Repetitive Head Impacts: A Major Concern At All Levels of Sports

UPDATED

A growing body of research suggests that  brain trauma among football players (and athletes in other sports such as soccer and ice hockey) is less the result of violent collisions that cause concussions as the cumulative effect of repetitive head impacts (RHI). The discovery has lead to increased calls by experts to take steps at all levels of sports, from professional down to the youth level, to limit exposure to such repetitive trauma, while a shrinking minority continue to urge a more cautious approach until more is known.

Although scientists have long suspected that RHI caused brain damage, especially in boxers, a 2010 study of high school football players by researchers at Purdue University (1,13) was the first to identify a completely unexpected and previously unknown category of players who, though they displayed no clinically-observable signs of concussion, were found to have measurable impairment of neurocognitive function (primarily visual working memory) on computerized neurocognitive tests, as well as altered activation in neurophysiologic function on sophisticated brain imaging tests (fMRI).

Indeed, researchers found, the players with the most impaired visual memory skills were not those in who had been diagnosed with concussions but were in the group which, in the preceding week, had experienced a large number of RHI – around 150 hits – mostly in the 40 to 80 g range of linear acceleration.

Shock waves

Publication of the Purdue study sent shock-waves reverberating through the football world, with the findings cited by concussion experts calling on youth sports organizations to take more aggressive action to minimize exposure to RHI, including sub-concussive blows, by changing the way contact and collision sports are played and practiced, and reducing the amount of brain trauma a child incurs by limiting the number of hits they sustain in a sports season, over the course of a year, and during a career.

Governing bodies at all levels of football responded with rule changes:

• In 2012 Pop Warner instituted rule changes  designed to limit contact during practices.
• In 2013, state high school athletic associations in Arizona, Washington State, Iowa, and Texas moved to impose some limits on full-contact practices.
• In June 2013, the Pac-12 announced that it would adopt a policy limiting full-contact practices as well, although it did not state what those limits would be, only that they would be less than allowed by the NCAA.  The next month, the conference announced that the limit would be two a week, the same as the Ivy League put in place before the 2011 season.  No other major college football conference has followed suit, at least so far.
• In July 2014, the NCAA issued new guidelines recommending that full-contact practices during the season be limited to two per week. The NCAA guidelines also recommend no more than four contact practices per week during the preseason and no more than eight of the 15 sessions during spring football.
• That same month California governor Jerry Brown signed into law AB 2127, limiting middle and high school to two full-contact practices – each no more than 90 minutes long – per a week during the 30 day period before the regular season and during the regular season itself, and banning off-season contact practices completely.
• In advance of the 2014 season, the Wisconsin Interscholastic Athletic Association mandated new limits on the amount and duration of full-contact activities during team practices, prohibiting full contact during the first week of practice, limiting full contact to 75 minutes per week during week 2, and capping it at 60 minutes thereafter.
• In November 2014, the National Federation of State High School Associations (NFHS) recommended to its member associations that they adopt limits on full-contact practices in high school football. The recommendations, contained in a position paper issued by the NFHS Concussion Summit Task Force in July 2014 (42), were  approved by the NFHS Sports Medicine Advisory Committee and the NFHS Board of Directors, and discussed by the 51-member state associations at the NFHS Winter Meeting in early January 2015.
• In the months leading up to the 2015 fall season, some state associations adopted the NFHS recommendations exactly, while others altered them to more closely fit the needs of their member schools: The state associations in Iowa, Kansas, Georgia and Tennessee opted to limit full-contact practice to 90 minutes a week. Other states, such as Ohio, chose to limit full-contact to 60 minutes a week instead.
• For the 2016 football season, Indiana, Florida and a number of other states imposed limits on contact regular season contact practices.  According to Terry O’Neil, a former NFL executive and the founder of Practice Like Pros,  in an interview with USA Today, the total number of states which now have some limit on the amount of contact allowed in high school football practices now stands as 46, with New Hampshire, Delaware, South Dakota, and Louisiana the only four states currently without any such restrictions.

Some states have gone further.  The Kansas State High School Activities Association (KSHSAA), for instance,  was one of many state associations to make pro-actively make changes to its football rules that went beyond the recommendations of the NFHS Task Force. For example, players in Kansas are no longer be able to participate in “Live Action” the day after a game. And, effective with the 2016 season, they will not be allowed to participate in games on consecutive days, a change was made to address the issue of student-athletes playing a varsity game followed by a junior varsity game the next day.