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Would changing the ‘culture of resistance’ in sports reduce youth concussions?

October 30, 2013 at 12:00 AM EDT
While pro football has begun to confront the consequences of concussions, a new report is putting the spotlight on younger athletes and the risk they face from repeated head injuries. Jeffrey Brown talks to Dr. Robert Graham of The George Washington University, former NFL player Fred McCrary and athletic trainer Tamara McLeod.

GWEN IFILL: Now to the nagging, troubling questions about youth sports, the risk of concussions, and how parents should weigh the tradeoffs.

Jeffrey Brown has the story.

JEFFREY BROWN: The NFL is already playing under a new spotlight on concussions. Days before the season began, the league agreed to a $765 million settlement with 4,500 former players.

They’d charged that owners concealed information on the effects of repeated head injuries. That history was the focus of a PBS FRONTLINE investigation that aired earlier this month on the links between head injuries and brain disease.

Now a new study explores the risks for athletes well before they reach their college and professional years. The report by the Institute of Medicine, a nonprofit, independent organization, focuses on sports-related concussions in youth, from elementary school through adolescence.

One member of the panel, Dr. Frederick Rivara of the University of Washington School of Medicine, pointed to a key problem: the lack of data for this age group.

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DR. FREDERICK RIVARA, University of Washington School of Medicine: There’s essentially nothing known about concussions in elementary school and middle school-aged kids. And that’s really why there’s a need for more research in this area. It probably makes sense to everyone in the room that guidelines for college kids don’t apply to 5-year-olds.

JEFFREY BROWN: But some things are known. The study finds that, besides football, sports putting children at highest risk include ice hockey, lacrosse and soccer for both boys and girls.

Helmet design doesn’t necessarily reduce the risk of injury, despite recent efforts to enhance headgear. And a culture of resistance makes young athletes less likely to report concussion symptoms, so they can keep playing.

The researchers call for the youth sports community to handle concussions as serious injuries, requiring full recovery. And it’s clear that parents are paying attention. A new Marist poll says one in three Americans are less likely to let their children play football due to concerns over head injuries.

And we hear from three people who are involved in all of this. Dr. Robert Graham of the George Washington University was the chair of the group that produced today’s report. Fred McCrary is a former Pro Bowl fullback who played in the NFL for 11 seasons ending until 2007. He now coaches his sons in youth football. He also was a plaintiff in the lawsuit against the NFL. And Tamara McLeod, an athletic trainer who works with schools and researches concussions, she’s with A.T. Still University in Mesa, Arizona, and was a reviewer of today’s report.

Robert Graham, I want to start with you. And I want to pick up on just this question of what is and isn’t known. We know that concussions are important events. What do we know about the long-term effects, especially when it comes to young people?

DR. ROBERT GRAHAM, The George Washington University: Well, I think to pick up on Dr. Rivara’s comment just as we came into this conversation, you might say we know an increasing amount about the numerator.

We know more and more about the incidents of how many concussions are reported in different sports and different agents. What we don’t know is the denominator. We don’t know whether or not we’re getting all of the reports, and, specifically, research needs to be taken on a longitudinal basis. If something happens to somebody at the age of 7, what are the implications at the age of 10, at the age 21? We don’t have any of that.

JEFFREY BROWN: And this is because there hasn’t been a lot of attention paid to people, to children at this age?

ROBERT GRAHAM: I think what we’re seeing is in the last five years, two years an increasing amount of attention saying, you know, this may be a serious problem.

It’s not an area if you go back 10 years that you find an awful lot of research.

JEFFREY BROWN: Let me ask you about one specific that I think might surprise a lot of people, is about helmets.


JEFFREY BROWN: One of the things the study says is that helmets, they may be good for a lot of things…


JEFFREY BROWN: … but they don’t actually help when it comes to concussions.


And remember that this committee had to deal with evidence, peer-reviewed scientific studies, very high bar. But when you look at that, you don’t find any evidence that any helmet actually reduces the incidence of concussion. You still need to wear helmets because they do protect against skull fractures, soft tissue issues, cut — cuts. But there’s no evidence out there that is compelling that says if you wear this helmet, you will have a lower incidence of concussions.

