It is no surprise, then, that virtually every expert in the field puts education at the top of the list of ways in which the sport of football, indeed all contact and collision sports, can be made safer.
Typical is a recent statement1 by Paul S. Echlin, M.D., a leading concussion expert and researcher in Canada, who writes that:
Education is vital to decrease the incidence of concussion and improve treatment. Education and positive action are everyone's responsibility. To overcome cultural inertia concerning the growing knowledge about concussions, and the too-frequent inaction by supervising adults, we must look primarily to educating the next generation of coaches and parents.
The reason is self-evident: "concussion management depends highly on the knowledge base of all individuals involved, including athletes, coaches, athletic trainers, parents, and health care providers."2 In other words, everyone - from parents, to players, from coaches to athletic trainers, from school superintendants to athletic directors - needs to be educated about the ways the risk of concussion can be reduced and, when they occur, identified and managed in a way that minimizes the risk of further injury.
Players
One of the most important steps that a school or independent football program can take to ensure that football players who suffer concussions have the best possible outcome in both the short- and long-term is to hold a comprehensive concussion safety meeting before every football season (indeed, some even suggest that mandatory concussion education sessions should not only be held for coaches/players/parents before every season, but during and after the season as well).1
While nearly every state in the country now requires that parents and players receive some basic concussion safety information as a condition to participation, more education than can fit onto an 8 1/2 by 11 sheet of paper is urgently needed.
Increased appreciation and knowledge of concussions among student-athletes, experts believe, would provide a significant public health benefit by promoting a more safety-conscious sports culture in the United States.3
Parents
While there are lots of very protective parents, there are still too many who, sad to say, are willing to sacrifice their child's safety and — in the case of concussions, their long term health — at the altar of a winning performance, a touchdown scored, a scholarship won, a pro contract inked. It is not only fathers who fall into this unfortunate category. There are also too many moms who are over-invested in their child's athletic success, who enjoy too much doing what sports psychologists call "basking in the reflected glory" of their child's athletic achievements; who are content to let their child's very identity become wrapped up in sports; and who are unwilling — or unable — to end their dream of playing four years of high school sports and take away something they cherish, and, in doing so, put their child's very future at risk by allowing them to return to contact sports while still experiencing post-concussion symptoms or despite a history of multiple concussions.
Some parents admit that they allow their children to play in such circumstances even though they know about the potential for adverse long-term health consequences, like major depression and permanent cognitive impairment. One 2010 survey1 found that fully fifty percent of parents of children age 12 to 17 playing school sports knew a parent who would have their child return to sports too soon after a concussion. A 2012 survey by SafeKids Worldwide2 reported that nearly half of all U.S. coaches said they had been pressured by parents to play an injured child during a game. The most notable pressure is coming from parents, and being directed towards paid coaches - demands which may be hindering the coaches' ability to keep player safety as a top priority.
While the last six years have seen an increased focus by the media and football community on the issue of sports-related concussions, there is clearly a great deal of room for improvement in concussion education.
Too many parents still think that concussions only occur with a loss of consciousness and/or that it isn't dangerous to play with a concussion. Indeed, a 2010 national poll1 by Michigan's C.S. Mott Children's Hospital found that less than one in ten parents (8%) of children playing school sports had read or heard a lot about the effects of repeated concussions, while fully one third (36%) hadn't heard or read anything about the effects of multiple concussions.
Coaches
A 2012 survey2 found that 52% of all coaches mistakenly believe that there is an acceptable amount of head contact (i.e. getting their "bell rung," "seeing stars") young athletes can sustain without potentially causing a serious brain injury, with the percentages of those who felt this way highest among coaches under age 35, male coaches, and paid coaches. This despite the fact that 9 out of 10 coaches know that most concussions occur without a loss of consciousness.
Education works
In a study evaluating the impact of concussion legislation on concussion awareness among parents, coaches, and players, researchers at the University of Washington found that, a year after enactment of that state's pioneering youth sports concussion safety law in May 2009, 96% of respondents understood that concussions were a form of traumatic brain injury, and that 90% would delay an athlete's return to play when neurological symptoms were present, although fewer individuals understood the return-to-play guidelines contained in the law, including the requirement of written clearance from a health care professional with concussion expertise (73%) or that a parent could not clear the athlete for return to play (88%).
Continuing education
Because the science, medicine, and technology relating to concussion risk reduction, identification and management is constantly evolving, meetings should be held every year, with parents encouraged to engage in continuing education on their own by utilizing education resources such as the MomsTEAM concussion safety center and the Centers for Disease Control and Prevention, and by utilizing new technologies, especially the ever-growing group of smartphone applications.
