The New York Times
Frank Bruni Frank Bruni DEC. 19, 2015
PROBABLY no one tracks concussions among young athletes in the United States more closely than Dawn Comstock, and in many ways, she’s encouraged by what she sees.
It’s now less common for a player whose head has collided violently with a ball, a wall, the ground or another player to return to competition right away. It’s now more common for him or her to get medical attention.
But Comstock, an epidemiologist at the Colorado School of Public Health, is frustrated by stubborn gaps between truly safe behavior and the status quo. She told me that more than half of the high schools with football teams don’t have a full-time athletic trainer, so there’s no immediately available person with the specific mission of preventing and treating injuries.
There are also sports other than football — and trauma other than concussions — that don’t attract nearly the vigilance they should, she added. Above all, there’s an enduringly strange, dangerous relationship between parents and sports, specifically between parents and coaches.
“What I would love to see is parents taking as much time to investigate their child’s coach, the league that they’re putting their child into and the officials officiating the game as they do a day care center when their child is young,” she told me. “They don’t have trouble challenging a teacher, even a pediatrician. But somehow they have trouble challenging a sports league.”
This coming week, the major Hollywood movie “Concussion” opens. It stars Will Smith as a scientist who sounded the alarm about the long-term impact of repetitive head injuries in professional football.
And it reflects a storm of attention over the last decade to the serious, sometimes fatal damage done to the vulnerable brains of football players of all ages — and of soccer players, too. We’ve learned, for example, that soccer carries a greater risk of concussion for girls than it does for boys.
But the talk of a “concussion crisis” and the pronounced concern about football and soccer are blinding us somewhat to a larger picture, a broader lesson: Our veneration of sports, our adulation of athletes and our ethos of toughing it out put kids needlessly at risk of all sorts of preventable injuries in all kinds of improvable sports.
“I worry that we’ve been so focused on football that parents are pushing their kids out of that and into something else and not realizing that there are dangers there, too,” said Kevin Guskiewicz, one of the directors of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina at Chapel Hill. “We need to improve safety in all the sports that children play.”
Did you know that while the incidence of injuries in cheerleading is much lower than in the majority of high school sports, nearly a third of those injuries are concussions? The reason, Comstock explained, is a shocking lack of common sense and caution in monitoring an activity that isn’t automatically associated with violence.
“We’ve seen cheerleaders who’ve sustained concussions because they were practicing on the asphalt in the parking lot or on the cement sidewalk — or in the school cafeteria on a tiled floor,” said Comstock, adding that grass or mats would be infinitely more appropriate. “Why on earth would parents let that happen?”
Guskiewicz drew my attention to a study published just a few months ago in The American Journal of Sports Medicine that determined that among college athletes, concussions were most likely in wrestling, followed by men’s ice hockey and then women’s ice hockey. And women’s soccer and women’s basketball, in that order, were right behind football in terms of the danger of concussion.
Comstock, who supervises an ongoing national inventory of athletic injuries among high school students, said: “I have 22 sports in my surveillance system, and concussions have been reported in all but one of them. That includes swimming.” A distracted kid will swim head-on into the wall or into someone coming from the other direction. The sport without concussions, she said, was tennis.
BUT head injuries are just one peril, and not necessarily the chief one, even in football. There are many more deaths among football players of all ages from indirect trauma, including heatstroke and cardiac arrest, than from such direct trauma as head and spinal-cord injuries.
Douglas Casa, the chief executive officer of the Korey Stringer Institute at the University of Connecticut, said that from 2000 through 2009, which was the last full decade studied, such indirect-trauma deaths outnumbered direct-trauma deaths by 108 to 41.
Casa, who monitors and compiles that data, told me that he knows of 14 deaths among football players below the college level since July 1, which is about when practice for the fall season usually begins. Four were from cardiac arrest and two were from heatstroke.
“Anytime you hear about a kid dying from heatstroke in high-school football, it was 100 percent preventable,” he added. And he said that there are an even greater number of preventable cases of severe heatstroke that leads not to death but to prolonged or permanent health complications.
Last August, for instance, a 16-year-old in Riverhead, N.Y., who developed heatstroke during practice ended up in the hospital, where he spiked a 108-degree fever, was treated for serious kidney damage and spent the next five weeks.
Casa said that heat acclimatization — or the incremental acceleration of practices during a season’s start — can guard against heatstroke. But while many leagues and teams have implemented that, many haven’t.
Players’ posture can affect the likelihood of head injury but often isn’t studied and adjusted. And Comstock said that there’s no widespread, dependable monitoring of the nature and incidence of injuries among athletes in elementary and middle school.
“Don’t get me wrong: I’m not against sports,” she said. “I was a three-sport player. And I played contact sports. I played rugby for 13 years.” She and Guskiewicz both stressed that, at a time when too many kids are obese or diabetic, they want more of them to play sports.
But they also want more prudence in the mix. Some parents obsess about a high school’s success or failure in getting kids into Ivy League colleges but know nothing of the school’s athletic teams’ safety protocols. Some question the amount of homework more readily than the number of laps athletes run on a 95-degree day.
Some shop for lenient physicians who will declare their child healed and let him or her back out on the field. Athletic glory beckons.
“Sports has achieved an almost mythologized place in our country,” Comstock said. She’s wrong about the “almost.” She’s right about this: It’s not concussions per se but an unquestioning worship of sports that puts young lives in jeopardy.