Of all the questions people throw Dr. Sanjay Gupta’s way — and there are many for the neurosurgeon who is also CNN’s chief medical correspondent — among the most common deal with high-school football and concussions.
Is the game safe? Can it be made safe and still be the same sport? Should I let my kid play?
Gupta addresses these issues and more in his new special Big Hits, Broken Dreams — his new CNN special airing 8pm Jan. 29 — for which he spent a full season embedded with the Junius H. Rose High School football team of Greenville, N.C. It’s a community still reeling from the 2008 death of one of its players from head injuries.
Jaquan Waller died of what’s commonly referred to as “second impact syndrome,” where a second blow to the head causes more damage because the first one had not healed properly. While deaths are still relatively rare, multiple concussions are not. The special reports that 35% of high-school players suffer multiple concussions during their playing days, a number Gupta believes could actually be much higher.
I talked with Gupta about his exploration of the topic, why he doesn’t think removing face masks would solve it, and how he believes the culture at large needs to change in order to prevent the most serious injuries:
Channel Guide Magazine: Was there reluctance on the part of the schools or the team to talk about this issue?
Sanjay Gupta: I don’t think that there was an across-the-board reluctance. This was a big, big deal in North Carolina as a whole, but certainly in Greenville, with what happened to Jaquan Waller back three years ago. There’s a lot of sorrow, people still feel very badly about what happened, but they also are anxious to talk in part because they’ve done things. They’ve implemented certain programs to try and prevent that from happening again. It took a lot of their own diligence, their own work, their own research to get it done, so I think that in some ways from a psychological standpoint, this is a little bit of a moving forward for them, which they haven’t done in three years. This hit the community really, really hard.
CGM: Did you find that your medical background helped you as far as putting people at ease, everyone from your fellow medical professionals to the people at the high school? Maybe it would have been different if you were a typical reporter.
SG: I think so. With certain topics, and I think with this topic, it certainly helps. We’re very clear on our goals in terms of what we’re trying to do, and this is one of those things that happens to be in my sweet spot, with my knowledge and training. I think certainly with all the medical staff, but you know you find that the coaches and everybody, they were very open with me. These were people who haven’t been that open in the past, they were candid about it and said, “We haven’t talked about this in three years.” Part of it was it was painful to talk about, and part of it was they just worried that, you know, it would come off not the way they hoped or intended. Probably being a doctor and being a neurosurgeon did help. The kids were great, they really get it. The players were very candid with us, even candid about the fact that they have minimized symptoms in the past to get back on the field. They don’t deny that. Sometimes they wear that as a badge of honor.
CGM: Are there still a lot of misconceptions out there about this subject? Did you learn a lot?
SG: I always learn something new. As a neurosurgeon, this is something I’ve treated, something I’ve seen for a long time. We’ve always known in the world of neuroscience that there’s a lot of misconceptions regarding concussions. I think, in part, because the symptoms can be vague there has been a minimizing of the symptoms at all levels — high school, college, professional — in football and in other sports as well. What I got to see firsthand was how exactly people who had never been trained in recognizing a brain injury suddenly needed to become quite facile with it — really understand it — and make decisions based on that understanding. In some ways it’s asking a lot of people, but it’s so important in terms of preventing things like what happened to Matthew Gfeller or Jaquan Waller in North Carolina. Everyone seems really galvanized, and what I’ve seen now from a reporter’s standpoint is that you take a place like Greenville, N.C., and you realize the answers to the two questions almost everyone asks when you talk about implementing these safety protocols. One is, will it make a difference overall in terms of keeping the players safe? And two is, can you play safe and still win, and still have football be football? After spending a season with these players, and the doctors and trainers and visiting experts in this area all over the country, I think we can more definitively answer these questions and we tell that story through these players.
CGM: One of the suggestions you hear often is removing the face masks from the helmets. Is that something you think would be realistic, or effective?
SG: I don’t think so. I think face masks do provide a pretty important barrier. This is one of those things where you have a shift in what’s happening to the brain. People seem to think the helmet is really protecting the brain against a concussion, and that’s not necessarily true. What the helmet is doing is absorbing some of the hard hit you might take, preventing things like skull fractures. But whenever you are running fast and then you suddenly stop, that’s what’s called an acceleration-deceleration injury. So the brain, think of it like a big beach ball in a swimming pool, and the swimming pool is moving, let’s say, and all of a sudden the swimming pool stops, the beach ball keeps going, right? And it hits the side of the pool, then it hits the other side of the pool, back and forth. That’s what your brain is doing. … While you want to have good fitting helmets and obviously proper gear in all regards, this really focuses on recognizing what the concussion is and preventing the most tragic consequences of it, which is something we know how to do know in the world of medicine and the world of neurology.
