Skyline - The Big Sky Undergraduate Journal
Volume 2 | Issue 1
Article 1
2014
Identifying The Prevalence of NCAA American
Football Players Sustaining Traumatic Brain Injuries
(Concussions) During Spring Practice in the Big
Sky Conference
Kery R. White
Portland State University, [email protected]
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Recommended Citation
White, Kery R. (2014) "Identifying The Prevalence of NCAA American Football Players Sustaining Traumatic Brain Injuries
(Concussions) During Spring Practice in the Big Sky Conference," Skyline - The Big Sky Undergraduate Journal: Vol. 2 : Iss. 1 , Article 1.
Available at: http://skyline.bigskyconf.com/journal/vol2/iss1/1
This Research Article is brought to you for free and open access by Skyline - The Big Sky Undergraduate Journal. It has been accepted for inclusion in
Skyline - The Big Sky Undergraduate Journal by an authorized editor of Skyline - The Big Sky Undergraduate Journal.
Identifying The Prevalence of NCAA American Football Players
Sustaining Traumatic Brain Injuries (Concussions) During Spring Practice
in the Big Sky Conference
Keywords
concussions, concussion, sports, football, rugby, soccer, futbol, brain, head injury, closed head injury, head
trauma, brain injury, diffuse axonal injury, goose egg, bump on the head, concussion, headache,
postconcussive syndrome, CTE, chronic traumatic encephalopathy, kery white, white, kery, portland state
university, PSU, Big Sky, Heisman Trophy, hiesman, trophy, charles white, charles, roosevelt white, kristin
white, kristirose white, kelly white, eugene, or, oregon, pa, physician assistant, emergency room
Acknowledgments
A very special thank you to my mentor, Dr. Charles Webb, who practices Sports Medicine and Family
Medicine at OHSU Gabriel Park. Also to the Portland State University McNair scholarship committee, most
notably Dr. Toeutu Faaleava and Jolina Kwong Caputo.
This research article is available in Skyline - The Big Sky Undergraduate Journal: http://skyline.bigskyconf.com/journal/vol2/iss1/1
White: Concussion Prevalence in Big Sky Conference Football Players During Spring Practice
Introduction
In any given collegiate academic year, there are nearly half a million student-athletes
competing in various sports throughout the nation. The most prominent, division 1, or Football
Bowl Subdivision (FBS) is made up of 350 colleges and universities, 6,000 different athletic
teams, and fields nearly 170,000 athletes. One level lower, Division I-AA, or Football
Championship Subdivision (FCS), is composed of 300 colleges and universities and thousands of
athletes. It is within the FCS that Portland State University plays its football.
A good portion of FCS athletes participate in contact sports, which means that they are
exposed to the risk of receiving a traumatic brain injury (TBI) of varied levels of intensity. Many
of these student-athletes know a TBI as a “concussion”, or “getting your bell rung”. The truth of
the matter is that any way student-athletes like to term it, regardless, it is a TBI and with that
come many negative, short and long-term effects.
The Neurology Clinical Practice recently completed a study that surveyed 262 University
of Penn student athletes about underreporting concussions. The report found that “43% of
those with a history of concussion reported that they had knowingly hidden symptoms of a
concussion to stay in a game, and 22% of athletes overall indicated that they would be unlikely
or very unlikely to report concussion symptoms to a coach or athletic trainer in the future”
(Torres, 2013). This is alarming given the minimal amount of information we know about
concussions and how they negatively affect the brain. These players are risking their lives every
time they don’t report a concussion, or its symptoms. Truth be told, it only takes one bad blow
to the head, or simply a seemingly insignificant, but well placed blow to the head to suffer the
detrimental neurocognitive effects.
Of the most dangerous neurocognitive effects, and maybe the most relevant concussion
research at this present time is chronic traumatic encephalopathy, or CTE, which is a
progressive neurodegenerative disorder of the brain. In patients with CTE, a protein, known as
tau protein, is seen in Magnetic Resonance Imaging (MRI). Tau protein functions as a “plaque”
in the brain, which blocks neurological messages from being accepted and sent. CTE, seen in
many ex- NFL football players whose brains had been autopsied post mortem, possessed this
tau protein. These same players, who recalled “getting their bell rung” multiple times, some as
many as 200 over the span of their career, had reported similar headaches, outbursts of anger,
depression and even significant memory loss equivalent to that seen in elderly patients
suffering from Alzheimer’s disease. These neurocognitive deficiencies can be an effect of
receiving a single significant TBI or cumulative compounding concussions.