JEFFREY BROWN: All right, Fred McCrary, I would like to bring you into this, because you experienced concussions, many of them, I gather.

One of the thing this report cites is that — the culture of sports, the warrior culture of sport, and that’s something you experienced firsthand, right? Tell us a little bit about that, how it plays into concussions.

FRED MCCRARY, former National Football League player: It plays a great role into concussions simply because of this. When you get a concussion, it’s more about the kids. For me, it’s about my children, protecting my children.

If I can go out and protect my children and get educated on it, then I have done my job. I know what it’s done to me. I have had hundreds, probably, of concussions. What they consider concussions today, I have had hundreds. And for me to educate the youth on it and to give them my experiences, I think I have done a great job of it.

JEFFREY BROWN: In your experience in the NFL and what you see now today in a college level, even before we get down the young kids, is there more awareness, or is there still a sense that the player should go back in the game, you know, you have got to get back in the game, even if you’re hurt?

FRED MCCRARY: First, let me tell you this.

You know, I think it starts at the top with the NFL. It goes from NFL, when NFL was saying it’s ongoing studies, ongoing studies. So why would the colleges do it? Why would high schools do it? Why would the little leagues do it? There was no need, since there was so many ongoing studies for the NFL. So, why waste your time, why waste your money if the NFL — it starts at the top and it falls down, in my opinion.

And what was your question again? Sorry about that.

JEFFREY BROWN: No, my question was about whether that culture of pushing people back into the game, even if they have already had a concussion, still exists.

FRED MCCRARY: Well, probably not as much now. I’m pretty sure it’s very, very little now because so much has been made of it.

It’s been brought to the light finally. But back when I was playing, absolutely. You weren’t allowed to get hurt. That wasn’t just allowed. You get your butt back in the game. Make sure he’s all right. Give him some smelling salt. He’s fine. Put him back in, because a lot of times, they have nobody else. They said, we’re trying to win a game. You’re fighting your teammates. You’re fighting for your job.

You waited all your life to become an NFL player. Nothing’s going to stop you from going back that into that game. So, you lie about it. You say you’re fine and get back in.

JEFFREY BROWN: Well, let me ask Tamara McLeod.

When you’re dealing with younger — either high school and down to younger children, how much today are coaches, team doctors and others aware? In other words, who’s really responsible and taking responsibility for concussions?

TAMARA MCLEOD, A.T. Still University: Sure.

I think it varies depending on the age group that we’re talking about. At the high school level, about half of the schools in the country have a licensed athletic trainer who is there working under the direction of a physician. I think, in many states, the high school coaches are required to do some preseason concussion education.

So there’s definitely an increase in awareness at that level. When we get younger than high school, the youth sports, the club sports, the community leagues, I think that’s where we see a lot of variations, because there aren’t the same mandates that some of interscholastic associations have regarding education for coaches, parents, or athletes.

JEFFREY BROWN: Have you seen changes, specific changes in sports or in the way sports are conducted for young people, in other words, not allowing certain kinds of activities? Is that taking hold?

TAMARA MCLEOD: I haven’t seen that personally.

I think there’s definitely a lot of benefits to participating in youth sports, and we don’t want to send the wrong message in saying that kids shouldn’t be participating. What we really want is to encourage youth leagues, parents, and coaches to become educated, to understand what a concussion is, so that they can recognize if their child has had a concussion and seek appropriate medical care.

JEFFREY BROWN: Well, Robert Graham, you pick up on that, because the panel is not going so far as to call for particular changes or bans, correct?

ROBERT GRAHAM: Right. That is correct.

JEFFREY BROWN: So what do you think is the take-home message for you as a doctor, but also for parents who are listening here?

ROBERT GRAHAM: Well, I think it probably comes back to the main recommendation that was number six. It’s not a research recommendation.

