So far, most efforts towards protecting athletes from the effects of concussions have centered on identifying the injury and developing safe return-to-play guidelines. Now, attention is turning towards preventing the injury in the first place. The Ivy League has taken a major step in this direction, limiting the number of full-contact practices its football teams can hold in hopes of reducing players' exposure to concussive and repetitive sub-concussive hits.
After a six-month study, the league enacted new rules in August that limit squads to two full-contact practices per week during the season, which is three less than NCAA regulations. The limit did not apply during the preseason, but teams were only allowed one day during training camp when they could hold two full-pad practices.
In addition, the number of full-contact days during spring practice in the Ivy League has been reduced by one to seven, although the limit on practices with live tackling remains five. NCAA rules allow up to 12 full-contact practices, including eight with live tackling.
"Given the lack of data regarding the number or type of hits that may cause long-term consequences in certain individuals, the committee concluded that it is important to minimize the likelihood and severity of hits to the head," said Jim Yong Kim, President of Dartmouth College, who co-chaired the ad hoc Concussion Committee. "Based on current and available data, we have taken appropriate steps to help ensure the safety of our football players, but as this remains an evolving area of study, future research must be monitored, and our recommendations could then be revisited and revised."
The league now restricts activities during full-contact practice days. Its guidelines specify that players are expected to remain on their feet throughout every play or rep and that contact should be initiated from a player's front and above his waist. When a quarterback is in the pocket or throwing on the run, defenders must pull up before contacting him or only touch him with two hands.
For the most part, coaches are on board with the new rules. "Reducing the amount of contact during the week will not only reduce the chance of head trauma, but also keep players fresher on game days," said Harvard University Head Football Coach Tim Murphy. "Too much contact in practice can lead to diminishing returns."
In addition to the new restrictions, coaches are expected to spend more time teaching proper tackling and blocking techniques, including how to avoid leading with the head. And when an athlete does sustain a concussion, there are specific return-to-play guidelines. The league has also asked its schools' deans to understand that cognitive rest can be a key part of recovery and that academic accommodations may be needed.
Ivy League game officials are continuing to err on the side of caution when deciding whether to call penalties on plays involving hits to the head. The league also said players could be suspended for helmet-to-helmet or targeted helmet hits depending on the circumstances.
A final component of the plan is athlete education, which includes videos and presentations. "It is important for our student-athletes to not only recognize symptoms of concussion in themselves and their teammates, but to also understand the severity of such injuries and the need to relay that information to medical personnel," said Cornell University President David Skorton, a committee co-chair. "Our goal is to emphasize that a concussion is a serious injury that requires immediate and proper treatment, including physical and cognitive rest, to promote healing."
Although its initial report and recommendations were limited to football, the committee suggested similar reviews for other sports. It will start with men's and women's ice hockey, lacrosse, and soccer, with the possibility of new rules and practice limits.
The full Ivy League concussion report, including guidelines for full-contact practices, is available at: http://bit.ly/IvyFBReport.