Football has always been a dangerous game and while most people have always recognized that there was a chance that players can be injured at any time, that risk has generally been accepted as a cost of doing business. However, in recent years research into the long term effects of concussions and other repeated head traumas have shown that perhaps that cost is too high. The research into the dangers of repeat blows to the head have led to the passage of new rules on all levels designed to reduce the numbers of blows to the head sustained by players and to make sure that players who suffer potential concussions are evaluated properly by medical personnel before being allowed to return to the game.
While many of these rules have been met with disdain from fans who see them as the “pussification of football”, the truth is that something needed to be done to reduce the amount of head trauma sustained by players as it has become clear that the long term consequences are very severe. A question that needs to be asked though is whether or not these new rules are making a difference, are we reducing the amount of head trauma that players experience.
Ohio State clinical assistant professor of physical medicine and rehabilitation Joseph Rosenthal sought to answer this question as part of his pursuit of a Master of Public Health degree from OSU. Rosenthal and his colleagues looked at data collected from the High School Reporting Information Online (HS Rio) system which tracks injury information from a sample of 100 high schools across the country that have a certified athletic trainer on staff. Rosenthal looked at data from 2005 to 2012 across a total of nine sports: football, boys and girls soccer, girls volleyball, boys and girls basketball, wrestling, baseball, and softball. The study found that the concussion rate went from 0.23 concussion per 1,000 athlete exposures in 2005 to 0.51 concussions per 1,000 exposures in 2012.
At first glance these numbers seem alarming, as Rosenthal noted “It’s scary to consider these numbers because at first glance it looks like sports are getting more dangerous and athletes are getting injured more often.” Are all these new rules failing to do any good?
While the concussion numbers look alarming at first, a closer consideration of the data presents another explanation. It is important to remember that the data from HS RIO tracks reported concussions, not the actual number that occur. Thus, there are two reasons one could see a rise in concussion numbers, either more concussions are occurring or people are getting better at diagnosing and reporting concussions. Rosenthal himself seems to favor the second explanation, saying “This study is observational so it doesn’t offer any proof about why the rates are going up. But I think in reality it’s showing that concussions that were occurring before are now being diagnosed more consistently – which is important.”
As I have already stated, the past decade has seen a major growth in the awareness of the dangers posed by concussions and the advent of new rules concerning concussions. While most fans are aware of changes at the college and professional level, they are probably less familiar with the changes that have been made at the high school level. While rules for high school sports vary from state-to-state, most state high school athletic associations have passed new rules for player safety that focus on improving awareness of concussions and making sure that players who are suspected to have sustained a concussion are properly evaluated by a medical professional, not a coach, prior to being allowed to return to play; some states have even passed laws along these lines. Before moving to Australia, I was a high school football and basketball official in Michigan and concussion awareness was strongly stressed to officials.
While we would like to think that players who had sustained a potential concussion were always getting proper medical treatment before returning to play, the truth is they often weren’t. In many sports, especially physical ones like football, there is a long standing attitude of telling players to ‘just shake it off’ and get back there; as an official I personally witnessed coaches telling players this after the player complained about being shaken up or having a headache following a big hit. It wasn’t just the coaches that were the problem, many players themselves fail to report concussion-like symptoms because either they don’t realize what the symptoms may mean or that they were afraid that they would get taken out of the game. With these new rules and focus on the dangers of concussions, it is likely that many coaches and players have changed their actions and aren’t just trying to ‘shake it off’ but instead are actually reporting their symptoms and get properly evaluated. This is obviously a good thing and what everyone wants to happen but it also has the effect of potentially increasing the number of reported concussions even if the number of concussions that actually occur is the same or even dropping.
The data issue at hand here in this study, that reported concussions are increasing even if the actual occurrence rate of concussions is not, is something that isn’t just confined to this study, rather it occurs in a lot of scientific studies. Pretty much any study that looks at the change over time of something that has to be reported or diagnosed can potentially suffer from a similar effect and great care must be made to track how the reporting/diagnostic efficiency changes over the time period. For example, the number of people diagnosed with cancer has gone up dramatically over the last several decades but much of that increase is due to the fact that we are getting better at detecting and diagnosing cancer and people are doing a better job of getting screened for it. Other examples include the rate of things like ADHD or autism spectrum disorders where much of the increase in their rate of diagnosis is due to increasing public awareness of these conditions and changing diagnostic definitions.
Concussions and other head trauma continue to be a serious issue facing sports and it is great to see researchers at Ohio State taking a lead in studying whether the current efforts being made to reduce the concussion numbers is actually working. As this study shows, there is still much to be done in order to understand how effective the new rules and policies are but there at least appear to be some hints that recent efforts have increased the percentage of concussions that occur that actually get reported.