With Brain Injury Awareness month coming to a close, there is one final bit of good news: Pro hockey may finally recognize that game violence puts players at risk for concussion, and–here’s the exciting part–there are talks about how to curb head injuries. Perhaps they could take a lesson from the National Football League (NFL) and think big. Like, with a poster.

This past football season saw a new emphasis on concussion prevention, sideline diagnosis, and appropriate treatment. The NFL started its 2010 season by hanging posters in all team locker rooms describing the symptoms of concussion and clarifying the NFL’s position on how they should be reported and treated. Next, the NFL announced fines for helmet-to-helmet hits. During the first week after the fines were announced, three players felt the hurt: Two players received fines of $50,000, and one player–James Harrison of the Pittsburgh Steelers–was fined $75,000.

Those changes were implemented because concussion is no longer thought to be just a minor bump on the noggin. Recent research suggests that repeated concussions may be more than just a passing pain–they may cause early dementia and neurologic wasting similar to Lou Gehrig’s disease. Repeated concussions have also been linked to some recent suicides. It now seems irresponsible not to change the rules of the game to protect players.

Well, football season is over, and now its hockey’s turn to try to make a difference.

According to an article in The New York Times, change won’t come easy. There are two extremes in the concussion debate:

…general managers, sponsors and fans who favor a ban on hits to the head and their old-school counterparts who see such a drastic rule change as potentially robbing the league of its rugged appeal just when its popularity is growing.

Interestingly, head-hits are totally banned by the International Ice Hockey Federation, the National Collegiate Athletic Association, and the Ontario Hockey League.  And yet, the NHL still feels the need for debate. There is a partial ban, which outlaws blindside hits to the head and deliberate head shots. But checks to the head from straight-on are still legal. That’s right: It is perfectly legal for players to hit each other in the head as long as they deliver the head-check from straight ahead. Some are defending this Neanderthal practice. As reported in the article in The New York Times:

A leading voice among traditionalists is Toronto Maple Leafs General Manager Brian Burke, who has spoken often about the need to preserve “the fabric of our game.”

Recently, Burke said: “We want that hit in our game. What’s distinctive about our game from anywhere else in the world is the amount of body contact. So we have to try to take out the more dangerous hits and make it safer for the players, but keep hitting in the game.”

But many others see new rules to protect players against concussion as inevitable…and logical. There was a time when people debated whether players should stay on the ice the whole time, or if substitutions would be allowed…and there was a time when helmets were controversial. Everything changes over time, even sports. In this case, medical science has discovered that concussions can be a serious health risk; it’s up to the NHL to respond with appropriate safety regulations. Broken bones heal, but brain injuries can cause permanent and life-altering damage. We challenge the NHL to emulate pro football’s response to the concussion threat.

To read the full New York Times article, click here: Regulating Hits to Head Tests N.H.L. Tradition

For girls and young women, one sport accounts for more than 65% of of all high school catastrophic injuries, and more than 70% of all collegiate catastrophic injuries. (For the record, “catastrophic injuries” are life changing events, including traumatic brain injury, paralysis, and death.)  Less severe injuries are also common–each year, this sport sends more than 25,000 female students to hospital emergency rooms.

The sport?  Cheerleading.  And compounding the tragedy of injury is the fact that only 20-25 states list high school cheerleading as a sport… the NCAA doesn’t recognize cheering as a championship sport… and unless the number has changed since December 2009, only 3 colleges consider cheering a sport–none in North Carolina. (Statistics from Journal of Athletic Training 2009)

Call a Sport a Sport.

While “recognition” might seem like a minor point, it has major ramifications for safety.  A “sport,” performed competitively and for entertainment, requires strict guidelines to ensure the safety of athletes. In 1980, when cheering was still primarily about leading the crowd in cheers, there were fewer than 5,000 emergency room visits. Today, cheering involves highly skilled gymnastics (as well as being tossed in the air and trusting that someone will be there to catch you).

Without the sanction of being a sport, cheerleaders often have to practice in areas that make injuries more likely, such as an asphalt parking lot or a team member’s backyard.  A “sport” requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches.

Gimme an A-C-T-I-O-N.

