Concussions in High School Athletes from a Financial Perspective

Across the country, and across the world, millions of high school athletes take the field

(or the court, or the rink, etc.), anxiously anticipating the upcoming season of their

favorite sport. Often, these student-athletes dream of professional careers in these

sports. Some of the other reasons adolescents participate in sports at their high schools

include: hoping the sports might help get them into (or even pay for) college, having fun

and being with friends, trying something new, meeting new people, getting in shape,

staying in shape, or simply because some authority (e.g. parents, school policy)

requires it.

Whatever their motivation may be, merely by consenting to participate in these sports,

student-athletes are essentially accepting a certain level of danger: They are subjecting

their bodies to the potential perils inherent in all sports.

However, a distinction must be made. While all sports do entail a certain level of

physical danger, not all necessitate deliberate impact. There are some

sports––including (but not limited to) rugby, hockey, tackle football, wrestling, and

boxing––that are naturally predicated on the existence of physical violence. As Daniel

Finney’s op-ed puts it, unlike in other sports, where “injuries are a result of accidents or

malfeasance,” in contact sports (or in his case football) “violence is in every play, and so

are the injuries.”

The end result of the violence-oriented nature of these sports is, unsurprisingly, injury.

And the one injury that has been drawing the most attention in recent years (not without

reason) is concussions. Obviously, injuries in contact sports are not limited to

concussions, but the recent finding that CTE was found in over 99% of brains of former

NFL players (110 of the 111 brains studied) has intensified focus on head injury. Even

more importantly, it’s not just the professional athletes––the select few who get weeded

out as the best of their trade––who suffer from head injury. While the media often

focuses on the risk of head trauma to professional and collegiate athletes, the startling

rise in concussions among youth athletes goes underappreciated. People are far more

interested in the results from the recent study on CTE in the NFL than in the egregious

statistic about 15% of the US high school population––2.5 million students––reported

having concussion symptoms over a 1-year period, according to the CDC. Perhaps

even more nauseating, many are unaware that 11% of previously concussed high

school athletes will sustain another concussion before they graduate. Point is:

Concussions plague high school athletes too.

Considering the overwhelming potential for injury, it follows that promoting player safety

is necessary for the prolonging of these sports. A report from Harvard on the Football

Players Health study recommends that “responsibility for player health should fall upon

a diverse but interconnected web of stakeholders…[that should] work together to protect

and support [our athletes] who give so much of themselves to...America’s favorite

sports.” It is therefore crucial that we look at concussions in high school athletes and

identify who some of those stakeholders are and what the financial burden of

eliminating concussions means to them, specifically.

1. Players and their families

Needless to say, it is the student-athletes themselves––and, by extension, their

families––who have the biggest stake in player health and safety. Whether they’re

aspiring to have a career in sports or not, it’s in the athletes’ best interest to protect

themselves and their brains at all costs.

The easiest solution would be to not play at all. This isn’t a silly proposal: According to

the National Federation of State High School Associations, high school football

participation has been in steady decline over the past decade, experiencing a 2% drop

just this past year (down 6.6% over ten years). Some teams are even cancelling or

abbreviating their seasons to accommodate for shortages.

The New York Times cites a Yale study that “calculated that if contact sports could be

made noncontact”––virtually synonymous, even less extreme, than the kids stopping

play altogether––“there would be...601,900 fewer [injuries] among male high school

athletes. The savings...could be as much as…$19.2 billion per year for high schools.

And that takes into account only the immediate consequences of an injury, a paper by

the researchers says, not the long-term effects of concussions or repeated jarring of the

brain in collisions.”

But for those who do play––and who are therefore of more interest to us for the purpose

of this article––life becomes a bit more difficult. The teams whose seasons are not

canceled may experience a self-perpetuating feedback loop, whereby shorter rosters

means increased playing time and on-the-field responsibilities, which then leads to even

more injuries and even shorter rosters. The players and their families themselves get

stuck paying more medical bills, but not investing in research. Why would they? One

player and his family has little incentive to look after and protect everyone else from

head injury. It’s much easier (and cheaper) to take care of yourself and move on. This

means more money going toward treatment and less toward finding better paths toward

prevention; and since so much of the treatment of head injury involves rest and

relaxation, this money does little to further the cause of protecting student-athletes

going forward.

