Monday, June 6, 2011

A nationwide effort to deal with concussions

Tuesday's Toronto press conference on concussions was notable not just for the improvements announced, which were significant in their own right, but also for the wide range of groups that came together to discuss the issues around head injuries. The conference featured everyone from CFL commissioner Mark Cohon to Football Canada director of sport Rick Sowieta to CIS chief executive Marg McGregor and Toronto Argonauts' CFLPA representative Bryan Crawford, and it had representatives from essentially every level of organized football in Canada. Despite that wide-ranging composition, the panel demonstrated a remarkable consensus on many key issues; concussion awareness has to be increased at all levels, football rules and tackling instructions have to be refined to discourage dangerous play, head injury treatment has to be standardized and done in accordance with international protocols and research into concussions has to continue.

Some direct measures were announced to achieve these goals, such as handing out standardized concussion cards and posters (which you can see and download here) with information on symptoms, treatment and returning to play. These are going to be put in every high school, university and CFL dressing room, and that's a tremendous step forward on both the awareness and standardization fronts. Other announced measures, such as the CFL's move to league-wide computerized testing (following the internationally-recognized SCAT2 and ImPACT protocols), improved training programs on concussions and proper tackling for coaches at all levels and new concussion-reporting rules in amateur football, are going to play a huge role as well. The specific changes shouldn't be overlooked here, as many of them are likely to make a difference. However, the most important overall takeaway may be that this was a presser/conference call that lasted almost 90 minutes and featured people from organizations with significantly different mandates and goals, but yet saw agreement on just about every major issue. Moreover, that agreement was generally along the lines of the latest research, which isn't particularly usual for sports leagues; most have changed concussion protocols gradually and slowly. Here are some key comments from some of the panelists on the conference call:

Mark Cohon, CFL commissioner: Cohon (pictured at centre above) spoke about the need for increased awareness and prevention of head injuries, as well as improving concussion management protocols and research. He said the new cards and posters will play a crucial role in that.

"They spell out, really, for players, for coaches and for parents, what you need to know," he said. "They spell out the signs and symptoms of a concussion, the importance of never returning a concussed athlete to play and information on treating and managing concussions."

Cohon said the CFL wants to improve concussion awareness and management efforts not just in the professional game, but at every level of football in Canada, which is why they've put such a focus on working with other organizations.

"We're raising awareness at a very early age, at the peewee level all the way through our alumni association," he said.

Cohon said the league's been paying attention to all the recent disturbing news about concussions (including Monday's confirmation that former Chicago Bears safety Dave Duerson had chronic traumatic encephalopathy).

"There has been a real focus on concussions in sports over the last couple of months," Cohon said.

He said the league's been looking at ways to improve concussion treatment for years, though. They've brought in standardized concussion treatment procedures, and the new computerized system will help even more. Another key element of their procedure is enhancing the distinction between football and medical personnel, and making sure that medical personnel are the ones making decisions about when players can return, one of the most critical areas in addressing concussions.

"Clearly, there is a delineation between the football people and the medical staff," Cohon said. "The football people don't want to be involved with this."

Cohon said the CFL's efforts aren't happening in a vacuum, as they're paying close attention to what's going on in the NFL and in American research institutions like Boston University's Center for the Study of Traumatic Encephalopathy. They plan to share information from the studies they're involved with across the border, and they want to emphasize that concussions aren't an issue limited to the CFL, but are a key topic for all of football and really all of the sports world.

"We have a very solid relationship with the NFL," Cohon said. "We'll share that information with people at the NFL, with our colleagues on the panel, with anyone who plays any sport."

Cohon said unreported concussions are far less of a problem in the CFL than they used to be, which is a positive sign that things are starting to change.

"I am convinced that every concussion is being reported and being dealt with," he said. "I trust our doctors. I trust our therapists. I trust our teams to report that."

He chalks that up to increased awareness of concussions and their long-term effects, which have helped players to realize how serious they are.

