Dr. Laura Miele-Pascoe is a guest blogger for Scientific American. The following article was posted on the Scientific American blog on November 24, 2014. The views expressed are those of Dr. Laura Miele-Pascoe and are not necessarily those of Scientific American.
Concussion Culture: How to Protect Young Athletes
In May of 2012, former NFL linebacker Junior Seau took his own life by shooting himself in the chest. Seau was dealing with depression, mood swings and insomnia. An autopsy of Seau’s brain revealed that he suffered from Chronic Traumatic Encephalopathy (CTE), which Boston University’s CTE Center defines as “a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head.” It’s a disease associated with dementia, and it can only be diagnosed posthumously.
After Seau’s suicide, CTE blossomed into the cultural lexicon. The NFL started to receive a wave of negative media attention, and the sport had become synonymous with CTE and concussions, which continues today. In a recent study, “new data from the nation’s largest brain bank focused on traumatic brain injury has found evidence of a degenerative brain disease in 76 of the 79 former players it’s examined,” according to PBS’ Frontline.
The conversation has shifted from the NFL to youth football after the implications of CTE were revealed, and a debate rages in regards to the appropriate age for tackle football. In response to the negative attention, the NFL created a program called Heads Up Football to teach coaches, parents, and athletes proper tackling technique. More than ever, parents are considering whether or not they would allow their children to play football—or choose what was then perceived as a relatively safer option like soccer.
But the idea of safety in sports began to shift again after evidence emerged that the first case of CTE was found in a soccer player. His name was Pat Grange, and while he was alive, doctors had diagnosed him with amyotrophic lateral sclerosis (ALS). When Grange died at the age of 29-years old, researchers at Boston University and VA Boston Healthcare System determined he actually had CTE. While the researchers couldn’t say for certain, many experts believe that over a long period of time heading the soccer ball can contribute to CTE.
As a sports psychology consultant, coach, professor at Ohio University, and personal trainer, these developments are of a concern to me because I’m responsible for the safety of my athletes and their recovery after injuries. I have seen athletes who have had to walk away from sports entirely because of multiple head injuries, and I have also seen many athletes fail to take concussions seriously enough because of a hyper competitive culture and proclivity to hide pain. Even with all of the latest news surrounding concussions, I have found in my experience that some athletes still lack an appreciation for the seriousness of concussions and the recovery process. So how can educators, coaches, and trainers help ensure the safety for young athletes?
The first step is obvious: education. Parents, athletes and even coaches still lack an understanding of the widespread problems of concussions and their lingering impact. Collectively, the work of USA Football, the CTE Center and The Center for Disease Control and Prevention are pushing for a larger understanding of concussions, but it needs to continue and trickle down to the locker room even more. The larger perception of concussions is that the dangers are limited to violent sports, but attention needs to be placed on all sports and concussions in general, especially where there is contact to the head.
But the second step to protecting young athletes isn’t so obvious, and it comes from a greater understanding of sports culture and psychology. For example, a recent study on concussion rates among high school sports reported that girls’ soccer had the third highest concussion rate, only behind football and hockey and nearly double that of boys’ soccer. That’s an alarming statistic. So how can we explain girls’ soccer as the third highest reported sport among concussions?
There is certainly a medical aspect that must be addressed. The Sports Concussion Institute has stated, “Soccer is the most common sport with concussion risk for females (50 percent chance for concussion).” Also, Dr. Robert Cantu, the CTE expert and neurosurgeon at Boston University, revealed in an interview in 2012 with NBC News that, “Girls as a group have far weaker necks. The same force delivered to a girl’s head spins the head much more because of the weak neck than it does to the guys.”
As the data and the physical disparities suggest, girls’ soccer has one of the highest incidents of concussions in youth sports, and it’s essential to continue to educate parents, coaches, educators, and young athletes to counteract the idea that boys’ football are the only ones suffering from concussions. Girls’ soccer clearly has a high rate of concussions, too. To keep this in perspective, a professional boxer punches at 20 mph; a football player who tackles a stationary player is at 25 mph; and the impact of heading a soccer ball is 70 mph, according to the Sports Concussions Institute.
