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Owen Thomas’ football career at the University of Pennsylvania came to an abrupt end on April 26, 2010. Having recently been named team captain, Thomas was found dead outside of his apartment building. He had made the decision to end his own life.
A few months after Thomas, a defensive end in his junior year, committed suicide, startling findings pointed to factors that may have been involved in his death. A brain autopsy at Boston University’s Center for the Study of Traumatic Encephalopathy discovered that Thomas had developed early chronic traumatic encephalopathy, or CTE, a disease associated with depression and loss of impulse control.
The results of the autopsy were surprising: CTE, which often results from repeated, hard hits to the head, had previously been linked primarily to NFL players—never to an amateur collegiate player. CTE is unique in that it can only be diagnosed posthumously through a brain autopsy, but most individuals who are diagnosed had also suffered concussions, and in some cases multiple concussions, during their lifetimes. Thomas had never been formally diagnosed with a concussion.
Thomas’ death and his CTE diagnosis rattled the football community. The realization that this debilitating disorder could stem from subconcussive hits and could start at such a young age was both tragic and concerning. As cases like Thomas’s continue to illuminate the long-term effects of concussions and CTE, coaches, trainers, and players in collegiate football are discussing ways to make the game safer, both through regulation and education.
The Ivy League has been proactive, more than most NCAA conferences, in regulating student exposure to concussive hits. In a report released in July 2011, the Ivy League Council of Presidents reduced the number of in-season contact practices to two per week, three fewer than the current NCAA regulation.
“We started to restrict the number of contact periods that we did during a given day and tried to do more drills where we would teach more than we would actually perform with contact—save that for game time,” said Brown football coach Phil Estes. “We’ve cut our contact down so that normally we’re doing less contact within a practice, but also less contact during the week.”
Overarching change in how the NCAA handles concussions is slow, and many of their regulations tend to trickle down from the NFL. A new NFL ruling meant to prevent concussions prohibits running backs from lowering their heads into a tackle outside of the tackle box, but this ruling has not yet been adopted by NCAA football.
The NCAA has made some changes. Progress came early in 2012 when the NCAA opted to move kickoffs and touchbacks forward five yards in an effort to reduce high-impact hits during kickoff returns. That said, Jim Gossett, head athletic trainer at Columbia University, believes that the rule may not be enough to limit brain injury if CTE is indeed caused by an accumulation of hits below concussion level.
“I think [hits during kickoff returns] tend to be the most high-velocity hits...but I think when you start to look at some of the concerns on the neurological problems, it may not be the full-blown concussion that’s at the root of the problem,” Gossett said. “It may be these subconcussive hits that are happening multiple times per day, per week, that have a cumulative effect. That’s the bigger question.”
"I think everyone has a level of concern over that—the repeated head trauma, even if it doesn't lead to a concussion,” Jeff Frechette, head athletic trainer at Dartmouth University, agrees. “There have been several studies that have shown that all these minor head bumps are possibly cumulative over a period of time. And all of that may lead to this development of CTE. I think there is a lot of research that still needs to be done about that."
Stanford University is participating in research on the subject by conducting a head impact study that assesses to what degree specific types of impacts correlate with or cause concussion-like injury. By using devices in their athletes’ mouthguards to measure the amount of force generated in hits, researchers are gathering data about the severity of different types of head impacts.
“We’ve involved men’s and women’s soccer for heading the ball everyday to try to determine if the number of subconcussive hits can lead to a concussion, or predispose someone to a concussion, or if they have no effect at all,” said Jesse Free, an assistant athletic trainer at Stanford, who went on to explain that this part of the study may reveal findings significant to football as well as soccer.
Though researchers still have much to learn regarding mild traumatic brain injuries and their causes, findings have led to an enhanced emphasis on educating student athletes about the dangers of concussions. As part of a concussion management plan mandated by the NCAA, schools must educate their athletes annually about the signs and symptoms of concussions.
Christopher Kaeding, the head team physician of The Ohio State University’s Athletic Department, described the school’s concussion curriculum for athletes. “We educate players every year on the potential severity of concussions and repeated concussions and the importance of them reporting to [the medical staff] that they’ve had a concussion,” said Kaeding. “In fact, they sign a statement that they have an obligation to inform the medical staff of their symptoms.”
Trainers have started to see the effects of concussion education and heightened awareness of the dangers of concussions. According to Bernie DePalma, head athletic trainer of Cornell University, the growing research linking head trauma to debilitating diseases has caused his student-athletes to be more forthcoming about possible injuries sustained on the field.
“Athletes are more concerned about it. They will come to you with symptoms, moreso now than ever before, because of what they’re hearing or reading,” DePalma said. “We have athletes come back in August saying ‘I read all this stuff in the summer and I want to make sure [that I’m not at risk].’ They report their concussions now better than they ever did.”
With the enhanced regulation, education, and reporting of concussions, identifying and propagating safe practices is everyone’s priority. Estes, Brown’s football coach, believes the consequences of not prioritizing safety could be severe.
“If we don’t make the game safer, we won’t have a game in a few years,” Estes said. “I think the parents will look at it and say, ‘I’m not going to subject my son to a potentially dangerous situation.’”
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This article has been revised to reflect the following correction:
CORRECTION: April 4, 2013
An earlier version of this article incorrectly stated the name and title of Jesse Free, an assistant athletic trainer at Stanford University.