In 2004, I had written that the then-ongoing media storm over steroids and other performance-enhancing drugs would never go away.
I was wrong. The illicit use of PEDs by athletes has not gone away but the non-stop coverage of the issue essentially has. It has been driven from the headlines by another topic that I will hazard to guess won’t be supplanted any time in the foreseeable future.
This topic has been on 17-year run that seems to grow stronger by the month. Just look at the stories that have dominated newspaper sports sections, ESPN, Sports Illustrated, social media and even national news broadcasts over the last 10 days.
On Sept. 15, the American Academy of Pediatrics announced the highlights of its National Conference and Exhibition that was in Chicago this year and ran until Tuesday. One of those highlights and the one that received the lion share of the attention was the presentation of a study from Texas that found youth and high school girls soccer players were five times more likely than boys to conceal a concussion and keep playing.
Two days later, Tom Brady appeared on “CBS Sunday Morning” and said in reference to concussions that, “I don’t worry about ‘em, no.” Then he went on to compare playing an NFL football game with being in a car crash.
Tuesday was marked by contradictory publications that originated from Boston University, one of the more notable centers studying the effects of head trauma in sports. On the one hand, Dr. Peter Cummings, a BU professor and neuropathologist, wrote an essay for Yahoo Sports in which he explained why he thought it was safe for his 11-year-old son to play football. Meanwhile, BU’s Chronic Traumatic Encephalopathy Center published a study showing that playing youth football before age 12 doubled one’s chances of developing behavioral issues and tripled the chances of depression later in life.
On Wednesday, a young child was struck in the head by a line-drive foul ball at Yankee Stadium and needed hospitalization. Most news organizations declined to replay the incident, instead showing multiple players from the Twins and Yankees in tears.
Also that day, the Associated Press reported that, over the first three weeks of the college football season, there had been a 73 percent increase in targeting penalties in the Bowl Subdivision.
The latest cycle of concussion-related catastrophes reached a crescendo, though, on Thursday when BU announced former Patriots tight end Aaron Hernandez had Stage 3 (out of 4) CTE at the time of his death. Roughly simultaneously, Hernandez’s lawyer filed a $20 million lawsuit against the NFL and the Patriots on behalf of Hernandez’s fiancé and daughter. Hernandez committed suicide at age 27 in April while serving a life sentence for murder.
Controversy and context
How are parents and athletic administrators to digest this onslaught of information?
Let’s take the stories one by one before looking at the question as a whole.
For years, it has been known that female soccer players suffer concussions at a rate far higher than males and approaching that found in football. (The rates in wrestling and women’s hockey actually exceed football at the college level.) One assumption was that the reported soccer rate was much higher among girls because the girls were more honest. Another suspected factor for the disparity was neck strength. The better one’s neck strength, the lower one’s risk of concussion and boys have stronger necks than girls. Based on the above-mentioned study, it looks as if the neck strength theory still has legs. The girls being more honest than the boys? Not so much.
Brady saying he’s not worried about concussions may sound foolish. However, he may be on to something. For adults, the symptoms of concussion fully resolve 90 percent of the time within two weeks. (Among teens, the number is closer to 75 percent.) Furthermore, multiple studies out of BU indicate that number of concussions is not a risk factor for CTE. Instead, the risk rises with number of years of playing any collision sport — all those "car crashes" that don’t necessarily cause a concussion.
Cummings’ opinion certainly collided with many of his colleagues, but I applaud his courage to express a viewpoint contrary to the ongoing media narrative. Nearly every concussion-related story published by a media outlet in the last 10 days mentioned a BU study published earlier this year, purporting to show that the brains of 99 percent (110 out of 111) of deceased NFL football players had varying stages of CTE. As Cummings pointed out, however, it was families who already suspected CTE in their loved ones that donated those 111 brains. This was not, then, a scientific sample intended to determine the rate of CTE among ex-NFLers. Other longitudinal studies, with scientifically chosen samples, have failed to show any increased risk of neurodegeneration among those who have played football only at the high school level. Still, it is difficult to argue with the data generated regarding those who played prior to age 12.
Nor is it difficult to argue that head injuries are a risk beyond football. In baseball, where the risk is particularly great for catchers and umpires, the danger extends off the field to those in the stands. Of course, if the foul ball in question had been hit at New York’s other MLB venue, Citi Field, protective netting would have stopped it. Why is MLB waiting to make protective netting, at least as far as the outfield end of both dugouts, mandatory in all of its stadiums?
College football referees are apparently done waiting for players to improve their on-field behavior. Good for them, calling targeting more frequently. It should be called every time it occurs. Ultimately, the severity of the penalty — ejection — will effect a change in behavior among players.
As for Hernandez, his history of misbehavior off the field dates back to age 16, when his father died unexpectedly following hernia surgery. Angry at the world, he began associating with a criminal crowd, long before CTE would have been contributing to any violent conduct. There is no evidence that CTE triggers murderous behavior. As for suicide, stop and consider what prominent BU researcher Ann McKee said in 2013 during an episode of PBS’ Frontline entitled “League of Denial.” She theorized that all football players would be found to have CTE. If that is so, then perhaps the dreaded disease, for all the problems it does cause, makes suicide less likely because the suicide rate among retired NFLers is lower than that among the population at large. As for the lawsuit, any player who stopped playing prior to 2014 — the Patriots released Hernandez in 2013 — is covered in the $1 billion settlement between the league and that group of players. That settlement prohibits individual ex-players in the group from suing separately unless they opted out of the agreement and Hernandez did not opt out.
Separating fiction from truth
Michael Owens, MD, JD, Medical Director of Concussion Clinic of Community Healthcare System, would like to see the media opt out of providing concussion-related misinformation.
According to Owens, if two commonly held assumptions were corrected, then management of the injury would be far easier for him.
“(It is) a mistaken notion that brain imaging (MRI or CT scan) is routinely necessary,” he said. As for the fear of potential long-term consequences, he said, “It is not a direct line from concussion to CTE.”
An overall better understanding of what concussion is and what it is not may also put parents and players at ease when faced with the diagnosis.
“Concussion is the result of the brain being shaken in the skull at the cellular level,” Owens explained. “It throws off brain chemistry and utilization of glucose, affecting blood flow to where busy parts of the brain don’t get enough glucose and then are unable to function as well. It is not a brain bruise. It is nothing that will show up on routine imaging such as a CT scan or MRI. It is defined more by what it isn’t.”
When Owens sees a patient following a concussion — barely half are athletes, with the remainder being victims of car accidents, falls, violence, and work place injuries — he draws an analogy with other sports-related injuries, where the treatment is relative rest, not total rest.
“I advise breaking (tasks) into shorter snippets of time,” he said. “Take a break. You can’t ‘push through’ with this injury. It is not productive. Nor is absolute rest. We don’t put people in dark rooms.”
What he does is use a multi-disciplinary team to manage the injury in a manner that makes rapid and complete recovery more likely.
“We are the only full-time, full-service concussion clinic in the area,” he said. “We are staffed by experienced athletic trainers who are ‘in the trenches’ with the athletes and know how to get them back safely. We have the best vestibular clinic in Northwest Indiana and we have access to other ancillary services such as speech pathology.”
With such a program in place, Owens is confident that concussion need not be the cause for long-term concern for parent and player that the media have painted it to be.