Reduction of Concussions in the Game - Research Paper Example

There should be more education on the long-term effects of concussions and tougher punishments for helmet to helmet contact, because this would lead to a decrease in severe brain injuries. 1. Introduction The development of sport activities worldwide has been related to various health problems. In fact, the research developed in the specific field has revealed that the risk of athletes to have severe health damage because of their participation in sport activities is high. Such case exists in football. The specific sport has been related to concussions, a severe head injury which is the result of the helmet-to-helmet contact during the football game. Many efforts have been made by international sport associations, like the NFL, and local sport organizations for the limitation of concussions in football. In most cases, the use of helmets of advanced technology has been initiated – for reducing the rate of concussions in football games. However, this measure has been proved inadequate to protect athletes from concussion. The alteration of existing football rules would be the only way for controlling concussions. In fact, it is only through the prohibition of helmet-to-helmet contact – as part of the game – that concussions can be controlled, i.e. the target set by the football administrators and regulator should be the ban of concussions and not their reduction, which is not achievable in practice. On the other hand, because the total prohibition of helmet-to-helmet contact in football might be difficult to be established an alternative method of controlling concussions should be adopted: tough punishment should be impose for helmet-to-helmet contact; in this way, the rate of concussions would be decreased. At the same time, the footballers should be informed on the short term and the long-term effects of helmet-to-helmet contact and of concussions. The importance of the above measures is verified through the findings of the theoretical and –mostly- the empirical research developed on the particular subject – as presented analytically below. It should be noted that even if different criteria have been used by researchers in order to evaluate the short term and the long term effects of concussion, their studies lead to similar assumptions: initiatives should be developed for the control of concussions in football because of their severe effects of the health of athletes. 2. Concussions and football The expansion of concussions in football cannot be denied. Because of their frequency of occurrence in football, concussions have been regarded as part of the specific sport. In accordance with Hoerner (1997) the concussion can be described as ‘the traumatically induced alteration in mental status’ (Hoerner, 1997, p.35). It is explained by Hoerner (1997) that concussion is part of the football games even if efforts have been made for the control of the phenomenon. It is also noted that the concussion in football is usually captured through videotype and for this reason, the guidelines given from the medical practitioner regarding the recovery from the trauma can be more effective – at least compared with the concussions occurred during road accidents or other activities where the conditions of the accident cannot be known – at least fully – to the medical practitioners involved in such cases. Moreover, concussions in football have been extensively studied – through appropriately customized empirical research; for this reason, important information is available regarding the treatment necessary for the quick – as possible – recovery from a head injury caused by a football related concussion. In order to understand the expansion of concussions in football it would be necessary to examine primarily the position of concussions as part of the game. In accordance, with Nowinski (2006) concussions are indispensable part of football at such level that their limitation can be characterized as a challenging task. In fact, it is noted by Nowinski (2006) that it can be made no discussion on the reduction of concussions as such discussion would be with no particular value. Gradually, concussions have been made acceptable - in the context of a football game. It is for this reason that any measure taken for the limitation of concussions has failed to achieve the specific target. The use of helmets of advanced technology is the most common measure for the control of concussions. However, this measure also has been proved inadequate to prevent severe head injuries – a result of concussions. Under these terms, it is suggested by Nowinski that the discussion on the reduction of concussions should focus on their elimination, not on their reduction. It is assumed that the above researcher refers to the rules of the football games; these rules should be appropriately updated so that concussions are totally banned. In practice, the elimination of concussions faces many delays because of a series of reasons. At the first level, the athletes do not always report the concussions; this issue is highlighted in the study of Solomon et al. (2006, p.22). This fact has the following consequences: a) the exact rate of concussions in football cannot be precisely estimated; moreover, since the