Abstract - What is LETRR?
I have titled my thesis project as “Concussions and Football: A Hidden Epidemic.” To most, this title is troublesome. Everybody knows about concussions in football. However, the extent and depth of knowledge that most people have about the subject is so minimal. The concussion crisis is a silent epidemic that has been going on for far too long. This sentiment is what I have been working on for the past nine months - halting the concussion crisis before it turns into a full blown disaster. The way that I have chosen to tackle this problem is with LETRR, a comprehensive proposal for the betterment of concussion management in the game of football. The five letters stand for: Legislation, Equipment, Technology, Rules, and Regulation. Improvements and change in one particular area or another will help the cause, but a complete overhaul of the game of football as we know it may be the best solution to an unsolvable problem. Injuries, more specifically concussions, are a part of the game of football. There is not a perfect solution to fix the problem. The key concept that I am trying to make clear is that the status quo is not acceptable. Awareness of the problem needs to be heighten for it seems as if the majority of Americans have no problem with the game of football, culminating in the “football players know what they are getting themselves into” defense. This argument is inherently flawed because of the fundamental fact that nobody truly knows what is being dealt with. The brain is the most arcane and important part of the human body. Concussions have been a part of the game of football since its inception and will remain in the game until its denouement (another issue that must be addressed). However, it is never too little, too late to stand up and say enough is enough. That’s what LETRR is all about: an acronym, an idea, a proposal for the overall betterment of the game of football that we all know and love.
Legislation
Why is legislation so crucial? A young athlete’s brain is still developing, thus the effects of a concussion are amplified and produce more detrimental damage compared to a head injury in an older player. Young athletes’ lives are at stake, thus legislation is of the utmost importance. What I propose is called “Strict Standardization” - the complete overhaul of existing state concussion laws in favor of one federal law with strict and stringent rules. The biggest problem with existing legislation is that it differs vastly between states, emphasizing neglect that many states exhibit in their concussion laws. On the following pages, I have provided a data table from The Journal of Law, Medicine, and Ethics 42:3 that showcases the alarming differences in just the content of concussion information that is provided to youth football players. Variation in legislation does not just stop there. The amount of material in the bills themselves is greatly varied. Mississippi, the last state to pass concussion legislation, “boasts” a mere three page law, while Texas’s law is fairly detailed with nine pages. However, I see the greatest problem with the core legislative elements in concussion legislation. There are eight core legislative elements. Every state (including Washington D.C.) requires medical clearance prior to return to play and requires distribution of educational materials to either students, parents, or legal guardians. Every state, except Wyoming, requires removal from play if an athlete sustains a concussion (and it is bewildering as to why Wyoming does not follow such a fundamental rule). However, the other five core legislative elements lag behind in implementation. Only one state (Michigan) requires baseline testing of student athletes, twenty-six states require coaches to be trained in concussion management, twelve states have concussions laws that extend beyond school football and into youth-sport organizations, three states require concussion data collection, and only four states require classroom accommodations for concussed students (return to learn) (Cook, King, and Polikandriotis 286). Why skip out on the safety of America’s future? Take concussion data collection for example. Collecting data and making the information readily available can help determine the best methodology for the distribution of educational material, the need for mandatory coaches training, the benefit of baseline testing, the best accommodations needed at school, practice, and home, and the number of athletic trainers or other properly concussion trained medical personnel who respond to sports-related injuries at the practices and games. Importantly, data can also be used as the foundation to not only establish the extent of the concussion problem in youth athletics, but to help elucidate the mechanisms of injury and the effectiveness of preventative interventions. Instead of letting each state set its own guidelines, one federal law that makes the eight core legislative elements mandatory will do wonders in keeping the game far more safer than it has been in previous decades. Along with this change, age restrictions should be in placed. What is the point of letting eight and nine year old children tackle, like as seen on Friday Night Tykes? Instead, I propose flag football until the age of twelve years, allowing much less brain strain on young adolescents. Then a transitionary phase takes place from ages twelve to thirteen in which athletes play wrap-up football, while at the same time learning the proper tackling techniques that I will cover later in this proposal. From age fourteen onward, tackle football can be played, allowing a smooth transition from the last year of junior high to high school. Setting laws on one of America’s most famous pastimes will be no easy feat. However, in order to stop the growing epidemic of concussions in football, drastic measures must be taken - drastic measures that will save youth athletes from drastic consequences.