One of cheering biggest and most vocal supporters is Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). The group’s 26th annual report devotes a special section to cheerleading injuries, which describes the current state of cheering as a sport, details specific catastrophic injuries and how they occurred, and suggests sample guidelines that could help prevent cheerleading injuries. As quoted from the report (available here):

“Is cheerleading an activity that leads the spectators in cheers or is it a sport? If the answer is to entertain the crowd and to be in competition with other cheerleading squads, then there must be safety guidelines initiated. The authors of this research question why it is called cheerleading, when competitive cheer has nothing to do with leading the crowds at athletic events in cheering for the athletic teams on the playing field. Following are a list of sample guidelines that may help prevent cheerleading injuries:

1. Cheerleaders should have medical examinations before they are allowed to participate. Included would be a complete medical history.
2. Cheerleaders should be trained by a qualified coach with training in gymnastics and partner stunting. This person should also be trained in the proper methods for spotting and other safety factors.
3. Cheerleaders should be exposed to proper conditioning programs and trained in proper spotting techniques.
4. Cheerleaders should receive proper training before attempting gymnastic and partner type stunts and should not attempt stunts they are not capable of completing. A qualification system demonstrating mastery of stunts is recommended.
5. Coaches should supervise all practice sessions in a safe facility.
6. Mini-trampolines and flips or falls off of pyramids and shoulders should be prohibited.
7. Pyramids over two high should not be performed. Two high pyramids should not be performed without mats and other safety precautions.
8. If it is not possible to have a physician or certified athletic trainer at games and practice sessions, emergency procedures must be provided. The emergency procedure should be in writing and available to all staff and athletes.
9. There should be continued research concerning safety in cheerleading.
10. When a cheerleader has experienced or shown signs of head trauma (loss of consciousness, visual disturbances, headache, inability to walk correctly, obvious disorientation, memory loss) she/he should receive immediate medical attention and should not be allowed to practice or cheer without permission from a physician.
11. Cheerleading coaches should have some type of safety certification. The American Association of Cheerleading Coaches and Advisors offers this certification.
12. The NFHS should make cheerleading a sport, which will place cheerleading under the same restrictions and safety rules as all other high school sports. The NCAA should follow this same recommendation.”

HensonFuerst commends the research and activist efforts of Dr. Mueller and his team. We represent the interests of far too many children and young adults whose lives have been shattered due to head trauma or other catastrophic injury. There are few things in life as heartbreaking as broken potential. We agree that it is time to let recognition and regulations catch up to this fast-moving, physically demanding sport. Yes, sport. Let’s at least make an effort to stop the hemorrhage of young, enthusiastic lives.

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page. If you have questions, HensonFuerst has answers.

(Related and interesting articles can be found here: Flying without a net: Cheer injuries on rise. MSNBC and Cheerleading is leading cause of catastrophic injury in young women, ScienceDaily.)

In late April 2010, an NCAA panel recommended that all schools have a clear plan for what to do when a student athlete receives a head injury. The main issues are recognizing signs of mild traumatic brain injury (MTBI, also known as concussion), understanding the potential severity of every head injury, and deciding when the athlete is fit to resume playing. (Sports Illustrated/CNN)

The first week of May, it was announced that athletes at all Big Ten colleges will be required to undergo education about the symptoms of MTBI.

On May 9, 2010, Dylan Steigers died of a football-related head injury. He walked off the field after a scrimmage, vomited–a sign of concussion–then taken to the hospital. He died of subdural hematoma (bleeding on the brain). His death will surely be remembered and cited often as yet another reminder of how serious every head injury can be. (OregonLive)

At HensonFuerst, we are highly attuned to the dangers of brain trauma.  Every day we see clients whose lives have been changed forever after an accident. We support the principle of brain injury education for athletes, coaches, parents, and college administration officials.  The more we all understand about the signs and symptoms of brain injury, the more we respect the seriousness of even “mild” concussions, the more we encourage wellness over performance, the fewer disabled athletes will require a lifetime of special care.

We hope that the responsibility for recognizing when an athlete may be unfit to play is given to those who have the appropriate medical training. We say this because it was reported that “students will sign a waiver acknowledging their responsibility to be an active participant in their care.” (Dr. Jeffrey Kutcher, as reported on AnnArbor.com.)

Yes, it is important that athletes report their symptoms honestly–without fear of mockery or reprisals–but people who have a brain injury can be confused, forgetful, and disoriented. If the intention of this waiver is to get athletes to become more aware, that’s wonderful, but we hope that it is not used as a way to shield the colleges from their responsibility to protect the students.

HensonFuerst is a proud supporter of the Brain Injury Association of North Carolina (BIANC).