football associations are not aware of the actual expansion of the phenomenon they avoid taking measures for the control of concussions. Furthermore, the measures taken are based on false figures – since the exact number of concussions is not available – and they cannot contribute highly to the elimination of the phenomenon, b) the development of severe health problems among footballers cannot be controlled since the athletes do not ask for relevant medical support. In this way, the impact of concussions in football is further increased. The implications of the lack of awareness of concussion are also discussed in the study of Patlak (2002); in the above study it is made clear that concussion cannot be always identifiable. It is explained that ‘a football player is expected to suffer many blows to his head during a football game; but it is unlikely that he fall unconscious (Patlak, 2002, p.1). As a result, he continues to participate in the game and in the practices without thinking that his health may be under severe threat. It is at this point that the education on the effects of helmet-to-helmet contact and the concussion would be particularly valuable. If athletes were appropriately educated on the symptoms and the effects of concussion they would be more likely to report concussion with no delay reducing the chances for a severe damage to their health. In this way also, the football administrators and legislators would be aware of the actual level of the problem and could introduce the appropriate measures for the control of concussion. NFL has tried to control the expansion of concussion by introducing severe punishments for ‘for illegal and dangerous hits that often result in head injuries’ (Behen, 2010). On the other hand, the methods of treatment of concussions followed by physicians in football have been differentiated. Athletes who have suffered a concussion are likely to be given more days in order to recover from the head injury – compared to the past. In fact, in a study conducted from 1996 up to 2007 it was proved that during the years 1996-2001 the number of days given to athletes for recovering from concussion was ‘1.92 while in the period 2002-2007 this number has been increased – reaching the 4.73 days’ (Behen, 2010). This change shows the difference in the methodology used for the control of concussion in football. On the other hand, it is explained that the above increase in the number of days available to athletes that have suffered a concussion shows a difference in the severity of concussion and not necessarily an increase in the attention paid by the state on the limitation of concussions. Moreover, it is noted that currently, the athletes are more likely to report a concussion – compared to the past. At this point the role of the state in the reduction of concussion has been clear; by providing the appropriate education to footballers of all ages, NFL has helped to the limitation of the phenomenon of non-reporting of the concussions. In the long term, the above trend has a significant effect on the decrease of concussions among footballers. The promotion of a conservative management of concussions – compared to the past – by physicians is also important to the increase of effectiveness of the treatment of concussion (Behen, 2010). However, at this point also, the intervention of the state is clear. It should be noted that the support of the state towards the limitation of concussions is not always visible. In this context, Gregory (2010) highlighted the need for the increase of the participation of the state in the reduction of concussions in football. If being examined in detailed, the figures related to the occurrence of concussions in football show a limitation of the phenomenon, but the relevant trend may not be always clear. 3. Long – term effects of concussions The fact that concussions are part of football cannot justify their expansion. The severe head injuries caused because of concussions should be taken into consideration by legislators and the administrators of football associations. Concussions should be prohibited as part of football games and severe penalties should be imposed on the violators of the relevant rules. The above suggestions are based on the findings of empirical research regarding the short and long-term effects of concussions. Briscoe (2006) refers to a study conducted in Netherlands in 1998. In the above study, the long-term effects of head injuries on footballers and other athletes were examined through a series of neuropsychological tests. The findings of the study revealed the failure of footballers to respond successfully to the relevant tests. The tests employed in the study were indicatively the following ones: ‘the Bourdon-Wiersma test (mistakes), the Wisconsin Card Sorting test, the Figure Detection test and so on’ (Briscoe, 2006, p.195). In another study conducted in 1999 by Matser et al. (1999) the severe long-term neuropsychological effects of concussions were verified; the rate of occurrence of concussions during football games was also measured. The findings of the above research could be summarized as follows: a percentage of 21% of the footballers/ participants revealed that they had at least 2-5 concussions during football games. The percentage