The Herald News, Fall River, MA
  • FOCUS: Experts say ‘return-to-play’ laws need more teeth to be effective

  • In just five years, 49 states have passed laws to raise awareness about concussions and ensure proper treatment of head injuries in young athletes. The rapid spread of “return-to-play” laws came after the revelation of long-term brain damage in several former National Football League players and alarm at the local level that young athletes needed more protection and care in dealing with concussions.

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    As the new laws settle into place, experts believe they are just a first step. The laws focus on education, but there are no penalties in place to ensure their effectiveness.
    Meanwhile, concussions are increasing, and almost half the concussions in high school sports occur in football. But determining exactly what can and needs to be done is difficult in the shifting landscapes of sports and medical research.
    This third concussion ended his high school sports career and thoughts of contact sports in college. The risk of more concussions was too great.
    Soehnlen's concussions brought headaches, light sensitivity, difficulty concentrating, anxiety and depression. His symptoms were worse and recovery time longer with each concussion. Researching his senior paper taught Soehnlen the worst-case scenarios of head trauma, from long-term cognitive disability to death.
    Fortunately, Soehnlen received enough mental and physical rest to allow his brain to recover. He graduated in the spring and, now healed, feels like himself again.
    “I’m glad I’m still me,” Soehnlen said.
    As the 2013 high school football season begins, the discussion continues on how best to protect the brains of young athletes.
    The mental deterioration of numerous former NFL players over the past decade made concussions a national topic.
    High-profile players such as Mike Webster, Dave Duerson and Junior Seau were all dead by the age of 50 or younger after suffering the effects of repeated hits to the head.
    Page 2 of 6 - Duerson and Seau committed suicide in 2011 and 2012, respectively. Both shot themselves in the chest to preserve their brains for study. Autopsies on many former players found chronic traumatic encephalopathy, a progressive brain damage that comes from repeated head trauma.
    A 13-year-old football player in the state of Washington, Lystedt suffered permanent brain damage when he continued to play in a junior high game after suffering a concussion. His ordeal led to what became known as the Lystedt Law.
    The law requires a youth athlete suspected of a concussion or head injury to be immediately removed from play and that a physician provides written clearance before the athlete returns. The law also requires parents and athletes to sign a concussion information sheet and mandates the creation of concussion education materials for coaches, players and parents.
    Washington’s governor signed the law in May 2009, and it became the model for variations of the law passed in 48 other states. Only Mississippi has no form of concussion law.
    Dr. R. Dawn Comstock is a faculty member at Colorado University’s Pediatric Injury Prevention, Education and Research Program. She maintains the High School Reporting Information Online injury surveillance system, a database that collects injury information on prep sports across the country. According to Comstock’s data, the estimated number of concussions in high school football jumped from 55,007 in 2005-06 to 140,057 in 2011-12.
    Most experts believe fewer concussions are being missed, rather than more concussions occurring. Some estimate that 50 percent of concussions still go undiagnosed, down from the estimated 80 percent in the 1990s.
    “I think the biggest part of (concussion laws) is education,” he said, “so that people can deal with it, be aware of it and know where the resources are for the best people on the medical team to care for those with brain injuries so we’re not returning people to play too soon.”
    • Educating coaches, parents and players on signs and symptoms of concussion;
    From the medical community to the policy makers, experts agree that the laws have been successful in grassroots education. But whether the laws provide significant protection for young athletes is unclear. Comstock just completed the first year of a three-year research project that hopes to assess the impact of the new laws.
    Anecdotal evidence suggests that the laws are making a positive impact.
    But experts believe the laws constitute a first step, not a final answer.
    The laws do not include penalties for failure to comply with the new regulations by coaches, school officials and medical workers. They do not require a minimum or standard level of medical resources at games or practices. They do not have provisions to ensure the effectiveness of the required brain injury education.
    “You might consider these laws to be a low-cost, partial solution to a large public health problem,” said Hosea H. Harvey, a professor of law at Temple University, referring to traumatic brain injuries (TBIs) in youth sports.
    Page 4 of 6 - Harvey questions if it was wise for all states to follow the Lystedt model without evidence the law reduced the danger of youth TBIs. He believes NFL support for the new laws drove their rapid spread.
    Jeff Miller, the NFL’s senior vice president of public affairs, acknowledged that the league helped organize sports medicine and local advocacy groups in each state. But he believes the testimony of parents and student athletes who have dealt with concussions had the greatest effect on lawmakers.
    Cantu at Boston University believes there needs to be more checking into the qualifications of physicians who decide when a player returns to action. He also believes some form of testing or other evaluation is needed to confirm that those who watch brain injury training are actually learning the material. Sitting through an online video typically is all the laws require.
    One idea is that every high school sports program should have an athletic trainer. An athletic trainer is someone specifically trained to provide early assessment and treatment of sports injuries, including concussion.
    Some coaches believe concussion laws are an overreaction in a violent game played by increasingly bigger, faster and stronger players.
    Research shows that the presence of athletic trainers in a school sports program mean more concussions are diagnosed than in schools without them. Without athletic trainers, the worry is many athletes are playing with concussions but they and their coaches don’t know it.
    Page 5 of 6 - Such a tool would remove much of the guesswork involved with diagnosing concussions. Diagnosis often requires honest answers from players who have been brought up in a culture of gritting their teeth and playing through pain.
    The best potential area for prevention is limiting exposure to head trauma. Players absorb roughly 2,000 hits to the head in practices and games during a season. Several organizations, from the NFL to Pop Warner, have limited full-contact practices.
    Rule changes will continue to be considered, with much attention likely paid to the kickoff since the highest incidence of severe injuries occurs then.
    The wave of new concussion laws clearly helped raise awareness of the dangers of concussions in high school football.
    But whether parents, school districts and those who govern high school sports will take more steps to require certain levels of care, new rules or different equipment remains to be seen.
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