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NCAA-DoD Alliance Moves Concussion Study Forward; Student-Athlete Mental Health in Focus; Pac-12 Study Assesses Football’s Targeting Rule
Executive Summary
NCAA & Department of Defense Alliance holds its fifth annual conference.
The NCAA and DoD's continued investment in studying concussions and treatment help equip physicians and athletic trainers with valuable knowledge in providing care to student-athletes and service academy cadets.
The length of time student-athletes are being held out of competition reflects the influence of concussion research.
No two concussions are alike, but symptoms may be.
In addition to concussions, mental health is a top priority for NCAA Medical Leadership
Dr. Brian Hainline, NCAA’s Chief Medical Officer, shares his thoughts on resocialization coming out of the thick of the pandemic.
Mental health illness can make one vulnerable to physical injuries.
Coaches play a huge role in supporting student-athletes’ mental health.
A Pac-12 study assesses effectiveness of college football’s “targeting rule,” which is intended to prevent head trauma.
The Pac-12 study examined 538 Pac-12 games over a four-year period from 2016-2019.
Youth football participation rates assessed in context of concussions - report indicates prep football participation in California dropped by 11.7 percent over a five-year stretch prior to the pandemic (2014-18).
An area of continued investment in college athletics is health and safety across a spectrum of topics, including concussions and mental health.
The fifth annual NCAA-Department of Defense Grand Alliance Concussion Conference, presented virtually last month, featured concussion experts and researchers sharing preliminary and recently published data.
The conference, titled "A New Era of Scientific Collaboration," was hosted by the NCAA Sport Science Institute and U.S. Department of Defense in partnership with the Atlantic Coast Conference and the University of North Carolina- Chapel Hill.
"We're proud of the research gained through the NCAA-DOD Grand Alliance, including the CARE Consortium, the Mind Matters Challenge, and now the long-term CARE-SALTOS Integrated Study," NCAA Chief Medical Officer Brian Hainline said. "Our goal is to continue to learn more about concussion and head impact exposure, which translates into valuable knowledge for the physicians and athletic trainers who are charged with providing care to student-athletes and service academy cadets."
Hainline briefly discussed concussions and the CARE Consortium on the latest NCAA Social Series. He also addressed the COVID-19 pandemic and mental health resources in a health and safety update for college sports.
North Carolina Chancellor Kevin Guskiewicz, a neuroscientist and concussion researcher, opened the conference with a reflection on the beginnings of the research and the importance of collaboration between NCAA member schools and the Department of Defense.
"This has all occurred through valuable partnerships and multicentered studies involving hundreds of athletic trainers, coaches, physicians, policymakers and student-athletes," Guskiewicz said. "We do this all for the protection of their health and well-being and to improve safety for athletes at all levels of play."
In 1996, Guskiewicz worked with Mike McCrea, professor and vice chair of research in the department of neurosurgery at the Medical College of Wisconsin, on a concussion study that was funded by the NCAA. Guskiewicz shared that he never could have imagined where the scope of research would be today. There are now thousands of study participants and data points to help inform the growing field of sport neuroscience and traumatic brain injury prevention and treatment.
Atlantic Coast Commissioner Jim Phillips echoed the importance of this initiative and the benefits for nearly 500,000 student-athletes across the country and almost 10,000 within the conference.
"It is these extraordinary student-athletes that drive us to continue working together to further ensure their health and safety remains our top priority," Phillips said.
The NCAA-DOD Grand Alliance Concussion Conference was a free-to-attend forum to share emerging information with athletic trainers, team physicians, sports medicine clinicians and athletics health care administrators from NCAA member schools. Stakeholders from military medical facilities and others who oversee and manage sport-related concussion and repetitive head impacts also participated.
In a recent interview with the NCAA’s Andy Katz, Dr. Hainline stated that much progress has been made about science of concussion which has led to rule changes at the NCAA level, such as preseason football model being modified in terms of how practices are conducted.
The emergence of data has helped drive policy changes and the ways in which concussions are being managed is also evolving and how long student-athletes are being withheld from competition. “It’s more common for student-athletes to be held out a month based on data and emerging science around concussion,” Hainline added.
“No two concussions are alike. What is common after a concussion is to have symptoms, but for some it may be persistent symptoms,” like disordered sleeping, a mood disorder or seeing double for longer periods of time. “If you really tune in to these systems, one can do targeted therapy to address them.”
