By Zachry Walston, PT, DPT at PT Solutions
Miami Dolphins quarterback Tua Tagovailoa has been in the headlines after being stretchered off the field during the game with the Cincinnati Bengals on September 29. He was diagnosed with a head injury and entered concussion protocol.
Some are thinking back to Miami’s Week 3 win over the Buffalo Bills and questioning Tagovailoa’s return to the field in the second half after suffering an apparent concussion that left him stumbling and leaning on two offensive linemen for support. Some believe he should never take another hit and retire from the NFL. Fortunately, he is doing well and progressing in his rehabilitation, but that doesn’t change the fact that concussion identification and management remain a challenge.
On the Colin Cowherd Podcast, Joe Burrow, star quarterback of the Cincinnati Bengals, recently stated, “It’s part of the game, I think. Part of what we signed up for.” He continued, “You’re going to have head injuries. You’re going to tear your ACL. You’re going to break your arm. That’s the game that we play. That’s the life that we live. And we get paid handsomely for it. I think going into every game, we know what we’re getting ourselves into.”
Unfortunately, these comments will be taken to mean concussions are okay and players simply need to accept them. That is the wrong message to send any athlete, especially youth players who look up to stars like Burrow. Concussions are not ankle sprains you can “shake off” and “grit through.” Tua’s concussions are a reminder that concussions should not be taken lightly. If there is any indication a player suffered a concussion, immediate action should be taken.
This is the question a player may ask in the middle of the game while their head feels like it is actively splitting, their vision blurs, and they hear a faint ringing sound. It seems like the answer should be straightforward, but the player has teammates, coaches, and fans counting on them. Suck it up and keep playing, right? Everyone gets their bell rung a couple of times.
What would you do in this situation? What do you think most student-athletes do? Do they even question whether they should continue playing?
Concussions remain prevalent and a concern in many sports, not just football. While many safety precautions have been implemented – such as limiting headers in soccer and head-to-head contact in football – these don’t address one of the most prominent issues: identifying concussions.
Research has shown concussions are vastly underreported. Reasons include not thinking the symptoms were severe, not wanting to lose playing time, not letting teammates or coaches down, and worrying those same coaches and teammates would think the players are weak.
Athletic trainers are a crucial source of information for athletes. Unfortunately, that education doesn’t always lead to changes in behavior. One research study compared high school athletes with and without athletic trainers at their school. While the athletes with access to a trainer were more knowledgeable about concussions, they were no more likely to report their concussions to an authoritative figure.
PT Solutions recognizes that we must do more than educate athletes about concussions. We are proud to partner with Team Up Speak UpTM and join their mission to improve concussion reporting to reduce its negative impact on athletes. With the Team Up Speak UpTM approach, team leaders give a speech to fellow athletes about the importance of reporting a concussion. This speech can come from a team captain, a coach, an athletic trainer, or all three. Here is an excerpt:
“We’re a team, and teammates look out for each other. A teammate with a concussion needs your help. I expect you to speak up to a coach or athletic trainer if you think a teammate has a concussion.”
This approach only works if the whole team, especially the authority figures, are on board. Players will remain silent if they advocate for speaking up, but the coach writes off concussions as not serious and a part of the game. Conversely, if players know the coach is on board, they are more likely to speak up.
This is where athletic trainers can have an enormous impact. Athletic trainers are part of the team and sometimes the best person to make the call to remove a player. They are more removed from the game than the players and coaches and can make more objective decisions. That’s not to say it is easy for athletic trainers to intervene.
Megan Burke is an athletic trainer for PT Solutions, and she understands the challenges athletic trainers face when trying to shift the culture about concussions.
Megan started at River Ridge high school in New Port Richey, Florida, four years ago. The culture and mindset at River Ridge were like many schools across the county – concussions were part of the game. Players and coaches called it ‘getting your bell rung’ or ‘seeing stars.’
“Concussions just weren’t discussed when I started. Players were trained to keep symptoms quiet.”
When athletic trainers start at a new school, they face the challenge of establishing trust. The title and training aren’t enough, increasing the challenge of creating a culture shift around concussions. So, how should athletic trainers introduce concussion education and advocate for Team Up Speak Up™?
“Lay out the expectations as soon as possible. Don’t be afraid to go against the grain. You must advocate for what’s right and best for the athletes.”
Megan is passionate about the Team Up Speak Up™ initiatives and playing a role in treating and minimizing the impact of concussions. While she initially faced questions from the coaching staff – they didn’t have complete trust in her clinical decision-making from the start – her support from athletes and parents never wavered.
Athletic trainers need to lean on that support. As the old saying goes, people don’t care how much you know until they know how much you care. Team Up Speak Up™ is about protecting players.
Megan’s first junior varsity athletes are now her seniors and leaders of the varsity team. How much of an impact has she made through Team Up Speak Up™? In the first game this season, an athlete reported a teammate’s symptoms, making the first reported concussion of the year a player referral. She now has the full trust and confidence of all team members.
To maximize the effectiveness, all players must be on board and trust one another. In the heat of competition, a player may waver and elect to stay in the game. If a teammate suspects something is wrong, they need to speak up. If an athletic trainer or coach senses an issue or spots symptoms of a concussion, they need to pull the player without question.
Team Up Speak Up™ works. Studies show players who remove themselves from games and practices immediately after a concussion miss three fewer days of competition on average. The chances of significant time missed, and serious injury diminish as well.
Team Up Speak Up™ alone isn’t enough though. We also need protocols in place to protect athletes from themselves. Competition and financial incentives interfere with judgment. A player who suffers a concussion needs help from teammates, coaches, parents, trainers, and healthcare providers to ensure the proper procedures and treatments are taking place.
Team Up Speak Up™ was launched in 2016 and is adopted by sports governing bodies such as USA Football, USA Hockey, USA Rugby, USA Lacrosse, The Ivy League, and The National Federation of State High School Associations (NFHS). More than 1,500 teams and organizations have pledged to adopt their message, accounting for more the 6.25 million athletes in the US and Canada. While this is excellent progress, many more athletes need the support of athletic trainers.
To help spread the message, pledge to deliver the speech by filling out the form on TeamUpSpeakUp.org, give the speech to your team, and post a video of your team hearing that speech on social media with the hashtag #TeamUpSpeakUp.
You can learn more about Team Up Speak Up™ and the impact athletic trainers can have through the following videos:
