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Author Topic: Head trauma FAQs  (Read 96 times)

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Online lionscoach

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Head trauma FAQs
« on: December 07, 2017, 01:06:07 AM »
Here are some of my opinions regarding the risk of football-related head trauma after several years of thinking about the topic. Again, opinions.

Q. Does playing football cause CTE?

A. It can, yes.

Q. Doesn't that make football too dangerous for children and high school athletes to play?

A. Not really. The answer depends on the magnitude of the risk and methods to minimize it, as well as the very important issue of the benefits of football.

Q. Why would any parent let their kid play football, knowing what we do about head injuries?

A. The reality is that "what we know" is not what everyone assumes that we know. There are very little scientific data regarding typical risks of permanent brain injury from playing football, and what data there are do not establish that football is unreasonably dangerous.

Q. Wasn't there a study that reported that children who played football had more cognitive and emotional problems?

A. There was a publication of some results of a voluntary survey. This type of investigation is really not scientific, nor statistically relevant. Neither is the "convenience cohort" study that reported CTE in 99% of professional football players whose brains were studied (even the study's authors agreed with this). It is prudent to consider such reports as part of the decision making process but it is not reasonable to draw conclusions from them.

Q. Why do some parents let their kids play football if they are not 100% certain that it is safe? Why take the risk?

A. It is not reasonable, nor in fact desirable, to expect 100% safety in any activity. Serious, intelligent and responsible people know this and they still let their kids play football, ski, skateboard, swim, rock-climb, ride bicycles, kayak, etc.. One reason that they let their kids play football is that nearly everyone knows someone who played organized football at some point, and these former players are not over-represented among those with cognitive and emotional abnormalities. Their own  experiences, either in playing football or knowing people who did is that football did not result in a population of brain-damaged invalids.

Q. What evidence is there for claiming that?

A. Well, again, nearly everyone knows someone who played organized football, even if for a year or two. They also know people who sustained sports-related concussions, regardless of the sport, and that these people, football players, hockey players, martial artists, etc.,  are among their acquaintances who are healthy, happy and productive in their later lives. Furthermore, football players are over-represented compared to the general population among the graduates of service academies, particularly among those who attended in the 1950s through 1980s. Yet, they are, as a group, not prone to underachieving due to football related head trauma.

Q. But Dave Duerson, Junior Seau and Mike Webster had CTE, probably from playing football.

A. That is true, and it is extremely likely that football was the cause of CTE in these athletes. However, the discussion of risk necessarily includes the discussion of risk factors, and these risk factors are most definitely not uniform among football players.

Q. What are some of these risk factors?

A. The first thing to realize is that Duerson, Seau and Webster were all professional football players and as a result a.) experienced many more head traumas, b.) experienced these traumas much later in life, c.) had incentives to continue incurring these traumas, d.) played during a time when using the helmeted head as a weapon was encouraged and the associated risk was under-appreciated, e.) had practice routines that involved significant head-related collisions, among other things.

Q. What does age have to do with it?

A. Susceptibility to injury increases with age in general. For example, are you more likely to break a hip if you trip on a carpet at age 64 or age 19? It is reasonable to expect the same principle to apply to brain injuries.

Q. Shouldn't the risk of brain injury go down after players started wearing helmets?

A. Not necessarily, because of something called the Pelzman effect. In short, the presence of safety gear encourages the adoption of unsafe practices. It was not long after the introduction of the plastic shelled helmet that players and coaches realized that a competitive advantage could be had by using the head as a weapon. The helmet and facemask helped protect against skull fractures and broken noses, but provided only marginal protection against brain trauma. Given proper technique and coaching, there is no reason why the risk of brain injury in football should be any greater than that associated with rugby or soccer, or in fact, any sport that involves significant kinetic energy.

Q. What kind of unsafe practices should parents watch out for?

A. A number of questionable and ultimately ill-advised techniques entered football and were passed down starting in the 1960s and 1970s with the introduction of the air-suspension helmet. These included "butt-blocking," "facemask to the numbers" tackling, targeting an opponent's ear hole. "head across the bow" tackling and even. for a short while, spearing. These techniques, along with needlessly violent drills, such as "bull in the ring," prolonged Oklahoma drills, "meet in the alley," etc. encouraged, or at least did not discourage contact between helmets.

