[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
CONCUSSIONS IN YOUTH SPORTS: EVALUATING PREVENTION AND RESEARCH
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
MAY 13, 2016
__________
Serial No. 114-145
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
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COMMITTEE ON ENERGY AND COMMERCE
FRED UPTON, Michigan
Chairman
JOE BARTON, Texas FRANK PALLONE, Jr., New Jersey
Chairman Emeritus Ranking Member
ED WHITFIELD, Kentucky BOBBY L. RUSH, Illinois
JOHN SHIMKUS, Illinois ANNA G. ESHOO, California
JOSEPH R. PITTS, Pennsylvania ELIOT L. ENGEL, New York
GREG WALDEN, Oregon GENE GREEN, Texas
TIM MURPHY, Pennsylvania DIANA DeGETTE, Colorado
MICHAEL C. BURGESS, Texas LOIS CAPPS, California
MARSHA BLACKBURN, Tennessee MICHAEL F. DOYLE, Pennsylvania
Vice Chairman JANICE D. SCHAKOWSKY, Illinois
STEVE SCALISE, Louisiana G.K. BUTTERFIELD, North Carolina
ROBERT E. LATTA, Ohio DORIS O. MATSUI, California
CATHY McMORRIS RODGERS, Washington KATHY CASTOR, Florida
GREGG HARPER, Mississippi JOHN P. SARBANES, Maryland
LEONARD LANCE, New Jersey JERRY McNERNEY, California
BRETT GUTHRIE, Kentucky PETER WELCH, Vermont
PETE OLSON, Texas BEN RAY LUJAN, New Mexico
DAVID B. McKINLEY, West Virginia PAUL TONKO, New York
MIKE POMPEO, Kansas JOHN A. YARMUTH, Kentucky
ADAM KINZINGER, Illinois YVETTE D. CLARKE, New York
H. MORGAN GRIFFITH, Virginia DAVID LOEBSACK, Iowa
GUS M. BILIRAKIS, Florida KURT SCHRADER, Oregon
BILL JOHNSON, Ohio JOSEPH P. KENNEDY, III,
BILLY LONG, Missouri Massachusetts
RENEE L. ELLMERS, North Carolina TONY CARDENAS, California
LARRY BUCSHON, Indiana
BILL FLORES, Texas
SUSAN W. BROOKS, Indiana
MARKWAYNE MULLIN, Oklahoma
RICHARD HUDSON, North Carolina
CHRIS COLLINS, New York
KEVIN CRAMER, North Dakota
7_____
Subcommittee on Oversight and Investigations
TIM MURPHY, Pennsylvania
Chairman
DAVID B. McKINLEY, West Virginia DIANA DeGETTE, Colorado
Vice Chairman Ranking Member
MICHAEL C. BURGESS, Texas JANICE D. SCHAKOWSKY, Illinois
MARSHA BLACKBURN, Tennessee KATHY CASTOR, Florida
H. MORGAN GRIFFITH, Virginia PAUL TONKO, New York
LARRY BUCSHON, Indiana JOHN A. YARMUTH, Kentucky
BILL FLORES, Texas YVETTE D. CLARKE, New York
SUSAN W. BROOKS, Indiana JOSEPH P. KENNEDY, III,
MARKWAYNE MULLIN, Oklahoma Massachusetts
RICHARD HUDSON, North Carolina GENE GREEN, Texas
CHRIS COLLINS, New York PETER WELCH, Vermont
KEVIN CRAMER, North Dakota FRANK PALLONE, Jr., New Jersey (ex
JOE BARTON, Texas officio)
FRED UPTON, Michigan (ex officio)
(ii)
C O N T E N T S
----------
Page
Hon. Tim Murphy, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 1
Prepared statement........................................... 3
Hon. Diana DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 4
Hon. Richard Hudson, a Representative in Congress from the State
of North Carolina, opening statement........................... 6
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 7
Prepared statement........................................... 9
Hon. Fred Upton, a Representative in Congress from the State of
Fred Upton, prepared statement................................. 161
Witnesses
Kelli Jantz, Mother of Jake Snakenberg and Concussion Awareness
Advocate....................................................... 10
Prepared statement........................................... 13
Karen Kinzle Zegel, Mother of Patrick Risha and Chronic Traumatic
Encephalopathy (CTE) Awareness Advocate........................ 18
Prepared statement........................................... 20
Eugene F. (Buddy) Teevens, III, Head Football Coach, Dartmouth
College........................................................ 29
Prepared statement........................................... 32
Andrew Gregory, M.D., Medical Advisory Committee Member, USA
Football, and Associate Professor of Orthopedics, Neurosurgery
and Pediatrics, Vanderbilt University Medical Center........... 35
Prepared statement........................................... 37
Additional information submitted for the record.............. 51
Kevin Margarucci, Manager, Player Safety, USA Hockey............. 61
Prepared statement........................................... 63
Steve Stenersen, CEO, US Lacrosse................................ 76
Prepared statement........................................... 78
Terry O'Neil, Founder/CEO, Practice Like Pros.................... 89
Prepared statement........................................... 91
R. Dawn Comstock, Ph.D., Associate Professor, Department of
Epidemiology, Colorado School of Public Health................. 102
Prepared statement........................................... 104
Thomas M. Talavage, Ph.D., Professor of Electrical and Computer
Engineering, Weldon School of Biomedical Engineering, Purdue
University..................................................... 122
Prepared statement........................................... 124
Submitted Material
Subcommittee memorandum.......................................... 162
Brochure, ``REAP The Benefits of Good Concussion Management,''
Rocky Mountain Hospital for Children at Presbyterian/St.
Luke's, submitted by Ms. DeGette............................... 169
Brochure, ``Flag Until 14,'' Patrick Risha CTE Awareness
Foundation, submitted by Ms. DeGette........................... 189
Report, ``Sports-Related Concussions in Youth: Improving the
Science, Changing the Culture,'' Institute of Medicine and
National Research Council of the National Academies, \1\
submitted by Mr. Hudson
----------
\1\ The information has been retained in committee files and also
is available at http://docs.house.gov/meetings/IF/IF02/
20160513/104914/HHRG-114-IF02-20160513-SD099.pdf.
CONCUSSIONS IN YOUTH SPORTS: EVALUATING PREVENTION AND RESEARCH
----------
FRIDAY, MAY 13, 2016
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 9:33 a.m., in
room 2123, Rayburn House Office Building, Hon. Tim Murphy
(chairman of the subcommittee) presiding.
Members present: Representatives Murphy, McKinley, Burgess,
Griffith, Bucshon, Hudson, Collins, Cramer, DeGette,
Schakowsky, Castor, Tonko, Yarmuth, Clarke, Green, Welch, and
Pallone (ex officio).
Staff present: Leighton Brown, Deputy Press Secretary;
Rebecca Card, Assistant Press Secretary; Jay Gulshen, Staff
Assistant; Kelsey Guyselman, Counsel, Communications and
Technology; Brittany Havens, Legislative Associate, Oversight;
Charles Ingebretson, Chief Counsel, Oversight and
Investigations; John Ohly, Professional Staff Member, Oversight
and Investigations; Chris Santini, Policy Coordinator,
Oversight and Investigations; Gregory Watson, Legislative
Clerk; Jeff Carroll, Democratic Staff Director; Ryan
Gottschall, Democratic GAO Detailee; Tiffany Guarascio,
Democratic Deputy Staff Director and Chief Health Advisor;
Christopher Knauer, Democratic Oversight Staff Director; Ukna
Lee, Democratic Chief Oversight Counsel; Elizabeth Letter,
Democratic Professional Staff Member; Matt Schumacher,
Democratic Press Assistant; and Andrew Souvall, Democratic
Director of Communications, Outreach, and Member Services.
OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Mr. Murphy. Good morning, and welcome to the Oversight and
Investigations hearing. We are here today to continue the
committee's ongoing examination of concussions. This hearing
follows an initial roundtable we had in March where we had a
constructive dialogue with leading experts in the field about
how to address the challenge of concussions.
Today's hearing will focus on youth sports, specifically
the areas of prevention and research.
While there's always some risk of injury participating in
sports, particularly at a young age, it is shown to have many
benefits. The benefit of youth sports participation include
better health through increased activity, improved academic
achievement, physical skill building and social development, to
name a few.
I might add that the number one health risk of youth is
increasing rate epidemic proportion of child obesity. We know
that that leads to increased adult risk for diabetes,
cardiovascular disease, and all sorts of other problems. So we
want children to pay careful attention to their nutrition and
be active.
While the estimates suggest that more than 30 million
children, ages 5 to 18, participate in organized sports each
year, and that despite this being the largest population of
athletes, this group is one of the most underserved populations
when it comes to the level of awareness, prevention, and
research related to head injuries, which brings us to our task
for today.
We want to examine what is being done today to reduce the
instance of head injuries to young athletes, what policies and
guidelines are currently in place to limit their risk of
injury? How are these policies developed? And do they go far
enough, what educational and training policies exist for
athletes, coaches, and parents? How does the large number of
disparate leagues, teams, clubs, and recreational opportunities
available to young athletes complicate efforts to improve
injury prevention?
While youth sports are not nearly as far along as many
professional leagues, progress has made in recent years. All 50
States and the District of Columbia have enacted concussion
laws and some youth sports, organizations, and leagues, such as
Pop Warner Football, USA Hockey, U.S. Soccer, to name a few,
have implemented policies to reduce the amount of head contact
in practice and games. Others, such as USA Football, provide
education and guidance to enhance training and awareness for
coaches, parents, and athletes. A number of these groups are
represented here today, and I look forward to hearing how their
efforts are affecting their sports.
Based on their experience thus far, are we doing enough,
and what does the science tell us? The last question is
particularly interesting and important. There's a lot we do not
know about concussions generally, but pediatric populations,
including youth sports, are severely underrepresented in
assisting research, and therein lays the challenge.
The public wants answers that science is not ready to
provide. We have much to learn how concussions and repetitive
head injuries affect younger individuals, both immediately as
well as later in life. Therefore, I'm interested to learn how
youth sports, organizations develop, review, and update their
policies, guidance or educational efforts in light of the
limited but rapidly evolving research about concussions.
We don't know how traumatic brain injury affects our youth,
and it makes that much more challenging to protect them. Adding
to the challenge, we currently lack any form of protective
injury surveillance, including concussions for athletes younger
than high school age. Given the large number of athletes,
teams, leagues, and other recreational opportunities, this is a
daunting task. But if we do not understand the magnitude of the
challenge, how different factors such as age, gender, sports,
socioeconomic status, et cetera, influence outcomes, how can we
be sure we are making the best decision for our kids?
This morning on our first panel, we are joined by two
mothers; Ms. Kelly Jantz and Ms. Karen Zegal, both of whom
tragically lost their son as a result of injuries sustained
while playing youth sports. Ms. Jantz' son, Jake, was a
promising freshman athlete at Grandview High School in Aurora,
Colorado, and is the namesake of Colorado's Jake Snakenberg
Youth Concussion Act. While Ms. Zegel's son, Patrick Risha, was
a star running back at Elizabeth Forward High School in my
district and played football from the moment he could pick up a
ball. We greatly appreciate your willingness to share your
stories as it reminds us why it is so vital that we continue to
examine this issue.
Later on our second panel, we will have Dartmouth's head
football coach, Buddy Teevens, and representatives from some of
the sports organizations, USA Football, USA Hockey, and U.S.
Lacrosse that oversee or provide guidance to U.S. sports
leagues. We will also hear from practice life pros to learn
more about additional options to keeping athletes safe.
Additionally, we have prominent researchers in the field.
They will be able to speak to how we can approve research and
surveillance, better monitor injuries, and minimize the risk of
injury based upon science.
I appreciate all of our panels for joining us this morning.
This is an important issue, and your perspectives are important
to advance the public dialogue on these complex injuries.
I also want to thank Ranking Member DeGette for her support
in this initiative and look forward to continuing our efforts
together in this endeavor.
[The prepared statement of Mr. Murphy follows:]
Prepared statement of Hon. Tim Murphy
We are here today to continue the committee's ongoing
examination of concussions. This hearing follows an initial
roundtable that we had in March, where we had a constructive
dialogue with leading experts in the field about how to address
the challenge of concussions. Today's hearing will focus on
youth sports, specifically areas of prevention and research.
