the smelling salts and encourage players to stagger back onto the field. Indeed, the just-mentioned retired-football-player study found that 71 percent of the former NFL players who had had a concussion returned to play the same day, even though it's now clear that a concussed brain needs healing time.

Yet as evidence for the dangers of concussion adds up, pro athletes are still paid to give the last full measure of devotion, not to set a healthy example to the young amateurs who idolize them. The televised spectacle that is football would not be complete without trainers taping players up and sending them back into battle: "On Sunday afternoons, 1,700 players abuse their bodies playing this violent collision sport," wrote a New York Daily News sportswriter (see "In NFL, You Play..." in the bibliography). "The rest of the week, they worry what the boss is thinking. Some play hurt, some play in pain, and some play when they shouldn't. ..."

That attitude, a unhealthy melange of muchismo machismo and an "Am I replaceable?" fear of the guy down the bench, quickly filters down to the high-school level, says sports-injury expert Frederick Mueller. "We recommend that if a kid is not feeling good, or is ill, he should tell the coach, and the coach should relate to the players that it's OK to say this. But for some reason kids don't do that. It's the football mentality. You play when you are hurt."

Among pro players, he adds, the "do or die" mentality has a financial basis: "If you're out of the game, somebody will take your spot, maybe take your position [for next game]; there's a lot of money involved."

And that's exactly where a dispassionate monitoring system can help, says neurosurgeon Joseph Maroon. He helped devise software called ImPACT that can detect concussion even among athletes who refuse to admit injury. ImPACT, he says, is "a neurocognitive test that measures memory, processing of information, reaction time and handling complex information tasks." After 10 years of development, ImPACT is used with all players in the NFL and the National Hockey League, and in many colleges and high schools.

The software records baseline data on athletes before the season. Twenty-four to 48 hours after a suspected concussion, the athlete is retested, and the results are compared to the baseline test. "This is the first system, on a wide-scale basis, that provides objective data, rather than a physician looking into your eyes and saying you're not able to play," Maroon says.

Given the hazard of playing with concussion symptoms, Maroon says, ImPACT can help physicians determine when it's safe "to return to playing a contact sport, or whether or not you should consider retiring from contact sports." In the past, he adds, "there were arbitrary guidelines that you should be out for some time, say three weeks, but there are all sorts of variation in the severity of concussion."

And while athletes hate standing on the sidelines, he says, "the test cuts both ways. It can also facilitate getting back to play earlier than previously."

Graph shows bicycling most dangerous
According to the U.S. Consumer Product Safety Commission, bicycling injures more children than any other warm-weather sport. Close behind come basketball and football. Data: NIH

So your kid plays football ...
What to make of the new evidence about the dangers that contact sports pose to the head? "None of our findings suggest that football is an unsafe sport," insists Guskiewicz, who has studied the game's long-term physical and neurological hazards. However, he adds that "there needs to be an awareness among coaches, parents and players that concussion can be very dangerous, can predispose people to future injury and to chronic conditions such as depression."

Given the growing concerns about concussion, Guskiewicz says parents of young athletes need to know the facts, then decide accordingly. "If you are a parent of an athlete who's had two or three concussions, you have to sit back and look at what's out there. After three serious concussions, maybe it's time to hang up the cleats for that sport, and say, 'Let's try something different.'"

A lot is at stake on the playing field, and it's not just who wins. Young athletes, he says, "have an entire lifetime where they need to have good cognitive senses and abilities to function in society. You have to step back and look at the bigger picture."

Given the player's risks, he says, "how important is it to return?"

How important is our amazing sports-injury grab-bag?


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