Equipment and Technology
Helmets. Those are the first pieces of football equipment that comes to mind when people associate concussions with football. It makes perfect sense - a helmet covers the brain, a blow to the brain can cause a concussion. So instead of circling around the issue, why not attack it head on? Modern day football helmets are ineffective (“Study Shows Helmets in Use Not Made to Prevent Concussions”). They are big and bulky, allowing for the transmission of a great amount of force when used as a weapon to bring down or run over an opponent. Modern day helmets give players a psychological belief that they are invincible, leading to more reckless decisions on the field. One sentiment that is widely shared between former NFL players, including Super Bowl champion Hines Ward, and some members of the medical community is the reinstatement of old school, leather style helmets (Smith, “Hines Ward: If You Want to Prevent Concussions, Take the Helmet off”). Justification for this decision is evidenced by data taken from a study on head, face, and neck injury occurrence in youth rugby. The results of the study counteract the argument that by giving up the helmet a huge influx of catastrophic injuries (skull fractures and such) will occur. Statistically, that is just not true. Out of the 1841 injuries that were recorded in the study, only two were deemed to be catastrophic. One of those two injuries was due to improper tackling technique (McIntosh, McCrory, Finch and Wolfe 192) . Catastrophic injuries already occur in the game of football. The change to a more lightweight helmet would not only reduce the concussion rate in football, but also have either minimal or no effect at all on the occurrence of catastrophic injuries in the game. Removing the helmets of today will force players to make safer decisions on the field and tackle properly. Plainly, players will start feeling the immense stress they put their brains under. Bulky helmets were just hiding this pressure all these years - hiding but still causing damage. Thus, I introduce MIPS, the multi-directional impact protection system. MIPS helmets are the best of both worlds, offering more protection to the brain while maintaining the same degree of security against catastrophic injuries. MIPS helmets have undergone extensive evaluation and testing. The data collected has produced very impressive results - a reduction in brain rotation by as much as 40 to 50 percent (Foster, “The Helmet That Can Save Football”). There is no more time left to just sit around and hope that the concussion crisis will fix itself. It is time to start the implementation of MIPS helmets in football. To begin, there must be comparable concussion data to justify a transition from regular helmets to MIPS helmets. This is where legislation is crucial (the interconnectedness of LETRR is very pertinent to its success). If legislation can pass that mandates all states to collect concussion data (as I proposed earlier) , than clear evidence can be seen in the reduction of concussions before and after the implementation of MIPS helmets. Implementation will begin at the elementary, middle, and high school levels because of the relative ease in securing an equipment contract compared to the battle of fighting off sponsors in the NCAA or NFL. After a set period of time, whether it be a year to three, it is expected that MIPS helmets will show a significant decrease in the concussion rate. At this point, an offensive strategy must take place. Persuading higher division leagues, like the NCAA, NFL, or CFL will be simple because said leagues will be under intense scrutiny if nothing is done to alleviate the concussion crisis when a clear cut solution has been proven to be a success. While a helmet change is of the greatest necessity, other more minor changes should be made as well. One of these changes is making mouthguards mandatory. Most people do not even know that mouth guards are not mandatory in football. The reason why mouthguards are not mandatory in football is because players complain that they are uncomfortable and interfere with breathing and communication between teammates. The reason why the NFL is not making mouthguards mandatory is because doing so would mean that they are admitting guilt for something they should have done sooner. Making mouthguards mandatory keeps the players safer and counteracts the argument that they are detrimental to a player’s ability because if everybody has to partake in the mandate, then no player’s skillset has deteriorated relative to another’s. To allow the game to flow just as smoothly, an exception to the rule should be made to quarterbacks and defensive signal callers, that way clear communication can still be taking place. The other change I am proposing is specific to certain positions. All offensive lineman and defensive lineman must wear neck rolls due to the high amount of sub-concussive hits that they receive. Neck rolls restrict the head and neck from jolting too quickly, minimizing the chances for a concussion. Throughout the year, I have incorporated technology into equipment because there is only just one piece of technology that I have been focusing on and it is located within helmets. However, this one piece of technology is so crucial that I had to dedicate a whole section on its behalf. That piece of technology is a wearable sensor implanted within helmets to measure the frequency, severity, and direction of impacts in order to know whether or not a concussion has occurred and use the data collected to learn how to prevent such blows from occurring in the first place. Implementing this sort of sensor technology will be crucial in the collection of more advanced concussion data and will be a monumental step in finding ways not only to reduce the rate of concussions but also possibly prevent concussions from occurring. Without technology, there would be no MIPS helmets. So while it may seem as if technology is being glossed over in this proposal, it is a critical factor associated with the betterment of concussion management in the game of football.