It is clear that there is a potential for a large percentage of collegiate athletes to suffer
from the long term effects of TBI’s while participating in their sport, but what is being done to
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advance our knowledge of TBI’s in collegiate athletics? There are many reports that have
surfaced, largely in the past ten years in regards to concussions, but many have been
completed on subjects within major athletic conferences and institutions, those such as the Ivy
League, South Eastern Conference (SEC), Pacific 12 (Pac-12), Big East, etc. The issue with this is
that not all athletes around the country play for conferences and/or institutions with major
monetary backing to support such research. The athletes who attend underfunded programs,
such as those in the Big Sky conference, are largely underrepresented. These athletes don’t
have access to many of the amenities that programs such as Stanford, the University of
Southern California, the University of Washington and UCLA have. These institutions have oncampus medical centers that receive tremendous monetary support and grants to fund
research projects on their student athletes. Schools in the Big Sky athletic conference with
significantly less resources rely more on grass-root efforts, such as this, to keep up with the
pace of research that is being completed for upper-echelon conferences and institutions.
One of the primary reasons there needs to be an emphasis on the lower-tiered
universities and colleges is that a majority of the countries’ athletes do not participate at the
division-1 level—there is a small sample size for the necessary research. Much of the research
having to do with college concussions is completed using “top-tier”, D-I athletes. What about
the thousands of other athletes? Do studies on concussions not matter for them? I see a missed
opportunity in the population of which to choose from in gathering data for a much talked
about issue—concussions in athletics. In terms of research, divisions I-AA, II, II may as well be
non-existent because there are few studies relative to concussions being done on these
athletes. Most research on concussions as it relates to athletics, is performed on NFL and D-1
collegiate athletes. Very good research has been conducted, but there is also a very large pool
of potential research data in the younger athlete—athletes that range from ages 5, who play in
the “tiny-mite” divisions of the Pop Warner Youth Football Leagues to the high school athlete.
According to the 2013-2014 NCAA Football rules and interpretations, currently there are
no regulations to the amount of contact players can be exposed to during a practice, although
the PAC-12 conference and the IVY league schools are transitioning to what the Pac-12 calls a
“comprehensive Student-Athlete Health and Well-Being Initiative” (Pac-12 Conference, 2013).
With the launch of this initiative, the conference will enact a new policy to reduce footballrelated contact, providing student-athletes more closely monitored contact, while also
providing coaches an opportunity to teach and/or re-teach correct tackling methods. Not only
will there be reduced contact in practices, the Pac-12 is creating a head trauma task force,
which will “study head trauma and find ways to limit damage and exposure to Pac-12 studentathletes” (Pac-12 Conference, 2013). This student-athlete health and well-being initiative will
also gather “top doctors and researchers from Pac-12 institutions, convene at a conference in
early 2014 where doctors and researchers share research and joint initiatives, and commit
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White: Concussion Prevalence in Big Sky Conference Football Players During Spring Practice
$3.5M in research grants for projects at Pac-12 institutions aimed at improving student-athlete
health and well being” (Pac-12 Conference, 2013). This proves that there is knowledge that
concussions in collegiate football are prevalent, and big money is being spent to gather more
data, but again, cutting edge research is being conducted with the top-notch, upper-echelon
athlete in mind, backed by major funding and major cooperative efforts by many parties around
those institutions.
In a given football season there are over 1,100 student athletes who are at risk for
concussions. The goal of this research is to identify if there are ways to minimize/further
prevent athletic concussions in an effort to add years to athletes’ lives, greatly decrease side
effects of multiple head traumas, and thus increase the quality of life for athletes around the
world. With the increased pressure placed on athletes to compete at higher levels, comes an
increased risk for concussions. Because schools such as those in the Big Sky conference don’t
have access to the funding that schools in the major athletic conferences do, the focus of this
research is to identify cheaper, more efficient ways to prevent concussions and promote
healthy, quicker ways to return to the playing field. This data is not only good for those
interested in the Big Sky Conference, however, the data collected can potentially help all
programs around the country with limited resources—as well as major programs in an effort to
minimize “extra” spending.
This research is aimed at finding ways to decrease the likelihood of players receiving a
traumatic brain injury before one is sustained. By providing strength and conditioning coaches
this data, they will have more reason to incorporate a neck specific strength training into their
team’s workout regimen. In addition, this research aims to identify which methods of neck
strength training work better, given the preferred neck strength training method given by
strength and conditioning coaches, in direct comparison to the concussion rate for that school
during Spring Practice. I believe that programs with a focus on neck strength training, by a
variety of methods, will lead to both a decrease in the prevalence of concussions seen by
athletes in contact sports.
Being a former football player myself, it is a reality that many of the weight rooms
around the country, at both the collegiate and high school levels, are equipped with free
weights, weight benches, squat racks and all types of other cutting-edge strength training
apparatus. However, what you will rarely find is a neck strength machine. Of the most
neglected muscles in the body amongst football players are the neck muscles because many
think (and may be correct), that neck muscles will not help them run a faster 40-yard dash, for
example. But when thinking about creating longevity for football players, “concussions follow
only ligament sprains as the most common injury reported amongst collegiate football players
from 2004-2009” (NCAA.org, 2013).
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This study tracks Big Sky and Pac-12 football players through spring practice (nearly 3
months) to determine what each conference’s prevalence of concussions are, and whether
each program has a neck-specific strength training program in place.
Methods
In obtaining this data, email correspondence was primarily used. The Big Sky conference
is the focus of the research, so it was necessary to obtain a list of all of the athletic trainers and
team physicians ‘ email addresses in the Big Sky Conference. To add a frame of reference as to
where Portland State stands amongst other division 1 (FBS) programs in the area, it was
necessary to obtain email addresses for athletic trainers and team physicians for Pac-12
conference programs as well. Once the complete list was obtained, emails were sent out to
each individually, asking for the following data:
1. The number of football players you have for spring football (between Feb—May, 2014)
2. The number of concussions that were sustained by football players during spring drills.
3. Whether your institution participates in a neck-specific strength training program.
Upon receiving responses, the next step was to gather a list of email addresses for all
strength and conditioning coaches in the Big Sky and Pac-12 Conferences. Once this list was
obtained, an email was sent to each individually, asking for the following data:
1. What types of neck strength exercises you put your football players through?
Following collection of all (or most) of the response emails from athletic trainers, team
physicians and strength and conditioning coaches, analysis of data was the next step. Analysis
of the data consisted of tracking which schools in the Big Sky reported concussions, versus
those that did not. Of those schools that reported concussions, did they participate in neckspecific strength training? Of the schools that reported no concussion, did they participate in
neck-specific strength training? Furthermore, for purposes of where the Big Sky stands in the
landscape of collegiate football, the same comparisons were made to schools in the Pac-12
conference. Specifically, which schools in the Pac-12 reported concussions, and did they
participate in neck-specific strength training? Comparatively, did the schools in the Big Sky
conference that reported concussions participate in neck-specific strength training? For
purposes of determining where the Big Sky stands in the landscape of collegiate football, did
they participate in a neck-specific strength training program? This is compared directly to those
schools in the Pac-12 who reported no concussions and whether they participated in a neckspecific strength training program.
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Results
7 of the 13 Big Sky schools responded to the request for data, and 7 of the 12 Pac-12
schools reported data. Figure 1 and figure 2 represent the data that was given, by each
conference. Program names are not used and will remain confidential.
Of the nearly 600 athletes that participated in spring football practice in the Big Sky
Conference, there were 8 (total) reported concussions (Fig. 3). In the Pac-12, just over 600
athletes participated in spring football practice, with a combined total of 10 reported
concussions (Fig. 3).
Athletes who participated in spring football in the Big Sky and Pac-12 conferences had
just over a 1% chance of sustaining a concussion—and it being reported (Fig. 4). This shows
little to no difference in the risk for sustaining a concussion in the Big Sky compared to
sustaining a concussion in the Pac-12 conference.
One of the most important pieces of this research is to discover whether neck-specific
strength training lowers the prevalence of sustaining a concussion during spring practice. There
was no correlation between the schools that reported concussions and whether they
participate in a neck-specific strength-training program, as shown in figure 5. The major
anomaly occurred in the Pac-12 conference, where schools that reported having a neck-specific
strength training program in place show to have a higher prevalence of concussions. In
contrast, in the Big Sky, schools with no neck-specific strength-training program show to have a
lower prevalence of concussions in spring practice.