While there is always some risk of injury, participating in
sports, particularly at a young age, has shown to have many
benefits. The benefits of youth sports participation include
better health through increased activity, improved academic
achievement, physical skill-building, and social development,
to name a few.
Estimates suggest that more than 30 million children, ages
5 to 18, participate in organized sports each year. Despite
this being the largest population of athletes, this group is
one of the most underserved populations when it comes to the
level of awareness, prevention and research related to head
injuries.
This brings us to our task for today. We want to examine
what is being done today to reduce the incidence of head
injuries in young athletes. What policies and guidelines are
currently in place to limit the risk of injury? How are these
policies developed and do they go far enough? What educational
and training policies exist for athletes, coaches, and parents?
How does the large number of disparate leagues, teams, clubs
and reactional opportunities available to young athletes
complicate efforts to improve injury prevention?
While youth sports are not nearly as far along as many
professional leagues, progress has been made in recent years.
All 50 States and the District of Columbia have enacted
concussion laws and some youth sports organizations and
leagues--such as Pop Warner Football, USA Hockey, US Soccer, to
name a few--have implemented policies to reduce the amount of
head contact in practices and games. Others--such as USA
Football--provide education and guidance to enhance training
and awareness for coaches, parents, and athletes. A number of
these groups are represented here today and I look forward to
hearing how their efforts are affecting the safety of their
respective sports. Based on their experience, thus far, are we
doing enough? What does the science tell us?
This last question is particularly interesting and
important. There is a lot we do not know about concussions,
generally, but pediatric populations, including youth sports,
are severely underrepresented in existing research. And therein
lays the challenge--the public wants answers that the science
is not ready to provide. We have much to learn about how
concussions and repetitive head injuries affect younger
individuals, both immediately as well as later in life.
Therefore, I am interested to learn more how youth sports
organizations develop, review, and update their policies,
guidance, or educational efforts in light of the limited, but
rapidly evolving, research on concussions. If we don't know how
traumatic brain injury affects our youth, it makes it that much
more challenging to protect them.
Adding to the challenge, we currently lack any form of
effective injury surveillance, including concussions, for
athletes younger than high school age. Given the large number
of athletes, teams, leagues, and other recreational
opportunities, this is a daunting task. But if we do not
understand the magnitude of the challenge, how different
factors--such as age, gender, sport, socioeconomic status,
etc.--influence outcomes, how can we ensure we are making the
best decisions for our kids?
This morning on our first panel, we are joined by two
mothers--Ms. Kelli Jantz and Ms. Karen Zegel--both of whom
tragically lost their sons as a result of injuries sustained
while playing youth sports. Ms. Jantz's son, Jake, was a
promising freshman athlete at Grandview High School in Aurora,
Colorado and is the namesake of Colorado's ``Jake Snakenberg
Youth Concussion Act.'' While Ms. Zegel's son, Patrick Risha,
was a star running back at Elizabeth Forward High School, in my
district, and played football from the moment he could pick up
a ball. We greatly appreciate their willingness to share their
stories, as it reminds us why it is so vital that we continue
to examine this issue.
Later, on our second panel we will have Dartmouth's Head
Football Coach, Buddy Teevens, and representatives from some of
the sports organizations--USA Football, USA Hockey, and US
Lacrosse--that oversee or provide guidance to youth sports
leagues. We will also hear from Practice Like Pros to learn
more about additional options for keeping athletes safe.
Additionally we have prominent researchers in this field that
will be able to speak to how we can improve research and
surveillance, better monitor injuries, and minimize the risk of
injury based on the science.
I appreciate all of our panelists for joining us this
morning. This is an important issue and your perspectives are
important to advancing the public dialogue on these complex
injuries.
I also would like to thank Ranking Member DeGette for her
support on this initiative and look forward to continuing our
efforts on this endeavor. I now recognize the Ranking Member
for 5 minutes to deliver her own remarks.
Mr. Murphy. So I now recognize the ranking member for 5
minutes to deliver her own remarks.
OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Ms. DeGette. Thank you so much, Mr. Chairman, for having
this follow-up hearing on our roundtable that we held on
concussions and brain trauma earlier this year. I am very
pleased that we are looking, first, at youth sports through
official hearings, because studies have shown that children and
teens are more likely than adults to get a concussion, and they
take longer to recover.
Athletes at the professional college levels, they can make
their own decisions about undertaking the risks associated with
certain sports, but we need to ensure that children and their
parents have enough data to make informed decisions about
participation in youth contact sports. Part of that discussion
needs to be the recognition of how valuable these sports are,
both for physical fitness and team building, as you so well
stated, Mr. Chairman. But I think we also need to have an open
discussion about how to make them safer.
I approach this issue, both as a policymaker and a parent.
And as I said in the roundtable, I support evidenced-based
policy making and am very encouraged that we are having ongoing
research to better understand brain trauma. But at our
roundtable, the experts said that they are going to have
answers about what the protocol should be in 7 to 10 years. And
what I said at that hearing is, as a mom, when I'm deciding if
my kid is going to play Pee Wee sports, I can't afford to wait
7 to 10 years. By then, they will be in high school, and so we
need to take whatever evidence that we have right now, and we
need to figure out for now what we should tell the parents and
what we should tell leagues that they should be doing as the
best practices as far as we know right now.
For example, at what age should children start playing
tackle football? How many times a week should children be
engaging in full contact practices? And when they do begin to
play, how do we teach them to tackle safely and to protect
their heads and the heads of other players? And how do we
ensure that coaches are educated in teaching these skills to
young players? I'm sure that we can ask other questions in all
youth sports, not just football.
I agree that most, if not all parents, would agree that it
is better to err on the side of caution. The worst-case
scenario would be that we discover later, that some of these
safety measures may have been unnecessary. But as a mom, I
always want to have more safety rather than less safety,
especially when you're talking about our children's brains.
Now, as we implement changes in sports now, this is not a
reason to stop researching our gaps in knowledge. We need to
understand the long-term effects of concussive and
subconcussive injuries; we need to analyze whether the rule
changes being implemented are having the desired effects; we
need to study how to prevent brain injury in the first place.
I also am interested from hearing in our witnesses on the
second panel about the differences they are seeing in girls and
boys sports and how the rates of concussion differ. I know that
there have been studies suggesting that women and girls report
concussions at higher rates than men and boys in similar
sports. I want to know about that disparity, and also if
there's any disparity about the actual effects on brains.
Both of our panels contain excellent witnesses, and it's so
important to have them today. I'm really proud to welcome two
witnesses from Colorado. Kelly Jantz, as you heard, tragically
lost her son Jake to second impact syndrome in 2004.
And, Kelly, I'm so proud of you, because what you did is
you were instrumental in ensuring that concussions are taken
seriously in youth sports, and that parents and coaches have
the information they need. As the chairman mentioned, in 2012,
Governor Hickenlooper signed the Jake Snakenberg Youth Sports
Concussion Act into law in Colorado, and we're really proud
that you've taken his legacy to that. We really are.
Dr. Dawn Comstock is on our second panel. She's from the
Colorado School of Public Health. And like me, a Colorado
native. She's one of the leading experts in sports injury
epidemiology. Her database gathers information on injury
exposure and incidents among high school athletes. She looks at
injury patterns like examining the correlation between neck
strength and concussion risk to inform prevention and
mitigation strategies. And so I want to thank you, also, Dr.
Comstock, for making youth sports safer.
I want to thank everybody who is here today to help us
figure this out. And I also really want to say, we want to see
sports succeed. I can't let this hearing go by without
congratulating the world champion Denver Broncos, for example,
which I have season tickets. And I also want to say, as I said
before, one of my great sadnesses is that I was unable to
persuade either of my daughters to play ice hockey, and they
took up dance instead.
But the point is, all--every child in this country should
be safe. We love sports. We want to see sports succeed, but
that means that we have to do our utmost to improve player
safety and guarantee that participation in sports doesn't mean
that you have long-term health consequences.
So I know, Mr. Chairman, you intend to have more hearings.
I think this is the perfect place to start. I want to thank you
again, and yield back.
Mr. Murphy. Thank you. Go Steelers.
Of course, right now the Penguins are in the playoffs. We
wish them the best, too, and all athletes.
I now am going to recognize--first of all, I want to say
the opening statement of Mr. Upton will be included in the
record. He could not be with us this morning.
[The prepared statement of Mr. Upton appears at the
conclusion of the hearing.]
Mr. Murphy. But we're going to recognize Mr. Hudson for an
opening statement.
OPENING STATEMENT OF HON. RICHARD HUDSON, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NORTH CAROLINA
Mr. Hudson. Thank you, Mr. Chairman. I thank you, Chairman
Murphy and Ranking Member DeGette, for your focus on this
issue. Even as painful as it is to hear Representative DeGette
talk about the Broncos, so I want to represent Charlotte, North
Carolina, home of the Carolina Panthers. There's always next
year.
I would like to thank the panelists for your important
testimony today. Your experiences and expertise help the
committee better understand the gravity of concussions in youth
sports and what we need to do to prevent concussions and the
long-lasting effects for future generations.
Unfortunately, pediatric trauma, which concussions and
traumatic brain injury is a part of, is the number-one killer
of kids. Pediatric trauma has become a particular focus of
mine. I've been fortunate to have the Childress Institute for
Pediatric Trauma partner with me in examining what we can do to
help our children live long, fulfilling lives. Childress
Institute was started by my dear friend, Richard Childress'
wife Judy, with the goal of discovering and sharing in the best
ways to prevent and treat severe injuries in children. The
Childress Institute supports a number of pediatric research
programs, including the Concussive Care Fund, which funds
initiatives prevent and treat injuries in youth and
recreational sports. The promising research being done to
prevent and treat trauma not only broadly, but also on specific
issues like concussions, takes on particular importance to me
as a father of a 7-month-old baby boy. I'm thankful so much
awareness is being brought to this issue by discussions like
today.
As one trauma surgeon said to me, it's not a life saved;
it's a lifetime saved. And I want to also note that my fellow
North Carolina Representative, G.K. Butterfield and I are
hosting a pediatric trauma briefing with the Energy and
Commerce Committee on Tuesday, May 24th. I would encourage
anyone who is interested to please attend, and I look forward
to today's discussion.
With that, Mr. Chairman, I yield back.
Mr. Murphy. Is there anybody else on our side who have
anything they want to add at this point?
Then I now recognize the ranking member, Mr. Pallone, for 5
minutes.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Mr. Chairman.
And I want to thank all of our participants for joining us
today. Additionally, I would like to thank the chairman for his
commitment to this committee's examination of concussions and
brain trauma. Earlier this year, we had an initial roundtable
on this issue, and at the time I requested to Chairman Upton
that we hold a series of hearings on concussions and sports-
related head trauma. I propose that we start with an
examination of head impacts in youth sports, and I'm gratified
that we are here today to discuss this very topic and look
forward to the additional hearings on this important issue.
Parents across the country are concerned about the risk of
concussions, and with good reason. I have my own experience as
a parent in dealing with my daughter's concussion and
deciphering the medical advice provided. It's challenging as a
parent to balance the news stories and the results of the
latest research against the value of our children's
participation in sports, and I can certainly relate to parents'
concerns and their confusion about how to make the right
decisions for their children.
And there is compelling research to suggest that the
effects of repeated head trauma, even those received during
one's youth, can accumulate and cause serious consequences, and
these consequences can stem from injuries once considered minor
known as subconcussive hits, or repetitive hits to the head.
Purdue University Research is led by one of our witnesses
today, Dr. Tom Talavage, found significant structural changes
to the brains of high school football players, even among those
who were not diagnosed with a single concussion. And what is
particularly troubling is that these changes persist at even 12
months later, suggesting lasting damage. Many other studies
have documented an association between subconcussive hits and
changes in brain chemistry, decreased brain functioning, and
behavioral changes. A recent study by a group of researchers at
Boston University found that exposure to hits, regardless of
whether a concussion occurred, is Associated with a higher
likelihood of mood disorders, like depression. Researchers have
also repeatedly found evidence of the linkage between head
impacts and CTE, a devastating degenerative brain disease.
