College Players Often Don’t Tell of Hits to Head, Studies Find

The New York Times

Ken Belson

October 13,2014

The controversy over why Michigan quarterback Shane Morris was allowed to return to the field with a “probable mild concussion” from a violent hit last Saturday highlighted a communications breakdown on the Wolverines’ sideline. But it also pointed to the inconsistent ways in which coaches and players acknowledge hits to the head — if they acknowledge them at all.

Three studies published in the past few weeks have offered more insight into that issue, concluding that the self-reporting of concussions by college players varies by position, with offensive linemen the least likely to report concussions and less significant hits to the head.

The studies, led by Christine Baugh of Harvard and assisted by researchers at her institution and Boston University, also indicated that efforts by the N.C.A.A. and other groups to raise awareness of concussions had been uneven and that freshmen were more likely than upperclassmen to believe their coach would think they did the right thing by reporting a concussion.

The studies were released amid fresh questions about whether coaches, trainers and doctors were doing enough to monitor football players for concussions. Three high school football players have died in the past week, including a 16-year-old from Long Island after an on-field collision.

The three new studies were based on a survey of 730 Division I football players on 10 teams during the 2012 season. The findings concluded that for every diagnosed concussion, players sustained six substantial hits that they suspected might have caused a concussion but did not report. The players added that for every diagnosed concussion, they also received 21 dings — or smaller hits — that they also did not report.

While concussions were diagnosed in less than 4 percent of the overall cases, the researchers noted that not every unreported head hit could be assumed to cause a concussion. Yet because medical personnel were not notified, in part because the players often did not view at least some of the hits as significant, it was difficult to know precisely how many concussions they might have sustained.

“This suggests that these somewhat routine, lower-magnitude impacts may have clinically relevant, yet undiagnosed, manifestations, and that athletes incurring these regular symptomatic impacts may see post-impact symptoms as routine and not worthy of reporting to a medical professional,” the authors wrote in one of the studies, in The Journal of Neurotrauma.

The underreporting of concussions and smaller head hits was most prominent among offensive linemen, that study said. For each diagnosed concussion received by an offensive lineman, nearly eight other possible concussions were not diagnosed and another 25 dings were not reported, the study said.

The authors said that offensive linemen might believe that dings were typical because they were involved in so many collisions. And because they travel shorter distances before hitting defensive linemen, the force of the impacts to their heads may be smaller than those received by players in other positions.

Still, the long-term effect of so many hits to the head may be significant, the authors said.

“The findings of this study indicate that the regular hits taken by offensive linemen are leading to more frequent post-impact symptoms than other positions, but are more frequently left unreported, possibly due to their routine nature,” they wrote

The authors of the three studies emphasized that one of the biggest hurdles to preventing and diagnosing concussions was educating players to understand when they might be injured and to report their symptoms to medical personnel.

“In youth, high school and college sports environments, there are many incentives to keep an athlete in play even when he/she has sustained an injury, including a concussion,” they wrote in a second study, published in The Journal of Law, Medicine & Ethics. “For example, athletes themselves often want to remain in play as to not let down their teammates and coach.”

The authors of that study found that colleges did an inconsistent job of giving players information about why and how to report a concussion. The study found that about 40 percent of athletes did not recall receiving information about concussions and the responsibility to report concussion symptoms.

A third study — also published in The Journal of Law, Medicine & Ethics — explored players’ attitudes toward reporting concussions. It found that freshmen were most likely to believe that their coaches would believe they did the right thing by reporting a concussion.

The authors found that players who felt their coach was less supportive of reporting concussions had significantly more undiagnosed concussions than peers who felt their coach was more supportive.

The findings suggest that players of all ages need to be taught how to recognize concussions and report them. At the same time, objective measures need to be developed to identify concussions so that coaches and doctors are less reliant on players self-reporting them, said Chris Nowinski, a co-founder of the Sports Legacy Institute, who has read the three studies.