CGM: There’s been a lot of talk about not just the hard, concussive hits that do damage, but the more constant subconcussive hits that cumulatively can have a similar tragic outcome. Are those types of injuries also preventable?
SG: Well, you’re absolutely right, and we spend a fair amount of time talking about the subconcussive hits. In terms of preventing them, obviously as just about everybody who’s involved with football has told us and would tell you, it’s impossible to make the game completely hit-free or somehow take away these more minor, subconcussive hits. What we now know more than anything else is the impact of those subconcussive hits over a lifetime on a person’s brain. You may have seen some of the research coming out of the Sports Legacy Institute where we spend a lot of time. They look at the brains of football players who were relatively young, and may have died for unrelated reasons, but they find that the brains of these young men had the pathological findings that are similar to Alzheimer’s disease. But instead of the people being in their 70s, 80s and 90s, they’re in their 30s and 40s. So one of the things that keeps coming up, not just in football but in all sorts of sports, including soccer for example … is that a lot of hits a player takes [happen] during practices. With soccer, if you’re hitting the ball over and over and over again [with your head] as part of your practice drills, that could be 80 percent of the head hits for the season. … At a school like the one where Coach [Todd] Lipe is, here in Greenville, N.C., they’ve changed the way they practice as well. They’re trying to reduce the number of hits, even these subconcussive hits, because he just doesn’t think there’s a need to just drill his players’ heads over and over again in practice, so they focus on different things. They focus on body tackling, two-point stance, a lot of different plays that aren’t going to give the brain and the head unnecessary blows.
CGM: That’s encouraging for Greenville, but do you think the tide is turning nationally, or are we still a long way from that?
SG: I think it’s absolutely turning. … The NBA has concussion guidelines, the NHL has concussion guidelines that they’ve had for a little while, and obviously the NFL. More people are talking about this than ever before, and I think a couple things are coming to the forefront. One is that the term “concussion” itself may be a little bit of a misnomer. I think what you hear, again from a lot of experts in the field, is that “concussion” has been a term a lot of people have minimized. People always think that’s a temporary thing, a person will get over it, they’ll be back to play if not today then tomorrow or the next day. It’s a brain injury. And if you call it a brain injury, the way people approach it, the way people treat it and just are careful about it just changes completely. But the second thing is this idea that comes up in the documentary, what do we know in terms of keeping high school football players safe, and should all high schools be required to have some of those basic things if they’re going to have a football program? I think that this is a little bit of a call to action because the experts seem to agree on some things in terms of what is necessary. For example, [there needs to be] a person on the field during practices and during games who can recognize the signs of a concussion and has the power to keep a player out. Take the helmet, keep the player out of the game. You’ll hear from a lot of the experts, saying, “We know times are tough. The economy is down and school budgets are one of the things that have been affected. But this is one of those things that you’ve got to make happen. You’ve got to have a certified athletic trainer out on the field to be able to keep these players safe.” So there’s really some specific things ultimately that you find in Greenville, N.C., that are probably basic things that every school should have.
CGM: It’s intuitive to maybe think that the bigger size and faster speed of the players today is contributing to there being more of these types of injuries. Is that the case, or are we just more aware of the injuries that are happening?
SG: I think you’re right. The players are bigger, they’re faster, they’re stronger, and some of them have been coached from a really young age in ways that really don’t do them any favors in terms of preventing concussions. Leading with their heads, not learning body tackling, all that sort of stuff. So I think there is greater awareness of concussions for sure as well, but these players are — I mean, I spent all season with these guys, and I’m not a particularly huge guy, and just being around even these high-school football players, you get hit and you have a headache for a while. You know your brain’s been rattled. We know it’s not just “getting your bell rung,” as it’s often referred to. It’s a brain injury.
CGM: Yeah, I heard that phrase a lot in the scenes I saw.
SG: Did you play football?
CGM: I did, in high school. I remember one instance where someone’s helmet got me right on the chin, and you just sort of fall down and forget what happened.
SG: Oh, yeah. You start seeing stars. And you might have wondered at the time, as a lot of players do, “What just happened?”
CGM: “How’d I get on the ground?” Yeah.
SG: And now we have a better understanding to the brain during something like this, and what happens to the brain when this happens over and over again.
CGM: People say you need to just sit out for a while, but do you ever fully heal from a concussion or a brain injury?