CTE has been found in former athletes as young as 25 years
old and in adults who never played football beyond the high
school level. And there remain a number of unanswered questions
about what risk factors make individuals more susceptible to
these debilitating conditions. We also need to understand what
happens in the brain when it's hit, and how many hits trigger
these neurological effects. And while there is still research
that needs to be done, that should not be an excuse for
inaction. What is not in dispute is the association between
head trauma from contact sports, such as football, and lasting
brain damage in degenerative decisions, such CTE. Even the NFL
publicly acknowledged this link at this committee's roundtable
back in March.
Some researchers in this field suggest that we should,
quote, ``wait on the science before making changes to the rules
of youth sports.'' And I respectfully disagree. We cannot ask
children and their parents to wait 10, 15, or 20 years for the
science to catch up before we take measures to make sports
safer. We need to be asking questions right now and
implementing the appropriate rule changes.
The science has raised enough red flags about the dangers
of repetitive head trauma that I think it is incumbent upon
those who organize and promote youth contact sports to take
every effort to make the games as safe as possible. And earlier
this month, the subcommittee ranking member, Ms. DeGette, Mr.
Green, and Ms. Schakowsky joined me in sending letters to
collegiate and youth football leaders. We asked them to explain
what rule or policy changes they are considering to address the
risks associated with both concussive and subconcussive hits.
And I expect that we will have a response by May 25th. And I
commend Pop Warner for announcing yesterday that it would ban
kickoffs in games starting this fall.
I also look forward to hearing today from other youth
sports organizations about what they are doing for their
individual sports, and whether additional measures need to be
considered.
And last, Mr. Chairman, I want to express my deep thanks to
both Kelly Jantz and Karen Zegel for joining us today. I can't
even imagine the losses you and your families have experienced.
Thank you for your willingness to share your experiences
with this committee. We can learn from you as we pave a path
forward to better protect our kids. And thank you, again, to
all our witnesses for their contribution and for helping us
with our comprehensive review of concussions and head trauma.
I hope we can all continue to work together to find the
best ways to address this significant public health issue to
protect our children. I yield back.
[The prepared statement of Mr. Pallone follows:]
Prepared statement of Hon. Frank Pallone
I want to thank all of our participants for joining us
today. Additionally, I'd like to thank the chairman for his
commitment to this committee's examination of concussions and
brain trauma.
Earlier this year, we had an initial roundtable on this
issue, and at the time, I requested to Chairman Upton that we
hold a series of hearings on concussions and sports-related
head trauma. I proposed that we start with an examination of
head impacts in youth sports. I am gratified that we are here
today to discuss this very topic, and I look forward to
additional hearings on this important issue.
Parents across the country are concerned about the risks of
concussions, and with good reason. I have my own experience as
a parent in dealing with a child's concussion and deciphering
the medical advice provided. It is challenging as a parent to
balance the news stories and the results of the latest research
against the value of our children's participation in sports. I
can certainly relate to parents' concerns and their confusion
about how to make the right decisions for their children.
There is compelling research to suggest that the effects of
repeated head trauma--even those received during one's youth--
can accumulate and cause serious consequences. And these
consequences can stem from injuries once considered minor,
known as subconcussive hits, or repetitive hits to the head.
Purdue University researchers, led by one of our witnesses
today, Dr. Tom Talavage, found significant structural changes
to the brains of high school football players, even among those
who were not diagnosed with a single concussion. What is
particularly troubling is that these changes persisted even 12
months later, suggesting lasting damage.
Many other studies have documented an association between
subconcussive hits and changes in brain chemistry, decreased
brain functioning, and behavioral changes. A recent study by a
group of researchers at Boston University found that exposure
to hits, regardless of whether a concussion occurred, is
associated with a higher likelihood of mood disorders like
depression.
Researchers have also repeatedly found evidence of a
linkage between head impacts and CTE, a devastating
degenerative brain disease. CTE has been found in former
athletes as young as 25 years old and in adults who never
played football beyond the high school level.
There remain a number of unanswered questions about what
risk factors make individuals more susceptible to these
debilitating conditions. We also need to understand what
happens in the brain when it's hit, and how many hits trigger
these neurological effects.
While there is still research that needs to be done, that
should not be an excuse for inaction. What is not in dispute is
the association between head trauma from contact sports, such
as football, and lasting brain damage and degenerative
diseases, such as CTE. Even the NFL publicly acknowledged this
link at this committee's roundtable back in March.
Some researchers in this field suggest that we should
``wait on the science'' before making changes to the rules of
youth sports. I respectfully disagree. We cannot ask children
and their parents to wait 10, 15, or 20 years for the science
to catch up before we take measures to make sports safer.
We need to be asking questions right now and implementing
the appropriate rule changes.
The science has raised enough red flags about the dangers
of repetitive head trauma that I think it is incumbent upon
those who organize and promote youth contact sports to take
every effort to make the games as safe as possible.
Earlier this month, subcommittee Ranking Members DeGette,
Green, and Schakowsky joined me in sending letters to
collegiate and youth football leaders. We asked them to explain
what rule or policy changes they are considering to address the
risks associated with both concussive and subconcussive hits. I
expect that they will respond to us by May 25th. And I commend
Pop Warner for announcing yesterday that it would ban kickoffs
in games starting this fall. I also look forward to hearing
today from the other youth sports organizations about what they
are each doing for their individual sports, and whether
additional measures need to be considered.
Last, I want to express my deep thanks to both Kelli Jantz
and Karen Zegel for joining us today. I cannot even imagine the
losses you and your families have experienced. Thank you for
your willingness to share your experiences with this committee.
We can learn from you as we pave a path forward to better
protect our kids.
Thank you again to all of our witnesses for your
contributions and for helping us with our comprehensive review
of concussions and head trauma. I hope we can all continue to
work together to find the best ways to address this significant
public health issue to protect our children.
Mr. Murphy. The gentleman yields back. I ask unanimous
consent that Members' opening statements be introduced in the
record.
And, without objection, the documents will be entered into
the record.
Now, I would like to introduce the witnesses for our first
panel for today's hearing. We are going to try to get through
their testimony before votes.
The first witness on today's panel is Ms. Kelly Jantz. Ms.
Jantz, the mother of Jake Snakenberg. Jake passed away after
suffering from second impact syndrome. Following her son's
death, Ms. Jantz has become a dedicated activist, committed to
raising awareness of concussions in youth sports. We thank Ms.
Jantz for preparing her testimony and look forward to her
insights on these matters.
I also want to welcome Ms. Karen Zegel. Ms. Zegel is the
president of the Patrick Risha CTE Awareness Foundation. The
Foundation was created in memory of her son, Patrick Risha, who
I enjoyed reading about during his football career. He passed
away after suffering from CTE.
Thank you, Ms. Zegel, for your testimony today. We look
forward to your comments.
So you two are aware that this committee is holding the
investigative hearing and when doing so has the practice of
taking testimony under oath.
Do either of you object to testifying under oath? Seeing no
objections, the Chair then advises you that under the rules of
the House and rules of the committee, you are entitled to be
advised by counsel.
Do either of you desire to be advised by counsel during
your testimony today?
Neither one does. In that case, would you mind, please,
rising and raise your right hand, and I'll swear you in.
[Witnesses sworn.]
Both answered affirmatively, and you are now under oath and
subject to the penalties set forth in Title 18, section 1001 of
the United States Code.
I will ask you each to give a 5-minute summary of your
written statement. There will be light in front of you which
will be red when that time is up.
You can begin, Ms. Jantz. Turn the microphone on and bring
it very close to you if you don't mind. Thank you.
STATEMENTS OF KELLI JANTZ, MOTHER OF JAKE SNAKENBERG AND
CONCUSSION AWARENESS ADVOCATE; AND KAREN KINZLE ZEGEL, MOTHER
OF PATRICK RISHA AND CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE)
AWARENESS ADVOCATE
STATEMENT OF KELLI JANTZ
Ms. Jantz. Chairman Murphy, and Ranking Member DeGette, and
members of the subcommittee, good morning and thank you for
this opportunity to provide testimony on the important issue
regarding youth and youth-related sports concussions.
I commend you and your colleagues on the work of this
committee to shed light on this critical issue. My name is
Kelli Jantz, and I'm the mom to Jake Snakenberg. My son was
your typical all-American boy, devoted to sports, his friends,
and our family. Jake was often referred to as our social
butterfly in our family. He had a big heart and genuinely cared
for those in his life. He had a joy about him that others could
not resist. His big brother summed it up best when he said Jake
drank up life like it was pouring from a fire hose. He gave 110
percent in everything, especially sports.
On September 18th, in 2004, Jake got up at 6:15 in the
morning in anticipation of his freshman football game. He loved
football and all it offered; the physical challenge, the spirit
of competition, and probably most of all, the friendships that
were involved. He was particularly excited about playing in
this game, because he had been held out of a few practices
because the week prior, he had suffered an injury where his
arms and hands went numb and tingly. What he described to us
sounded like maybe he had tweaked his neck or strained his
neck. He hadn't lost consciousness; he didn't see stars. You
wouldn't have associated it with a major type of injury. He
didn't report to his dad or me and any headaches during the
week, though his friends had said that after that injury, he
had complained of some headaches. Regardless of that, he was
able to return to practices and meet the required number of
practices to play on the game day.
In warmups on the 18th, Jake took a really hard hit that
really appeared to shake him. He noticed me looking on and
waved me off to let me know he was oK. When the game began and
he lined up for a play, right before the snap, Jake stumbled
forward. A whistle was blown, and they called a penalty, and
flag was thrown. And Jake got up and started to come to the
sideline, and then stumbled and went down again, and he never
got back up again. He was unconscious, and 911 was called
immediately, and a life flight was dispatched to the football
field. Jake was airlifted to Swedish Medical Center where a
neurosurgeon advised us that Jake had could suffered a head
injury, and steps were being taken to decrease the swelling in
his brain. He told us that Jake may never play football again,
and would likely have a long recovery. But he followed that
statement with, if Jake survives this injury. Tragically, Jake
didn't survive. It was determined that Jake had suffered
second-impact syndrome, a condition leading to rapid swelling
of the brain from more than one concussion. It's a phenomenon
unique to young brains.
It was likely that Jake had suffered a concussion the
previous week. Subsequent hits during practice and warmups,
though not associated with the concussion, had a compounding
effect and continued to further injury his already compromised
brain.
Since Jake's death, I have made it my mission to continue
to raise awareness of the consequences of concussion in youth
sports. Following Jake's death, Dr. Karen McAvoy developed the
REAP Project, which was adopted by a Rocky Mountain hospital
for children and is made available to the Colorado Department
of Education. This program deals with all youth concussions,
regardless of the cause, meaning not just sports-related
concussions, as any concussion can directly impact a student's
learning ability.
I've had the opportunity to support REAP Concussion
Management Program, which is being adopted by other States
through helping distribute the REAP manuals funded by the Jake
Snakenberg Memorial Fund.
Looking at the wealth of research on the consequences of
youth concussion and the rapidly evolving advances in
concussion management, we would be remiss and, actually, it
would be irresponsible not to take every possible opportunity
to develop measures to protect our youth from the devastating
disabilities and potential death resulting from these types of
injuries.
To help--excuse me. I think, actually, in closing, these
children are our future, and it's our responsibility as parents
and coaches, teachers, medical professionals, policymakers, and
the community as a whole to make sure we do all we can to
support the necessary culture change to make youth sports as
safe as possible, and protect our children as well as to
provide appropriate treatment and assistance should a
concussion occur.
I want to thank you, again, for addressing this critical
issue and allowing me to participate in the hearing today.
Mr. Murphy. Thank you.
[The prepared statement of Ms. Jantz follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Murphy. Ms. Zegel, you can go for 5 minutes. Thank you.
STATEMENT OF KAREN KINZLE ZEGEL
Ms. Zegel. Chairman Murphy, Ranking Member DeGette, and
members of the committee, thank you so much for inviting me to
speak today. My son, Patrick Risha, was a hometown hero in high
school football. I'm going to cry.
