Chat with ESPN The Mag's Peter Keating
Keating covers investigative and statistical subjects for ESPN The Magazine. He started writing "The Biz," a column looking at sports business from the fan's point of view, in 1999. He also coordinates the Magazine's annual "Ultimate Standings" project, which ranks all pro franchises according to how much they give back to fans. His work on concussions in football has earned awards from the Deadline Club, the New York Press Club and the Center for the Study of Sport in Society.
Send in your questions now and then join Keating at 4 p.m. ET on Monday!
Peter Keating (4:00 PM)
Hi everybody, we're set to get started in about a minute.
It's estimated that more than a half million kids in the U.S. go to the hospital each year with a concussion. Do you think in the next couple of years the number will increase or decrease?
Peter Keating (4:05 PM)
I think that the number will go up in the next couple of years, unfortunately. The number of young athletes participating in sports is still growing, while education about concussions is just starting to spread -- and the number of trainers, doctors, coaches and parents -- and athletes -- with information about concussions isn't keeping up.
Were you as surprised as I was to learn that girls suffer from concussions more then boys?
Peter Keating (4:06 PM)
I was. I became interested in the whole subject of concussions in sports when I started looking a couple of years ago at how the NFL handles them. Like most people, I thought about concussions in terms of football and boxing.
Do you think the fact that men have more developed necks than women do is a major reason as to why women are at s higher risk for concussions?
Peter Keating (4:10 PM)
Scientific research hasn't established why women suffer concussions at higher rates in sports that both men and women play. But physical differences obviously could play a part. Men and women have different neck muscle strength, on average. And women also -- again, on average -- work less on strengthening their necks. When you can see a hit coming, the neck can act as a shock absorber and really cut down on the trauma your brain suffers from a blow to the head.
Peter Keating (4:12 PM)
Also about physical differences: men and women have different hormones helping to protect their brains.
Is it true that mouth guards prevent concussions?
Peter Keating (4:14 PM)
There's not much published scientific research on this, but there's plenty of anecdotal evidence that says good mouthguards, such as custom-fit mouthpieces, can help reduce the impact of blows to the head. And that definitely helps prevent broken jaws and smashed teeth, and maybe concussions, too.
Why is it that girls suffer more concussions? It's the same way with knee injuries too. They get the short end of the stick with these injuries.
Peter Keating (4:15 PM)
We've mentioned some of the physical possibilities. But there are other potential reasons, too. Women, on average, get less information from all sources, including coaches, doctors and the media, about concussions than male athletes.
Peter Keating (4:17 PM)
Something else that I found interesting, and disappointing, is that doctors take longer to follow up with female athletes than with men, possibly because they dont't take women's symptoms as seriously. Young women get headaches for many reasons, and sometimes even people in the medical profession overlook what can be serious symptoms.
Peter Keating (4:20 PM)
I personally also think there's a coaching and equipment gap between men's and women's sports. Of course, many women's sports teams have great coaches and fine equipment, but most schools just don't spend the resources keeping women's programs state of the art as men's, including when it comes to keeping athletes healthy. One young woman told me: As dangerous as concussions are in football, at least those players have protective equipment and padded goalposts -- whlle cheerleaders are often crammed into small spaces doing dangerous stunts without any gear at all.
ru (Brookfield CT)
is it true that you die if you go to sleep with a concussion?
Peter Keating (4:22 PM)
No! If you get a concussion, you may get very sleepy, and you may sleep for unusually long periods of time. But complete rest, physical and mental, is actually the only way to recover from a concussion.
What's the biggest thing that we don't know about concussions that doctors think we should?
Peter Keating (4:23 PM)
I'll give you what is absolutely the biggest misperception: You don't have to be knocked out to get a concussion. Lots of people assume that, but it isn't true.
Peter Keating (4:24 PM)
Something else doctors want people to know: a concussion is a brain injury, not an injury to the outside of the head. The New York Jets under Eric Mangini used to list concussions on their injury list as "head" or "neck" injuries, and that is just wrong.
