Law and Wellness: Concussions still a great unknown

After Dave Duerson took his life last year, an autopsy revealed the former Chicago Bears safety suffered from a neurodegenerative disease resulting fromrepeated head trauma.

Duerson’s tragic story isn’t the only instance of a professional athlete with a history of brain injury committing suicide. But drawing a direct line of liability between these cases and the inevitable head trauma suffered during his career is not always that simple.

Duerson’s suicide became the tipping point for a national concussion awareness campaign that has yielded heightened head injury protocols in every sport. What remains in question is whether the legislative fervor and liability suits will hold muster or whether they will reduce head traumas among athletes.

As a result of research conducted on athletes like Duerson, knowledge of concussions has increased dramatically. At least 3,000 former NFL players are named as plaintiffs in cases against the football league, all alleging the league failed to provide fair warning about the life-threatening damage caused by repeated head trauma. But these lawsuits have an uphill climb. Since nearly all of the plaintiffs played football through high school and college — and most of them even prior to that — there’s no evidence that the lasting effects of head trauma were sustained exclusively during their professional careers.

Given young athletes’ vulnerability to concussions, proving that prolonged head trauma was sustained later in life is much harder to show. That vulnerability has been the cause for an increasing number of regulations for leagues of even the youngest athletes. Will these new parameters save lives?

The Centers for Disease Control and Prevention says 135,000 children and young adults ages 5 to 18 are being treated for sports- or recreation-related concussions and other head injuries each year. The number of emergency room visits by youth suffering from concussions or other traumatic brain injuries sustained while playing sports increased by 62 percent from 2001 to 2009.

Chris Nowinski, a former WWE wrestler, author of the 2006 book “Head Games” and co-director of the Boston University Center for the Study of Traumatic Encephalopathy — the organization that studied Duerson’s brain — explains why the risk for concussions is elevated among young athletes.

First, a young person’s head is disproportionately large compared to the rest of his or her body. Their necks, not yet fully developed, do not distribute the impact force through the body very well. Head injuries require less force to inflict.

Second, detectable symptoms of concussions can be so subtle that under some circumstances, even medical trainers must rely on athletes to self-diagnose. Young athletes cannot be trusted to detect, let alone report their own symptoms. In football, particularly at the collegiate and professional levels, coaching staffs often detect that something is amiss when a player is running the wrong play. But in youth football, that is far more common, with or without a head injury.

Everyone responds differently to concussions, and because of myriad factors, no two concussions, nor their symptoms, are the same. Nowinski said the worst case scenario for an athlete who suffered a concussion is second impact syndrome, which results in one of two outcomes for the athlete: impaired for life and requiring 24-hour care or death.

In 2009, Washington became the first state to enact legislation mandating an extra layer of precaution in high school sporting events once a concussion is suspected. Since then, all but three states have pending legislation.

Illinois passed a similar law about a year ago. Under its guidelines, no athlete after exhibiting signs, symptoms or behaviors indicative of a concussion can return to play until first cleared by a medical practitioner. It mirrors the bylaws of the Illinois High School Association and defines a medical practitioner as someone who is a medical doctor or a certified athletic trainer.

With so much at stake and with the difficulty of diagnosing head trauma, medical officials find themselves held to murky liability standards. Dr. Jeffrey Kutcher, director of the Michigan NeuroSport Program at the University of Michigan, said the level of familiarity the attending medical official has with the athletes is one of the most important factors in making a proper diagnosis.

Students have had a very difficult time pinning injury liability on a school or coach because of the difficulty in proving that any prolonged complications resulting from a particular injury are the direct result of a single occurrence. This is especially true of concussions and is the most substantial obstacle facing the class-action lawsuit against the NFL.

Under the new NFL collective-bargaining agreement, hits in practice have been drastically reduced simply by limiting the number of full-contact practices to twice a week. By reducing practice repetitions, there’s a high likelihood that concussions will decrease.

The responsibility for detection and recovery rests with the officials designated under each institution’s guidelines. And those officials are more or less safe from venturing unknowingly into legal infractions because of fuzzy liabilities standards.

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