He grew up in an area that measured the worth of a man by
his prowess and heart on the football field. He started just
south of Pittsburgh, and with the Elizabeth Forward Youth
Leagues when he was 10 years old. He was not gifted with size
or speed, but nonetheless, worked hard to become a great player
and through that, achieved his dream to go to an Ivy League
school. It is that work ethic and perseverance in a collision
sport that ultimately killed him.
Patrick took his own life at the age of 32, but actually,
we have come to know CTE took his life. Patrick never played in
the NFL. Patrick was like millions of children before and after
him that just played for fun and success in life. But
throughout high school, prep school, and Dartmouth College, our
sweet, tough, young running back received enough subconcussive
blows to his head to essentially seal his fate. When he died, a
newscaster friend of the family suggested he might have CTE. I
had never heard of CTE before. I've had heard about NFL players
having brain injuries and concussions, but I never dreamed it
could affect a player at the college level.
When Patrick's autopsy revealed he had widespread CTE, I
was in shock and horror. How many other players like Patrick
are there out there? How many other families are dealing with a
loved one gradually becoming unwired, with no clue what is
happening? Not every grieving family has a newscaster friend
saying the words CTE.
For the sake of American families, this has to change. And
we are grateful this committee is conducting this hearing to
learn more about the disease, and the impact on families and on
our society.
Personally, I worried about Patrick becoming paralyzed, but
I thought the chances were extremely small, and I thought he
had so much to gain from playing.
If I had known the repeated tackles my son endured were
slowly killing him, I would have stopped it. No family wants
their child to suffer a disease that causes him to lose his
mind slowly, and with such anxiety and loneliness. Yet, every
day, parents are signing their kids up for youth collision
sports. These parents don't understand the horror they may face
with their child. Parents need to be told the truth.
The human brain is much more fragile than we ever imagined.
The brain doesn't heal the way skin and bones do. Traumas could
be very well permanent. For thousands of years, men have fought
in arenas for sports and entertainment. Somehow we seem to have
evolved to a point where we're now willing to put children into
arenas to tackle each other for sport. We put them in the
equivalent of cheap Halloween costumes to emulate their NFL
heroes. We ask them to be tough little warriors. That's what
our family did, and we were so proud when Patrick carried his
team to victory.
Sadly, we lost an amazing young man before he ever had the
chance to live his life, and gifted and promising young
children like Patrick all over this land are winning battles on
the sports field, but sadly losing their chances for a happy,
healthy, productive future.
Patrick's tragic end was not an isolated incident. Parents
need to know that one in three players may develop CTE.
Soldiers coming home and ex-amateur collision athletes are
being diagnosed with PTSD, ADHD, anxiety, depression, drug
addictions, anger issues, et cetera, when, in fact, they may
have CTE.
When I see a guy on TV hitting his wife, shooting his
friend, or going on a high-speed car chase, I wonder if maybe
he played one too many football games. People need to know that
this invisible disease is more common than we know, that it can
develop in youth, high school, and college levels of collision
sports. Families need to know what the causes and symptoms are,
and how to address the disease.
This has been hidden in plain sight for much too long. It
was this realization that prompted us to form the Patrick Risha
CTE Awareness Foundation and the Web site, stopCTE.org. We also
created a brochure, Flag Until 14 to help parents understand
the key issues of CTE.
Heading the ball has recently been eliminated from youth
soccer. Checking in hockey has been eliminated in youth
leagues. Yet, over 2 million children are still putting their
precious brains at risk in tackle football. The urgency of this
problem is beyond measure. I wish we would have known the truth
25 years ago.
There are those out there who would prefer parents didn't
know about CTE. They will obfuscate the issue with unreasoned
arguments. We've heard a few, like you can get a concussion
riding a bike, or you're turning our warriors into pansies, or
do you want them to sit and play video games for the rest of
their lives? When you have lost your son to CTE and you
understand how it is caused and how prevalent it is, these
arguments are hurtful and, in my opinion, keep children at
risk.
We see CTE as a human tragedy of immense proportions, and
we need the help of everyone in this room and beyond. We all
now have the duty to save children and families. CTE is 100
percent preventable. We need to remove repetitive head trauma
from youth sports. To do anything else is to be complicit to
the problem, knowing more families will suffer the pain we
personally endure every day.
Thank you very much.
[The prepared statement of Ms. Zegel follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Murphy. I thank both for that moving testimony. I think
I'm just going to ask you one question. And that is, you
mentioned that Patrick began playing football at age 10 and
continued on. Do you know if his coaches, anybody working with
the teams, had any specialized training to recognize, or be
aware of concussions and injuries and discussed with his
teammates? Do you know if there's any of that training?
Ms. Zegel. At that time, I knew most of the coaches
personally, and I would have to guess no. I mean, we're going
back a ways before people starting talk about concussion.
Mr. Murphy. Even on the collegiate level, too? Even on the
college level, too?
Ms. Zegel. At the college level, as a parent, I was never
informed of anything like that.
Mr. Murphy. OK.
Ms. Zegel. I mean, that would have been nice to know then,
but, no.
Mr. Murphy. Ms. Jantz, can you answer that, too? Any
training you thought the youth coaches had to recognize, be
aware of anything with concussions or head injuries?
Ms. Jantz. Not back in 2004 when Jake experienced this.
Even--I mean, Jake's stepfather and myself were both medical
professionals, and while we understand, you know, obviously,
hitting your head is a bad thing, we certainly didn't have the
background that we have now where you would have the
opportunity to truly, you know, step back and look at it.
Perhaps he would have been pulled and not played the next week.
So I think that in those times, we did not have that, and now
we have an opportunity to make sure that coaches and the people
who are involved with our kids have all that information.
Mr. Murphy. Thank you.
Ms. DeGette.
Ms. DeGette. Thank you. Just following up on the chairman's
questioning.
Ms. Jantz, I've been given this brochure. I think probably
your Foundation was involved in helping put this together. Is
that right? And it's called, REAP, Remove/Reduce, Educate,
Adjust/Accommodate Pace by the Center for Concussion at the
Rocky Mountain Hospital for Children. And it really goes
through a lot of information for educators and parents.
Ms. Jantz. Yes.
Ms. DeGette. It's a wonderful piece. I'm wondering, is this
distributed? What do folks do with this?
Ms. Jantz. Well, we have a used that. It is distributed and
available. We've made it available to school districts, to
various groups, actually, I like to say anybody who I can get
to listen, I will be happy to give that to. And it's a
comprehensive way of managing concussions, and it's community-
based. And it's got a section for parents; and it's got a
section for medical professionals, and it has a section for the
students and teachers. So everybody has a different piece in
this.
We're not with our kids 24 hours a day.
Ms. DeGette. Right. And, Ms. Zegel, you also have formed a
foundation, an advocacy foundation. And I'm assuming that
you've also been working to get information like this out to
parents, educators, coaches?
Ms. Zegel. Right. Our current goal is--we're working with
medical examiners and coroners on one end, trying to get them
to recognize the disease if they are presented with a drug
overdose, or suicide, or something like that. Then on the other
end, we're trying to get--push for parents to have informed
decisions that flag football is fun and--and it could be a lot
of very famous football players never played until high school.
Ms. DeGette. And you've got your brochure right next to
you?
Ms. Zegel. Yes, my daughter made that up.
Ms. DeGette. Your daughter made that? That's wonderful. Mr.
Chairman, thank you so much.
Ms. Zegel. Thank you.
Ms. DeGette. And I would ask unanimous consent to put both
of these brochures in.
Mr. Murphy. Without objection, that's a great idea. Thank
you.
[The information appears at the conclusion of the hearing.]
Ms. Zegel. Thank you.
Ms. DeGette. Thank you for coming.
Mr. Murphy. Without objection. We want to thank our first
panel. They have just called votes, so what we are going to do,
we are going to take a break. Vote. I think we have three
votes. We will do that as quickly as congressionally possible.
We will come back. This will give the panel and opportunity to
sit down and be ready. As soon as that last vote, I ask members
to be back here immediately. We'll get going, because our goal
is to finish this hearing before the second set of votes. So we
will work on that.
Thank you, we will be recessed until votes are ended. Thank
you.
[Recess.]
Mr. Murphy. Could our witnesses please take their seats?
All right. Thank you. We're going to get moving right away
because we know we've got another vote series, and we'd like to
all give you the opportunity to testify. So I'd like to
introduce the witnesses of our second panel for today's
hearing.
We have Mr. Eugene Buddy Teevens to lead up our second
panel. He has been head football coach at Dartmouth College
since 2004, where he has implemented a policy of noncontact
practices. I believe, Coach, you also were a teammate of the
famous coach from Harvard University named Tim Murphy. He's my
twin.
Next, we'd like to welcome Dr. Andrew Gregory. Dr. Gregory
is here as a member of the Medical Advisory Committee for USA
Football.
Mr. Kevin Margarucci--did I say that correctly?--of USA
Hockey. Mr. Margarucci has 20 yours of experience as a
certified athletic trainer and now serves as the manager of
player safety at USA Hockey.
Next, we welcome Mr. Steve Stenersen. Mr. Stenersen has
served as executive director and now president and CEO of USA
Lacrosse since 1998.
Next, we welcome Mr. Terry O'Neil. Mr. O'Neil is the
founder and CEO of Practice Like Pros, whose mission is to
educate high school coaches on alternative practice regiments.
Next, Dr. Dawn Comstock, who is an associate professor at
Colorado School of Public Health and one of the Nation's
leading experts on high school injury surveillance.
And finally, I'd like to introduce Dr. Thomas Talavage.
Dr. Talavage. Close enough.
Mr. Murphy. Is that close enough? What is the correct? Say
it.
Dr. Talavage. Talavage.
Mr. Murphy. Talavage. I'll get it right.
Professor at the Weldon School of Biomedical Engineering at
Purdue University. Dr. Talavage is also the founding codirector
of Purdue's MRI facility and a part of the Purdue Neurotrauma
Group.
Thank you to all the witnesses for being here today. I look
forward to having a productive discussion.
You're all aware that the committee is holding an
investigative hearing and when doing so has the practice of
taking testimony under oath. Do you have any objections to
testifying under oath?
Seeing no objections, the Chair then advises you that under
the rules of the House and rules of the committee, you're
entitled to be advised by counsel. Do any of you desire to be
advised by counsel during your testimony today?
And seeing no comments on that, then in that case, would
you all please rise, raise your right hand, and I'll swear you
in.
[Witnesses sworn.]
Mr. Murphy. Thank you. All witnesses have answered in the
affirmative. And so now you're all under oath and subject to
the penalties set forth in Title 18, Section 1001 of the United
States Code.
I'm going to ask you all to give a 5-minute summary of
you're written statement. Please pay attention to the lights in
front of you because we are on tight time for that.
Mr. Teevens, you're now recognized for 5 minutes. Coach, go
ahead. Make sure your microphone is turned on and you pull that
mike as close to you as possible, almost touching it. Thank
you.
STATEMENTS OF EUGENE F. (BUDDY) TEEVENS, III, HEAD FOOTBALL
COACH, DARTMOUTH COLLEGE; ANDREW GREGORY, M.D., MEDICAL
ADVISORY COMMITTEE MEMBER, USA FOOTBALL, AND ASSOCIATE
PROFESSOR OF ORTHOPEDICS, NEUROSURGERY AND PEDIATRICS,
VANDERBILT UNIVERSITY MEDICAL CENTER; KEVIN MARGARUCCI,
MANAGER, PLAYER SAFETY, USA HOCKEY; STEVE STENERSEN, CEO, US
LACROSSE; TERRY O'NEIL, FOUNDER/CEO, PRACTICE LIKE PROS; R.
DAWN COMSTOCK, PH.D., ASSOCIATE PROFESSOR, DEPARTMENT OF
EPIDEMIOLOGY, COLORADO SCHOOL OF PUBLIC HEALTH; AND THOMAS M.
