By YASMEEN ABUTALEB
Capital News Service
COLLEGE PARK – Football players hurl their bodies toward opposing players to knock them down. Hockey players check each other with full force, slamming each other against walls. Soccer players dive into scrums to get the ball.
Many athletes play through a spate of injuries and concussions for the sake of the game. They refuse to let coaches or parents down. They refuse to let teams down. Even if it sometimes costs them their health.
As concussion and general injury awareness increase, some sports leagues and researchers are finding ways to improve safety in sports. Yet a lingering problem remains, one that studies and protocols can’t always fix: The culture behind sports often pressures athletes to ignore injuries and continue playing, to “tough out” what can be a life-threatening blow.
“Unless your leg is falling off, literally, you’re expected to get back up,” said Samantha Sanderson, a former Division 1 college soccer player and co-founder of Concussion Connection, a support group for athletes in the midst of concussion recovery. “It’s really difficult as an athlete to say no.”
Researchers have studied various aspects of the culture behind youth and teen sports, including how pressure — from parents, coaches, teammates and the athletes themselves — and coaching techniques impact athletic performance and willingness to report injuries or symptoms.
A team of researchers from the University of North Carolina last year looked at high school athletes’ willingness to report concussions. They found the majority of athletes did not report symptoms or full-fledged concussions for various reasons, including fear of missing playing time and lack of education about how to identify symptoms.
Additionally, parental pressure plays a large role in athlete performance, according to a 2010 study from the Journal of Sport Psychology. This pressure can lead to sports performance anxiety, which can leave the athletes more susceptible to injury, noted the research team from the University of Lincoln and Loughborough and Aberystwyth universities.
“Parent behavior construed as negative, coercive, or as communicating excessive evaluative concerns, contributes to a more threatening sport performance environment,” researchers wrote. “Such behaviors are frequently part of a ‘win at all costs’ mentality that increases stress and reduces enjoyment.”
Though parents want to protect their kids, they are not always willing to go as far as pushing to modify rules that could alter the competitiveness of the sport.
“There has to be a healthy balance [between trying to mitigate injuries and changing the game],” said Alex James, whose son Khari James, 13, has been wrestling for a year and playing tackle football for five years in Baltimore. “You’re not trying to incubate them, but you’re also trying to protect them.”
Athletes are often expected to ignore injury symptoms and continue playing to support their teams, Sanderson said. The pressure that once came from parents and coaches eventually comes from the athletes themselves, spearheading a vicious cycle and more firmly rooting a culture of doing whatever it takes to win.
When Sanderson played soccer at the University of Miami in 2008, high schools and colleges had not yet implemented baseline concussion testing. There was little talk of concussions, she said.
So when a teammate’s elbow hit Sanderson in her left temple and she fell to the ground, she ignored “feeling funny” and finished the practice, she said. Within a week, she sustained another concussion in practice. But her memory during that week is fuzzy; she thought she had been hit twice in the same practice. A teammate told her the hits were a week apart.
She stumbled around after her first and second hits to the head, teammates told her, yet no one told her to sit out.
Most physicians now mandate athletes sit out of practices for at least a month after they get a concussion because they are more susceptible to a second one and severe brain injuries.
Sanderson complained of headaches for two weeks before she was advised to see a doctor. A subsequent visit with a neurologist showed she had sustained two relatively severe concussions.
“Most of us who have been an athlete identify with the fact that you want to be successful, you want to be there for your team, but you’re afraid you’re going to let your teammates down,” said Johna Mihalik, an author of the 2013 study and assistant professor at the University of North Carolina and faculty member in the school’s Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center. “You may still choose to not disclose it, even though there might be consequences to that.”
Though Sanderson could finish practice after both her concussions, she said she soon experienced nystagmus, a condition caused by abnormal functions in the part of the brain that controls eye movements. Reading was nearly impossible. She had vertigo. Headaches. Noise sensitivity.
When she tried to walk through her home, she hit her head on a shelf and knocked herself out. Her GPA went from a 3.5 to a 2.8.
She had to quit soccer altogether after her junior year, giving up her dream of ever playing professionally.
“If someone asks you if you’re OK as an athlete, you’re trying to think of how to say yes even if you’re not,” she said. “That speaks to athletes not having the capacity to say, ‘Hey, I’m not OK right now, I have a head injury.’ ”
While concussion symptoms in middle school or high school sports may seem mild, athletes may later experience a loss in neurocognitive function and symptoms that continue far after the day of injury, according to several studies. Yet researchers estimate up to 50 percent or more of concussions in high school sports go unreported, a statistic that was examined in greater detail in Mihalik’s team’s study. Many of the athletes surveyed could not identify common concussion symptoms, such as nausea and amnesia.
Public health officials have begun crafting guidelines to improve safety in youth sports and change the culture so athletes are more inclined to report injury symptoms. The hope is this will lead to earlier diagnosis of injuries before they become catastrophic.
The Institute of Medicine-National Research Council issued a report in March entitled, “Sports-Related Concussions in Youth: Improving the Science, Changing the Culture,” which offers several suggestions to improve safety and injury prevention and diagnosis efforts.
These include establishing a national surveillance system for elementary school-aged through college-aged athletes to determine the number of sports-related concussions; creating national metrics and guidelines for concussion diagnosis and management; and a large-scale effort to change the culture surrounding concussions among all age groups, as well as boost education.
“At the end of the day, kids don’t want to be told they can’t play their favorite sport,” said Kerri Lowrey, deputy director of the Eastern region for the Network for Public Health Law, an organization that provides legal technical assistance to those promoting public health. “It’s difficult to get them to understand even if you feel OK, if you’re having these residual symptoms, it’s not safe for you to play if you don’t wait for your brain to heal.”
Though it’s improved, education is still sorely lacking, especially among younger athletes and their parents. While high schools and colleges have athletic trainers and coaches who are required to go through concussion training, the onus falls on parents and coaches to identify symptoms in youth sports, said Steven Rowson, a researcher at Virginia Tech who studies head impacts in sports.
“Asking a concussed player if they can play is like asking a drunk driver if they can drive,” Sanderson said. “It takes someone outside of that person to get them to sit out, to get them to speak up and say something, because the athlete just doesn’t know.”
CNS reporter Tim Schwartz contributed to this report.