Peter Keating (4:25 PM)
And then maybe the most important thing doctors want people to know is that it's extremely dangerous to go back to play before you recover from a concussion. If you still have symptoms, including headaches, you're very vulnerable to more injuries.
Do you think, in regards to soccer, that coaches should wait until a specific age before they introduce heading the ball to players?
Peter Keating (4:28 PM)
I washed out of my soccer league in sixth grade, so this is a little above my pay grade. But I think good coaches wait until they know players can understand how to head the ball properly. There's a whole progression soccer players go through to learn this, starting with being in a crab position and building to heading the ball while standing up. Even young players can do this, but they have to be capable of absorbing the technique -- and of knowing they need to report injuries fully and honestly.
Peter Keating (4:29 PM)
I should also add, it seems like many soccer concussions come from midair collisions and getting kicked while on the ground, not just from heading the ball, as many people (including me) might have assumed. So that's something to be careful about.
Is it just cost that has prevented college and high school football programs from getting the "concussion resistant" helmets like Schmitt?
Peter Keating (4:32 PM)
Cost is definitely a factor in any decision to buy equipment, but it's important to realize not all helmets marketed as concussion-resistant really are. Football helmets do a good job of preventing skull fractures, not so good a job stopping concussions. Of course it's important to always where a helmet in hockey as well as football, even in practice.
Do you think the Athetic Associations that govern these sports have an obligation to educate the coaches and trainers regarding concussion?
Peter Keating (4:36 PM)
Absolutely. Athletic associations need to be on the cutting edge of education and prevention. It will take a while for research to catch up with knowing exactly what's going on with young athletes and concussion. But in the meantime, the organizations that say it's okay for a school district to have a sport must make sure that district's coaches and trainers know the latest information about how to stop, diagnose and treat concussions.
When a player has a concussion, do you believe he/she should make the decision on his/her own on whether or not to play the game, or do you think it is the team doctor or coaches who should decide to tell the player that they are not allowed to play because, it is dangerous?
Peter Keating (4:37 PM)
It can't be the player by him or herself, because athletes always want to play, and if you've possibly suffered a brain injury, you're in no shape to determine how badly you're hurt.
Peter Keating (4:38 PM)
It really can't be the coach, either, because you just can't put the burden of conflict between winning a game at that moment and protecting your players long-term, you can't put that conflict on one person.
Peter Keating (4:39 PM)
It has to be the team trainer, consulting with doctors, and with full information given to players and their families.
Cosmo (Anytown, USA)
Is it possible to get a concussion without actually taking a hit to the head?
Peter Keating (4:41 PM)
Yes, if you are hit violently enough somewhere else. Concussions are brain injuries, so anything that suddenly shifts the brain inside the skull, like a severe hit to your shoulder, or even whiplash, can cause a concussion.
mike ny [via mobile]
how long can syptoms from a concussion last? could it be more than a year?
Peter Keating (4:43 PM)
Most people get better from concussions pretty quickly, in a matter of a few days at most. But if you keep active, and especially if you take further blows to the head, before a concussion builds, then the symptoms can build and build and last for a long time, even years. The young women we talked to in our Outside the Lines and ESPN the Magazine pieces are examples of this.
Rob Magnolia, DE
As an athletic trainer/PA-C in ortho sports medicine there is a great deal of information about baseline testing for these injuries as well as return to play guidelines. i think you will find that many so called sports medicine physicians don't know the first thing about how to assess a mild brain injury. ATC are typically the first line to athletes and they should know how to assess them.
Peter Keating (4:45 PM)
Sadly, this is true. I live in Montclair, New Jersey, where a young man who played football for our high school suffered a head injury, was sent home, went to a pediatrician who cleared him to play, went back, suffered another blow and died almost immediately of Second Impact Syndrome. Concussions don't usually show up on MRIs or CT scans, so doctors can miss them. We need more trainers at games, and we need better-educated doctors, trainers, coaches and families -- and athletes.