TALAVAGE, PH.D., PROFESSOR OF ELECTRICAL AND COMPUTER
ENGINEERING, WELDON SCHOOL OF BIOMEDICAL ENGINEERING, PURDUE
UNIVERSITY
STATEMENT OF EUGENE F. (BUDDY) TEEVENS, III
Mr. Teevens. Thank you, Mr. Chairman. I'd like to thank
Kelli and Karen for their testimony as well. I think it
underscores the importance of the committee.
Voice. Can you bring the mike closer?
Mr. Teevens. Closer?
As I mentioned, I'd like to thank Karen and Kelli for their
stories, and I think it underscores the importance of the
committee and your task.
My name is Buddy Teevens. I've been a college football
coach for 35 years. I've coached in the Ivy League, the SEC,
the PAC-10, the Big Ten, Conference USA, and the Yankee
Conference. During the course of summers, I work with all age
groups, peewees right through high school-age kids.
And football is a very special game. The life lessons with
all the team sports, things people learn, the friendships they
make, the experiences they have. I love the game of football,
but I love my players more.
And looking at concussive head injury through the course of
time, I was--5 years ago, I made the decision that we were
going to eliminate tackling from our practices, in-season
practices, spring practices, pre-season practices. And the
guarantee I make to parents is their son comes to Dartmouth,
they will never tackle or be tackled by another Dartmouth
football player for their 4 years.
Now, making that decision, I wasn't 100 percent sure I was
doing the right thing. I worried about my players. Was I
putting them at a competitive disadvantage? Was I preparing
them fully for games? It was not a popular decision amongst my
staff. It went from complete ridicule, to disbelief, to
condemnation in some parties.
I was convinced, however, I did a lot of research on it,
that the way that we teach tackling was not the way that we
tackle in games. And what I looked at, at length, was our
defensive tape and how we actually tackled. And then we tried
to replicate that tackling practice that we saw in games
against pads, fitting them against other players without going
to live concept, tackling sleds. We developed at Dartmouth,
with the Thayer School of Engineering, a mobile tackling
device, which has been quite beneficial in terms of actually
replicating a moving target.
With that, we actually tackle, I would say, more than
anybody else in the country. Each of my players annually, 500
to 800 tackles per year, but never one against another human
being. The only time our guys tackle are 10 games per year
during the course of the season.
What's happened is our injury reduction has been
phenomenal. Missed tackles, which we chart aggressively,
dropped 50 percent the first year that we went to this
nontackling process. And people ask me why, and it's, quite
simply, the skill of tackling, we practice more than we did
when we were tackling live. It's a shame, but in our sport, the
most injurious act, tackling, is the one that's practiced the
least because of the fear of the risk of injury.
So by putting our guys in a position to tackle with
regularity, and this was unanticipated, we've become much more
proficient at executing the act of tackling. You hear an awful
lot about rugby tackling. I think football is a different
sport. Shoulder tackling is a thing that we do preach. We don't
talk about the head other than say take it completely out of
contact points. And it's like riding a bike. You don't just
throw someone on a bike and let them start to figure it out.
There's a process, training wheels and so on, support from
parents. I do the same thing with our football players.
A lot of folks ask me, well, can you do that at different
levels? Without question. People look at the NFL, and I use
them as a model. They hit less than anybody in the world and
their concussive results in practice are probably some of the
best. We've gone from a football team that struggled at times
to we're a championship team. We've won 17 games in the last 2
years, Ivy championship this year, and we had zero defensive
concussive head injuries this season. And it's all a process of
how you present to your players. The buy-in has been
appreciable. It's been wonderful from a recruiting standpoint.
Can other people use it? And I speak nationally with this.
Prep school, Pop Warner school, youth football, they'll say,
well, how do you teach someone that's never tackled a human
being? Well, it's a crawl, walk, run. Start with pads and
progress forward. And I fully believe at any level that the
approach we take--and I'd like to kick on a video right now, if
I could. I think I've got time. And this will demonstrate more
accurately than I could with words how we actually practice
tackling.
[video shown.]
Mr. Teevens. We tackle literally every day that we practice
and we put people in a position to execute the things that they
would do on game day. A tackle's different from position to
position. A defensive lineman will not execute the same skill
set that a defensive back will. And we've actually broken it
down to levels of tackling, planes of tackling, and then
repetitions that we have. The end result is we play at a very
high level. We've been very, very successful and we've been
very, very safe.
[The prepared statement of Mr. Teevens follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Murphy. Thank you very much.
I now recognize Dr. Gregory for 5 minutes.
STATEMENT OF ANDREW GREGORY
Dr. Gregory. Chairman Murphy and members of the
subcommittee, my name is Dr. Andrew Gregory. I'm a pediatric
sports medicine specialist at Vanderbilt University Medical
Center. I'm a fellow of both the American Academy of Pediatrics
and the American College of Sports Medicine, as well as a
member of USA Football's Medical Advisory Committee. I am not a
USA Football employee, nor do I receive any compensation for
being on the committee. I'm also a parent of an 18-year-old
daughter who's a soccer player. Thank you for the invitation to
testify on USA Football's behalf.
In short, USA Football is the sport's national governing
body and a member of the U.S. Olympic Committee. It is an
independent nonprofit organization. We create resources and
direct programs establishing standards using the best available
science, educating coaches, parents, and athletes. Our programs
are endorsed by more than 40 organizations spanning medicine
and sport, including the American College of Sports Medicine,
the National Athletic Trainers' Association, and the American
Medical Society for Sports Medicine.
I'd like to highlight three elements of how USA Football
addresses player safety. The first of that is education. We
train more youth and high school football coaches combined than
any other organization in the U.S. Education is the core of our
Heads Up Football program, which we're going to highlight. This
is delivered through online courses and in-person clinics.
There are six educational components of this program, which you
can see listed on the slide: Concussion recognition/response,
heat preparedness and hydration, sudden cardiac arrest, proper
equipment fitting, and then tackling and blocking techniques.
More than 6,300 youth leagues and 1,100 high schools
nationwide representing about a million young athletes enrolled
in Heads Up Football in 2015.
The second element is research. USA Football advances
player safety by commissioning independent research. According
to a 2014 youth football study encompassing more than 2,000
players, leagues that participated in the Heads Up Football
program showed a 76 percent reduction in all injuries during
practice, 38 percent reduction in all injuries during games, 34
percent fewer concussions during practice, and 29 percent
decline in concussions during games.
A subset of this group showed that players and leagues
enrolled in Heads Up Football had two to three fewer head
impacts of 10 Gs or greater during practice, which may equate
to more than 100 fewer impacts in a season.
On the high school level, Fairfax County Public Schools has
reported a 43 percent decline in football-related concussions
since 2013 for 3,000 players since implementing Heads Up
Football, and a 24 percent decline in overall football
injuries.
And, finally, we'll highlight innovation. USA Football
provides practice guidelines, practice planning tools, and
defined levels of contact. You can see the levels of contact
listed there on the slide, including air; bag; control, which
is a noncontact or nontaking down to the ground drill; thud,
which is a controlled drill where you are not taken down to the
ground, but there is contact; and then, finally, live action,
where you are taken down to the ground.
More young footballers than ever are learning the
fundamentals of gradually and appropriately tackling before
advancing to full contact. Where USA Football's programs are in
place, today's youth and high school football is not the same
as what it used to be for your children or what you may have
watched.
We'll conclude with a video showing the difference that USA
Football and Heads Up Football are making.
[Video shown.]
[The prepared statement of Dr. Gregory follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Murphy. Thank you.
Now we'll hear the testimony of Mr. Margarucci. You're
recognized for 5 minutes.
STATEMENT OF KEVIN MARGARUCCI
Mr. Margarucci. Thank you, Chairman Murphy, Ranking Member
DeGette, and distinguished members of the subcommittee. It's a
privilege to be here today on behalf of USA Hockey to discuss
the issue of player safety.
USA Hockey takes safety as a top priority and always has
and has been one of the leaders in safety among youth sports
entities. The safety starts with our leadership and goes on
down to the rest of our organization, from our president, Jim
Smith; our executive director, Dave Ogrean; our chief medical
and safety officer, Dr. Michael Stuart, from the Mayo Clinic in
Rochester, Minnesota; the chairman of our Safety and Protective
Equipment Committee, Dr. Alan Ashare from the St. Elizabeth's
Medical Center in Boston. He chairs a committee that has been
around for some 40 years, which guides our board in making
safety policies for our sport.
The USA Hockey Foundation yearly awards grants in the area
of injury prevention and research with ice hockey injuries.
Recently, I was hired as manager of player safety, a full-time
position at USA Hockey, which further shows a commitment to
safety in our sport.
And, finally, we've had the Hockey Equipment and
Certification Council, which was urged to be formed by USA
Hockey in 1978. This is an independent body which studies the
equipment that manufacturers produce and makes sure that meets
the standards for protection in ice hockey.
When we look at prevention, we start with our rules
enforcement. We have a very strict officiating education
program, which involves online modules for refs at every level,
classroom work, and on-ice clinics. At every level, once
officials are working, they are supervised, mentored, and given
feedback, and shown videos of proper rule enforcement to make
the game safer.
We have implemented stricter penalties, with emphasis on
boarding, charging, checking from behind, and head contact. In
2009 and 2010, our rule book focused on the standards of play
and emphasis on body checking. In 2011, our executive board
ruled to make a rule change which increased the legal age of
body checking in our sport from 12 and under level to the 14
and under level. This decision was based on a lot of scientific
research, not only on player skill development, but also safety
and injury risks between those age groups.
In 2009, USA Hockey created the American Development Model.
This model is an age-appropriate skill development and training
based off of research of long-term athlete development.
Our coaching education program has been a gold standard in
youth sports for years. In 2011-2012, there became online
required modules for our coaches, which include concussion
awareness and recognition in all those modules for the age-
appropriate levels.
Within this structure, we've published a checking the right
way for youth hockey, which is an age-appropriate progression
of skills required to properly body check in the game of
hockey. It starts with skating, and is always focused on
attitude, ethics, and respect for the sport and your opponents.
It goes from skating, positioning and angling, stick checking,
body contact, and then body checking.
Heads Up, Don't Duck was a program initiated by Dr. Ashare
in 1995. This was followed in 2010 by our Heads Up Hockey
program. Both programs, the emphasis is playing the game with
your head up, especially when coming in contact with the
boards, goalposts, or opponents; keeping your heads out of
taking and giving a body check; do not check from behind; and a
library of skills and drills to teach these to our players.
We educate our members constantly through information
available on our Web site; electronic communications through
newsletters to our parents, players, coaches, officials, which
often have concussion awareness and education materials in
them. USA Hockey will start publishing an electronic newsletter
specific to safety in the fall of 2016.
Currently, the Mayo Clinic sports medicine is doing
research to identify objective testing to identify those
athletes with potential concussion using blood biomarkers,
sideline EEGs, and the King-Devick Test. And this study is
funded by our USA Hockey Foundation.
Finally, on the treatment side, we have a comprehensive
concussion management program available to all of our
associations, which is the minimum standard for any USA Hockey
program to follow. And the biggest message in this is when in
doubt, sit them out.
Thank you for allowing me to speak here today on this
important topic of player safety and concussions.
[The prepared statement of Mr. Margarucci follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Murphy. Thank you, Mr. Margarucci.
Mr. Stenersen, you're recognized for 5 minutes.
STATEMENT OF STEVE STENERSEN
Mr. Stenersen. Good morning, Chairman Murphy, Ranking
Member DeGette, and distinguished members of the House
Oversight and Investigations Subcommittee of the Energy and
Commerce Committee. My name is Steve Stenersen and I serve as
CEO of U.S. Lacrosse, the sports Maryland-based national
governing body.
Our nonprofit organization has proactively led and funded
many sport-specific prevention and research initiatives that
have resulted in a number of interventions in the areas of
rules, equipment, and education. We also participate actively
in the efforts of numerous national collaborations focused on
reducing injury risk in youth sport, which I have referenced in
my written testimony.
Lacrosse is the oldest sport native to the North American
continent. Native American play was first documented by Jesuit
missionaries in the 1600s. Modern rules for lacrosse were first
adopted in the late 19th century, but two distinctly different
versions of the sport for men and women evolved in the first
half of the 20th century. Lacrosse has experienced an
unprecedented surge of popularity in recent years, in part due
to the formation of U.S. Lacrosse as the sport's first national
governing body in 1998.
