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Concussion: How the NFL came to shape the issue that plagued it

Press Release:

ANN ARBOR — Players kneeling during the national anthem is the most recent NFL controversy, but certainly not the first nor the biggest.

Concussion has dogged the NFL since the 1990s, and its initial response — avoidance and superficial gestures to mollify critics — damaged its public image. However, in recent years, the league has repositioned itself as a leader in concussion prevention and research, a new University of Michigan study shows.

The study found that the NFL’s newly proactive stance shows how a large organization can wrest control of and shape the very issue that haunted it.

“They said, ‘We’ll change, but it’s going to be on our terms. We want to be the leaders in concussion,'” said study author Kathryn Heinze, U-M assistant professor of kinesiology. “They said, ‘If we have to change, we’ll take credit. We’ll create the funding. We’ll create the partnerships with other organizations. We’ll work to pass new laws.’ When they finally realized they had to do something they realized they had to be the leaders.”

The NFL is likely one of the few organizations that could achieve this, largely because it’s so influential, Heinze said. Still, the league would have been better off implementing these changes years earlier.

“There’s a lesson here around getting ahead of these changes sooner and avoiding the intermediate stages where organizations resist or avoid change,” Heinze said. “They may have avoided some of those lawsuits, or the Judiciary Hearings on concussion, yet we still see this path very often.”

The study’s purpose wasn’t to judge the NFL’s handling of concussion, but rather to look at how one organization reacted to demands for institutional change. Heinze stressed that findings in no way suggest that the NFL has done all it can to protect players from concussion, only that it has now adopted a leadership role in addressing the problem.

Researchers looked at the NFL’s response to concussion from the early 1990s to 2015. From the 1990s to 2008, the NFL either dismissed concussion as a non-issue or made superficial gestures that didn’t yield substantial change, a strategy called decoupling. Later the league made significant but incremental changes that didn’t yield fundamental shifts.

For instance, in 1994 the league created a concussion study committee, but most members were affiliated with the league and weren’t concussion experts. Later, it appointed an independent director, but 10 of the 14 members remained tied to the league in some way.

However, from 2009 to 2015, the league responded to intense, coercive internal and external pressure by making fundamental organizational shifts, the study says. For instance, it abolished the existing, much-criticized concussion committee and established the Head, Neck and Spine committee, which consisted only of concussion experts unaffiliated with the NFL.

More importantly, Heinze said, the league changed its ideology and also engaged in advocacy, which enabled it to shape the agenda regarding the concussion issue. It finally acknowledged the long-term effects of concussion. It served as a broker, forming partnerships with academia, government and business. It was instrumental in passing a law in 50 states to protect youth athletes who experience concussion; only four states passed this law prior to NFL involvement.

Heinze said researchers were surprised by how dramatically an organization’s position could shift in a relatively short time.

“I know it took a while, but once they decided to go in that direction, they attacked it from multiple perspectives,” she said.

Whether other large organizations model the NFL and take a leadership role on controversial issues remains to be seen. Heinze said the NFL’s initial response of denial and avoidance is much more typical.

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Compression Garments Reduce Strength Loss After Training

Media Release:

Regular training enhances your strength, but recovery is equally important. Elastic bandages and compression garments are widely used in sports to facilitate recovery and prevent injuries. Now, a research team from Tohoku University has determined that compression garments also reduce strength loss after strenuous exercise.

Their research findings were published in the European Journal of Applied Physiology.

The team – led by assistant professor János Négyesi and professor Ryoichi Nagatomi from the Graduate School of Biomedical Engineering – used a computerized dynamometer to train healthy subjects until they became fatigued. The same equipment was used to detect changes in the maximal strength and knee joint position sense straight after, 24 hours after and one week after the training.

The computerized dynamometer (Cybex, division of Lumex, Inc., Ron- konkoma, New York, USA) used for both data acquisition and training. ©János Négyesi

Their results revealed that using a below-knee compression garment during training compensates for fatigue effects on maximal strength immediately following the exercise and once 24 hours has elapsed. In other words, one can begin the next maximal intensity strength training earlier if one has used a below-knee compression garment in the previous workout.

Although compression garments reduce strength loss, their findings reaffirmed that they afford no protection against knee joint position sense errors.

