December 15, 2022. By Callan Loflin.
This past weekend North Carolina closed the books on another high school football season by crowning its state champions. However, it’s not too soon to look ahead to next year and one of the more critical issues impacting the sport – concussions. Each year there are nearly 300,000 football-related concussions, according to the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program, and half of these go unreported or undetected. Given these concerning statistics, it is time we protect our athletes by critically reviewing concussion protocols.
As a medical student and a former traumatic brain injury (TBI) research coordinator, I have witnessed firsthand how TBI drastically alters one’s cognition, ability to function, and quality of life. Unlike orthopedic trauma, concussions are an invisible injury that can go undiagnosed, or may be diagnosed but inadequately monitored, putting patients at further risk. Something as simple as going to work or school becomes nearly impossible due to the overstimulation from lights and noise, in addition to challenges with impaired cognition. So, returning to play after concussion, which is considered a mild TBI, is both a challenging and unsafe task for athletes.
Look no further than what happened with Miami Dolphins quarterback, Tua Tagovailoa, this fall. After exhibiting gross motor instability in a game on September 25, he was allowed to return to the field the same day and was not reassessed after the game. Given that he was not followed under the concussion protocol, Tagovailoa continued playing and took a subsequent hit on September 29 that sparked a lot of conversation in the media, which ultimately led to the recent revision of what constitutes “no-go” signs and symptoms in the NFL concussion protocol.
Though it is like apples and oranges comparing NFL concussion protocols to that for high school, we can learn several lessons from recent events. First, it is imperative to assess concussions in young athletes more comprehensively on the sideline to account for atypical concussion symptoms like ataxia, a lack of motor coordination in balance or speech, that may be confused with a different injury. It is also vital that we consider who is conducting a concussion assessment on the sidelines. If it is easy for neurotrauma consultants who are licensed physicians to miss symptoms in the NFL, then it is likely we are not recognizing concussion symptoms under the Friday night lights as well as we should without licensed providers assessing athletes. A good first step is better supporting athletic trainers.
A 2017 study published in the Journal of Neurotrauma demonstrated that former high school and college football players who experienced repetitive head injuries faced depression, cognitive impairment and behavioral dysregulation later in life. So, although each brain injury is unique and assessment is imperfect, it is crucial that we continue to discuss how to improve our assessment of athletes. If we are noticing loopholes in the highly publicized Tagovailoa case, then how many players are sustaining head injuries and are falling through the cracks of protocols that we do not know about?
Though young athletes are driven by the love of the game and professional athletes are bound by million dollar contracts, both feel an obligation to push through injury. Yet, we must consider the consequences of returning too soon after head trauma. The brain is an incredibly complex and delicate 3 pound organ that executes everything we say and do. Is it worth risking our ability to think and feel for the glory of the game? We have the research to show it’s not – we must improve sideline concussion assessment. It’s time for change.
UNC School of Medicine Class of 2025
2022-23 NC Schweitzer Fellow