College football's governing body needs to catch up with the National Football League and mandate guidelines to deal with concussions, say leading researchers from the University of North Carolina and Duke.
The NFL announced stricter return-to-play guidelines on Wednesday for professional players who have suffered concussions. But unlike pro football and the state's high school football organization, the National Collegiate Athletic Association does not have a universal policy on concussions, despite ample evidence that repeated head injuries have caused permanent brain damage to football players at all levels. In some cases, the injuries have proved fatal.
Researchers such as UNC's Kevin Guskiewicz and Duke's Joel Morgenlander, both of whom have served as NFL consultants on concussions, think the NCAA should develop specific regulations governing head injuries.
"Most universities have tried to put in place a more comprehensive program," said Guskiewicz, the director of UNC's Sports Medicine Research Lab. "Some haven't reacted as quickly as others. That's when the NCAA needs to step in and evaluate it."
The NCAA did not respond to several requests for comment this week.
Studies show damage
Football thrives on violent collisions, but the NFL came under increasing scrutiny as studies showed the long-term impact of multiple head injuries. A number of studies published from 2004 to 2007 have indicated a substantial link between NFL concussions and later-life risk for depression, Alzheimer's disease and cognitive impairment.
At the local level, the deaths in 2008 of two North Carolina high school football players led to testing, tougher guidelines and calls for certified athletic trainers to be present at all games.
New NFL rules
The NFL's new policy requires a player who has a concussion to remain out of action on the same day if he shows certain symptoms, including memory gaps, dizziness and headaches. The previous standard, established in 2007, kept a player out of a game only if he lost consciousness.
Morgenlander, a Duke neurology professor who worked with the NFL for three years on a committee studying mild traumatic brain injuries, said the NCAA has an opportunity now to follow suit with its own standard.
"It's reasonable for the NCAA to say, 'We're worried about our players, too,'" he said.
Cam Sexton, who played quarterback at Catawba College this season and previously at UNC, put it more bluntly, saying there "absolutely" should be NCAA-wide regulations. Sexton suffered the second concussion of his college career this season Oct. 10 in a game against Carson-Newman. Two weeks after the hit, the quarterback couldn't shake the constant headaches and decided to call it a season. He still hopes to play professionally.
The tough-guy ethos
Tough guidelines could protect players from themselves, Sexton said. Even in college, Sexton said, players are fighting to keep jobs and often ignore injuries to get back on the field.
"If you set the guidelines, it takes away some of the pressure," Sexton said. "It helps protect the player, and in a game where everyone is getting bigger, faster, stronger."
Dr. David Berkoff, the Duke football team's physician, said the biggest challenge on all levels is altering that tough-guy ethos.
"The culture of, 'Ah, we're tough, we'll just play through it,'" Berkoff said. "That's what needs to change."
Mike Hanley, the head athletic trainer at East Carolina University, fears that the NFL regulations, which rely on players to be honest about their symptoms, will lead players to lie about their condition.
"You hope that doesn't happen, and you hope you're able to build a rapport with your players so they will tell you," Hanley said.
Evaluation after a hit
The N.C. High School Athletic Association adopted guidelines last year that prevent a athlete from returning to a game or practice after a concussion until he or she has been evaluated and released by a doctor. The physician must fill out a return-to-play form.
Wake County schools administer a computer-based test that creates a score to be used as a baseline for assessment after a player is injured. The 20-minute test consists of questions that measure memory, recognition, reaction time and ability to focus.
ECU, UNC, Duke, N.C. Central and Wake Forest all use computerized neuropsychological tests for their athletes.
Most of area schools follow the same protocol. A player is not allowed to return if he loses consciousness or has dizziness, headaches, nausea or loss of memory within 15 minutes of the hit. And before players can return to practice they need to be symptom-free at least 24 hours, 48 in more severe cases, and remain that way after a cardiovascular test.
"They can lie about symptoms," Hanley said, "but they can't lie about their reaction time."
Staff researcher Denise Jones contributed to this report.
