As the opening of the new Will Smith movie "Concussion" approaches later this month, NFL and college players continue to bash it out on the gridiron, sometimes suffering head injuries causing them to miss time on the field.
Until the movie arrives, there will be more questions than answers, and that's where Thomas Buckley comes in. Buckley is an assistant professor at the University of Delaware specializing in football-focused concussion/head impact research. He is providing research to the landmark NCAA/Department of Defense Concussion Assessment, Research and Education Consortium (or CARE), a longitudinal study to enhance the study of athletes and service members. He works hand-in-hand with UD's Division I football team. In addition to the long-term effects of concussion, he investigates concussion management, how concussions impact gait, sideline evaluation, and concussion education.
Below is a brief question-and-answer with Buckley on the movie, NFL protocol and what the future of concussion research holds. He is also available for further comment and interviews.
What are your thoughts on the story behind this movie?
Bennet Omalu, who discovered CTE in [former Pittsburgh Steelers center] Mike Webster, is a fascinating character. He’s a brilliant man with an incredible background and story. There were a lot of fortuitous events that took place. He didn’t go out looking for this. Webster was one of the most famous football players in a city [Pittsburgh] that’s football crazy. Webster’s cognitive decline over time was very public. From what I’ve read, the movie really delves into Omalu’s backstory. The movie is really his story. The NFL and concussions are only part of the movie.
Is the NFL reckless about players' health? Yes, but it is not concussion-specific. If you are a professional athlete, there is an expectation that you will sacrifice your physical health to play the sport at that level. Professional athletes know they will likely pay the price later in life – they’ll have trouble getting out of bed and knee-replacement surgeries and shoulder surgeries. These guys don’t look and act like your average person. Their strength, power and athleticism are incomprehensible to the average person. The concussion side of this is: Did they know that they were risking their cognitive health? Who knew what when? It’s hard to say. My opinion is that the NFL didn’t know, but that they also probably ‘didn’t want to know.’
It’s not just the NFL. Up until about five years ago, the guidelines of the American Academy of Neurology, which is independent of the NFL, allowed for same day return to play from a mild concussion. And just a few years later that concept is medical malpractice.
What do you think the most important thing athletes of all ages and their families should know about concussions?
Concussions happen in all sports. It is more common in football; that is due in large part to the number of people who play. The rates are high in football, soccer, wrestling, and ice hockey and men’s lacrosse.
Understand that if a concussion does occur, make sure it is treated correctly. The vast majority (85-90%) of people recover fully from a concussion in a couple of weeks.
Helmets don’t prevent concussions; they prevent skull fractures.
What's the most misunderstood aspect of concussions?
Playing youth or high school football is not a brain damage sentence. The vast majority of concussions will resolve within a couple of weeks. People think concussion and they assume the worst. The stories in the media are examples of people struggling with recovery; the people who recover quickly are the ones no one talks about. If you suffer a concussion as a kid, there is no evidence right now that it will lead to long-term brain damage.
What do you find is most surprising for people to learn about concussions?
In sports with the same rules, such as soccer and basketball, women get more concussions than men.
You don’t need to be knocked unconscious.
Most people are just fine afterwards.
The majority of literature on soccer heading says that it’s not problematic.
What do you think of the NFL's concussion protocol?
It’s great on paper.
Is it scientifically sound?
The protocols that they have in place are consistent with the best evidence today. If they do everything that they said they were going to do, then it’s as good as it will ever be. The protocols aren’t always followed. I’ve worked as an athletic trainer on the sidelines of college football games; it’s crazy. In the NFL’s case, with approximately 50 players in addition to coaches and equipment staff on the sidelines, you don’t have a clear view of the field. Even for the spotter in the press box, they are looking at 22 players. It’s tough. For the ones where the player is very slow to get up, those really shouldn’t be missed. There is a microscope on the NFL right now. They can’t afford to miss. ESPN is not going to give you credit for catching 99 out of 100.
Is there another sport with a better protocol—one that should be emulated?
Very recently, the English Football Association came up with concussion protocol that is much more conservative than any in the U.S. For an adult over 19 years old, the minimum time out is 19 days. For someone under 19 years old, the minimum time out is 24 days. You are shut down completely for two weeks and then you go through a five-day return protocol. While this is more conservative, there really isn’t evidence that it is necessarily better. The problem is: The NFL is light-years ahead of diagnosing concussions compared to soccer leagues.
What’s the next big thing in preventing/managing/treating concussions?
More hype. There is this pill, that helmet, and so on. When you see something come out that says, “This new product will solve the concussion problem,” take it with a grain of salt. From a scientific point of view, a better helmet can reduce concussion risk, but not prevent concussions; it’s not going to make it go away. The ‘Holy Grail’ is probably the blood biomarker. If we could take a blood sample on the sidelines and look at players S-100B level or tau-protein levels, we could have a quantifiable number that says when you have a concussion and when you are recovered. The science isn’t close to that, but there is a lot of work being done on that. The second big thing is imaging – a diagnostic imaging test that can identify concussion and changes that occur from repetitive head impacts.
Should parents be afraid to let their kids play sports?
No, but make sure take a good look at the sports organization. Does the organization understand what concussions are? Do they have a plan in place to treat concussions?
For example, there’s no reason for 7- and 8-year olds to run the Oklahoma drill. If a coach is running it, that’s probably not a safe environment for a kid to be in.
Kids need to learn technique – how to hit and how to get hit. It’s critical – but it needs to be done from an education point of view and not just hitting for the sake of hitting.