2017-09-07 / Sports

Football Rules Changed To Increase Safety on Field

By Kevin R. Hess

The Michigan High School Athletic Association (MHSAA) made two significant changes in its rules involving blindside blocks and onside kicks for 2017, continuing efforts to focus on player safety.

A blindside block is defined as “contact by a blocker against an opponent who, because of physical positioning and focus of concentration, is vulnerable to injury by a block coming from outside his field of vision.” Blindside blocks have not been eliminated, as they are in college and the NFL, but they are only allowed with open hands.

This rule change is intended to eliminate forceful contact, but still allow the block to occur. Blindside contact that is deemed forceful and initiated with other body parts will be penalized as excessive and unnecessary.

The new rule for onside kicks still allows a “pop-up” strategy, in which the kicker drives the ball into the ground to get it to hop, but the ball now must bounce at least twice. The intent of this rule is to eliminate situations where teams are running over each other at full speed.

Three other changes were made that do not affect player safety:

Defensive backs may face-guard receivers, meaning they can deliberately block a receiver’s vision without making contact. In the past, this was illegal unless the defender was looking back for the football.

An encroachment penalty will be called on defensive players who strike the offensive snapper’s hand, arm, or ball prior to the release of the ball to begin play.

Teams accepting a penalty during the final two minutes of either half can have the clock restarted at the snap of the ball, rather than the referee’s ready for play signal. The advantage will be to preserve or consume time, depending on which is most beneficial to the team accepting the penalty.

The changes come just weeks after a study was released in the Journal of American Medical Association (JAMA) linking chronic traumatic encephalopathy (CTE), a degenerative brain disease, to long-term participation in football. CTE can be diagnosed only postmortem and is found in individuals who have been exposed to repeated head trauma. It is marked by a buildup of abnormal tau protein in the brain that can disable neuropathways and lead to a variety of clinical symptoms, such as impaired judgment, aggression, memory loss, confusion, impulse control issues, anxiety, depression, and, sometimes, suicidal behavior.

Dr. Charlene Sweeney, neurologist with Mackinac Straits Health System, says it is important that parents, coaches, and athletes take any sign of a head injury seriously and get medical treatment immediately.

“If a player has headaches, confusion, or dizziness, they need to seek medical attention sooner rather than later,” she said.

Schools in the eastern Upper Peninsula and the MHSAA are taking the issue seriously. The association is tracking head injuries through a statewide reporting process and coaches such as St. Ignace High School’s Chris “Iffer” Marshall and Cedarville High School’s Scott Barr are trying to prevent them with improved equipment and changes in the way they conduct practices.

Most CTE diagnoses are found in military veterans and people who played contact sports, particularly American football. The study, led by Dr. Ann McKee, professor of neurology and pathology at Boston University, found that 177 of the 202 brains studied had mild to severe cases of CTE.

The brains studied were of men who had played football at various levels. Two had played only in middle school, 14 played through high school, 53 at the college level, 14 semi-professionally, eight in the Canadian Football League, and 111 played professionally in the National Football League. The report showed that prolonged exposure to football significantly increased one’s chances of having CTE.

This was the largest CTE study released to date. The findings were sobering to many. Of the 177 cases of CTE, 133 were considered severe and the other 44 were deemed mild. One hundred-ten of the 111 NFL players showed signs of the disease. Only three of 14 who had played through high school were diagnosed with the disorder and all of them were mild cases. Ninety percent of those who played through college were diagnosed with CTE, along with 64% of semi-professional players and 87% of the CFL players, the majority of them with severe cases.

Based on interviews with the families, 96% of the mild cases had significant behavioral and/or mood symptoms and 85% presented had clear cognitive symptoms, such as confusion, dizziness, and memory loss. One-third of those with CTE had signs of dementia. In comparison, 89% of those with severe cases had behavioral and/or mood symptoms, 95% had cognitive symptoms, and 85% had signs of dementia.

The median age of death of all participants in the study was 66. The youngest subject died at 23 and the oldest at 89. The median age of those with mild cases was 44, while the median age of those with severe cases was 71.

