Image of a brain wrapped in bandagesIn the midst of playoffs games for the National Football League (NFL), last weekend a New York Times article highlighted recent rule changes designed to protect quarterbacks and receivers from debilitating injuries like concussions. And on Monday, questions arose as to whether Seattle’s quarterback played through a concussion during Seattle’s comeback win over Green Bay in the NFC Championship. Although much of the focus is on mitigating the incidence and prevalence of concussive injuries in professional football, more attention should be devoted to similar rule changes and ways to prevent and address traumatic brain injuries in collegiate athletics.
In November, the body of Kosta Karageorge, an Ohio State University football player and wrestler who had sustained several concussions, was found in a dumpster. Police believe he shot himself. In a text sent to his mother just days before his death, he wrote “Sorry if I am an embarrassment, but these concussions have my head all f…ed up”.

The impacts of concussion

The potential effects of concussions include post-traumatic seizures, depression and anxiety, and repeated traumatic brain injuries can result in cumulative neurological and cognitive deficits, including an increased risk of Alzheimer’s disease and Chronic Traumatic Encephalopathy (CTE), a progressive neurodegenerative disease. In our own work we have encountered young women and men suffering from severe depression and debilitating migraines, and once strong students dropping out of school as a result of mismanaged concussions.
The mounting evidence of the dangers of concussions and the tragic death of Karageorge should serve as a clarion call to the National Collegiate Athletic Association (NCAA). The NCAA was formed after two White House conferences convened by President Theodore Roosevelt to address the repeated injuries and deaths occurring in early 20th century college football. Given that the NCAA is axiomatically dedicated to “safeguarding the well-being of student-athletes” in the 1,281 institutions which it regulates, we argue that it needs to take stronger action to prevent and/or reduce the risk of concussions. Simply put, we believe that by failing to proactively protect the health and safety of collegiate athletes by enforcing mandatory concussion policies, the NCAA has deviated from – if not failed – its original mission and mandate.
Head trauma caused through participation in sport is a public health problem that can be mitigated through the formulation and execution of good concussion policies and sound management plans. Key elements of effective concussion management plans include educating athletes, coaches and trainers, requiring that athletes believed to have a concussion be immediately removed from play, and insuring that all concussed athletes receive full neurological evaluation – and medical clearance – before being allowed to return to play.
Challenging the culture
This seems simple enough, but the challenge in implementing these protocols is the “culture of resistance” in sports. Both athletes and coaches frequently view removal and prohibition from play as “weakness”, and often praise teammates for playing through pain and injury. NCAA student-athletes are particularly vulnerable because scholarships and future professional sports careers hinge on their sustained athletic performance. College sports are big business: coaches have million dollar salaries, and many players have potential future contracts – often worth millions – on the line. Such high stakes economics do little to foster voluntary best practices and adherence to guidelines that advocate removal from play. In light of these realities, we believe that a higher level of accountability, with penalties for non-compliance, is needed.
Although the bulk of attention on the concussion issue has focused on football, studies show that both male and female athletes in other sports, such as lacrosse, hockey and those traditionally perceived as “safe” such as baseball, soccer and gymnastics – are also susceptible to concussions, and hence are in danger of concussion-related brain disorders. As an organization that regulates all collegiate sports, the NCAA has an obligation – and, we feel, a real opportunity – to improve safety, and have a meaningful impact upon the value of collegiate athletics (and students’ lives) by creating robust, standardized concussion protocols that are implemented in a variety sports.
A more robust concussion policy
The NCAA’s current Concussion Policy requires that each member school have a concussion management plan on file, yet there is no penalty for failure to adhere to proper concussion protocols. A recent study revealed that implementation of the NCAA’s Concussion Policy was inconsistent and highly variable across institutions. Many schools have not made their concussion management plans publicly available. Of particular concern is that the education of coaches, team physicians, and student-athletes is not standardized, and in some schools entails little more than distribution of a concussion fact sheet. This past July, in the wake of a concussion lawsuit settlement (which was recently rejected by a federal court judge for being insufficient), the NCAA released new concussion guidelines, but again, these consist of only a voluntary set of best practices.
Spurred by the Ohio State tragedy, last month the NCAA’s Big Ten Conference announced new concussion protocol standards that include penalties for non-compliance, and use of an independent athletic trainer to monitor post-concussion recovery. Although this higher level of accountability is certainly a step in the right direction on the part of the Big Ten, such mandatory concussion protocols and penalties need to be established, in place, and enforced in all NCAA member schools.
The NCAA maintains and enforces strict policies that prohibit a multitude of infractions – from mailing the wrong size envelope to recruits, to signing autographs; why then can’t it establish and enforce equally stringent concussion policies to protect those student athletes that it purports to serve?