of the footballers that had at least one concussion because of football was estimated to 27% (Matser et al., 1999 in Briscoe, 2006, p.196, also in Sentowski, 2007, p.20-21). As for the long – term effects of concussion on health, it was proved that concussions can cause severe damages to various aspects of the neuropsychological system of footballers. More specifically, all participants failed to respond successfully to the tests conducted for the study – even if the rate of failure has been differentiated among the participants – probably in accordance with the number of concussions that the participants had. The neuropsychological tests included in this study referred to different aspects of neuropsychological functions: ‘Digit Span Test (forward and backward), Associate Learning, Logical Memory and Visual Reproduction tests’ (Briscoe et al., 2006, p.196, Sentowski, 2007, p.20-21). In other words, a percentage of 48% of the participants – almost half of them – had at least one concussion because of football. Moreover, the effects of concussion on the footballers’ neuropsychological functions have been severe – for some of them damage has caused even from one football related concussion (Briscoe et al., 2006, p.196). An important aspect of concussions is presented and analyzed in the study of Hoerner (1997); it is mentioned by the above researcher that a concussion can be repeated shortly before a previous one. This fact can lead to extremely severe health damages – the effects of concussion, which is repeated shortly after another concussion, have been described as ‘second impact syndrome’ (Hoerner, 1997, p.36). In accordance with Hoerner (1997) the concussion of this type can lead to ‘severe neurological disability or death’ (Hoerner, 1997, p.36). Because of the above fact, it is suggested by Hoerner that footballers who had a concussion avoid participating in a game shortly after the occurrence of the concussion – at least for the period of time that the effects of the first concussion need in order to disappear. On the other hand, it is noted by Hoerner that those athletes who had concussions for many times are likely to develop permanent neuropsychological damages (Hoerner, 1997, p.36). Reference is made on relevant studies, which showed that the risk of a permanent damage on health is extremely high on 25% of the athletes that had three concussions and 40% of athletes with five concussions (Hoerner, 1997, p.36). From another point of view, Lovell (2004) supported that the chances of athletes of high schools to have a concussion is relatively low. At the same time it is noted that the number of concussions occurred in helmet-to-helmet contacts of high school athletes is also low. Based on the findings of ‘a three-year study conducted by the National Athletic Trainers’ Association’ (Lovell, 2004, p.27) the above researcher noted that only one concussion is expected to occur among 9,000 helmet-to-helmet contacts in high school football (Lovell, 2004, p.27). The above figure is extremely low indicating that there is no particular reason to worry for the appearance and the development of concussions – at least regarding high school graduates. It is noted, however, that concussions are likely to threaten the health of athletes in the long term, meaning that their effects may not be visible immediately – at the time when the head injury occurs. For this reason, they should be appropriately treated without delay even if they are considered to be of minor importance. In accordance with Hyde et al. (2007) concussions are extremely common in football. Moreover, it is explained that the long term effects of concussions may be severe mostly because concussions are not always reported – a fact which is not related necessarily with the intention of the athlete to hide the specific event. The lack of symptoms is rather considered as the most usual reason for non-reporting the concussions. Reference is made to a study developed in Wisconsin among football players; in that study it was revealed that approximately 50% of the football players ‘did not report their head injuries for a variety of reasons’ (Hyde et al., 2007, p.312). On the other hand, Hyde et al. (2007) refer to the data revealed through a study conducted between 1945 and 1999; in that study it was proved that the percentage of deaths due to concussions in high schools is extremely high – it has been estimated that 75% of concussion – related deaths have taken place in high schools (Hyde et al., 2007, p.312). The above figures show the need for early intervention of the state in the limitation of concussion. It is not only at the level of the professional football meetings that measures are introduced. Rather, high school students need to be appropriately informed on the effects of concussion and of helmet-to-helmet contact in general. There are two issues that have been proved to be particular important for the effective treatment of concussion: a) concussion is not always identifiable by the athletes and b) under certain terms the athletes do not report the concussion either mostly because of their fear on the effects of the specific accident on their career. The above issues are highlighted in the study of Solomon et al. (2006). Reference is made to the