Rules and Regulation
Tackle like a rugby player. This sentiment has been stressed heavily by Seattle Seahawk’s head coach Pete Carroll. Yes, the Seattle Seahawks. The same team that won Super Bowl XLVIII and has been known over the past few years to boast the NFL’s best defense. Wait, hold on a minute. Does that mean football can be played both safely and effectively? The answer is yes, a million times yes. Implementing Seahawks tackling, which is really just a “rugby-style” shoulder tackling method, is a no brainer. Coach Carroll has released a 21 minute instructional video showing the way his coaching staff teaches tackling (“Seahawks Tackling”). It is not like this has been hidden away in secrecy from every other football organization in the world. Coach Carroll started implementing his rugby-style tackling system back in USC during his time as head coach. The video has been distributed to 14,000 high school football programs and 8,000 youth football programs through the Hudl video network (Farnsworth, “Pete Carroll Tackles a Serious Issue with Instructional Video”). NFL commissioner Roger Goodell has praised Carroll’s work and hopes that players, coaches, and parents at all levels of the game take the time to watch it. Yet, implementation is nonexistent. In order to start the wave of change, the NFL must enforce this shoulder tackling method. All 32 teams must undergo mandatory offseason training in order to learn the tackling techniques. From there, all levels of football, especially the NCAA, will have to implement Seahawks tackling as it will be the tackling technique used at the highest level of football. With the implementation of Seahawks tackling, spear tackling, a dangerous method of “tackling” in which a player uses their body as a spear (head out, arms by their side), will be no more. Spear tackling is illegal in all sports in which tackling is a part of the game - except American football. The combination of making spear tackling illegal and teaching proper tackling techniques will not only reduce the concussion rate in football but also reduce the rate of catastrophic cervical spinal cord injuries. To emphasize, proper tackling techniques are at the forefront at making the game of football safer. So much “branching out” can be done from implementing rugby-style tackling. The head will be taken out of the game in favor for shoulder to thigh contact. To discourage reckless tackling even more, the severity of penalties related to incorrect tackling must become harsher, specifically, incidents that revolve around helmet to helmet collisions. With the onset of proper tackling techniques, helmet to helmet collisions will become non-existent. Thus, if a helmet to helmet collision occurs, it will be hard to deem it as accidental. What I propose is changing the current penalty from 15 yards to 20 yards for a helmet to helmet collision. If a pass is thrown to a receiver and the receiver has full possession of the ball momentarily before the hit, than a helmet to helmet collision that causes the receiver to drop or fumble the ball past 20 yards from where the ball was initially thrown will result in a penalty that places the ball at the spot of the foul. If the pass is within 20 yards, a penalty will result in which 10 yards will be added from the spot of the foul. With these rules and regulations put in place, the game of football will continue to thrive without becoming “watered down”. Dr. Bennett Omalu, a leading neuropathologist in the study of CTE, recalled a discussion he had with an NFL doctor while reviewing the Mike Webster CTE case. Omalu states that the NFL doctor told him, “Bennett, do you know the implications of what you are doing? If 10 percent of mothers in this country would begin to perceive football as a dangerous sport, that is the end of football.” (Brinson, “Frontline PBS doc ‘League of Denial’ Examines NFL Concussion Problem”). With the implementation of proper tackling techniques, the game of football will, without a doubt, become much more safer, which, in turn, will revitalize endangered youth football leagues around the globe. So, let us not destroy the game of football and the lives of its athletes. Let us preserve both.
Epilogue
At the beginning of the school year, I did not know what to expect from this thesis project. I mean, what was I planning to spend the next 9 months of my life researching, studying, analyzing, and presenting about? I love sports and I want to go into the medical field. However, what am I truly passionate about? What provides me with a sense of fulfillment? That is the question that I had to ask myself before I started my thesis project. I honestly do not know the method in which the answer came to me but it eventually did. I wanted to change the landscape of something I loved because I wanted to preserve what was so special to me. Change. Change is a lackluster word. No, I wanted to leave behind a piece of work that would uproot the game of football as we know it but still leave behind the parts needed to keep the machine running. What I have proposed has the possibility to save tens of thousands of lives. Even after the presentation of my work, I will continue advocating for better concussion management in the game of football. I walked into this thesis course with the thought that the end goal was just to present my work. Instead, I leave this course with the realization that I have presented much more than just the work I have accomplished. I leave this course presenting a burning passion of mine that will only burn brighter each and everyday until progress is made to make the game of football safer and the lives of athletes longer.
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