Pete (New Jersey)
Since a concussion isn't an injury you can "see" do you think some people cause more damage by trying to return too early? Perhaps a coach or teammates or fans think the player is "soft" because they aren't playing, when in reality they still have lingering effects from the concussion.
Peter Keating (4:47 PM)
Absolutely. An entire culture has built up around playing through "dings" just like you'd play through other "minor" injuries. Unfortunately, when it comes to young women, they suffer more symptoms but get less treatment, yet want to return to play just as badly, so they are especially vulnerable to further damage.
To Todd's question. No matter what the team doctors aint it still up to the players to do what they feel is best for them.
Peter Keating (4:49 PM)
Well, I hope this is the case only in the negative sense. Which is to say, a player should never force him or herself to play if doctors are saying no. But an athlete also has a responsibility to his or her own future to not play when injured if someone is trying to force that. I realize that's all way easier said than done.
Carol S. Wetumpka, AL
I am a advocate for TBI. My son played high school sports and received several concussions. He is now a college student and was assaulted close to his college campus 2 years by several other guys. He received severe head injuries (TBI). Since my son's assault, I have researched TBI in order to help my son I to understand his injuries. I have recently meet with my local Senator about TBI legislation. The public awareness TBI is very low and more awareness is needed on this "silent epidemic." Here a a great website on TBI - Alabama Traumatic Brain Injury Model at UAB Hospitial. www.uab.edu/tbi
Peter Keating (4:50 PM)
Carol makes an excellent point, which is that sooner or later, with so many young athletes getting hurt, regulators are going to get involved. The good news is that may get some money flowing to schools for testing, training and equipment.
Peter Keating (4:51 PM)
In New Jersey, there's a Traumatic Brain Injury Fund that takes 50 cents from every car registration fee in the state and dedicates it to neuropsych testing for students. If you care about this, it's a good idea to find out what your local officials are (or aren') doing.
What was the most distressing part of your research?
Peter Keating (4:53 PM)
The absolute worst thing was to realize that young athletes might very well be at risk for developing the cumulative, irreversible brain damage seen in football players and boxers.
Peter Keating (4:54 PM)
Scientists recently found the kind of brain tangles that can eventually lead to dementia in the brain of an 18-year-old football player who had died. And as I said earlier, women are at particular risk because they are so prone to returning to play too early, and accumulating more damage.
What are ways to prevent concussions?
Peter Keating (4:56 PM)
Stay alert and awake, even if you're goofing off in practice. So many young athletes have told me they got hurt when they were blindsided or even just having fun.
Peter Keating (4:56 PM)
Wear the proper equipment. It may be boring to wear a helmet even if you're just skating around on the ice, then again, so is wearing a seat belt.
Peter Keating (4:58 PM)
Pay attention to technique. There are ways in football to tackle with your upper body, not your helmet, just as there are right and wrong ways to head the ball in soccer. If there's one thing your coach says that you listen to, make it that.
Danielle Wapak, Ohio
Why are males more affected than females ??
Peter Keating (5:01 PM)
Actually, in sports men and women both play, women suffer concussions at higher rates. That's the focus of the piece we just did on OTL and have out in the current issue of the Mag.
Peter Keating (5:01 PM)
In high school soccer, women's concussion rate is 68% higher than for men. In high school basketball, it's nearly triple.
Rob Magnolia, DE
Peter, the information is out there on how to examine athletes, evaluate them, grade them and return to play. the sad thing is in this country we have so many medical people who want to be associated with "sports medicine" and actually get kids hurt. To David and Todd. there are return to play tests and guidelines that help ATC's, Doctors and PA-Cs assess whether it is safe for an athlete to return. it is never ok for an athlete or a PARENT to say it is ok for an athlete to return to sports. that gets kids hurt. most of these tests are copyrighted so I can put them here.
Peter Keating (5:03 PM)
To finish up here, Rob makes a good point. There are good tests and protocols available -- schools and districts don't have to feel like they need to reinvent the wheel on this.
Peter Keating (5:03 PM)
Thanks for coming, everybody, and for all your questions. Hope we got the word out a little more about all this.