An important piece to this project is the types of neck-specific strength training
programs teams used/use to achieve a “yes” data record for whether their program
participates in a neck-specific strength-training program. Of the training methods that were
received, 5 programs reported using “manual resistance” in which players will partner up to
apply force to the others neck, exercising the muscles in the neck. Other programs reported
using neck machines, as seen in figure 6. The second most recorded response for methods of
neck training include the use of “neck harness” (figure 7), in which a leather headpiece attaches
to the exercisers’ head and a chain hangs down in front and a weight of varying loads are
attached. The least reported method of neck strength training was neck plate curls (figure 8).
When doing neck plate curls the exerciser lies face down on a bench with his/her head hanging
over the edge. Using both hands, holds a weight of varying loads on the back of the head and
slowly tilts the head upward, then lowers back down.
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It is worth noting in figure 5, that all schools in the Pac-12 reported having a neckspecific strength training program in place for their athletes. In the Big Sky conference, only 2 of
the 7 schools required a neck-specific strength training program for their athletes.
Discussion
From the data that was collected, the results did not turn out as expected. The
hypothesis for this research was that programs with a focus on neck-specific strength training,
by a variety of methods, will lead to a decrease in the prevalence of concussions seen by
football players during spring practice. The data in figure 5 shows that my hypothesis is not
correct. The two schools in the Big Sky conference that reported a neck-specific strengthtraining program also reported the highest number of concussions during the duration of the
experiment.
Along those same lines, all of the Pac-12 schools reported that they have a neck-specific
strength-training program in place, but only one out of the seven schools reported having no
concussions during spring practice. There are many potential reasons for the skewed data, but
of the most important is the fact that this research project was based upon self-reporting—
trusting that the team physicians and athletic trainers accurately report data. Another reason I
believe the data is not indicative of the true story around concussions is that athletes are not
reporting when they receive a concussion, or feel they simply “got their bell rung”. Being a
former football player at Portland State University who received multiple concussions, some
reported, many not, I can empathize with football players who feel the pressure that they must
be on the field to keep their position and/or bypass the stigma that you’re weak if you report a
concussion. For almost as long as the sport of football has been around, the most macho,
manliest of men play football and with this comes competition to be the most “manly man”—or
not to be the least manly man. Because of this, regardless of the injury, football players are
reluctant to (especially voluntarily) report an injury for fear that athletic trainers and team
physicians will insist they do not participate in practice/games until further testing is
completed—which equates to time off of the playing field.
Another interesting relationship in terms of programs in the Big Sky athletic conference
and programs in the Pac-12 conference, figure 3 shows that nearly the same number of athletes
participated in this study and the Big Sky had a smaller number of concussions (8 in Big Sky, 12
in Pac-12). This is important to notice because with the large amount of resources available to
Pac-12 programs, Big Sky conference programs seem to be doing a good job of working with
the resources they are given to prevent concussions—whether through weight training,
coaching, or other means.
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Although my hypothesis was proven incorrect, I believe that more testing needs to be
done on athletes regarding concussions, in particular, studies determining the prevalence of
underreporting by collegiate athletes—because I believe that’s where the best data resides. In a
study regarding high school football players, “29.9% reported a previous history of concussion,
and 15.3% reported sustaining a concussion during the current football season; of those, 47.3%
reported their injury. Concussions were reported most frequently to a certified athletic trainer
(76.7% of reported injuries). The most common reasons for concussion not being reported
included a player not thinking the injury was serious enough to warrant medical attention
(66.4% of unreported injuries), motivation not to be withheld from competition (41.0%), and
lack of awareness of probable concussion (36.1%)” (Clinical Journal of Sport Medicine, 2004).
These numbers are alarming, and this study was strictly based upon high school football players
only. Few studies have been done this with collegiate athletes, maybe due to restrictions placed
on collegiate athletes participating in studies such as these. Regardless, I am willing to bet that
the rates of not reporting/underreporting are significantly greater for a number of reasons.
For many big time collegiate football players, if they are not on the playing field because
they reported a concussion and are now sitting on the sidelines mending, scouts cannot see
them for the NFL and other major football associations who will pay for play. Some athletes feel
as though making it to the NFL is their ticket out of (in many cases) poor upbringings and see
the NFL as a way to support family currently living in poverty. For these players, there is no way
they will let an athletic trainer or team physician derail them from the tracks toward their goal,
by telling them they need to sit out and rest due to an injury they cannot physically see—even
though removing the player from strenuous activity following a concussion is the correct
method of action to allow the brain the time it requires to attempt to repair itself.
