Additional reporting and research were contributed by Michael Schiller, Isaac Burke, Moussou N'Diaye, Maureen Meyer, Austen Rioux, Colby Sears, Julie Shamgochian, Cassidy Kotyla, Marla Friedson, Julian DeSoiza and Kate Durkin.
As knowledge of the consequences of concussions in contact sports deepens, debilitating ties between concussions and contact sports are changing everything from in-game rules to concussion protocols. And athletes at all levels are playing a new game.
Yet many issues are still in cultural and legal flux. Famously, the NFL has long struggled with lawsuits from former players and now the NCAA, their schools and conferences are feeling the legal wrath and little-by-little are improving their concussion-related safety protocols. However, there are concerns that their efforts, most unwillingly forced by courts, are not enough.
“I do not see the NCAA drastically making any changes in the next 10 to 20 years unless the government steps in and forces them to or their revenue is hurt by bad press,” said Emily Must, a sport law professor in the Mark H. McCormack Sport Management Department at the University of Massachusetts Amherst.
Though change has been subtle, it has altered how sports are played from youth to professional levels.
Youth sports
From the professional and college levels to local youth leagues, preventing concussions is becoming a familiar topic. John Power now knows many of the tell-tale signs of concussions when it comes to protecting his athlete son.
“There is some training in the coach’s handbook like ‘what’s your name, when’s your birthday, count to ten,' you know, there’s just cognitive tests. Can you look to the right, look to the left? And it’s if the athlete can’t remember their name or their phone number or can’t count to ten, you know there’s simple things like that,” Power said.
What’s more, youth leagues have also made official rule changes to protect young children. Soccer, which has been cited as one of the biggest sports associated with concussions, recently saw a fundamental rule change at the youth recreational level. In 2015, the U.S Soccer Federation instituted a new rule.
“Now children age 10 [who play soccer] and under will be prohibited from headers, with other restrictions for older kids," the rule states.
Amherst resident Jessica Rudnik ultimately let her 9-year-old son Thatcher play contact Pee-Wee football for the Amherst Hurricanes.
But she had reservations.
“He’s always wanted to play,” she said. “He’s a big fan of football, and I said no for a long time.”
“I couldn't believe that second graders were playing, and he wanted to play and both my husband and I were like, ‘ehhhh.’ So we asked people about it, we have a couple friends who are doctors,” Rudnik said.
Rudnik said those friends told her that at 8 and 9 years old, the children can’t hit hard enough to do significant damage. They let Thatcher play. But they’re not sure they’ll continue to allow him to play football once he gets to the more advanced and physical levels.
College athletes and the NCAA
There were more than 460,000 NCAA student athletes in 2013, according to ESPN. Further, there are 21.5 million children between the ages of 6 and 17 who participated in sports around the country that year, ESPN said.
That's a lot of people to be responsible for, and professional athletic organizations are publicly confronting the issue of concussions by changing the rules.
Athletes, coaches and officials at these levels observe the efforts made to prevent hits and other activities that could potentially cause concussions, which results in the scope of the game being altered and preventive measures being put in place to protect athletes at all levels more than ever.
According to UMass cheerleader Brittany Ratté, the efforts of the UMass Amherst Athletic Department to communicate the dangers of concussions with the UMass Amherst cheerleading team have heightened as recently as 2016.
“I think they’re being so much more cautious about it now, especially here at UMass,” Ratté said. “This is the first year that we had one of the trainers come in and actually talk to us at the beginning of the season about concussions and tell us like signs of them and whether they can be so minor that you don’t even know you have them.”
Hockey player Meredith Gallagher is also a trained EMT.
"The EMTs don't really take into account the concussion stuff," she said. "They have basic tests – what we get trained to do is very minimal, and isn't a good gauge as to whether someone really has a concussion or not. That's something that needs to be done by a neurologist."
Matt Pease was forced to end his soccer career after seven concussions. He says a supportive coach protected him from further head injuries.
“[My coach was] very understanding and he’s very protective,” Pease said. “There are coaches out there that will force their players to keep going, going, going because they don’t really understand the effects.”
Professor Emily Must believes that too much of the focus and safety protocol are geared toward football and not enough toward other sports.
“I think too much of the focus is on college football and ignores the concussions occurring in hockey and especially in women's sport,” Must said.
The legal landscape
In May 2016, the New York Times reported six former NCAA football players opened a concussion lawsuit against their teams, conferences and the league. They claimed negligence on the handling of their head injuries. These lawsuits were separate from an earlier class action lawsuit against the NCAA that saw a judge later approve new safety protocols as terms of the settlement.
The former and current student athletes who joined class action cases or filed suits on their own said the issue came down to protection.
“[They] claimed that the NCAA was negligent and had breached its duty to protect all current and former student-athletes by failing to adopt appropriate rules regarding concussions and/or manage the risks from concussions,” according to the National Collegiate Athletic Association Student-Athlete Concussion Injury Litigation.
Negligence by definition is the “failure to exercise the care toward others which a reasonable or prudent person would do in the circumstances, or taking action which such a reasonable person would not.”
Because student athletes are not employees, are considered volunteers and assume most of the known risks that playing collegiate sports bring, the law protects the NCAA. Proving negligence is difficult, but not impossible. Especially in conjunction with class actions which involve a group of plaintiffs.
The sports represented in litigation are more commonly football and soccer which are two of the most dangerous sports concussion-wise.
Concussion laws and extensive mandated safety protocols in youth sports are just as important to avoid negligence litigation against coaches and other volunteers.
“Concussion laws are essential to increasing safety in youth sports. Coaches, athletes and parents need to be educated about the severity of a concussion. Education will create cooperation to make sure the athlete who suffered the concussion is taken out of the game and will not participate until completely symptom-free and cleared by a medical professional,” states the Marquette Sports Law Review.
Since 2012, safety protocols in youth sports have been adapted with recent rule changes at the earliest levels.
The pros
Knowing how to quickly and easily identify concussions keeps players out of the game and out of potential danger. Major league athletic organizations including the NFL and the NHL have changed how their games are played in an effort to minimize the number of violent contact in-game.
“The NFL moved kickoffs up five yards to the 35-yard line last season, an attempt to increase the number of touchbacks and de-emphasize kick returns — one of the most violent and chaotic plays in football," the league said in an online statement.
The NFL also reworked an older rule prohibiting players from striking opponents with their helmets. The old wording applied only to receivers getting hit. Now the rule applies to all players on the field.
The National Hockey League also made adjustments to their rules to protect their players. Rule 48 was adopted in 2011, which broadened the definition of what constitutes an illegal check to the head.
However, the NHL has been criticized for taking steps to reduce head injuries without putting an outright ban on hits to the head.