Head Impacts: Everyone, and Every One, Counts

ALL athletes are susceptible to injury – coaches, let’s do what we can to keep them safe. Everyone, and Every One, counts. #BeyondStrength @coach4kindness

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This year, more than 100 million high school athletes will take the field… or court, or pool. No matter what sport they play, head injuries are possible. It’s not just football coaches who need to keep an eye out. All coaches need to be conscious of athlete safety. As coaches, we hold the reigns.

Speaking of reigns, many find it surprising that equestrianism – horseback riding – has a higher rate of concussions per participant than any other sport.

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Instead of villainizing football, let’s be sure the concussion discussion includes all athletes.

The effects of a concussion are varied and complex. They can be difficult to identify, and sometimes misleading. For example, if an athlete shows up to practice sleep-deprived, they might experience cognitive delay on time-sensitive tasks. If they are significantly dehydrated, they might have a headache. Either of those two symptoms, in the presence of potential exposure to concussion, would warrant taking an athlete out of competition.

It is certainly better to err on the conservative side and remove an athlete from competition with false symptoms of a concussion than ignore those symptoms and place the athlete at risk of further exposure.

By the time an athlete is symptomatic, they enter one of the three core areas of concussion safety: Recovery. At this point, the athlete should be placed in the hands of an experienced medical professional.

The two additional realms of concussion safety are Volume and Intensity. Intensity, referring to the magnitude of impact received (often measured by a combination of linear and rotational acceleration), should be closely monitored. Collision intensity can be difficult for coaches to control, though future articles on BeyondStrength.net will address this issue.

The piece of the concussion discussion which falls most directly under a coach’s control is Volume. Volume, defined by the total number of collisions, or the accumulation of exposure to potential concussion, should be monitored by coaches along the course of day, week, and season.

Opportunities and Outcomes

Total exposure to potential concussion is the number one predictor of injury. This makes obvious statistical sense; total exposure increases the likelihood of any outcome. For example, the more carries a running back has, the greater his chances of eventually scoring a touchdown. He won’t necessarily score a touchdown, of course, but his odds increase alongside increased opportunity.

The more head impacts an athlete receives, the more likely they are to be concussed. Obvious enough.

But it appears the relationship is more than just playing the odds. A recent study led by Brian D. Stemper of Marquette University found that “repetitive head impacts likely decrease biomechanical tolerance for concussion” – the implication of this is significant, since this ultimately means that athletes are “more susceptible to injury from lower magnitude impacts.” Many coaches have seen injuries occur on plays that do not seem terribly vicious. Depending on the volume of exposure preceding an impact, the intensity of that impact might play less of a role than we initially thought. The Stemper study found that 56% (n=28/50) of concussed athletes were injured on impacts with a probability risk (a calculation which includes intensity of impact) of less than 1%.

This adds a clarifying idea to the running back metaphor:

1. The more opportunities a running back has to carry the ball, the greater the odds that he will eventually score a touchdown. (increase due to overall opportunity)
2. The more opportunities a running back has to carry the ball, the closer to the goal line he will be; accumulation of yards in the direction of the goal line increases the likelihood of scoring a touchdown. (increase due to accumulation effect)

As a running back racks up yards during a drive, steadily approaching the goal line, he might put himself in a situation where a short, 2-yard run might get him into the endzone.

If we were to measure total head impacts instead of yards, we might find that a low-magnitude, routine collision is enough to concuss an athlete. Why? Because of accumulation, or total Volume, of exposure.

Coaches, we have to take this into account.

The Coach’s Role

What can we do? Start by keeping an eye on the total number of impacts your athletes experience over the course of a practice.

Contact is a necessary part of many sports, and an unintended but largely unavoidable part of others – in either case, it should be monitored. There is no science to identify an athlete’s exact exposure threshold; each athlete has a unique level of susceptibility to concussion. Individual contexts include genetics, lifestyle habits, and level of preparation. With so many variables that are difficult to track, here are three easy ways to keep an eye on volume.

1. Prepare. Plan to challenge your players, get them ready to compete, but plan with total number of repetitions in mind – keep in mind that a long, healthy season is better than one practice. (Practice guidelines from USA Football here)
2. Listen. Ask them how they are feeling and listen closely to how they respond. Listen to their body language as well. (List of symptoms from Mayo Clinic here)
3. Count. Take note of overall repetitions, with special attention given to high impact collisions. Trust your gut – too much is almost always too much, and there is a fine line between developing toughness and developing injury.

Keeping student-athletes safe requires mindful coaching. We have to pay attention and be intentional.

Be intentional, but don’t be afraid. The world around us is changing, in a good way – we have more access to information than ever before. Embrace the science and don’t buy in to hysteria. But do everything you can to keep your players – the brothers and sisters, the students, the future leaders, the children – safe.

As always, your behavior must match your goal. Contact us if you need support.