U.S. Lacrosse established a Sports Science and Safety
Committee when the organization was formed, and that committee
is comprised of prominent medical and research professionals
representing a variety of specialties, as well as
representatives from a number of multisport organizations.
We've been described as one of the most proactive sports
organizations in the country relative to our commitment to
injury prevention, and we were recognized for our efforts in
that regard last May through the introduction of a
congressional resolution, H.R. 267.
Our Sports Science and Safety Committee prioritizes and
oversees research initiatives, recommends interventions to the
U.S. Lacrosse board of directors, and leads the development of
educational initiatives intended to reduce injury risk and
directed to coaches, officials, players, and their parents. My
written testimony includes references to the published research
and safety interventions U.S. Lacrosse has led.
We also have invested significantly in the development and
deployment of the sport's first standardized coaching/
officiating curricula. Unfortunately, public focus is too often
directed at equipment interventions, which are less effective
in preventing injury than assuring that players are properly
taught and games are properly officiated. Among the biggest
challenges we face is convincing youth leagues and State high
school associations that requiring our standards for lacrosse-
specific coach and official education is fundamental to a safer
and more enjoyable playing experience.
The prevention of lacrosse-related concussion has been a
particular area of focus for U.S. Lacrosse, and we've committed
considerable time and resources to concussion education,
research, and prevention. The benefits of playing youth sports
are well documented. And while lacrosse is considered to be
relatively safe compared to other sports and activities,
serious injuries, such as concussions, occur.
There is much we have learned about the nature of
concussion in recent years, particularly the critical
importance of recognizing symptoms and removing children from
play until cleared by a medical professional trained in
concussion management. We've also learned that no piece of
protective equipment on the market today can prevent a
concussion; that the mechanism of injury is different from
sport to sport; and in the case of lacrosse, different in boys
lacrosse than girls lacrosse.
We've learned that the injury and its recovery can be a
very different experience for girls than boys, which demands
further focus and study. And we've learned that increased sport
specialization at younger ages is increasing the number of
injury exposures for young athletes and contributing to
increases in overuse injuries on developing bodies.
Perhaps most importantly, we've learned that the vast
majority of children who experience a concussion can recover
fully if their injury is recognized quickly and they receive
proper care.
Concussion remains a significant health concern in youth
sports and it will remain a priority for U.S. Lacrosse.
Accordingly, we'll continue to invest in research that helps us
learn more about the mechanism and frequency of the injury in
both boys and girls lacrosse in order to advance educational,
rule, and equipment interventions most effective in reducing
injury risk.
Thank you for the opportunity to share my thoughts on this
important issue, as well as your efforts to increase the health
and wellbeing of our Nation's young athletes.
[The prepared statement of Mr. Stenersen follows:]
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Mr. Murphy. Thank you, Mr. Stenersen.
Mr. O'Neil, you're recognized for 5 minutes.
STATEMENT OF TERRY O'NEIL
Mr. O'Neil. Mr. Chairman, thank you.
Mr. Murphy. Would you put your microphone on, please? Is it
on? There should be a light. And just pull it as close to you
as possible.
Mr. O'Neil. So, Mr. Chairman, we'd like to begin, if we
may, with a sound bite, 30 seconds from Dr. Ann McKee, which
follows on many comments heard earlier this morning. Dr. McKee
is one of our colleagues. These were her comments 2 months ago
during your roundtable.
[Video shown.]
Mr. O'Neil. ``Immediately,'' Mr. Chairman, a word we heard
this morning as well, and that's our middle name: immediately.
Let me begin by saying here's where we started with our
chase for immediate results. The National Football League, 32
teams, 2,000 players, as you know, practicing for 5 months in
regular and postseason. There were 271 total concussions in the
NFL this last year, 271. Question: Not in the games, but in
practice, how many concussions do you think on NFL practice
fields last season? Answer: Eight, because they've learned how
to practice. Those eight concussions in a universe of 271
represents 3 percent.
So now the big question. What is that number in high school
football, do you think? What percentage of high school football
head trauma occurs on the practice field? Sixty to 75 percent.
The worst, most shameful statistic in all of football, and this
is the reason we're in business. This is the reason why a
number of Hall of Famers, at no appearance fee, chase around
the country with us; among them Warren Moon, Anthony Munoz,
Tony Dorsett, Mike Ditka, showing high school coaches on video
how to practice with less contact. These men do this generously
because they believe this is the future of football.
So let's quantify our recommendations. We're going to show
you how they practice in the pros.
[Video shown.]
Mr. O'Neil. This is called full-speed-to-contact practice,
which means they run the play full speed to get the timing, the
pacing, the choreography of the play, but at the last moment,
the moment of imminent contact, rather than tackle, they break
away from each other. It's football ballet, as you see it here.
Here's Dartmouth College.
[Video shown.]
Mr. O'Neil. You'll see a pass down the middle. A safety in
practice here could light up this receiver with a perfectly
legal hit, but it's his teammate, so at the last minute, he
veers away from it. He'll save that tackle for Saturday. OK?
In the NFL, Cleveland Browns, watch number 22 in white
here. He'll track this play full speed. Everybody stays on
their feet, because only bad things happen when you go to the
ground. He tracks the ball carrier, but at the moment when he
might tackle, he stops and let's the ball carrier continue. 48
in brown, lead block here, one of the most vicious hits in all
of football. What's he do, 48 in brown, he comes--he identifies
the player to be blocked, he comes to him, sinks his hips and
just lays his hands on him. And what about this defensive back
in the shadow? Is he going to tackle on a Wednesday or a
Thursday? No. He did everything to put himself in position
except make the tackle.
Seattle Seahawks, same thing. Are they going to tackle a
teammate in the middle of the week or save it for Sunday? They
save it for Sunday.
Contrast that now with high school football. Here's a high
school scrimmage. A quarterback has four teammates with their
hands on him. Are they going to hold him up, wrap him and hold
him up, or take him to the ground? This has been a good
practice exercise for everybody involved. We've learned a
little something from it.
Let's go back to the quarterback. Did we take him to the
ground or wrap him up and hold him? We took him to the ground
and broke his wrist. Totally needless.
At this same high school in Connecticut, a young man named
Cody Gifford played, son of Frank and Kathy Lee Gifford. Frank
was a colleague of mine at ABC Sports many years ago. Cody
actually made the team at USC as a walk-on. You can't believe
how proud his father was. My son, Liam, also played at this
same high school. He's now a backup quarterback at Tufts.
Frank Gifford and I used to talk about this frequently, and
one day we sat and we put together the composite injuries in
high school between our two sons, the concussions, the
fractures, the knee ligaments. How many of those 10 major
injuries do you think occurred in games and how many in
practice? Two in games, eight in practice. Utter madness, Mr.
Chairman.
So what do we recommend to rectify the problem? We are the
only organization of the five national organizations who
operate in this space that's committed to an immediate
abolition of contact football below the age of 14 and ninth
grade. We want to convert those leagues to flag. No contact
until ninth grade.
Once in high school, no full contact in spring, summer, and
off season; 3 hours total in preseason; 30 minutes a week
during the season.
Mr. Murphy. We're going to have to wrap up so we can
continue on.
Mr. O'Neil. How does this compare to the other major
organizations operating in this space? National Federation of
High Schools and USA Football, which operate in concert, allow
three times as much contact as we do, Pop Warner four times as
much contact as we recommend, and the NCAA six times as much as
we recommend.
[The prepared statement of Mr. O'Neil follows:]
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Mr. Murphy. Thank you. And during questions, if there's
other conclusions you want to make, we'll--we're way over time.
Dr. Comstock, you're recognized for 5 minutes.
STATEMENT OF R. DAWN COMSTOCK
Dr. Comstock. Thank you, Chairman Murphy. It's an honor to
be asked to testify before this committee, particularly
representing Colorado's School of Public Health at the
University of Colorado Anschutz Medical Campus as a--under
Congresswoman DeGette's in her State.
I'm here today because I run the National High School
Sports-Related Injury Surveillance Study. I've done so for the
last 11 years. In effect, I've dedicated my entire career to
trying to improve high school athletes' safety, not because I'm
a policymaker or a clinician, but because I collect the data
that's needed to drive informed, evidence-based decisions. I
want to share just a few examples today and describe why those
are so important.
This first slide shows some high school RIO data, just
simple concussion rates over time. You can see that concussion
rates were stable for a few years before dramatically
increasing, in fact, doubling between 2008 and 2012. They've
leveled off in recent years.
Understanding trends over time like this is crucially
important both so that we can evaluate the magnitude of the
problem, but also so that we can determine which interventions
may, in fact, be effective and which ones may not. Only long-
term surveillance information can provide this data.
This next slide shows that some of the information I heard
a little earlier that, you know, we don't want to wait to try
to do intervention work because we don't want to wait for the
years and years it takes to collect the data; we don't have to
wait. I intentionally put just 1 year worth of high school RIO
data up here to show you that, even with 1 year of
surveillance, we can look at patterns and trends across sports,
across genders, across type of activity. And this is just the
tip of the iceberg.
I capture up to 300 variables on every concussion that's
reported to my system. I can literally tell you when, why,
where, how, and to whom each concussion occurred. This data can
drive evidence-based intervention efforts.
And I and many other researchers in the United States have
the drive, the desire, the resources, technological and
methodological, and the experience to be able to do this work
at the youth level, just as it's currently being done at the
collegiate and high school levels. What we don't have is the
funding.
Injury surveillance can also demonstrate positive outcomes
as well; very important. This slide shows that we've actually
had a big success when it comes to managing high school
athletes' concussions. In the 2007-2008 academic year, 30
percent of high school athletes diagnosed with a concussion
returned to play in less than 7 days, which is a violation of
accepted return-to-play guidelines. And disturbingly, 8 percent
returned to play the same day they were injured. That's
unacceptable.
Look at how things have improved. Last year in 2014-2015,
less than 10 percent of all athletes returned to play within 6
days, and less than 2 percent returned the same day they were
injured. This is the result of prevention; not equipment
prevention, but education and regulation prevention. Effective
prevention in public health, we talk about three legs of a
stool. Equipment is one piece in terms of concussion, but
educating individuals and providing good, strong policy based
on evidence are the other two legs.
I would love to come away from the efforts of this
committee, incredibly important efforts, with the ability to do
this work at the youth level. Currently, no one can give you
this type of data for children playing sports who are younger
than high school age. That's a travesty. We've got to protect
our children who are playing sports because we want them to
play sports.
I'm not against sports, not even against contact sports.
Despite my appearance, I played rugby for 13 years. Yes, I'm
only 4' 11''. I played rugby for 13 years. I appreciate the
fact that participating in sports is a very important way that
children can incorporate physical activity as part of a daily,
healthy lifestyle.
We need everyone sitting at this table and our policy
representatives, like the distinguished members of this panel,
to work together to drive evidence-based prevention practices
now. We don't want to wait for 30 years to learn about long-
term consequences of concussion. That's secondary and tertiary
prevention. We need primary prevention. I already know that
concussions are bad for us. I want to keep kids from being
injured in the first place.
Thank you.
[The prepared statement of Dr. Comstock follows:]
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Mr. Murphy. Thank you very much, Doctor.
Now, Dr. Talavage, you're recognized for 5 minutes.
STATEMENT OF THOMAS M. TALAVAGE
Dr. Talavage. All right. Thank you very much, Chairman.
So I'm Thomas Talavage. I'm a professor of electrical
computer engineering and biomedical engineering at Purdue
University, founding codirector of our MRI facility. I've been
a member, in recent years, of the NCAA's Task Force on
Concussions and I'm a member of the Scientific Advisory Board
for the NCAA-DOD CARE Consortium. And I'm also one of the
founding members of the Concussion Neuroimaging Consortium,
which is a multi-institutional effort to bring together the
researchers who have a history of publishing and doing research
in the area of concussion and traumatic brain injury together
to solve many of these problems. I serve for the Purdue
Neurotrauma Group as our specialist in neuroimaging, and I'm
also the lead PI for the Purdue College of Engineering's
preeminent team on engineering healthier brains.
