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Trickle-Down Safety: Sports Concussions

Memory, it's what keeps sports fans going during the poor seasons and what energizes us during rich playoff runs.

We don't just rack up wins, we build memories, that throw, that catch, that move.

There's something universal, timeless, and even beautiful about this.

Human bodies in motion, athletes, sports, competition, at times, it's most impressive.

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But in every sport, at every level, we know there is more on the line than just a match.

No game, no season, no team, and no tradition really matters.

When stacked against human suffering, where lives are at stake, it's no longer about sports, but safety.

Fans know that, coaches know that, officials know that, leagues know that, players know that.

And athletes, parents, and loved ones definitely know that.

How do we as a society recognize, manage, treat, and prevent head injuries like concussions?

Inside Science.

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What I've noticed in my years of serving on the medical staff for the Pittsburgh Steelers is a see change.

In the viewpoint of the players, the coaches, and the organization.

I have personally been involved in situations of a player coming off the field saying, hey, I just got hit.

Can you check me out and make sure I'm okay?

That didn't happen ten years ago, that was not a part of the game in 1980, but it's a part of the game now.

The National Football League has taken this issue very seriously.

And has worked very hard over the last decade to create what is often called a concussion protocol.

Where the athletes are identified during the course of the game's play, pulled off the field, and put through a very specific set of evaluations.

And there's a very high threshold to return an athlete to play on the same day if there has been any form of suspicion of a concussion.

The public attention and focus on the issue of concussion, which really has its roots in the issue of concussion in professional football.

Has triggered enormous elevation in the safety of the game for athletes at the professional level.

With a broad trickle-down effect on youth sports in general from coast to coast.

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The trickle-down effect has impacted not just football, but soccer, lacrosse, etc.

And it allows for youth sports leagues to copy or mimic what is happening at the higher levels of the sport.

This has introduced a tremendous amount of safety into recreational sports in the United States that simply didn't exist a quarter of a century ago.

Dealing with a concussion starts with protocols established to prevent a player who has sustained a concussion from making the injury worse by returning to play and risking further head injury.

When athletes experience a second significant impact before recovering from a concussion, it's called second impact syndrome.

It tends to be something you see in teenagers.

It can lead to this cascade of brain-swelling that is fatal in 50% of the patients.

Safety also starts with training officials.

In youth sports in the United States, almost every coach has to go through a certification process.

Most states would say that if a school district is not following the concussion laws, they can't use public lands.

And there needs to be an educational program aimed at the athletes, the family, and the coaches and trainers.

At some levels, such as in professional football, even the evaluators are evaluated, Okonkwo said.

There is, in fact, a system in place to evaluate the performance of the medical staff.

Just as much as there is a system in place to evaluate the performance of officials refereeing games, etc.

The issue is taken very seriously, the data is reviewed in a continuous fashion.

And the expectations are in place that medical staffs for each of the franchises in the National Football League will adhere to the standards put in place for the evaluation of an athlete with a possible concussion.

Parallel to what sports leagues have done, local governments have also acted in the past few years.

State by state, new laws have been added to the code, collectively known as the Lystedt laws.

So Zackery Lystedt was a teenager in Washington state who suffered that severe complication of a second concussion before he recovered from the first.

Nearly fatal outcome, thanks to excellent medical care, he survived, but with a lot of disability.

So that led to the first of the concussion laws in Washington state .Thanks to the interventions of medical professionals, and frankly, sports professionals as well, the NFL took it on as a major project.

Every state now has a set of laws, and usually what these laws say is that any athlete who's symptomatic can't go back.

If the advent of Lystedt laws has added iron to the glove by forcing players who may have sustained a concussion from the field of play.

Rule changes have also added to safety by helping to prevent concussions in the first place, Okonkwo said.

We know that there are protections that are put in place for the quarterback.

We know that there are protections put in place for blindside hits.

There are a number of plays that used to be highlight reel plays, that are now viewed as plays that do not have a place in the game of football.

There is a direct drive to eliminate those dangerous plays from the game.

We've seen college football introduce the opportunity to eject a player from the game with just one single infraction of targeting.

Most football coaches now have really realized that while hitting in practice doesn't really improve the effectiveness of the player in competition.

And it's really been led by a group at Dartmouth College and their coach Buddy Teevens, who's really focused on that.

When you look at the numbers, the absolute number of concussions in youth sports are actually higher in multiple sports other than football.

Girls' soccer, lacrosse, have higher rates and higher absolute numbers of concussions on an annual basis than kids playing football.

There is a very deep conversation happening in youth soccer about whether heading the ball should be allowed in youth soccer.

And there appear to be some clear indications that, again, athletes who are under the age of 14 who do not have a sufficiently mature neck musculature.

Are at higher risk for a consequence if they are heading the ball in soccer.

In addition to changes in the rules, advances in the clinic may have broad impacts in coming years.

More personalized treatment and promising new diagnostic research, like MRIs, that will be able to show the brain alterations after a concussion.

I think as you look into the decade ahead, you're gonna start to see a lot of the medical reality's catching up to what the regulatory interventions have done.

On the treatment side, we have already seen tremendous advances in the capacity to parse out the different forms of concussion.

And start targeting rehabilitation and treatment strategies to patients who have vestibular problems, or who have vision manifestations of their concussions, etc.

We are at the dawn of wonderful, fabulous things that are happening in the field of traumatic brain injury and in the field of concussion and in the field of sports-related concussion.

This is Inside Science.

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