“Tackling” The Need For Concussion Awareness in Football

Being from the south in the US, we all love the game of football. Usher just killed it at the 2024 Super Bowl Halftime Show and the NFL Draft is quickly approaching in April. The sport captivates millions with its athleticism, teamwork, tailgating, and sheer excitement. However, beneath the glitz and glamor of the game lies a troubling reality that we don’t like to harp on: the prevalence of concussions among the players. 

Let’s look at some statistics…

• Between 1.7 and 3 million sports- and recreation-related concussions happen each year. Around 300,000 of those are from football (UPMC 2024).

• The total number of concussions suffered preseason and regular-season practices and games was 219 in 2023 - up from 213 in 2022 (Reed 2024).

• 345 out of 376 (91.7%) of NFL players were diagnosed with CTE  (chronic traumatic encephalopathy) in their brains in an autopsy study by Boston University (Mann 2024).

These statistics are eye opening. They shed some light to a huge problem that not only football players, but all athletes face every time they step out onto the field. 

Yes, concussion numbers are lower than they were a few years ago but still not great.

Clearly, this isn’t something that can be changed overnight. There are a lot of holes and a significant lack of education when it comes to how we view concussions overall. So, the one thing that most of us can probably agree on and ACT on to make a more impactful difference is helping to spread awareness and education about concussions. 

So, this blog aims to do just that.

1: How We View It

Let’s talk about a common injury in football: an ACL tear.  

An ACL post-op repair takes almost a full year to return to sport.

It is all about gradual progression of regaining neuromuscular control, strength, gait mechanics, and then incorporating the individual back to more higher level tasks such as cutting and running when the repair site can undergo more load.

So we understand that a ligament tear like an ACL is a serious injury that causes problems outside of just the knee itself. The general public knows that a vigorous rehab process is needed after surgery to promote appropriate healing and to prevent further injury. 

So why do we not view a damaged brain – the brain that is the control center for EVERYTHING we do - from a concussion in the same way? 

I don’t know why, but we definitely SHOULD!

I think we could all agree that our brain is one of, if not, THE most vital organ. But if it gets damaged, we just rest it and assume we can go on living our normal life a few days later? No! 

It, just like an ACL tear, is going to affect so many different systems besides itself and therefore require some extensive TLC and specific, tailored rehabilitation to return back to normal. 

2: How We Find It

There is a HUGE lack of education among players, coaches, parents, and even healthcare professionals regarding the true signs and symptoms of concussions. According to UPMC, 5 in 10 concussions go unreported or undetected (2024). 

Think about when an athlete takes a huge hit and falls back and hits their head. They lie there for a minute, but then are pretty quick to get back up on their feet. They go to start walking and seem a little unsteady at first but then are able to appear normal and continue playing…

Did the referee see the stumble? Did the coach? Did the athletic trainer on the sideline? Did the player’s teammates notice something seemed a little off and choose not to say anything? Did that specific athlete know that he shouldn’t be playing because he feels disoriented, unstable, and has a pounding headache but keeps playing because he doesn’t want to lose playing time? Do we as fans see it from the TV and think to ourselves, “wow, he definitely has a concussion” but don’t give it another thought because he continues to play and seems fine? 

Yes, we are all guilty of perpetuating the vicious cycle. And I’m not saying it’s anyone’s fault. But, you can see how easily a concussion episode can be downplayed, missed, or go unreported. Failure to recognize and properly manage these injuries when they occur can have devastating consequences, potentially putting players at risk of further harm. 

3: How We Treat It

Every treatment regimen and recovery timeline is going to look different depending on the athlete, the severity of their injury, their symptoms, and how quickly their body responds to treatment. This could take anywhere from days to months. But on average, the typical amount of time an athlete is out is 9 days. They have to undergo a step-by-step progression through 5 phases of concussion protocol symptom-free before getting cleared by a physician and neurological consultant (Bagley 2022).

Yes, the athletes start with symptom-limited exercise and progress into more aerobic exercise before initiating non-contact drills such as strength training and cone drills. However, is vestibular rehabilitation also being induced? Do the athletic programs know the importance of vestibular training post-concussion? 

I don’t know for sure, but I would bet millions that the answer is no. 

Your vestibular system within your inner ear tells you where you are in space. When you have a head injury as in a concussion, the vestibular system is directly insulted and you have vestibular symptoms like blurry vision, difficulty eye tracking, imbalance, and dizziness. Vestibular rehabilitation is key in retraining your brain to communicate with your inner ear and eyes again more effectively so that everything functions together smoothly. 

So, yes a football player may be able to run on a treadmill or squat heavy symptom-free but as soon as you have them practice running with eye tracking or running with more head movements, a lot of times their vestibular system won’t be able to keep up and symptoms will persist. That is why vestibular rehabilitation is so important for all athletes post-concussion but most people, including coaches, athletic programs, and even healthcare providers do not know this!

**If you have had a concussion or know an athlete that has, make sure they schedule an eval to get their vestibular rehabilitation started today!***

So what?

So, education is key. You can see how many holes can be improved if more awareness and acknowledgment across the board was known. Players, coaches, parents, and medical personnel must be educated about the severity and dangers of concussions and empowered to recognize the signs and symptoms. Encouraging a culture of openness and transparency where players feel comfortable reporting their injuries without fear of judgment or viewed as “weak” is essential. 

We need to prioritize player safety above all else. This means implementing comprehensive concussion protocols that include: pre-season, mid-season, and post-season baseline testing and sideline concussion assessments to make sure concussions are not being missed throughout the season; incorporation of vestibular rehabilitation into standard concussion treatment protocol; and strict return-to-play guidelines. 

Ultimately, the prevalence of concussions in football is a complex issue that requires a multifaceted approach. By working together to foster a culture of safety, awareness, openness, and accountability, we can ensure that football remains a source of joy and entertainment for generations to come.

Resources: 

1. Bagley, Tucker. “Concussion List Tracker for NFL Players, plus NFL Concussion Protocol Policies.” Sharp Football Analysis, Sharp Football Analysis, 31 Dec. 2022, www.sharpfootballanalysis.com/analysis/concussion-list-tracker-players-nfl-protocol-policy/. Accessed 1 Mar. 2024.

2. “Concussion Statistics and Facts: UPMC: Pittsburgh.” UPMC, 2024. www.upmc.com/services/sports-medicine/services/concussion/about/facts-statistics. Accessed 1 Mar. 2024. 

3. Mann, Denise. “List of NFL Players with Chronic Traumatic Encephalopathy.” US News and World Report, Wikimedia Foundation, 20 Feb. 2024, en.wikipedia.org/wiki/List_of_NFL_players_with_chronic_traumatic_encephalopathy. Accessed 1 Mar. 2024.

4. Reed, Tashan. “NFL: Lower-Body Injuries down, Concussions up in 2023.” The Athletic, The Athletic, 2 Feb. 2024, theathletic.com/5245956/2024/02/02/nfl-concussions-lower-body-injuries/?redirected=1, Accessed 1 Mar. 2024.