As a rabid sports fan of the Pittsburgh Steelers and the
Pittsburgh Pirates and the father of four very, very active
young children, this is an issue that is very near and dear to
my heart and has been for a long time.
As a part of the Purdue Neurotrauma Group, I just wanted to
summarize really quickly that our goals and our proposal into
the future is to achieve safer participation in youth sports.
Our goal here is to make sure that more children can
participate in sports more frequently without really risk of
injury, or at least a reduced risk of injury to something that
is acceptable to us, such as riding a bicycle or playing
baseball or playing basketball.
Our goal is to achieve the same through the education of
athletes, parents, coaches, and health care providers regarding
the risks of not only concussive, but also subconcussive
injuries through engineering-based improvements in protective
equipment, through modeling and appropriate preventative
methodologies that allow us to monitor exposure to head
injuries and the risk of head injuries, and, finally, through
techniques such as have already been described with improved
training of athletes.
Through the past 7 years, our pioneering study has been
engineering based as following the model illustrated on the
slide, where we're applying structural health monitoring, a
technique developed from basic materials and basic structures
in our everyday world, whether they be planes, bridges,
automobiles, where you essentially do nondestructive
evaluation, you document that a material is in good health
before you continue forward with its use, and as that material
starts to exhibit some sort of change, you effect either
repair, or in the case of some materials, you allow them to
rest, allowing them to recover.
This methodology has been applied now, as I said, for 7
years in the study of high school girls playing soccer and boys
playing football. And our study, though, applying this
methodology began like most of the other studies in this
domain, where our real initial effort was to understand why
some kids got a concussion and some kids didn't. But what we
discovered very rapidly and has essentially driven our research
since that time is that, in truth, many of the children who we
think are not injured are, in fact, showing changes in their
physiology, changes in their brain that are strongly suggestive
of underlying brain injury.
And what's really critical is that not only are athletes
who are supposedly healthy, who do not have signs of a
concussion, who are not diagnosed or even examined by their
team's athletic trainer or their team's physician as having a
concussion, will look abnormal in this manner for up to 5
months after the season, which means that they may be spending
8 to 9 to 10 months of the year in an abnormal state.
So while we already know ahead of time that it's never a
good idea to hit your head, the question now becomes how long
is it that these athletes are injured and what can we do to
prevent that injury in the first place? So our study has, as
I've already mentioned, been going for 7 years, and if we are
able to find funding some time in the future, we will continue
to study, ideally later this year.
I only wish to be working from this methodology with the
goal being that if we understand how inputs, in this case
mechanical inputs of heads being hit, whiplash events from the
body being hit and the head snapping to the side, snapping
forward, or rotating abruptly, will allow us to understand how
each of those events affects the brain. Then we can go back and
now correctly develop protective technologies, helmets, that
will in fact prevent concussion rather than merely skull
fracture. We can develop appropriate methodologies for
identifying when an athlete should skip a practice, because
clearly we want the kids to miss practice, not the games, and
that's obviously what the kids want. And we will also then be
able to evaluate whether or not recovery has been truly
complete. Can we actually document that an athlete who has been
pulled and is getting ready to return to play looks healthy
enough that it makes sense for them to go back into play?
So with that, we really feel, as the Purdue Neurotrauma
Group and as myself as a researcher in engineering, that most
of these changes can be made with no cost to the enjoyment of
the game, but they are very likely to improve the freedom or
the comfort to engage in these activities without any
substantial consequences beyond those associated with other
noncollision sports, such as baseball, bicycling, or whatever.
And we really feel that the science is far enough along, that
these changes should be made now rather than to wait any more
time such that 30 million kids every year are exposed to
potential injury. There is no reason not to act.
[The prepared statement of Dr. Talavage follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Murphy. Thank you, Doctor.
I do want to recognize--I'm going to start off with some
questions here and let the members know that we're going to try
and continue this. There will be one vote at some point. We're
going to try and continue on and roll through that vote. So
we'll just start.
I do want to recognize in the audience, we have Nick
Lowery, Nick the Kick, right, played for the New England
Patriots, the Jets, and the Chiefs. Good to have you here
today. Thank you for your interest in concussions.
Also, Shawn Springs from the Ohio State, also the Redskins,
Patriots, and Seahawks. I think you were the number one pick
for the Seahawks, Pro Bowl. Both of you played Pro Bowl. Thank
you for your interest also in concussions.
And a former colleague, Phil ``the Doc'' Gingrey, is here
as well. We appreciate you coming back. I do want to say he
didn't make the Georgia Tech team, but I do understand you
drove the mascot car, the Ramblin' Wreck. So it's nice to know
your skill sets were seen where they were placed by Georgia
Tech. It's a good thing.
All right. I now recognize myself for 5 minutes.
This goes to Dr. Gregory, Mr. Margarucci, and Mr.
Stenersen. From the perspective of a youth sport organization,
what are the greatest needs in terms of research related to
concussions and player safety? Can you comment on those?
Dr. Gregory. Sir, for clarification, the greatest needs?
Mr. Murphy. Yes.
Dr. Gregory. So my first response would be to agree with
Dawn Comstock that we have these databases in college and high
school, and we don't have them in youth sports. And so
establishing a database for youth sports injury, I think, is
imperative.
Mr. Murphy. Mr. Margarucci, do you have a comment on that?
Mr. Margarucci. Yes. I would echo Dr. Gregory's statements,
that we do need to have a database of injuries that are
occurring in our youth sports so we can make these decisions.
And it's hard--we don't want to wait for the future, but we
need to start, I think, gathering some of this information
right now.
Mr. Murphy. Mr. Stenersen?
Mr. Stenersen. I would agree. I mean, each of us as sports
is trying to do our best to fund research to our
nonprofitabilities, but we need greater resources here to be
able to drive that research into the youths' play area.
Mr. Murphy. So along those lines with research, do you
encourage coaches? Is there a way to help coaches and teams
also keep track of their own database? This also, I assume,
Coach Teevens too, that coaches keep track of their own data to
see what happens at their own coaching style as a comparison.
Would any of you like to comment on that?
Mr. Stenersen. Well, I would say, and Dr. Comstock probably
has a word here, but the challenge with that is the quality of
the data that's collected. And unless it's collected well and
consistently, which coaches, generally speaking, are not want
to do, then we're concerned about having flawed data.
Mr. Murphy. Dr. Comstock, do you have a comment on that?
Dr. Comstock. Yes, I agree. We are concerned about the
quality of the data, and that is directly correlated to who's
reporting the data. At the high school and the collegiate
level, we rely upon certified athletic trainers, certified
athletic trainers, to report this data to us. However, I and
others have been investigating ways that we could modify our
surveillance systems to enable either a parent or a coach who
is trained appropriately and appropriately motivated to be able
to report, perhaps not 300 variables per injury, but at least
enough variables that we could drive forward a lot of these
discussions.
Mr. Murphy. And, Coach Teevens, you did record, you did
look for specific data.
Mr. Teevens. Through the conference in general overseas and
each medical team within the institutions report back. So
it's----
Mr. Murphy. And that's helpful to give the feedback, then,
along those lines?
Mr. Teevens. It is. You see where you stack up to some
other teams in your league.
Mr. Murphy. OK. So let me ask the panel too. How
significant is the issue of athletes not reporting concussions?
So if they themselves have symptoms, but they're not giving
that information on. Can you comment on that? Who would like to
comment?
Dr. Gregory?
Dr. Gregory. Yes. So I can tell you at all levels that is
an issue, that the problem's being knowing what the symptoms of
concussion are, and then if you report it to somebody, that
person knowing what the symptoms of concussion are. So I do
think that what Dawn showed with that data, that concussion
rates are actually coming back down, I think is a result of
education of coaches, athletes, players on what the signs and
symptoms of concussion are.
Having said that, I don't think we can stop there. We have
to continue those efforts so that everybody is aware of that.
Mr. Murphy. Anybody else want to comment on the player?
Yes, Dr. Comstock.
Dr. Comstock. Yes, sir. Actually, that same graph that
showed the doubling of concussion rates between 2008 and 2012,
our high school athletes didn't suddenly become twice as fast,
strong, and vicious. The years preceding that, there were
concussions occurring that just went undiagnosed, unrecognized.
So the increase in the concussion rates, I think, truly reflect
the great deal of education that's been done by individuals on
this panel as well as groups like CDC and CIPC, the National
Federation of State High School Associations, to make sure that
when a concussion occurs, it is recognized----
Mr. Murphy. So it may not have been that prior to that
increase that concussions weren't occurring, it's just they
were just getting reported?
Dr. Comstock. Exactly.
Mr. Murphy. And that means educating the players as well as
the importance of doing this.
Dr. Comstock. Yes, sir. And the parents and families and--
you know, the parents of these young athletes. It's important
to educate them as well.
Mr. Murphy. Do you see this as an ongoing problem with
regard to injuries that this is working or you still have a
ways to go?
Dr. Comstock. Well, I think the fact that that curve has
seemed to have peaked and leveled off, I think it actually is
an indication, coupled with the last slide that I showed that
shows how much better we're doing at managing concussions. I
think both of those speak very highly to the success that we
have had to date in educating parents, coaches, athletes,
policymakers about concussion. We still have further to go,
particularly in the younger groups.
Mr. Murphy. Thank you.
I'll yield now to Ms. DeGette for 5 minutes.
Ms. DeGette. Thank you so much, Mr. Chairman.
I want to take a look at some of the science that's out
there. And by the way, it was really an excellent panel with
everybody giving a great perspective.
Dr. Talavage, your work examines high school football
players as well as high school soccer players. Can you tell us,
from your research, about the head impacts from contact sports
and how they impact head injuries?
Dr. Talavage. Yes. So what we've observed through our 7
years of study is that when the athletes take large amounts of
blows per week, whether they be of a modest size, such as 10 G
or above--10 G just as a reference, if you just stand up and
drop down into your chair, you will generate roughly 10 times
the force of gravity acceleration on your head.
So when players are taking numbers of 60 to 70 blows per
week in football, for example, then those male athletes tend to
start showing alterations in their brain physiology that are
suggestive of either damage to neurons or at least some sort of
impairment in the way information passes around your brain, and
ultimately results in you being able to respond to a question
or to answer a task or to achieve a target on a game or
particular activity.
For our female soccer players that have been in our study,
they do not take quite that number of blows, but one of the
things we have observed is that they get hit pretty much every
day. So in the State of Indiana, high school football is able
to practice 2 days per week plus have a game. Soccer, there is
no restriction. They tend to practice 5 to 6 days per week.
So we do find that not only are there changes from the
actual raw number of blows, how frequently they're getting hit,
but there strongly appears to be a consequence of how much time
off are they given, which would suggest that there are natural
repair mechanisms that we can exploit. And I believe that when
we have these reduced contact cases, we are in fact benefiting
our athletes.
Ms. DeGette. Thank you. We had a forum in this committee in
March, you heard us talking about it, and at that forum, there
were some researchers who suggested that we don't have enough
science to act on this issue, and they said we should wait till
there's more research. What's your response to this line of
questioning? Very briefly.
Dr. Talavage. I don't believe that.
Ms. DeGette. And that's because you actually have
scientific research?
Dr. Talavage. We have now about 16 papers in publication
and we are working now with several other institutions around
the country, including Penn State University, Northwestern
University, Ohio State University, Michigan State University,
and University of Nebraska to publish work that shows that
there are, in fact, changes in the brain when you----
Ms. DeGette. If you wouldn't mind getting that data to this
committee, that would be very helpful for us in our
investigation.
Dr. Talavage. Be very happy to.
Ms. DeGette. Thank you.
I just want to ask you a couple of questions, Dr. Comstock,
about gender differences in concussions and head trauma. The
surveillance data you collected shows that girls soccer has one
of the highest rates of reported concussions among high school
sports. What do we know about gender differences in concussion
rates? Are girls more likely than boys to get concussions?
Dr. Comstock. Yes. That's a million-dollar question, if you
will. We first reported in 2007 that in gender-comparable
sports, so sports that both boys and girls play by the same
rules, using the same equipment on the same fields, sports like
soccer and basketball, girls have higher concussion rates than
boys. That's now been replicated by other researchers in other
populations.
