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SPORTS MEDICINE: Did sports medicine head in right direction over last decade?
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SPORTS MEDICINE

SPORTS MEDICINE: Did sports medicine head in right direction over last decade?

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As this decade comes to a close, a look back at the last 10 years reveals that the more things change, the more they stay the same.

In 2010, concussion was the sports medicine story of the year and so it remains. That same year, the Associated Press sports story of the year was the downfall of Tiger Woods. This year, AP’s choice for sports story of the year was Tiger Woods winning the Masters, after overcoming his personal demons and four back surgeries — among other medical woes.

While Woods’ story waxed and waned, the head injury story never lost its legs. In 2013, the NFL thought it had an agreement to provide a $765M pool of money to settle brain-trauma-related claims by retired players. However, fears that the pool was too shallow would delay final court approval until 2016. By then, the fund had been increased to $1B.

In the meantime, the movie "Concussion" — starring Will Smith — was released in 2015 to critical acclaim but to public indifference. Hurting the movie, perhaps, was the fact that it was “based” on a true story but full of dramatic fabrications.

Also, around the time of the movie’s release, the scientific evidence was building that number of concussions is not a risk factor for the development of Chronic Traumatic Encephalopathy . Instead, the risk increases with years of playing a collision sport. Bottom line? It is the thousands of sub-concussive hits to the head from blocks, collisions, hard falls, heading the ball, and tackles that add up to cranial catastrophe.

This year, another landmark study — this one on Scottish professionals — revealed that playing soccer carries essentially the same risk of neurodegeneration as playing American football.

The steady drumbeat from multiple media outlets regarding the risks associated with playing football have taken a toll at the high school level, with the nationwide numbers dropping nearly 10% over the last decade from 1.1M players to 1M.

However, is parental fear of football justified?

As reported in this space in 2012, 2016, and this year, three separate studies out of Mayo Clinic have looked at those who played high school football between 1946-56 and 1956-70, and then high school collision sports athletes who died later in life between 2005 and 2016. All three studies found no increased risk of developing a neurodegenerative disease later in life from playing football or other collision sport at the high school level. The third study did determine a significantly increased risk from playing football beyond one’s high school years.

Yet, beyond this space, coverage of the Mayo Clinic work has been sparse.

There has been no lack of coverage, though, on efforts to design a better helmet that will reduce the likelihood of concussion — despite concussion not being the cause of CTE. Far less attention has been paid to the fact that, encouraging laboratory results aside, every large-scale field study comparing newer helmet to old has found no difference in concussion frequency. VICIS is a Seattle-based manufacturer that started from scratch in 2013 with significant backing from the NFL and some of its players. Since the league started rating helmets based on laboratory tests, its top-rated helmet has been a VICIS. Nonetheless, at $1,500 per helmet until last year when the price was dropped to $950, VICIS could never penetrate the high school market, which is dominated by Illinois-based Riddell who sells NFL-endorsed models for less than $300. So, with financial losses in the millions and mounting, VICIS went into receivership last week in hopes of finding a buyer.

A possible problem with the newer helmets is that they tend to be larger and heavier than their predecessors, which means a larger “sweet spot” on the newer helmets as well as extra weight contributing to greater momentum once a collision has occurred.

Lost altogether in the rush to protect the head has been safety of the cervical spine or neck. Do these larger and heavier helmets make spinal cord injury more likely? Queried over the last decade, helmet manufacturers have either told me they don’t know or just declined to answer.

The status of three victims of spinal cord injury was highlighted here at the end of 2011. Morton High School football player Jeff Wozniak was able to walk out of the hospital after being briefly paralyzed in August of that year. Collegiate players Eric LeGrand of Rutgers and Chris Norton of Luther College were injured in 2010 and had made unexpected progress in 2011. As this decade passed, however, their progress plateaued and they remain wheelchair bound.

Aside from paralysis, the greatest fear associated with sports participation is sudden death, which required too much coverage in this space, particularly during the latter half of this decade.

A particularly bad year was 2018, when NBA G League player Zeke Upshaw collapsed during a March game but no medics checked his pulse because they assumed he had a head injury. Just a day after Upshaw’s mother filed a wrongful death lawsuit, University of Maryland football player Jordan McNair collapsed from heat stroke in May. Never immersed in cold water — a method that has a perfect save rate, McNair would succumb two weeks later.

ESPN would publicize Maryland’s systemic failures in September of 2018, but the revelations would come too late for Garden City Community College football player Braeden Bradforth, who also died of heat stroke the same day he collapsed in August.

Post-event analysis of all three cases determined that an emergency action plan was either not in place or not followed.

Fortunately in May of 2018 at Lake Station High School, a plan was in place and it was followed. During an open gym session, Raphael “Nathan" Perry collapsed; Lake Station athletic trainer Taylor Shoemake recognized Perry was in cardiac arrest; then athletic director Jason Hawkins retrieved a nearby AED; and Shoemake deployed it successfully, saving Perry’s life.

If all sports organizations follow that blueprint, sports medicine in the 20s will be dominated by happier stories.

John Doherty is a licensed physical therapist and athletic trainer. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.

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