• Lead Change Outside of the Operating Room

    Author: Julian E. Bailes

    Occasionally in life, as well as in one's career, there emerges an opportunity to get involved in endeavors which concern our society and the communities in which we live. I am a former football player and father, and serve as the Chairman of the Medical Advisory Committee for Pop Warner Football, the nation's largest and oldest youth football organization. I've also been involved on several NCAA sports safety committees, and as a member of the NFL Players' Mackey White Health and Safety Committee. As a neurosurgeon who has been a sideline team physician at the NFL and NCAA levels for the last 25 years, two decades ago it became apparent there was much more that we needed to learn and in which to become engaged, concerning neurological injuries in sports.

    The causes, incidence, and severity of concussion, or the potential for brain injury, are some of the hottest topics in sports media today. These issues have created a storm in youth sports-especially football. During the past decade, league officials, coaches, school administrators, medical researchers, concerned parents, and others, worked for the introduction of refinements in practice styles, rule changes, training techniques, and protective equipment. These include such alterations as limiting the type and amount of contact in practice, eliminating open field hits on defenseless players, checking in hockey and heading in soccer, and improved tackling techniques in football education of athletes, coaches, and parents, among other changes. In the near future, equipment innovations such as energy-dispersing technology, telemedicine, and improved protective equipment should enhance safety for all athletes.

    But it is important that the public not misunderstand widely publicized research and media reports concerning sports injuries, particularly at youth and high school levels. As neurosurgeons, we are integral in shaping and informing the changes we can and should make, while leading the effort to help the community better understand the true meaning of these findings.

    Increased levels of public and private investment in concussion prevention and management research should be a national priority. In addition, the media and the public have an opportunity to re-focus their attention away from apprehension and fear towards a more balanced approach, preserving the physical and character-development benefits of sports.

    Changes in the styles of practice and play, such as decreasing the use of the head in blocking and tackling in football, and reduction of overall contact exposure have also improved instances of concussion. Five years ago, Pop Warner was the first football league to legislate against head-to-head contact in practice and implemented Heads-Up Football, an education and safety program. These changes resulted in Pop Warner football players sustaining 100 or fewer head contacts every season, and a less than one percent annual concussion rate.

    Due to these changes, contact sports are safer than they've ever been. The answer is not to eliminate contact sports by prohibiting youth from full participation, but rather to work to find a solution which would allow youth and high school athletes to continue to enjoy the innumerable benefits of these sports, which include physical activity, teamwork, leadership, sacrifice, and achievement.

    We, as neurosurgeons, have the opportunity and capability to continue to evolve football, ice hockey, lacrosse, soccer, and other collision sports regarding the style of play, safety rules, and the introduction of such modern technology as "smart helmets" with sensors, medical sideline evaluation, and telehealth. Specialized concussion care providers and physicians can be available and extend the level of medical expertise to the point-of-care where and when it is needed so that the game and all its benefits can extend to youth and high school players. Exertional heat stroke is the third leading cause of fatalities in sports at the high school and college levels. Education, early recognition, proper management, and prevention are paramount to reduce this terrible modality. This is another example of how neurosurgeons can have an impact.

    For football, in particular, our mission should be to figure out how to make the game safer, but at the same time, retain all the challenges, competition, health benefits, and personal rewards in a sport which is uniquely American. Preventing concussions, recognizing symptoms, seeking medical evaluation, and following concussion guidelines are all essential for full recovery, proper return-to-play procedures, and the prevention of more serious effects. Certainly, we have made significant progress in gaining a better understanding about concussions, but given the knowledge gaps, there is more that needs to be done.

    Neurosurgeons' participation, engagement, and contributions to their local youth sports leagues, school districts, universities, and professional teams will represent a contribution to all those individuals as well as raise their profile for recognition of their practice. Neurosurgery's leadership in sports concussions is but one example of how involvement in our community can be rewarding and further efforts to provide better futures for our local youth and young adults. I encourage you to seek out ways to extend your expertise to applications beyond the relative comfort of what we know best, and truly make a difference in your community, whether by volunteering your services to a local sports team, or providing your skills in a way that is unique to you and your community.

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