Another point of interest of this study is that data was collected in just over 3 months,
during the span of spring football practices. I believe that players during spring practice are
more geared toward learning and implementing new schemes, where coaches place a premium
on keeping players healthy. During the regular season, however, players and coaches are not
holding anything back. It is during this (nearly) 6 month period of time that I would expect to
see an exponential increase in players reporting concussions, and also in underreporting/ not
reporting concussions. The greatest concern during this timeframe is cumulative concussions
and the effect that can have on an individual’s short and long term neurocognitive function.
Conclusion
While the data that was received, doesn’t enforce that neck-specific strength training
programs decrease the prevalence of concussions in collegiate football in this year’s spring
practices, it is important that this study raise awareness of the issue with a greater audience.
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An area of further research and potentially the next step in this research to improve the
data collection, is to attempt to connect with the athletes who remained as just a number in
this study, and look deeper into how players view concussions, and whether they have any
insight as to what needs to be done in order to create a better system to where athletes feel
okay about reporting the symptoms of suspected concussions. I believe the athletes hold the
key to that information, and being a former football player I know firsthand that a great deal of
injuries that an athlete sustains go unreported—athletes will attempt to push through until
they feel they can no longer hide it and only will they report it when it begins to affect their
play.
Another area of focus to increase the effectiveness of a study such as this would be to dive
deeper into how much contact, and the different types of contact each of the programs in the
study participate in. With a decrease in the amount of time hitting in full pads, there is an
inclination to believe that concussion rates would decrease as well—and the opposite—an
increase in hitting would lead to an increase in concussion rates. The goal here would be to
attempt to identify methods of contact that are most efficient at providing players repetitions
with tackling techniques, but also minimizes the prevalence of concussions.
In all, simply spreading the word about this issue is a step in the right direction. There are
many kids around the world who will, without question, sustain a concussion throughout their
athletic career. With more people conversing about concussions, comes more pressure to ramp
up efforts to learn more about how concussions impact the brain, and more importantly what
can be done to prevent them.
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Works Cited
1. Torres, Daniel, Kristin Galetta, and Westley Phillips. "Sports-related Concussion:
Anonymous Survey of a Collegiate Cohort." Sports-related Concussion. N.p., 19 July
2013. Web. 02 Feb. 2014.
2. "NCAA.org." About Division III. NCAA.org, 2014. Web. 02 Feb. 2014.
3. "Pac-12 Conference." Pac-12 News. N.p., 03 June 2013. Web. 08 Feb. 2014.
4. “Unreported Concussion in High School Football Players: Impli... : Clinical Journal of
Sport Medicine.” Accessed May 23, 2014.
http://journals.lww.com/cjsportsmed/Fulltext/2004/01000/Unreported_Concussion_in
_High_School_Football.3.aspx.
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Appendix
Figure 1. Number of Football players in spring practice in the Big Sky Conference, and number
of concussions per program.
# Of Athletes in Spring Football
76
70
83
77
95
70
95
# Of Concussions
1
1
0
1
1
3
1
Figure 2. Number of Football players in spring practice in the Pac-12 Conference, and number
of concussions per program.
# Of Athletes in spring football
82
105
84
83
94
85
85
# Of Concussions
2
3
0
1
2
2
2
Figure 3. Total numbers of players and occurrence of concussions based upon conference
(from the data that was received—Data is not for entire conferences)
Conference
Big Sky
Pac-12
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# Of Players in Spring
Practice
566
618
# Of Concussions
8
12
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White: Concussion Prevalence in Big Sky Conference Football Players During Spring Practice
Figure 4. Prevalence of Sustaining a Concussion (that is reported) by Conference
Calculation of Prevalence:
# # Conference
Prevalence of Sustaining a
Concussion (reported)
0.0141
0.0187
Big Sky
Pac-12
Percentage
1.41%
1.87%
Figure 5. Reported concussions from Big Sky and Pac-12 Conference, and whether it
participates in a neck-specific strength-training program.
Big Sky Conference:
# Of concussions
1
1
0
1
1
3
1
Participate in Neck-Specific
Strength training program
No
Yes
No
No
No
Yes
Yes
Pac-12 Conference:
2
3
0
1
2
2
2
Yes
Yes
Yes
Yes
Yes
Yes
Yes
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Figure 6. Neck Strength Training Machine
Figure 7. Neck Harness
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Figure 8. Neck Plate Curls
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