In the past year, no fewer than a dozen medical associations have endorsed concussion-treatment plans to help ensure the health and safety of college athletes.
On Monday the National Collegiate Athletic Association released its own recommendations, in collaboration with several groups. It suggested limiting contact in football practices to two times a week during the season, giving clear authority to doctors and other medical officials to oversee return-to-play decisions, and following a plan to ease concussed players back to the classroom.
But critics say the document is more telling for what it doesn’t include: a mandate to reduce contact in practice, consequences for programs that break the rules, and strengthened oversight of coaches who meddle in injury treatment.
Several athletics officials consulted on the changes give high marks to Brian Hainline, the NCAA’s chief medical officer, who helped organize a summit in January from which many of the proposals came. But despite his best efforts, they say, the resulting document is a watered-down version of what many people had wanted.
Critics say the NCAA, which faces a series of lawsuits over its treatment of players, needed to take the lead on fixing what many consider to be its chief health problem. But the proposals—which are mere suggestions, without the weight of NCAA enforcement—may just serve to placate the people who are really running the show.
Loose Guidelines
Last year The Chronicle surveyed hundreds of athletic trainers about their relationships with their coaches. The results didn’t make football coaches look so good.
Fifty-three athletic trainers at the NCAA’s highest level said they had felt pressured to return concussed players to the field before they were medically ready. When the athletic trainers didn’t do what the coaches wanted, many of the trainers were fired.
A year later, some trainers say, the problems persist.
The NCAA’s guidelines attempt to deal with that tension, in part by suggesting that all decisions affecting the medical well-being of athletes be made by properly credentialed health professionals.
But people who helped shape the guidelines say they don’t go far enough. They say Dr. Hainline, who is in his second year on the job, ran into resistance from certain groups, including conference leaders who balked at a top-down set of edicts. (For the record, one observer said, the American Football Coaches Association did not oppose the contact limits, in part because many teams already restrict contact to two practices a week during the season.)
Critics say the guidelines do not adequately regulate hits during the preseason, when many concussions occur. The proposal allows four “live contact” practices in any given week—with a maximum of 12 contact practices—during the preseason. The recommendations also limit contact in three scrimmages to 50 percent of play.
For athletics departments that already have trouble monitoring activities such as how much time players spend on their sport, such a loose guideline will be tough to enforce, one observer said.
“I don’t know how you monitor what percentage of a practice is contact,” said Charlie Thompson, head athletic trainer at Princeton University. “I stand out there every day, and I couldn’t tell you.”
Randy Cohen, associate athletics director for medical services at the University of Arizona, believes that one of the major gaps in the guidelines is a clear definition of contact.
Mr. Cohen, who consulted on the guidelines, wants a more meaningful discussion of contact and what kind of contact puts players at risk. He would also like to see an evaluation of the drills that teams run to identify those that lead to the highest incidence of trauma.
“We need to look at some of these drills,” particularly ones that encourage head-to-head collisions, he said, “and ask ourselves, Are they really worth it?”
Violent Contact
Over the past year, the NCAA has changed a number of rules to make the game safer, including penalizing players for the reckless use of their head, said Tim Kelly, head athletic trainer at the U.S. Military Academy, who has served on the NCAA’s Football Rules Committee.
But the game still encourages violent contact. The NCAA’s best hope of protecting players is to enforce changes during practice, several medical professionals said.
“Unless we make drastic changes to the rules, I don’t think we can make the game that much safer on Saturdays,” said Mr. Cohen. “But we can make it safer Monday through Friday.”
He would like to see football follow the lead of other sports, including Major League Baseball, boxing, and mixed martial arts, which have worked to limit the likelihood of head injuries. Baseball enforced changes to reduce collisions at home plate. And boxers and MMA fighters rarely absorb full-scale hits in practice, he said.
“If they can figure it out in boxing, we need to figure it out in football,” Mr. Cohen said. “The idea is, How can we prepare kids to play but do it with the least amount of trauma?”