But the data above on concussions rates, it’s clear that there are more reports of concussions in girls’ soccer still reveals something larger that educators must be aware of: the hidden truths of injured athletes. Girls are reporting more concussions than boys in soccer, but that could say more about the actual amount of concussions reported than actually sustained.
Concussions are still being under reported as a whole. For example, the New York Times recently published an article on the under reporting of concussions in Division I college football:
The three new studies … concluded that for every diagnosed concussion, players sustained six substantial hits that they suspected might have caused a concussion but did not report. The players added that for every diagnosed concussion, they also received 21 dings — or smaller hits — that they also did not report.
Perhaps this is a result of a lack of education to recognize the symptoms of concussions, a lack of baseline testing, or proper concussion protocols, but there is a larger issue being revealed about the culture of concussions.
Boys are conditioned to react differently to pain, both emotionally and physically, and they grow up believing that toughness and strength comes from silence about injuries. Certain types of coaches who encourage athletes to play through pain emphasize this idea. I have actually met old-school coaches who fail to admit the existence of concussions. They believe they “had their bell rung,” and it’s just a part of football and soccer. For example, just recently the University of Michigan football team, despite the extensive research on CTE and concussions, sent back a player into a game who had experienced a concussion. Subsequently, resulting in the demand to fire the head coach.
That’s not to say that young girls aren’t tough or play at a level of competition where they’re forced to hide pain either. Where athletes are competing for scholarships, there is even a larger culture to hide injuries, because they are often playing for something more than just pride. At this level, there is very little difference between genders, and they all try to hide pain, but it’s undeniable that there is a systematized culture to ignore pain, to play through injury, and, worse, to rush through the recovery process, which is generally more endemic in boys’ youth sports because of the larger amount of competition and sports available as well as a hyper masculine culture.
What people often forget about in regards to concussion prevention and safety is that young athletes go beyond just ignoring the pain during the game. They tend to rush through the recovery process, too. When a player receives a concussion, it’s essential that young athletes completely turn away from television, computers, use of their phones and even homework because the recovery process may be stifled it the brain does not rest. Depending on the severity of the concussion, I have seen athletes begin to shut down struggling with the injury. This is often the hardest part for athletes, because their competitive nature kicks back in, and they want to return to the field and their normal activities.
Besides ignoring the advice to shut down their mind from the connected world, they disregard the headaches, the mood swings, the potential for depression and the irregular sleep patterns. This is where sports psychology comes into play. Admitting that there is something emotionally wrong is a major issue for most athletes, too. Concussions are a different type of injury because they often lack physical signs. If they are deemed unable to play for an extended period of time, they may become anxious or more stressed which will have an adverse effect on the recovery process.
In addition to raising awareness of the science on CTE and concussions, it’s essential for coaches and educators to look at the culture of their programs and find ways to create locker rooms that are safe for athletes to express their concerns about their health. The only way that coaches and trainers can counteract the culture of toughness is to educate their players and explain these long-term impacts of concussions. Ultimately, athletes will always feel the stress of competition, but at least with a higher understanding of what is happening to their brains and a commitment from a coaching staff, athletes will be able to sift through the noise and emotions of sports. But it’s our job as adults to help young athletes admit when they’re in pain.
Dr. Laura Miele-Pascoe is an accomplished athlete as well as an experienced trainer, coach and teacher. She is a professor at Ohio University’s Coaching Education program and is frequently retained as an expert witness in cases where individuals have been injured during the course of sports, recreation, or schooling. Dr. Miele conducts forensic casework nationally/internationally.
Dr. Miele played Division I basketball at Arizona State; was Tight End for the Arizona Caliente, of the Women’s Professional Football League; and was also a New York Golden Gloves semi-finalist in 2004. She began coaching athletes in 1986 and has been involved as a personal exercise and fitness trainer since 1994. Dr. Miele has traveled extensively throughout the United States and Europe as an athlete and coach and has been involved in consulting, coaching and teaching a wide range of sports including Basketball, Volleyball, Softball, Baseball, Football, Archery, Bowling, Figure Skating, Hockey, Boxing, Wrestling, Field Sports, Golf, Soccer, Gymnastics and Tennis.