SG: I think you can heal from a concussion. There is pretty good data to suggest that resting the brain can allow it to heal and recover. So there is the good news in all of this. It’s sort of complicated by the fact that players, especially the ones that want to get back into the game, they’re the ones you’re asking about their symptoms. “Do you still have a headache?” “Are you having any problems with your vision?” They may not tell the truth if they want to get back on the field. That’s another big component, which you’ll see in the documentary, and that high schools are starting to implement. You’ve got to have some sort of baseline. They’re doing this with soldiers before they go into war, some sort of cognitive baseline. They’re doing this with players at the professional level, in both the NFL and the NBA, and they’re starting to do it at the high-school level as well. If they player takes a hit, and you’re worried about it as a trainer or a doctor, you can conduct a test. It’s a cognitive test, takes about 20 minutes. If there’s a change, if the player or patient has diminished in terms of their abilities, you know something has happened. You can’t really cheat on that test. They may minimize their symptoms, but the test is going to force them to tell the truth. It’s going to get the truth out.
CGM: So if it comes down to who should make the final decision whether a student should play, you would be more in favor of an objective test that takes the decision out of the hands of coaches or parents and into the hands of doctors?
SG: We asked that same question to Coach Lipe, who is the coach of a five-time state championship team, and football is a big deal down there. This is a town that Sports Illustrated called “Sportstown, U.S.A.” You can imagine the energy. I asked him that same question, and he said, “I make all the decisions except that one. If the trainer or doctor says the player’s not going back in, I never overrule that.” They make that call, they take the helmet, and the player sits out. So it’s not the coach who it typically is [making the decision], it’s the medical staff on the sideline. And again, both during practice and actual games.
CGM: One of the stats I heard in the special was just staggering, that 35 percent of high school players suffer more than one concussion.
SG: That’s what they estimate. And the numbers may be higher because a lot of players may minimize symptoms. You had asked are these numbers going up because of increased awareness, I think as things like this documentary come out and people become aware of this, I think the numbers will become even higher. I mean, every player I’ve talked to who has talked about a hit that they took that probably gave them a concussion, that’s what they’re describing. And if you played for three or four years during high school, you probably had that happen more than once.
CGM: When we talk about whether the tide is turning more toward taking safety seriously, do you see that as a top-down thing, with the NFL and NBA having to take the lead, or more of a bottom-up movement that starts in the high schools?
SG: I think there’s a little bit of both, and here’s what I mean by that. The culture overall is dictated by the NFL. A lot of these guys watch the NFL players and they basically want to be like them. They watch them go back in, even after some of them look like they’re not acting quite right, or they took a big hit. I interviewed Kurt Warner for this, and he thinks he probably got six concussions, and was very frank about that culture. “Sit out? What are you talking about? I’m MVP of the Super Bowl. I’m playing.” But in terms of bottom-up, I think the types of practicing and the types of drills and the way that these players are trained from a young age probably makes all the difference. One of the things that we’ll show in this documentary is the answer to the question I pose, which is can you play football safe and still win? And the answer is yes. But there are really specific things that have to happen, everything from two-point stance vs. three-point stance, really learning the principle of body tackling. People lead with their head because it’s easy and they feel it’s the most protected part of their body, so they just want to ram everything with their head. That’s not the way people, especially kids, should be trained to play football. So if the training changes now for young players, fast forward to when these players — the small percentage of them that will actually go on to play in college or professional football — there’ll be a different style of play. So I think it’s both top-down and bottom-up.
CGM: So one of the doomsday scenarios is that parents won’t want their kids to play football anymore and that the sport will die out. Do you see that happening, especially if the saftey measures are taken?
SG: Part of the reason I did this documentary is that so many parents would come to me as a neurosurgeon and ask about their kids’ post-concussive symptoms. You’ll find very few parents who say “I absolutely have no concerns about my kid playing football.” The concerns are already there, I guess is my point. So the way the tide shifts is if as a result of realizing that football can become safer and still be football and still have the ingredients that we love about this American sport, I think more parents will probably be OK [with it]. Parents who may have been on the fence about letting their kids play can say there is so much more awareness, that people are doing everything they can to mitigate the number of concussions, and now they know how to prevent the awful and tragic stories that we hear about this. Those just shouldn’t happen anymore. I think it could actually increase the popularity.
CGM: Is there a possibility of a follow-up report on this team, or this subject?
SG: I think so. Part of the reason we picked this time frame, which was three years after [Jaquan Waller's death], is that it takes awhile to completely change the way you coach your team and implement all these safety protocols. This was the first year that just about all those protocols were in place, and I think it’ll take a couple more years to see what the real trend is. The number of concussions are down, there’s been none of the worst tragedies, which is the Second Impact Syndrome, you know the second concussion before the first concussion heals. Those are good numbers, but it’ll take a little bit of time to figure out is this just the way high school kids should be playing football. It probably is, but that might merit a follow-up.
Photos: (Sanjay Gupta) Courtesy of JH Rose Yearbook; (Jaquan Waller) Courtesy Lifetouch