Feb 23, 2010 8:59:32 AM

Fresh data from the NCAA Injury Surveillance Program suggest that the occurrence of concussions in football games may be leveling off or even dropping after a persistent rise over nearly two decades of play.

Injury data for five fall sports have been made available online by the Datalys Center. The reports provide the first new NCAA data since the national sports-injury research center assumed responsibility last year for the Association's injury surveillance activities.

The apparent change in trend suggests the possibility of a positive effect from rules changes in 2005 addressing spearing and head-down contact in football and from more recent actions, including accompanying educational efforts.

"Beginning in 2005-06, our data show a lower injury rate for concussion," said David Klossner, NCAA director of health and safety and staff liaison to the Committee on Competitive Safeguards and Medical Aspects of Sports. "That can't necessarily be attributed completely to a rules change or enforcement, but it is a good indicator that the efforts we've taken have positively impacted student-athletes."

From 1988 to 2004, concussion injury rates increased an average of 7 percent annually in all sports, including football. In fall 2004, 3.4 of every 1,000 student-athletes who stepped on a football field in any given game suffered a concussion.

However, the injury rate dropped to 2.4 per 1,000 "athlete-exposures" during the 2005 season – the first season in which the new rule for spearing and head-down contact was enforced – and has ranged no higher than 2.8 in three seasons since then.

The NCAA Football Rules Committee took additional steps during that period to eliminate hits on defenseless players and blows to the head, including a ban on hitting an opponent with the crown of the helmet.

"In football, there has been a greater emphasis on evaluating and modifying rules pertaining to head contact," Klossner said. "Each year since 2005, there have been points of emphasis, education through rules videos and posters, and rules modifications."

The competitive-safeguards committee moved in December 2009 to address the rate of concussion injury in other sports, recommending a playing rule for all NCAA championship sports that would prohibit student-athletes who show signs of a concussion from returning to play until those symptoms resolve and clearance is provided by a physician or a designated health-care professional.

The NCAA Playing Rules Oversight Panel supported the concept last month by instructing each rules committee to thoroughly review rules for stopping play for injuries and to consider instituting rules that may further prevent head injury.

The Football Rules Committee endorsed a rule at its recent annual meeting requiring all injured student-athletes, including those who exhibit signs of a concussion, to be cleared by an appropriate medical professional (as determined by the institution) before returning to competition. The committee's chair, Oregon Athletics Director Mike Bellotti, said the proposal extends current policies regarding injured players to specifically cover possible concussions.

The competitive-safeguards committee recommendation leading to those actions was based in part on both historical and the new injury data, which address only the five fall sports of field hockey, football, men's and women's soccer, and women's volleyball. (New data from winter and spring sports will be published later this year.)

"The injury data are useful because they tell us factually that concussions occur across sports," Klossner said. "Too many people think concussion is just a football injury, but from the NCAA's perspective, it's a condition that is a concern across all the sports."

Among highlights of the fall data:

• Concussion is the second-most frequent injury in fall football and women's soccer, and the fourth-most frequent injury in field hockey, men's soccer and women's volleyball.
• Concussion accounts for 7.2 percent of game injuries across the five fall sports and 4.7 percent of injuries suffered during practice.
• Of every 1,000 student-athletes who take the field in any given competition, 2.7 suffer a concussion in football, compared to 2.1 in women's soccer and 1.1 in men's soccer.
• Concussions during competition accounted for about 11 percent of injuries in women's soccer, 9 percent of injuries in field hockey, 6 percent of injuries in football and men's soccer, and 4 percent of injuries in women's volleyball.

"The common injury mechanisms in the sports are blocking and tackling in football and direct player contact while heading the ball in men's and women's soccer, while more than half of competition injuries in field hockey are due to contact with apparatus (primarily the stick or ball)," Klossner said.

The apparent shift in the football concussion rate could be even more significant considering that the persistent rise in the rate over 17 previous years might be partly attributable to improved knowledge of and diagnosis of those injuries, and better reporting of their occurrence.

"Historically, a student-athlete may have experienced head contact and reported being dazed – had their bell rung – and it might have been a common practice for them to not report it," Klossner said. "These terms are no longer used as all symptoms refer to a concussive episode.

"Today, athletes with any signs of a concussion are now being withheld from play, and thus our injury surveillance data reflect improvements in concussion detection and management over time."

The new data, collected by certified athletic trainers at NCAA institutions, count injuries causing a student-athlete to miss at least one day of competition or practice. They indicate that football and women's soccer student-athletes who suffer a concussion are missing an average of six days of competition and practice, while men's soccer and women's volleyball student-athletes miss an average of five days and field hockey student-athletes miss four days.

"Recovery time is a variable because each student-athlete with a concussion is unique," Klossner said. "But we can use the data to talk with coaches and medical staffs of the sports to see how they're handling situations, and whether they believe rules are helping in that manner and whether they're being enforced.

 "The data also help medical staffs understand which sports may need to have certified athletic trainers and/or physicians on the sideline during practices and competition, based on how often they might expect a concussion to occur in a sport."

The data also are informative for coaches, Klossner said, by indicating that a student-athlete who suffers a concussion "should expect to miss playing time" and that coaches "should expect to be able to manage their games and practices around a student-athlete with concussion."

The new data on concussions, combined with international medical consensus statements, influenced the competitive-safeguards committee's recent playing-rule recommendation, which also would prohibit a student-athlete who shows such symptoms as loss of consciousness, amnesia or persistent confusion from returning to play on the day of the injury. The committee also recommended that only a physician should clear a student-athlete's return to practice or competition in those instances.

Pending consideration of the proposed rule, the committee revised its 16-year-old guideline on treatment of concussion in the NCAA Sports Medicine Handbook (Guideline 2i), to better advise member institutions on responses to concussion injuries and procedures for returning student-athletes to competition or practice.

The guideline emphasizes "it is essential that no athlete be allowed to return to participation when any symptoms persist, either at rest or exertion," and details circumstances in which a student-athlete should be withheld from competition pending clearance by a physician.

"We know that all concussions are significant, and that student-athletes should not return to play while they have any symptoms," said Debra Runkle, assistant director of athletics and head athletic trainer at Dubuque and chair of the competitive-safeguards committee.

"Medical staffs are acting cautiously in the interest of student-athlete well-being, not only for sports but for long-term life activities, for success in the classroom and academic purposes, and to make sure they can continue to play the sport that they love. Ultimately, medical care is best conducted at the local level and medical decisions are best made at the local level, for individualized student health care."

Klossner said the injury-surveillance data emphasize a need for medical staffs to be prepared to make return-to-play decisions.

"The medical staff is charged with evaluating the concussion and returning a student-athlete to play. The onus should not be on the coach. Understanding the incidence of concussions within a sport allows medical staffs to prioritize sideline needs and quick access to medical evaluation, for return-to-play decisions."

Overall, both the proposed rule change and the revised guideline reflect current knowledge about the short- and long-term effects of head injuries and the importance of seeking and providing appropriate medical care, and the prevalence of concussions across all sports.

"The data prepare us to better speak about the rules for student-athletes across sports," he said. "The data show that even though rules continue to be modified and sportsmanship enforced, sports with contact and collision still incur the risk of concussion."