It has do with this culture, change and the culture of resistance. The take-home message there for us is, it’s really important for parents, players, coaches to recognize that this is an injury that is significant and it needs to be responded to. If a player is out on the field and broke their leg, you wouldn’t take him to the sideline, tape it up, and put him back in.

You need to remove the player from play. You need to treat them, rehabilitate them. And the message to the parents is, be sensitive to it. To the players, don’t try to play through it. You’re not running out on your teammates. To the coaches, this is something where it’s part of your responsibility not only to develop these athletes and help them become really proficient at the sport, but also protect them and make sure that something doesn’t happen that harms them on down the line.

JEFFREY BROWN: Well, so, Fred McCrary, let me bring you back in, because here you are coaching your own sons and other young children, I guess. I was going to say young men, but they’re even still children.

What do you — what do you tell them? I mean, is there part of you, first of all, that wishes they were not playing football?

FRED MCCRARY: Well, a part of me wishes they wouldn’t.

I wish — I would rather they play golf, but since I’m their hero and they want to be like me, it’s my job to teach them the proper way. So that’s why I coach them. If I can teach them the proper way to block, the proper way to tackle, that helps lower the risk of them getting concussions.

And we have another thing on our team. It’s called a guardian cap, which we put over the top of their helmet to really protect and lower the impact, lessen the impact of their collisions. You know, like, kids’ necks aren’t — aren’t strong enough. Their heads, their brains isn’t strong enough, especially their necks. And their helmet is so heavy, so when they fall, a lot of times, they hit the ground and they are concussed.

So, if they can — if I can do that by protecting them with a guardian cap, which is a very, very, very well-put-together item that goes over the top of your helmet, it works, folks. Trust me, it works. And my kids have had no concussions, thank God.

JEFFREY BROWN: Well, Tamara…

FRED MCCRARY: Even the ones that I coach — even the ones that I coach.


Tamara McLeod, do you sense that I — we cited this study by parents, many of them now worried about having their kids play football and other sports. Do you sense that taking hold in any way?

TAMARA MCLEOD: I haven’t really seen it personally here.

A lot of the high schools and the youth leagues that we work with still have very full rosters. The parents are definitely asking more questions of the athletic trainers, ensuring that they have up-to-date information. And I think that’s part of the key, is not to shy away from the sports, but empower yourself with knowledge about how to recognize and handle these injuries.

JEFFREY BROWN: And do you see this as a growing field for people like yourself? The — I mean, the research, where we started this conversation, not a lot is actually known about people of this age.


And I think the research is going to start to trickle down. The more we learn about these younger kids, the development with the — with or without concussions and how best to manage these injuries is going to be important. And just like we have started to learn more about recovery in college athletes and high school athletes, youth sports athletes, I think, is the next frontier of concussion research.

JEFFREY BROWN: And with you, Robert Graham, briefly, what is next? I mean, what do you — what does your group want to see happen next in terms of research?

ROBERT GRAHAM: Well, I think you go back to the recommendations. We kept them very, very brief.

There’s a research agenda there that we hope the National Institutes of Health, Centers for Disease Control will start carrying out. There is a suggestion that you may be able to change some of the rules and styles of play to make it easier for young athletes not to suffer concussions.

JEFFREY BROWN: Rules as in?

ROBERT GRAHAM: An excellent example from the report, in Canada, one of the youth hockey associations said, you know, below a certain age category, we won’t have body checking. They did that, and the rate of concussions went down.

JEFFREY BROWN: So they’re already doing something like that?


JEFFREY BROWN: And you’re suggesting other leagues look at that.

ROBERT GRAHAM: Take a look at that.

And then last is this whole culture of resistance from players, parents, coaches. This is a serious thing. This is something to be taken seriously. It’s part of the background of sports. We don’t want to see people quit playing sports. There’s risks to a sedentary lifestyle. But play smart.

JEFFREY BROWN: All right, Robert Graham, Fred McCrary, Tamara McLeod, thank you, all three, very much.


FRED MCCRARY: Thank you for having me.