One of the reasons for the discrepancy, say researchers, is that those with mild cases, while maintaining many cognitive functions, struggled much more with depression, anxiety, aggression, and impulse control. The most common cause of death in the mild cases was suicide (27%), while neurodegenerative diseases such as dementia, Alzheimer’s and Parkinson’s were the most common cause of death in the severe cases.

Researchers say it is a common misconception that big, forceful contact is the most dangerous and most likely to cause head injuries. While the forceful blows are by definition harder than others, they are also much less frequent. Many who study brain trauma say that the accumulation of seemingly benign, non-violent blows, rather than the head-jarring concussions alone, are more likely to cause CTE.

A study compiled by researchers at Stanford University showed that a college offensive lineman sustained an average of 62 of these non-violent hits in a single game. Each one came with an average force on the player’s head equivalent to driving his car into a brick wall at 30 miles per hour.

In 2015, the Mayo Clinic funded a study that looked into the assumption that CTE was largely a football or professional athlete problem. Brains from 66 men who had participated in contact sports as youths, but did not play collegiately or professionally, were donated to the Mayo Clinic brain bank for research. Twenty-two of the 66 showed signs of CTE.

For comparison, researchers also evaluated the brains of 198 people who had no record of participating in contact sports and found none of them showed signs of CTE. The project’s researchers said while the findings were “surprising,” the analysis was too small to make large assumptions.

Dr. McKee said the same about her study, adding that it is important to do more research and not focus on a single pathology. While the data in this study is alarming, Dr. McKee and others say, the subjects studied all played football in the 1950s, ‘60s, ‘70s, ‘80s, and ‘90s, when there was not the same awareness, protocols, or equipment for those playing the game today.

Dr. McKee and her colleagues are working to understand more about CTE and who is most susceptible. Factors include lengths of exposure to head trauma, age of first exposure, and lengths of playing careers. The average exposure among the 202 men in Dr. McKee’s study was 15 years.

While contact football still exists from elementary through middle school, many youngsters now are avoiding it until high school, opting instead for flag football to minimize their exposure to head trauma, especially in the earlier years.

Michigan is taking the issue seriously, as the MHSAA requires each of its member schools to report head injuries to build data that will assist in identifying trends and progress being made toward reducing and preventing injuries. The 2017-2018 school year will be the third year in which schools are required to report them.

More than 99% of the MHSAA’s approximately 1,400 schools submitted reports. In 2016-2017, there was an 11% decrease in the number of confirmed concussions from the previous year. A total of 3,958 head injuries were reported among 283,000 student athletes from freshman to varsity level, meaning 1.4% of all athletes experienced a head injury. Sixty-six percent of the injuries happened in boys, as their participation in contact sports is higher than that of girls. Fifty-five percent occurred at the varsity level.

Just more than one-fourth of students with head injuries were cleared for activity within 6 to 10 days. Less than one-fourth of the student athletes required 11 to 15 days.

Among all sports, football and hockey had the highest proportion of head injuries, 44 per 1,000 participants in football and 36 per 1,000 participants in hockey. The next four sports in proportion of head injuries were girls’ sports: soccer, basketball, competitive cheer, and lacrosse.

Even though sports such as soccer, basketball, baseball/softball have similar or identical rules for both genders, girls reported significantly more concussions than boys playing those sports. Girls reported twice as many head injuries as boys in soccer, more than triple the number in basketball, and nearly triple the number in softball.

Michigan State University’s Institute for the Study of Youth Sports concluded, “there is merit for believing females may be more susceptible than males to having concussions because of structural differences to the neck and head, and also due to neurological differences in the brains of males and females.” John E. “Jack” Roberts, director of the MHSAA, said there is also reason to believe girls may simply be more honest in reporting their concussions.

“We need to find out why,” he said in a press release. “Are girls just more willing to report the injury? Are boys hiding it? These are some of our most important questions moving forward, and they will be critical in our efforts to educate athletes, their parents and coaches on the importance of reporting and receiving care for these injuries immediately.”

Schools submit head injury reports online through the MHSAA website. Staff members examine them and follow up with school administrators about the conditions and care of the student-athletes. To encourage players and their families to seek medical help, the MHSAA provides insurance “intended to pay accidental medical expenses, covering deductibles and co-pays left unpaid by other policies, resulting from head injuries sustained during practices or competitions and at no cost to the school or family.”

