Football Concussions: Lessons From Spine Injuries

Concussions have become as synonymous with football as buffalo wings. This week, Time magazine reports that somewhere between 43,000 and 67,000 high-school football players suffer concussions each year, and even that is likely a serious underestimation, "as more than 50 percent of concussed athletes are suspected of failing to report their symptoms." This followed on the heels of Malcolm Gladwell's New Yorkerpiece revealing the widespread brain damage and dementia among former NFL players. As one New York Magazine writer put it, "this football season will go down as the one during which the word concussion started appearing in the sports pages about as often as touchdown." Among all the bad news though, there is at least one reason to be hopeful: while concussions continue to plague football, sports leagues have proved remarkably adept at preventing another type of serious injury: the spinal damages that often lead to paralysis or death.

According to the National Football Head and Neck Injury Registry, the number of spinal-cord injuries among college players dropped by 70 percent between 1976 and 1987. Hockey, like football, is a notoriously dangerous pastime replete with head-to-head collisions. Still, research published in this month's Journal of Clinical Sports Medicineshows that spinal-cord injuries among ice-hockey players in Canada dropped from a peak of 18 in the mid-1980s down to six in 2005, the most recent year for which statistics are available. Clearly, something went right in terms of reducing spinal injuries. But what was it, and what can it teach us about reducing concussions?

First, instituting rules that specifically address a specific type of harm make a huge difference. In both hockey and football, the change started with researchers noticing high rates of spinal-cord injuries and recommending a rule within the sport to prevent such damages. The drop in spinal-cord injuries in football is mostly attributed to a 1976 rule barring high-school and college players from "spearing," hitting another player with the top of the helmet. The NFL now has a similar spearing rule, which comes with a 15-yard penalty. In Canada, the spinal-injury decrease followed a 1985 rule banning "checking" from behind (shoving other players into the boards).

Changing the regulations work—but only when enforced. "What's happened a lot in football is you get the rule, but refs just aren't making the calls," says Frederick Mueller, who directs the University of North Carolina's National Center for Catastrophic Sport Injury Research. "You can look at college games, pro games, and you see helmet-to-helmet hits. In the rule book, that's not allowed. But refs aren't calling it and coaches aren't complaining." In both hockey and football, you still see widespread, geographic variation in spinal-cord injuries. The Canadian province of Manitoba, for example, has a spinal-cord injury rate three times that of neighboring Alberta, even though hockey players are working under the same rules. Variations in enforcement could explain the difference.

So the hardest part of reducing injuries in professional sports is not instituting new rules, but rather changing the culture to appreciate and enforce those rules. "The solution is never one magic bullet," says Charles Tator, a neurologist at Toronto Western Hospital and lead author of the ice-hockey study. "It's a whole bunch of things that have to be put in place, like education, changing of rules, enforcement of rules, and making the culture not one of wanting to win at all costs—including any violence against opponents, or sending a player in who is not ready to play."

But, as the spinal-cord-injury research shows, it is possible to make a dangerous game less dangerous and, through consistent enforcement, change a sporting culture. It won't happen by this Super Bowl Sunday, or probably even next year's. But the growing awareness of concussions in football could very well be just the impetus for a more long-term cultural shift that the sport definitely needs.