Changing the culture of concussions

Recent revelations about the frequency and long-term impact of concussions have shaken professional football to its core. The NFL has embarked on awareness campaigns and a series of rule changes to deal with the crisis, but questions remain about whether the game is fundamentally unsafe to play at any speed—or any age.  

Knowing that these risks are by no means limited to football, the Institute of Medicine (IOM) and the National Research Council have issued a comprehensive report titled “Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.”

Two Penn faculty members are members of the IOM committee that authored the report: Susan Margulies, the George H. Stephenson Professor in Bioengineering in the School of Engineering and Applied Science, and Kristy Arbogast, the engineering core director of the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia and an associate professor in the Department of Pediatrics at the Perelman School of Medicine.

As experts in the biomechanics of brain trauma, especially in children, Margulies and Arbogast performed a thorough review of the literature on concussions in children and young adults ages 5 to 21. Though previous research has shown that children respond to these types of injuries differently as they age, there is a lack of data on the relationship between the forces involved in a head injury and the incidence in concussions across ages.

This means that helmets, while excellent at preventing injuries like skull fractures, cannot be said to offer any protection against these brain injuries.

The report recommendations include developing objective metrics for determining whether a concussion has occurred, establishing a national surveillance system to track them, educational materials for children, parents, and coaches, and rolling out age-appropriate rules and medical management strategies for dealing with these injuries. 

The report’s most immediate recommendation, however, was aimed at those most directly involved in youth sports, asking them to “change the culture” around concussions. Young athletes may not know that their symptoms are indicative of a concussion, or may feel compelled to hide those symptoms so they can keep playing—a challenge not present for other common sports injuries.

“We should be treating concussions like torn ACLs—as a serious injury that needs careful rehabilitation,” says Margulies.

“Part of the problem is that it’s an invisible injury,” says Arbogast. “A child with a torn ACL is walking around school in a brace, but a child with a concussion looks perfectly fine, and we don’t have any sort of scan that can tell whether they have one or not.”