“Our previous studies focused only on the effects of compression garments on joint position sense,” said Dr. Négyesi. “The present study found such garments to have the potential to reduce strength loss after a fatiguing exercise, which may help us better understand how applying a compression garment during exercise can decrease the risk of musculoskeletal injuries during sports activities.”

The researchers believe wearing a below-knee compression garment during regular workouts is beneficial because of the mechanical support and tissue compression it provides.

Looking ahead, the team aims to detect whether maximal intensity programs that last for weeks produce different outcomes than the current findings to determine the longitudinal effects of compression garments.

Publication Details:
Title: A below‐knee compression garment reduces fatigue‐induced strength loss but not knee joint position sense errors
Authors: János Négyesi, Li Yin Zhang, Rui Nian Jin, Tibor Hortobágyi, Ryoichi Nagatomi
Journal: European Journal of Applied Physiology
DOI: 10.1007/s00421-020-04507-1

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A new playbook: COVID-19, athletes’ hearts and return to play

Media Release:

BOSTON – Reports have indicated that COVID-19 may cause heart damage in hospitalized patients with severe cases of the disease, but it’s unclear whether cardiac injury also occurs in infected patients who are asymptomatic or experience only mild symptoms. This question is of particular concern for athletes because myocarditis–inflammation in the heart usually caused by a viral infection–can cause sudden cardiac death during exercise. In a special report published in JAMA Cardiology, a group led by sports cardiologists at Massachusetts General Hospital (MGH) and Emory University School of Medicine offers guidance for athletes’ return to play after they have recovered from COVID-19.

The article addresses the most common questions posed by the media, in clinics and athletic training rooms, and during discussions among cardiologists who care for athletes. With a consideration of evolving data, it represents a reassessment of a previous consensus statement by the American College of Cardiology that was published in May.

“This new set of recommendations is based on my and my fellow authors’ clinical experience treating athletes with COVID-19 over the past few months. Our primary objective was to outline an approach that reduced unnecessary testing while simultaneously ensuring we use resources responsibly to detect athletes at increased risk of adverse cardiac events attributable to the virus during their return to sports,” said senior author Aaron Baggish, MD, director of the Cardiovascular Performance Program at MGH.

Baggish and his colleagues have observed that athletes infected with COVID-19 who experienced no or mild symptoms did not exhibit signs of heart injury. For such athletes, they do not recommend detailed cardiac screening. The prevalence of cardiac injury in athletes who were infected with COVID-19 is still unknown, however, and the team believes it’s prudent to screen for heart damage in athletes with moderate to severe symptoms. The experts also note that despite recent small studies showing that cardiac magnetic resonance imaging has detected potential cardiac abnormalities in individuals who have recovered from COVID-19, they feel that current evidence doesn’t justify its use as a universal screening tool for athletes’ return to play.

“We hope the recommendations put forth in the document will assist practitioners in sports medicine, sports cardiology and general cardiology in the evaluation of athletes for return to play after COVID-19 infection,” said lead author Jonathan Kim, MD, MSc, chief of Cardiology Sports at Emory University School of Medicine. “These recommendations are intended to guide the process of determining who requires more detailed cardiac screening and ensure that all athletes post-COVID-19 infection should have a slow and gradual return to training with close monitoring of persistent symptoms, regardless of the severity of infection.”

The paper’s other authors were Benjamin D. Levine, MD, of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Dallas and The University of Texas Southwestern Medical Center; Dermot Phelan, MD, PhD, of the Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina; Michael S. Emery, MD, MS, of the Sports Cardiology Center, Department of Cardiovascular Medicine, Cleveland Clinic; Mathew W. Martinez, MD, of Morristown Medical Center, Atlantic Health System, Morristown, New Jersey; Eugene H. Chung, MD, MSc, of Michigan Medicine at the University of Michigan, Ann Arbor; and Paul D. Thompson, MD of Hartford Hospital in Connecticut.

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Menstrual dysfunction is more common among young athletes than among non-athletes

Young athletes experience more menstrual dysfunction than non-athletes do, according to a new Finnish study.

