Changing the Stigma of Injury
For stakeholders, I advocate for a message that emphasizes the optimistic and beneficial outcomes associated with the changed behavior, rather than emphasizing simple facts and fear. Athletes are competitive by nature. They want, more than anything else, to compete and to be better athletes. The power of denial is too strong to be overcome by the power of statistics and lists of risks associated with under-reporting or minimizing concussion symptoms. The social capital associated with participation is more valuable to most athletes than the “better safe than sorry” and “when in doubt sit out” messages associated with traditional education efforts.
Many times, athletes are put through a concussion protocol only when they have obvious signs and symptoms that can’t be hidden, or after they’ve tried to play through an injury only to get worse and worse with subsequent participation, eventually leading to forced self-report. A different, more effective approach to meaningful knowledge transfer involves teaching athletes about the role the brain plays in athletic performance. A message combined with assessment, measurement, and tracking of vision, balance, speed of mental processing, reaction times, prediction, and other skills that are neurologic in nature re-frames the brain in the context of sport. A more efficient brain with higher levels of these skills should also contribute to impact/collision avoidance and reduction in risk. Training these skills and monitoring improvements through testing and on the field exposes the athletes to concepts related to a healthy brain prior to an injury.
Framing the understanding of the brain in sports in this way completely changes the attitude associated with brain injury and will be much more likely to result in the desired changes in behavior as compared to the traditional “facts and fear” approach. In this way, and with this spirit, emphasizing what is known about risk reduction through limiting contact practices, the importance of hydration, safe and effective tackling techniques, the benefits of neck strengthening, and other aspects of concussion safety and prevention will be embraced by athletes and stakeholders, rather than seen as necessary evils.
Setting a New Example
With respect to the messenger, credibility and objectivity are critical, but just as important is the recognition, reputation, and influence of the messenger. I believe a real opportunity exists to utilize coaches, icons, and peers to deliver and/or reinforce the message. Traditionally, amateur and professional athletes have heard retired and active professional players speak of their own toughness and how they valued play so much they would need to be “carried off the field” rather than volunteer information about a suspected injury and remove themselves from competition. More recently, the pendulum has swung opposite, with some athletes retiring early or declining to compete for fear of CTE. Right or wrong, informed or ignorant, these voices are heard and aspiring amateurs mimic the messages.
Likewise, coaches have significant influence over the actions, activities, and behaviors of the athletes they coach. Too often, volunteer youth league coaches (and many high school coaches in underserved communities where assistants are frequently volunteers) tend to coach the way they were coached. They lack continuing education and have little knowledge of current and evolved approaches that stress safety as a key aspect of performance. As intuitive as it would seem that keeping your best players healthy and on the field should be a priority, many coaches default to the “old-school” traditions of proving toughness in how they conduct their practices and determine starting player selection. There are explicit as well as subtle, unstated messages being sent to the players who are being coached in this manner, and Players will respond in order to get and stay on the field. Make no mistake; player behavior is directly influenced by the insight (or lack thereof) of the coaches for whom they play.
Proper, effective knowledge transfer to coaches on safe participation and best practices regarding brain health and safety represents a major opportunity for those of us interested in making football safer. And like the players they coach, amateur, volunteer, and other football coaches will mimic the behaviors of the iconic coaches they respect. Emphasizing the optimistic and beneficial effects on performance when behaving in ways that protect and optimize neurological function is a strategy that can make football safer, and one that can be employed now.
Vernon B. Williams, MD, is director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine and chair of the American Academy of Neurology’s Sports Neurology Section. Additionally, he serves as a physician consultant for several professional, college, high school, and club-level athletic teams including the Los Angeles Kings, Los Angeles Lakers, Los Angeles Dodgers, Los Angeles Rams, Anaheim Ducks, and Anaheim Angels, and is a California State Athletic Commissioner.
This article originally appeared on Neurology Advisor