A Game of Hard Knocks: Football's Culture of Concussion

Frostburg State University football player Derek Sheely died two weeks ago following severe head trauma suffered during a routine preseason practice. He had no documented history of concussions. He did not even lose consciousness following whatever blow or series of blows that led to his death. While fatalities as a direct result of on-field injury are rare, this tragedy is just the latest reminder of the degree to which concussions and their resulting effects loom over the sport of football, and it is an issue that cannot be adequately addressed until the competitive culture of the sport undergoes significant reform from the bottom up.

Just how prevalent is head trauma in football? A study published by the Journal of Athletic Training found that the average college team experienced approximately 500 hits to the head of 80 g’s or higher, sufficient force to cause a concussion, during the course of each and every season. However, it is doubtful that any more than 15 of those collisions led a player to seek out medical attention. In fact, judging from my own experiences as a college football player, it would be surprising if the number of clinically diagnosed concussions hit double digits. Even at the high school level, it is expected that more than 50% of athletes fail to report their symptoms.

That is because football players have been conditioned their entire lives to play through whatever ails them. Players who take too many trips to the training room develop reputations as being “soft” that often stick with them for the duration of their career. This becomes even more of an issue with concussions, as there is no visible ailment or indication of the severity of the injury. Players who claim to have suffered a concussion without a serious or noticeable collision are many times suspected to be trying to avoid practice.

Perhaps most importantly, a majority of players’ competitive instinct will lead them to endure injury unless it is absolutely impossible to do so. The desire to compete combined with the fear of losing playing time if injured leads many to ignore what they may be feeling. 

All of these factors contribute to a culture that could not be worse for the athletes themselves. This culture makes it nearly impossible for the injury to be properly managed, meaning that athletes return to play before the brain has had enough time to fully heal. It is in these situations where any additional traumatic event can cause serious complications.

Until a proper understanding of the severity and long-term effects of head injuries is both commonplace and legitimately respected within the football community, no regulation or rule limiting contact will have any significant impact on player safety.

Youth coaches cannot continue to preach that being tough means never coming out of the game. Players who remove themselves from play with injuries cannot be ridiculed or looked down upon. And it is essential that this standard be set early in life not only because of the relative ease of habit formation but also because children and teenagers are more susceptible to brain bleeds and swelling as a result of multiple hits to the head.

While the change must happen from the bottom up, the NFL, along with government support, must set the example for the lower tiers of competition to follow. Some 21 states currently have strict concussion laws for student-athletes, but the work to this point is far from adequate.

Football is an inherently violent game. Concussions have been, and will always be, a part of the game. The culture that enables much of their acute, long-term complications need not be.

Photo Credit: Wikiemdia Commons

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Nate Wilcox-Fogel

Nate is a Clinical Research Assistant at the Stanford University School of Medicine. He graduated from Stanford University in 2009 with a BA in Public Policy along with a Master’s in Management Science and Engineering. Nate spent a year in Washington, D.C. as a Research Assistant for Senate Majority Leader Harry Reid before returning to California to work at Stanford and prepare for medical school. He is interested in health care policy in the military and hopes to pursue a career as a Navy physician.

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