Hainline added that exercise can be adjusted for student-athletes affected by concussions.
When asked about mental health strains including isolation during quarantine, remote learning and the recent news of student-athlete suicides, Hainline advised: “The pandemic isolated so many people. We are social creatures. That’s how we thrive. Taking us away from common humanity, it’s not surprising we saw a spike in depression, anxiety, and post-traumatic stress syndrome.”
“We all need to comeback and resocialize and take into account the sufferings we have had (during the pandemic).” Hainline cited the NCAA’s Mental Health Best Practices as a key resource for NCAA campuses— the best practices were authored in part by 25 leading mental health and medical organizations.
Hainline added: “Mental health symptoms or disorders makes you more vulnerable to develop a physical injury. The mind and body are always working together.”
Coaches play a “huge role” in supporting the mental health of their student-athletes, Hainline added, noting coaches should share with their teams that it’s “ok not to be ok” and that help is available.
“You can’t have good physical health if you’re ignoring mental health.”
The Targeting Rule
Moving to a more sport-specific health and safety hot topic, college football’s targeting rule has generated more debate in recent years compared to most other on-field health and safety-led policy adjustments.
As the San Jose Mercury News reported, the targeting penalty— in both college and the NFL— was designed to reduce blows to the head, thereby limiting instances of concussions and making the sport safer.
A multi-year Pac-12 study set out to determine if targeting plays “are higher risk for concussion than other plays in American football.”
The connection is clear: Concussion risk was 39 times higher during targeting plays than during all other plays.
“The Pac-12 has been looking at this stuff for years,’’ Utah athletic director Mark Harlan told the Mercury News. Harlan serves on the influential NCAA Football Oversight Committee and chairs the sub-committee on practice and playing.
“You look at the overall data, and it appears to have altered the game in a positive way.”
The targeting rule isn’t perfect— players have been wrongfully ejected. But the enforcement process has become more efficient and accurate over the years. In fact, the NCAA tweaked the process this spring, allowing teams to appeal suspensions in certain situations.
But the rule itself will remain in place, entrenched as ever following the results of the Pac-12 study.
“There has been a lot of discussion and debate about targeting and whether it’s called too frequently, so we wanted to look at the data,’’ said Dr. Doug Aukerman of Oregon State, one of the study’s authors.
“There was an increased relative risk of concussion diagnosis whether targeting was upheld or overturned.”
Conducted by 10 doctors and researchers affiliated with the conference, the study examined 538 Pac-12 games over a four-year period (2016-19).
The schools provided injury information so instances of concussion could be identified in the plays under review. The researchers filtered for plays in which targeting was called.
— 68,670 plays were reviewed, during which 213 concussions occurred (15 during plays where targeting was called and 198 on other plays)
— The incidence of concussion was 106.4/1000 plays for targeting plays and 2.9/1000 plays for non-targeting plays.
— The risk of concussion during targeting plays was 36.9 times greater than that for all other plays.
— The risk of concussion during targeting plays upheld was 49.0 times greater than that for all other plays.
“The targeting penalty, whether it meets the criteria or not, just the fact that the official threw the flag means it’s significant and the participants should be checked to make sure they’re OK,’’ Aukerman said.
The penalty itself, the frequency of concussions, the study and conclusions — it’s all significant when cast against one of the most serious threats to the long-term health of college football on the West Coast.
The Pac-12’s talent pipeline is drying up, folks, and it’s drying up faster than those in other Power Five leagues.
According to data published by the National Federation of State High School Associations, prep football participation in California dropped by 11.7 percent over a five-year stretch prior to the pandemic (2014-18).
The decline was comparable in Arizona (11 percent) and even worse in Oregon (14 percent). Meanwhile, participation in Georgia fell by 3.2 percent over the five-year span, while Florida saw a decline of just 0.6 percent. In Texas, high school football participation increased.
As the Mercury News article concluded, the Pac-12 has exposure and revenue problems that it hopes to rectify with a new media rights agreement in 2024. It has a competitive problem that should be solved (mostly or partially) by College Football Playoff expansion in 2026. But it has a participation problem that could continue unabated unless high school players and their parents across the conference footprint believe the game is being made safer.
“The more information we can get to the public,” Aukerman said, “and the more engaged health professionals can be in helping shape and evaluate the rules to create safer environment for a wonderful sport — hopefully, that will be reassuring that there are ways to play the game to mitigate risk.”
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