findings of the research developed by Dr. Scott Delaney in 2000. In the above research it was revealed that about 4 out of 5 athletes are not likely to be aware of the fact that they had a concussion (Solomon et al., 2006, p.22); some of them have felt the relevant symptoms, more or less, but even in this case, they didn’t realize that they had a concussion. The non-report of concussion when the athlete is aware of it can be more dangerous. More specifically, when the symptoms of the concussion are so limited that the athlete cannot realize the existence of concussion, then it is more likely that it is a non-severe concussion. However, when the concussion was made clear – usually when the helmet-to-helmet contact was strong – then the effects of concussion on health are expected to be severe (Solomon et al., 2006, p.22). Moreover, by ignoring concussion and avoiding the necessary treatment, the athletes involved are more likely to develop severe long – term health problems – in the context described in the studies presented above. 4. Conclusion Concussion can be characterized as a major problem for athletes in all sports. As revealed through the studies presented above, concussions in football are a common phenomenon leading to severe brain damages and a series of neuropsychological problems. The effects of concussions on the health of athlete can be estimated using appropriate tests and clinical exams, like the electroencephalogram (Zasler et al., 2007, p.412). However, in order for the concussion to be effectively assessed and treated it is necessary that it is reported – a term, which is not met in all concussions, as, explained above. Researchers have studied the effects of concussions of human health aiming to offer the necessary framework for its limitation. However, despite the empirical studies developed in the specific field, the reduction of concussion in football has been limited. The level of the problem is revealed through the figures published in the study of Falk (2005); in the above study it is noted that ‘between 1994 and 2003 twenty young men died from heat stroke when playing football’ (Falk, 2005, p.57). The above study refers only to the deaths occurred because of head injuries during to the football games. The actual expansion of the problem would be made clear if taking into consideration the number of concussions that have not been reported or those the effects of which were not revealed during the game but later (Klopfleisch, 2009). A series of measures – as indicatively explained below – would be necessary to ensure the effective control of concussion in the context of football games. 5. Recommendations The reduction of concussions in football could be achieved through a series of measures: a) the impact of concussion and of the helmet-to-helmet contact should be explained to footballers; relevant sessions could be initiated by NFL which should take a clear position towards the specific problem (George, 2009), b) existing rules regarding the helmet-to-helmet contact should be updated (Gregory, 2010); severe punishment should be imposed in cases of helmet-to-helmet contact aiming to prevent athletes from the specific activity during the football games, c) athletes should be obliged to participate – periodically – in appropriately customized neuropsychological tests. Through these tests, the potential existence of concussion could be identified – even if the athlete involved did not report it. References Briscoe, W. (2006) Focus on Cognitive Disorder Research. Nova Publishers Echemendia, R. (2006) Sports neuropsychology: assessment and management of traumatic brain injury. Guilford Press Falk, G. (2005) Football and American identity. Routledge Hoerner, E. (1997) Safety in American football. ASTM International Hyde, T., Gengenbach, M. (2007) Conservative management of sports injuries. Jones & Bartlett Learning Lovell, M. (2004) Traumatic brain injury in sports: an international neuropsychological perspective. Taylor & Francis Nowinski, C. (2006) Head games: footballs concussion crisis from the NFL to youth leagues. Chris Nowinski Patlak, M. (2002) Is soccer bad for childrens heads?: summary of the IOM workshop on neuropsychological consequences of head impact in youth soccer. National Academies Press Sentowski, H. (2007) Cognitive Disorders Research Trends. Nova Publishers Solomon, G., Johnston, K. (2006) The heads-up on sport concussion. Human Kinetics Zasler, N., Katz, D. (2007) Brain injury medicine: principles and practice. Demos Medical Publishing Online Sources Behen, M. (2010) NFL Players With Concussions Sidelined Longer: Study, Bloomberg Business Week, online, available from http://www.businessweek.com/lifestyle/content/healthday/644733.html George, T. (2009) NFL continues to tackle concussion issue head-on, NFL, online, available from http://www.nfl.com/news/story/09000d5d8104d786/article/nfl-continues-to-tackle-concussion-issue-headon Gregory, S. (2010) Can Football Finally Tackle Its Injury Problem? Time US, online, available from http://www.time.com/time/nation/article/0,8599,2027053,00.html Klopfleisch, B. (2009) Players Suffer Long-Term Effects from Multiple Head Injuries, online, available from http://www.suite101.com/content/football-players-and-concussions-a181232 Read More