Concussions and the culture of tough

Injuries are an inevitable part of sports, but increasingly there’s a sense that concussions are a quantitatively different kind of injury from a sprained ankle or even a torn ACL. In a culture that demands toughness and rewards playing with pain or walking it off, it’s difficult to change the perception that a head injury is just another obstacle to be overcome with determination.

The panel on injury analytics at the MIT Sloan Sports Analytics Conference brought together John Brenkus, the co-founder of BASE Productions and the host and co-creator of ESPN’s "Sports Science"; Stan Conte, the former director of medical services and head athletic trainer for the Los Angeles Dodgers; Peter Wehling, the orthopedic and spine surgeon from Germany who pioneered the Regenokine procedure used most famously on Kobe Bryant; and moderator Stephania Bell, a physical therapist and board-certified orthopedic clinical specialist who also serves as a fantasy analyst for ESPN.

When the discussion inevitably led to concussions, the panelists emphasized how they were not simply diagnosable by outmoded means such as counting fingers or seeing whether a player blacked out. And concussions can happen when there is no obvious head trauma involved, a concern particularly germane to a less contact-oriented sport such as basketball.

Speaking with me after the panel, Bell said, “There’s a lot of whiplash-type injuries. People can get hit in the side, never really contacting the head, but they’re going through this [side-to-side] motion. Inside, that’s what’s happening that’s creating the problem. It can create an electrical problem, neurons firing abnormally. Nerve tissue is really sensitive to shear. If you look at an actual brain, when it slides, the translational force of shearing damages the neurons, the structure of the brain.”

Although basketball has its share of impacts to the head and neck, especially from players hitting the floor or from elbows, this kind of indirect impact on the brain may be a more common and undiagnosed problem. The difficulty begins with assessing the damage because, as Bell said, the brain "can look completely normal -- no bruising, nothing else -- and yet things aren’t firing right.” She stressed the importance of knowing a player thoroughly in order to help determine if they are “off.” But it doesn’t stop there.

The culture of toughing it out compounds the difficulty of brain injury assessment.

“People start feeling a peer pressure to not report, and that makes the medical people’s job more difficult,” Bell said.

She said a lot of athletes are resistive to reporting their symptoms because, “They’re just competitive, and there are issues of perception or how it’s going to affect [their] contract. Are they going to be perceived as soft? But 15 years from now they can’t see straight.”

Bell lauded the NBA’s handling of Monty Williams’ comments on Anthony Davis’ concussion early in the season, explaining that the culture shift has to happen from the top down because medical practices at the youth level take cues from how injuries are handled at the professional level.

Brenkus echoed many of Bell’s points when it came to dealing with brain injuries, although he also sees the importance of dealing with adversity.

“With a concussion, you’re no longer the same human being,” he said. “Ankle, knee, back, anything else -- you’re the same human; you just gotta gut it out. And I’m a giant proponent of making it through adversity and playing with pain.”

Rather than changing from the top down, though, he believes efforts to properly diagnose and treat concussions has to begin at the youth level, where the attitude is often still to have a kid sit for a week and then get back out there.

He also had an interesting angle on brain injuries at the professional level.

“The job of a team owner or coach is not to perfectly preserve someone’s body,” he said, “but it is to preserve them as a human being.”

During the panel, he made the point that in sports, the UFC -- a league that more or less defines the concept of tough -- has a strict concussion policy: “You get a concussion at the UFC, you are not allowed to do anything for 90 days. And there’s no sport that’s more ‘man up’ than UFC.”

During a conference that has shown, time and again, how little black and white there is on the court or the field, it was somewhat startling to come across an area in which there was so much agreement -- that brain injuries are distinctly different from other kinds of injuries. The way they’re handled is still evolving, but changing practices have to go hand in hand with questioning sports culture.

The “man up” aspect of sports is usually painted negatively in these conversations, but a key aspect of sports is learning how to deal with adversity. It’s supposed to be one of the life skills that it imparts to children who participate. But the value of that has to be balanced with our new and growing knowledge about injuries that can’t be walked off or toughed out.

Whether the change is made from the top down or the bottom up, there’s reason to hope that successful implementation of new standards with regard to brain injuries will not only make sports safer, but they will also give us a better understanding of what sports give to and demand of us.