One hundred thirty-nine claims were made in 2016-2017, 20 fewer than in the previous year. Football, with 44 claims, and girls basketball, with 27, were the sports most cited.

The MHSAA has instituted a return to-play protocol that requires an athlete to sit out until at least the following day after a suspected concussion. After that, they are allowed to return to play only after a doctor, physician’s assistant, or nurse practitioner has cleared them unconditionally for activity.

The MHSAA’s Coaches Advancement Program includes courses that must be completed by all varsity head coaches hired for the first time. All varsity and sub-varsity head coaches and assistant coaches, at the start of each season, get detailed training on caring for athletes with possible head injuries.

Doctors say the popularity of the CTE issue leads to misunderstandings about the disease. Although it cannot be diagnosed prior to death, symptoms such as depression or anxiety are treatable.

The Mackinac Straits Health System’s Dr. Sweeney has practiced neurology since 2003 and has seen her share of head injuries in teenagers. The most common sports in which she has seen them have been football, hockey, and basketball.

The most dramatic head injuries she has seen, however, she says, have been a result of four-wheeler and snowmobile accidents. While head injuries are something of which to be cautious, Dr. Sweeney says, the benefits of sports far outweigh the risks.

“I would not discourage kids from participating in sports,” she said. “It’s important to highlight all of the positive things kids learn from sports, such as discipline, selfreliance, and teamwork. With the childhood obesity epidemic in our country, involvement in sports also encourages regular physical activity.”

She acknowledges the data from the CTE report is alarming, but says the more information gained, the better the care will be.

“The players in that study all played many years ago,” said Dr. Sweeney. “The information we get from studying their brains will help schools and programs to be better at preventing or at least significantly minimizing head injuries.”

She encourages parents to talk to the coaches about their programs and protocols for concussions and head injuries, to ease any fears they may have about their children participating.

“Our local high school coaches do a good job with training to protect the students as much as they possibly can,” she said. While there is always some risk of injury, she says, “There is a 100% chance that they will learn something of value (by participating in sports).”

While numbers of kids playing football fluctuate and have been trending down among schools in the Eastern Upper Peninsula, coaches believe it has more to do with enrollment numbers decreasing than fear over concussion issues.

Mr. Barr, the Cedarville High School athletic director and head football coach, said the MHSAA is on the cutting edge when it comes to researching and taking seriously the issues of head injuries in sports. Cedarville has made significant investments to improve player safety, purchasing new helmets for the football teams. The helmets cost $400 apiece and have a more pliable outer layer and have more “give,” to better absorb impact and cushion players’ heads against violent collisions.

“Health and education are the most important,” he said. “We’ve really emphasized taking the helmet out of the game and I give credit to the school board for allowing us to put more money into the safety of our kids. Honestly, we’ve seen more head injuries in basketball than any of our other sports.”

Mr. Marshall, new head coach of the St. Ignace Saints football team following the retirement of longtime coach and teacher Marty Spencer, says the health and safety of their players is the top priority.

“For one, our numbers are low and we can’t afford an injury of any type to our team,” he said. “More than that, we want to educate our players.”

Mr. Marshall said the first thing he did at the Saints’ first practice was take a helmet and read the label, emphasizing that the helmet is for protection and not to be used as a weapon when players tackle. Mr. Spencer did the same thing throughout his tenure as coach, he said.

Mr. Marshall said the coaches take the issue seriously and have changed the way they practice tackling: if they see a questionable hit in practice, they stop play and address the issue right away.

“We’ve adopted a drill of the Seattle Seahawks and our focus is on wrapping up an opponent around the chest and shoulder pads and driving them back with our legs,” he said. “We don’t want the kids using the crown of the helmet. We want them tackling with their heads and eyes up, seeing what they are hitting.”

Cedarville and St. Ignace each kicked off their 2017 seasons Thursday, August 24. The Trojans defeated Rudyard 46-28, while the Saints traveled to Indian River and fell to the Inland Lakes Bulldogs, 27-20.

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