Q. What are some of the best practices in minimizing the risk of football head injuries?

A. Number one, there is no substitute for a competent coach. The biggest risk factor for football related injury of all types is poor coaching. Coaches who think that they are born coaches and do not need to study and update their skills, coaches who think that they can coach because they once played and who think they are coaching if they just teach their players the way they were taught thirty years ago, or coaches who think they can "toughen up" players through pointless collisions are ones who should be avoided. Parents should look for coaches who:

     1. Teach basic blocking and tackling shills without protective equipment except for a mouthpiece.

     2.. Use their practice time to improve player skills rather than entertain themselves or to experiment with schemes and plays in daily full-contact scrimmages.

    3. Teach tackling techniques where the head does not cross in front if the ball carrier, and the face does not point toward the ground.

    4. Are willing to lose a game if it means protecting a player.

Q. What about :the hundreds of subconcussive hits that football players experience every week in practice?

A. If an athlete is experiencing hundreds of subconcussive hits a week in practice, that is bad, and completely unnecessary. A well coached team will often not have any full contact practices at all after about the third week of the season, but even those that do will not have more than a few head impacts per week among the entire team, not hundreds per individual.

Q. Shouldn't kids just find another sport to play?

A. There are not a lot of 5'4" 280 pound soccer players. For some athletes football is the sport to which they are best suited, or may simply be the sport that they like the best. During the 2017 season a legally blind athlete played center for a varsity football team; a 4'11"  running back scored a varsity touchdown; a girl (an actual, real girl) threw a touchdown pass in a varsity football game; several players competed with missing limbs. None of these were associated with special accommodations. The fact is that football is one of the most naturally inclusive sports there is. The range of skills and abilities that can contribute on a well-coached football team is enormous. So yes, kids may find other sports; they may also find that football is the best sport for them.


Offline Coach E

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Re: Head trauma FAQs
« Reply #1 on: December 07, 2017, 08:54:43 AM »
Good points. This can certainly help in having the discussion with concerned parents.

Q. What are some of the best practices in minimizing the risk of football head injuries?

A. Number one, there is no substitute for a competent coach. The biggest risk factor for football related injury of all types is poor coaching.

This, 100%. This could be extrapolated to all sports as well.

This, by the way, is the statement that got me essentially black-balled by the org in our town. I meant to say we needed more training, but the powers that be took my statement as a personal attack.
The object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane.
- Marcus Aurelius

Offline Michael

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Re: Head trauma FAQs
« Reply #2 on: December 07, 2017, 10:22:20 AM »
Always nice to see a reference to the Peltzman Effect.
“If you can't explain it to a six-year-old, you don't understand it yourself.” ― Albert Einstein

Offline Bob Goodman

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Re: Head trauma FAQs
« Reply #3 on: December 07, 2017, 11:08:32 AM »
A. A number of questionable and ultimately ill-advised techniques entered football and were passed down starting in the 1960s and 1970s with the introduction of the air-suspension helmet. These included "butt-blocking," "facemask to the numbers" tackling, targeting an opponent's ear hole. "head across the bow" tackling and even. for a short while, spearing. These techniques, along with needlessly violent drills, such as "bull in the ring," prolonged Oklahoma drills, "meet in the alley," etc. encouraged, or at least did not discourage contact between helmets.
Head-across-the-bow tackling did not start in the 1960s.  Indeed it is among the tackling techniques used in rugby.  It's not what's come to be known as the "rugby tackle", but it is named the "front tackle" in Prusmack's book on rugby.

I'm not giving up on that form of tackling.  I don't make as big a deal of it as the rest of the staff where I coached this season, where in drills they counted a near-hip tackle as incorrect, but I do like a player to get it when possible.  If all techniques where putting the side of one's body across the opponent's path, thus risking a collision with the head if the timing is off, are out, then along with the front tackle so go all forms of cross-body blocking, and I'm not giving those up either.

I'd like to know what kind of action would qualify an Oklahoma drill as "prolonged".  Is a 2- or 3-layer Oklahoma prolonged?  Also, if "meet in the alley" is what I think it is, that's a very basic and valuable tackling and ballcarrying drill.  Maybe you could describe it & explain what about the drill you have in mind by that name makes it unnecessarily dangerous to the head or neck.

To me if a drill simulates game action, it's probably a good drill, and is what the kids come for.  To say not to do it like that is to say the game itself is excessively dangerous and tolerated only because it sells, and is in effect just motivation to get the kids to practice.  We also hit the dummies and sleds and shields, but they're not much motivation for the kids to sign up, especially if they're scrubs who don't get much play time.  Matched well body on body, the scrubs can actually have fun in practice while they learn technique.