Researchers at Harvard University and Boston University collected data from 734 players at 10 Division I FCS schools during the 2013 season. The researchers surveyed the players for information on the frequency of contact practices, concussions and concussion-related symptoms, as well as the players’ intention to report symptoms and return to play while experiencing symptoms. They found some worrisome data when specifically examining offensive linemen.
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Offensive linemen appear to withstand more low-magnitude head impacts per week and per season than players at other positions. They develop more post-impact symptoms that are not visible to others, such as headaches, dizziness and difficulty concentrating. They are more likely to suffer impacts that they suspect cause concussions, or even “dings,” but they are less likely than other players to report them. Finally, offensive linemen return to play despite having symptoms more often than players at other positions.
Why would offensive linemen be less likely to report concussions?
It’s hard to know exactly why certain players are less likely to report head injuries. An athlete might fear looking weak to his teammates and coaches. He might worry he will let the team down. He might think that the injury isn’t serious. All athletes – not just in football, but also in many sports – are reluctant to report symptoms of a possible concussion. What is different about offensive linemen? It could be related to the very nature of what offensive linemen do on the field.
Offensive linemen and repetitive blows to the head
Wide receivers, running backs, safeties and cornerbacks might suffer more visible and potentially serious brain injuries due to the greater distance traveled at higher velocities at the time of collision. Offensive linemen only travel a foot or two before they collide with their opponents. But they do it every single play.
Offensive linemen in this study participated in more full-contact practices per week than all other position groups except tight ends and defensive linemen. Wide receivers can practice passing routes while avoiding contact. Offensive linemen can’t practice blocking without hitting somebody.
Sure, these collisions create less impact than those single blows that cause loss of consciousness. They can still cause milder brain injuries that accumulate over time. The symptoms those repetitive subconcussive blows cause – headaches, dizziness, feeling of being in a fog – can’t be easily detected by coaches and doctors.
So much of the concussion evaluation and return to play process depends on athletes letting someone know they have suffered an injury.
Players must report concussion symptoms
The authors of this study question whether offensive linemen grow accustomed to the symptoms and accept them as normal rather than reporting them. I can’t say if that theory is true, but I can say that these post-impact symptoms are not normal. If you are having a headache, blurry vision, or trouble concentrating during a game or practice, tell your coach or talk to the athletic trainer or doctor. Don’t assume you only have a “ding” or “got your bell rung.” We must eliminate those terms from sports. All head injuries are potentially serious. As the study’s authors point out in the discussion, “… It is important to recognize that the lack of concussion diagnosis does not necessarily mean that an impact was asymptomatic.”
Decreasing the frequency of impacts in football
This study might further amplify calls to limit contact in football practices. The NCAA’s Concussion Management Best Practice Guidelines call for no more than two live contact practices per week. Currently only the PAC-12 and Ivy League Conferences have live contact rules in place. Expect to hear more discussions about making one or more practices per week noncontact sessions in high school and youth football too.
While we wait to see the results of such practice changes, coaches, athletic trainers and team physicians will need to be increasingly vigilant when watching for signs and symptoms of head injuries in linemen. And all athletes, especially offensive linemen, need to recognize the seriousness of these blows to the head and seek medical attention when they have any symptoms.
Why do you think offensive linemen seem less likely to report concussions or concussion symptoms? What can we do to get players to tell their coaches or the medical staff they need to be examined? Share your thoughts below!
Note: A modified version of this post appears as my sports medicine column in the October 16, 2014 issue of The Post and Courier.