Press Release:

Menstrual dysfunction is more prevalent in young Finnish athletes than it is among non-athletes of a similar age, but athletes experience less body weight dissatisfaction than non-athletes do. These findings are from a recent study at the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. The study was conducted among members of sports clubs who exercised at least four times a week (athletes) and non-members (non-athletes).

The current study used data from the Finnish Health Promoting Sports Club (FHPSC) study, in which a cohort of athletes and non-athletes in adolescence (14-16 years) and subsequently in young adulthood (18-20 years) were investigated.

The findings of the study showed that in adolescence, 18% of both athletes and non-athletes reported menstrual dysfunction. However, 8% of the athletes reported primary amenorrhea (absence of menses by the age of 15) in contrast to the non-athletes group, where the prevalence of primary amenorrhea was 0%. In young adulthood, the prevalence of menstrual dysfunction in athletes was 39%, while 6% of the non-athletes reported menstrual dysfunction. In this study, menstrual dysfunction was defined as follows: primary amenorrhea, prolonged menstrual cycle (>35 days) or absence of menses for at least three consecutive months (secondary amenorrhea).

“We did not investigate the reasons for menstrual dysfunction, but we know from previous studies that one of the most common reasons for menstrual dysfunction is low energy availability (i.e., inadequate energy intake relative to exercise energy expenditure),” explains Suvi Ravi, the corresponding author and a PhD student at the Faculty of Sport and Health Sciences.

“The human body is wise, and in this kind of situation it allocates energy to the functions essential for survival and reduces energy allocation for the systems that are not so essential for life, such as reproductive function.”

The present study also assessed body weight dissatisfaction among the participants. The results showed that athletes were more satisfied with their weight and had less desire to lose weight than non-athletes did. Despite this, in both age groups about 20% of the athletes and about 40% of the non-athletes reported body weight dissatisfaction.

“This is concerning since we know that body weight dissatisfaction can result in disordered eating,” Ravi says.

“Attention should be paid to young people’s body weight dissatisfaction as well as menstrual dysfunction in order to prevent future health problems, such as disordered eating and impaired bone mineral density, which can result from low energy availability and menstrual dysfunction.”

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Study finds athletes fear being judged as weak when they experience pain or injury

Press release:

Trinity researchers have undertaken the first multi-centred, international, qualitative study exploring the athlete experience (in their own words) of sporting low back pain (LBP).

LBP is common in rowers and can cause extended time out from the sport and even retirement for some athletes. Rowers from diverse settings (club and university to international standard) in two continents were included in the study.

The findings have been published in the British Journal of Sports Medicine.

In an Irish context, rowing is currently one of our most successful sports and Rowing Ireland has 4000 registered racing members. About 50% of elite rowers in Ireland will have an episode of rowing related low back pain in a year. Australia is one of the biggest rowing nations in the world. Researchers at Curtin University in Perth, who partnered on this study are globally respected for their back-pain research.

With the evolution of professional sport, the mantra of ‘win at all costs’ pervades. This attitude is present even in grassroot sports.  Focus has shifted from enjoyable participation to prioritising performance outcomes, leading to athletes being regarded as an asset, commodity or an investment.

A culture of toughness and resilience is encouraged but this can create confusion when it comes to reporting  pain and injury which is common in sport. Athletes commonly internalise a myth that pain equates to weakness and personal failure. There is a rising interest in the influence of sporting culture on athlete’s welfare; athlete abuse through mistreatment following injury is part of this.

For many sports, athletes’ health is not prioritised, and this is now recognised as a form of abuse. Some athletes are not provided with a culture and environment where they can report pain and injury without negative consequences. To understand the extent of this issue and to safeguard athletes, their voice and experiences need to be heard in research.

Qualitative research allows athletes to tell their stories in their own words and is a good method of exploring their lived experience. By understanding what an athlete’s experience of pain and injury is will lead to a better management of injury and better outcomes. It is likely to contribute to prevention of injury.

The key messages from the study are:

  • Rowers in this study felt compromised by their LBP and in many cases felt that the prevailing culture and environment did not allow them to be open and honest about their LBP for fear of exclusion.
  • Many felt that they had to continue competing and training when in pain. This may have increased risk of a poor outcome from their LBP as well as the poor negative emotional/mental experience that they encountered
  • Rowers experience of LBP can lead to isolation and can have a profound effect on their life beyond sport.