"The culture has changed."

Working with players on concussions is crucial to the CFL's proposals, as few policies would get too far without support from the players' association. Cohon said that's critical to getting anything done, and player safety played a crucial role in the most recent collective bargaining agreement negotiations in 2010.

"When we sat down during our collective bargaining negotiations, we really focused on player safety," he said. "We need to make sure the CFLPA is in lockstep with us."

Bryan Crawford, Toronto Argonauts' running back/CFLPA rep: Crawford added an extremely valuable perspective to the discussion as the only active player on the panel. He reinforced that players are critically concerned about the issues at stake here, something that was evident from Doug Brown's recent column and the controversy it sparked.

"The union is extremely proud to be a part of this very, very important initiative," he said. "One of the critical issues is player safety."

The CFLPA recognizes that this isn't just about them, either, as they're fully on board with plans to improve concussion treatment and management issues at every level.

"As the professionals of our sport in our country, we recognize the importance of our mentorship and leadership role," Crawford said. "We have an obligation not just to lead, but to lead by example."

Crawford said the union plans to conduct players-only meetings with each team to inform their members on concussion issues.

"We're striving to raise awareness and better educate our members moving forward," he said.

He said he's confident team doctors and medical staff operate with enough independence to do what's best for players' long-term health.

"From my experience with the Argos, there's not a case where the doctors and the trainers employed by the team are doing anything other than in the players' best interests."

Dr. Charles Tator, brain specialist, one of Canada's leading concussion researchers and founder of ThinkFirst, a charitable organization dedicated to prevention of brain and spinal cord injuries: Tator's medical and scientific perspective brought a lot of credibility to this conference, and he was quite positive about the CFL's steps to address concussions.

"I can't praise the CFL enough for its mature response and approach to solving these issues," Tator said.

He also spoke about the various research efforts he's involved with, including studies of former football players' brains:

"The nature of the project is to try and bring some answers to the question of ‘Why are former professional athletes suffering these kinds of late-life brain damage?'" he said.

Matt Dunigan, former CFL quarterback and current CFL on TSN analyst: Dunigan brought an alumnus' perspective to the table and talked about how concussions have affected him.

"As a player, my mentality was if there was an extra yard to be gained, I was going to go for it," he said. "I initiated a lot of contact and I paid the price."

Dunigan recently spoke about encouraging his son to quit football after multiple concussions, which he said wasn't easy.

"It's the toughest thing I've had to do," he said.

Dunigan's personally committed to improving concussion research and education. In addition to speaking to kids and using his TSN platform, he's already agreed to donate his brain to Tator's study group after his death. They've already obtained four brains, and they're looking for more volunteers; Dunigan hopes his example will inspire others.

"I will be number five on that list," he said.

Dunigan is impressed with what's already been done on the concussions front.

"It does my heart good that we've come so far in such a short time," he said.

He said ongoing research and awareness initiatives aren't to get kids out of football, but to make football safer for them.

"It's not to discourage kids, but to continue to encourage kids," he said. "We're going to continue the research, the education to make this safe."

Those continued research and education efforts could be critical to the long-term survival of football, and it might just all start with initiatives like the ones announced Tuesday. Perhaps even more important is that the league, the players and officials at all levels of Canadian football recognize the severity of the problem and are working to find ways to mitigate it. Concussions are one of the most daunting and complex issues in sports, so they'll require considerable partnerships, research and brainpower to deal with. The groups involved in Canadian football are stronger together than they are apart, and they might just be able to make some notable things happen on the concussions front that the rest of the world could learn from. If they do, perhaps someday we'll look back at this conference as an historic starting point. For the moment, though, the initiatives announced at it are notable in their own right, and they should help make the game of football safer for everyone involved. It's tough to argue with that.

Amanda Peet Xenia Seeberg The Avatars of Second Life Daniella Alonso Gina Gershon

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