2. Schools

Most high schools across the country are equipped with sports trainers and other

medical practitioning staffers. Unfortunately, like any other job in healthcare, the

incentive structures for these trainers are completely warped. High school medical

trainers are paid flat-rate salaries by the schools or districts that employ them, and are

evaluated based on the number of injuries they effectively treat. Unfortunately, this

means little attention (and funding) is paid toward improvements in safety gear,

concussion protocol, and coaching style. Furthermore, it is difficult for individual schools

to change the rules for the types of contact that are and aren’t allowed in the sports they

let their students play. Schools just want their teams to be successful and, more

importantly, their student-athletes to stay (and excel) in school.

3. Government

Government has already played a huge role in addressing head injuries for high school

athletes. On the federal, state, and local level, laws have been passed with the intention

of protecting high school athletes. Unfortunately, since government cannot directly

manipulate the rules of a game or improve the wearable and non-wearable technology

designed for detection and prevention, they resort to treatment. All fifty states have

passed laws about when it is fair to allow athletes to return to the playing fields after

having sustained a concussion. But the short-term nature of political terms and the

outward-facing effort for appeasement of electorates means that the only impacts

politicians are willing to make in sports are the immediately visible ones. Funding long-

term is more of a job for the private sector. Furthermore, even those concussion

return timelines that have been stipulated in legislation are insufficient in mitigating the

short-term threats of re-injury. While these return-to-play protocols are a step in the right

direction, they often appear to doctors to be just a façade; many are completely

inadequate in comparison to what doctors recommend.

Moreover, a GW Public Health Online blog post argues that these laws cannot be the

only response to the problem. The post identifies Mary J. Barron, Ph.D., an assistant

professor and certified athletic trainer who laments that none of the recent state laws

“ban certain movements or strategies that contribute to concussions, and none require

data collection of traumatic brain injury.” Barron compares three specific pieces of

legislation––one from Washington, one from Texas, and one from Missouri––and finds

that each could use improvement; one option is to implement the Texas law’s strategy

of mandating the “removal from play if a parent, guardian or health care professional so

much as suspects a concussion, even in the absence of obvious symptoms...Barron

recommends that communities and legislative policy err on the side of caution: ‘When in

doubt, sit them out.’”

4. Specialized organizations and researchers

There are a number of both profit-oriented and non-profit organizations dedicated to the

causes of concussion detection and treatment. Campaigns like the Concussion

Foundation’s “Team-Up Speak-Up Pledge” and imPACT testing are meant to make the

jobs of sports trainers easier in diagnosing concussions in the athletes under their watch

thanks to increased consistency, transparency, and reliability. Even more importantly,

these organizations invest the resources at their disposal to the long-term that

government evades. However, since the results and data on concussion prevention are

relatively less visible, attributable, and exciting––much like the government––these

organizations and researchers spend less time and money focusing on concussion

prevention in the first place. The combination of accelerated treatment/return rates and

unchanged prevention rates ultimately results in higher re-injury rates, which only

exacerbates the long-term effects of head injury on young athletes.

5. Governing bodies of professional sports and their players’ associations

It’s quite obvious that the professional leagues and teams of these contact sports are

some of the most important stakeholders in promoting player health for the long-term

preservation of their sport. Even despite that, these entities invest relatively little of their

time and resources in logical next-steps like improvements in safety gear (e.g. helmets

and mouthpieces), concussion protocol, education in neck training, coaching styles, and

potentially even rule changes. The conflict of interest is evident: While teams want their

players to be healthy, it makes more sense for individual franchises to allocate their time

and resources trying to gain a competitive advantage over their opponents. In the

meantime, they––like the league governing bodies themselves, who sometimes even

deny the association of their sport with concussions altogether––kick the can down the

road, hoping that the other stakeholders in promoting athletes’ safety take it upon

themselves to figure it out.

By taking the concussion issue seriously and addressing it from the top down, the

professional tiers can actually help themselves the most by being the vanguard in

ensuring the long-term health (pun intended) and popularity of their sports. The more

they invest now in research of concussions and development of products for prevention

and treatment (tangible and not), the more likely their sport is to prevail in the long run.

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Of course, these sports are popular, cultural cornerstones that participants enjoy playing

and spectators enjoy watching. Moreover, beyond the simple thrill of the game, there

are multitudes of other, more nuanced benefits that student-athletes derive from playing

high school sports: engaging in healthy competition, working with teammates, and

learning to be coachable stand out among the plenty.

Right now, the current trajectory of attitudes toward these sports poses a threat. Fewer

and fewer parents are letting their children play sports like tackle football and hockey

from a young age. As a result, less money is being pooled into these sports and, in turn,

less money is being invested in figuring out how to prolong them. By doing the dirty

work now, these stakeholders can help these sports remain popular well into the future.

Tyler Friedsam

USBC Journal Writer

Class of 2022