What we don't know at this point, people are working on the
question, is, is it a biophysiological problem, are girls
somehow----
Ms. DeGette. Right.
Dr. Comstock [continuing]. Different----
Ms. DeGette. Right.
Dr. Comstock [continuing]. And are they really sustaining
more injuries, or is it a sociocultural issue? Because we don't
have a definitive, objective diagnostic test for concussions,
we're reliant on self-reports, and young female athletes may be
more likely to report it when they're experiencing signs and
symptoms.
Ms. DeGette. But do we need to get more data?
Dr. Comstock. Well, we already have the data that's
consistently shown this gender difference. We do----
Ms. DeGette. But what do we need to prove, then?
Dr. Comstock. So this is one case where surveillance data
isn't enough. We do need more detailed research to try to
determine are there biophysiological differences or is it a
sociocultural issue.
Ms. DeGette. And, Dr. Talavage, you're nodding your head
yes, you agree.
Dr. Talavage. Yes. I mean, this is exactly what the intent
of our type of study is. If we can understand how the brains
are changing, we can determine whether or not it takes less to
do it.
Ms. DeGette. And you've got girls and boys?
Dr. Talavage. We have girls and boys, 5 years----
Ms. DeGette. Now, Dr. Comstock, I'm almost out of time. I
just want to ask one more question.
Dr. Comstock. Yes, ma'am.
Ms. DeGette. You say that there's no data for--there's no
surveillance for under high school ages. Do you think this is
something that should be instituted so that people like you can
get that data to see exactly what's going on?
Dr. Comstock. Yes. I would love to do it. I'll give you the
name of ten other researchers that can. This is imperative.
Ms. DeGette. Who should set it up?
Dr. Comstock. My work has not been federally funded. I've
had nine different funding sources in 11 years of surveillance.
The NCAA funds their own system. I think it should be a Federal
effort, but I don't care if it's a joint effort of every one of
these organizations of youth sports. Somehow we have to get it
done.
Ms. DeGette. One has to do it.
Dr. Comstock. We have to get it done.
Ms. DeGette. Thank you very much. Thank you for coming.
Mr. Murphy. Thank you.
Just to remind members that votes are called. We're going
to continue to roll through.
Dr. Burgess, you're recognized for 5 minutes.
Mr. Burgess. Thank you, Mr. Chairman. I thank the panel for
being here this morning.
Coach Teevens, can I just ask you, I mean, your testimony,
when I read through it last night, it was like, wow, this is a
revelation, and it seems so obvious. Once you understand that,
oh, my gosh, this is a repetitive injury, so you're not
repeating the injury during practice, and so the only contact
is on game day. But that must have been kind of a hard decision
to make, because, I mean, when I was a kid growing up, it was
always repetition, repetition, repetition, practice, practice,
practice. Remember the old commercial? So what----
Mr. Teevens. When I announced it to my coaching staff, they
were waiting for the punch line. They thought I was kidding.
But I put enough time and effort into it. I thought it was the
appropriate approach to reduce injury with my players.
Mr. Burgess. And you feel now--of course, you, what, 5
years into this, you feel you have----
Mr. Teevens. It's made a decided difference in the way that
we practice, the safety. Peripheral injuries have dropped as
well, just the confidence. My frontline guys practice through
the course of the season. Defensively I had two players miss
games this year. One had a high ankle sprain, and at our
discretion we kept him out. Another had a lacerated kidney, a
leg whip, a freak incident, he missed five games. That was it.
So the regularity and the players--and I tell them, the
rules of the game are get the guy on the ground; not injured,
get him out of the game, get him on the ground. And you can
teach that skill set. And we just--we practice it extensively,
and I think we do a very good job, understanding it's an
injurious--there's a risk playing the game, and we can minimize
the risk.
Mr. Burgess. Let me ask you this, and maybe you--and I'm
sorry I wasn't here for your testimony, but when you go back
and look at your record prior to instituting this program and
in the years since, is there a marked difference?
Mr. Teevens. We were 0 and 10, 2 and 8, and we ended up the
last two seasons 8 and 2, and this past year 9 and 1.
Mr. Burgess. So you've become remarkably better as a coach
in that time?
Mr. Teevens. Yes. Appreciably better, appreciably so.
Mr. Burgess. Well, that's, again, fascinating story. It
seems so obvious when you look at it. OK. Repetitive injury:
We're going to reduce the risk by reducing the repetition,
then--I, you know, certainly want to thank you for----
Mr. Teevens. Quite simply, the more you hit, the more you
get hurt.
Mr. Burgess. I want to thank you for bringing that----
Mr. Teevens. Thank you, sir.
Mr. Burgess [continuing]. To the committee today. I don't--
I mean, again, I don't know that I was aware of that. I don't
know how I would have been aware of it.
Mr. O'Neil, I wanted to ask you, because, you know, when I
first started reading your testimony and Practice Like the
pros, and I thought, oh, my gosh, that would be dangerous,
wouldn't it? Because, I mean, those are the guys that really--
dreadful stories you read about people who actually try to hurt
each other in a game. But you had the observation with watching
a practice that you said it was almost like a ballet. Is that--
do I understand that correctly?
Mr. O'Neil. Yes, sir, it is, in that, as we pointed out
with the video, the players execute every aspect of the play in
rehearsal for Sunday until the moment of imminent contact, at
which point they break away from each other and pat each other
on the back.
In the high school level, the proof of the efficacy of this
is in the State of Wisconsin, the only State that is adhering
to our standards at this point, put the standards in 2 years
ago for the 2014 season. The University of Wisconsin Medical
School did a study that year, the results published last
October. Wisconsin high school football cut its concussions by
more than half simply by adhering to our standards. That's a--
that is a breathtaking number in our business, to cut your
concussions by more than half in 1 year. The quality of
Wisconsin football has never been better, the players are fresh
and ready to play. It is the high school model of what Mr.
Teevens is describing at Dartmouth.
Mr. Burgess. And has there been sort of widespread
acceptance of that in the high school level?
Mr. O'Neil. I'm glad you asked. Coach Teevens and I went to
the Wisconsin high school clinic about 7 weeks ago in Madison.
Because of these restrictions and because the coaches need to
know how to practice with less contact, we had enormous
attendance, more than 125 coaches. And the greatest followup
that we've experienced in our 30 clinics around the country,
more than half of those coaches asked for copies of our videos
so that they could take them, show them to their staffs, show
them to their players, and teach their players in the 30
minutes, just 30 minutes of contact per week in practice, how
to practice like pros or like the Dartmouth Big Green.
Mr. Burgess. You know, I can't help but observe that Emmitt
Smith won ``Dancing With the Stars'' a few years ago, probably
based on that same concept. Because weren't some pro players
using essentially dance moves and ballet moves to improve their
performance?
Mr. O'Neil. They were. And, Congressman, this--this
approach of less contact in the pros actually dates way back to
Bill Walsh at the 49ers in the 1980s, and has been refined and
developed by his disciples along the way to a point where so
many college players look forward to entering the pros in order
to avoid the carnage of 90 minutes, twice a week, full contact
in college practice, and instead practice the way the Dallas
Cowboys have for many years.
Mr. Burgess. Thank you very much.
Thank you, Mr. Chairman. I yield back.
Mr. Murphy. I thank you.
I now recognize Ms. Schakowsky for 5 minutes.
Ms. Schakowsky. First of all, I want to thank the moms that
were here. I want to thank Kelli Jantz and Karen Kinzle Zegel.
Mr. O'Neil, you showed that video of Dr. Ann McKee
answering my question at that----
Mr. O'Neil. Yes, ma'am.
Ms. Schakowsky [continuing]. At that roundtable. And I
wanted to focus on CTE, because I think very little focus has
been on the subconcussive brain injuries. And as she said, it's
about limiting the head injury that occurs on every single play
of the game at every single level of the game. And I followed
up that question to Jeff Miller of the NFL, he's the chief
person for health and safety, and said, what do you think? Is
it--is CTE linked to football? And he said, ``Yes, certainly.''
And little did I know that this was a kind of explosion
that happened outside, outside that room, and even has started
some conversation about what is the future of football? Is
there a future for the kind of football that we play?
So there's been a lot of talk about concussion, but I
wanted to ask now more about CTE. So, Dr. Talavage, what does
your research indicate about the effect that routine hits
sustained by high school football players and younger have on
brain function, even though they don't rise to the level of
concussion? What about CTE?
Dr. Talavage. So at this point, the linkage to CTE is a
little bit nebulous from our--coming from our end. Obviously,
from Ann's end, where you're able to look and see that
individuals who have experienced larger numbers of hits over
their career and over their lifespan tend to have more deficits
and tend to be more likely to evidence CTE, as per brain banks,
I think there's at least good circumstantial evidence for there
to be a clear linkage between the total exposure and the total
amount of brain stress that's accumulated from getting hit
repeatedly day after day after day, year after year.
Within our own athletes, though, what we can at least
identify is that our athletes spend probably 5 to 8 months of
the year in what appears to be a state of almost chronic
inflammation. And when you have chronic inflammation, we know
in the rest of the body that's a bad thing in the context that
the cells are not able to eliminate waste, they're not able to
bring in nutrients to keep those cells healthy.
And so if what we're seeing is, in fact, proven to be true
in our continued study, that we do have a level of chronic
inflammation essentially for 5, 8 months of the year, then we
are definitely putting our athletes at risk of precisely the
types of biochemical processes that are going to lead to CTE.
Mr. Schakowsky. Is there any test for CTE before an autopsy
after death?
Dr. Talavage. There are several imaging methodologies that
propose to identify the presence of Tau biomarkers within the
body, but there's nothing that has yet been confirmed.
Mr. Schakowsky. My understanding is the kind of
subconcussive events have to do with the brain inside the
skull, and has virtually nothing to do with helmets?
Dr. Talavage. So a helmet can, in fact, absorb energy, and
it would be very easy, in fact, to improve helmet designs, but
the companies aren't terribly interested in it at this point.
Their goal is to meet the standards. The standards that are set
forth are to prevent skull fracture and death on the field,
which is clearly a goal, which they are very effective, but
they do nothing to prevent concussion at this point in a
meaningful sense. Energy absorption would reduce the amount of
energy that reaches the brain. If you reduce the amount of
energy that reaches the brain, you are going to reduce the
amount of torsion, pulls, stress, compression on the cellular
tissue. And if you do that, you will, in fact, start to see a
reduction in the consequence of subconcussive hits. You should
see a reduction in the observation of concussion, and you
should, in the long term, see the reduction in the situation
such as CTE.
Mr. Schakowsky. Dr. Comstock, you don't think that kids
under what age should be playing tackle football?
Dr. Comstock. That's actually--I've never made any
recommendation.
Mr. Schakowsky. Oh, I thought you said something about it.
Dr. Comstock. Yes. I am aware of other researchers that
have given exact cut points.
Mr. Schakowsky. Did someone on the panel say that?
Mr. O'Neil. I did, Your Honor--Ms. Schakowsky. Our
organization is the one in five national organizations
operating in this space that believes strongly that grade
school boys and girls should play flag football exclusively,
and that contact football should start in ninth grade with a
transitional phase in seventh and eighth grade where in shorts
and T-shirts, boys who intend to play in ninth grade begin to
learn how to tackle and how to block using the state-of-the-art
in tackling technique called Sea Hawks tackling pioneered by
the coaches, Pete Carroll and Rocky Seto of the Seattle
Seahawks; Mr. Seto, being one of our leading supporters and a
fellow who tours with us and had made a number of videos for
us.
Mr. Schakowsky. Now, there's been a good deal of pushback
after Jeff Miller made his--his comment, Jerry Jones, the owner
of the Dallas Cowboys, you know, has absolutely disregarded
that. There's actually been some mocking of that, and this idea
of the conduction between manliness and football, I think, is
really concerning. And I wanted just to ask--let's see. I had a
couple of other questions.
Dr. Gregory, I am particularly--you know, if once all the--
well, let me ask you before my time runs out. That USA
Football's guidelines limit full contact practices to four
times a week, but I note that this represents more contact
practices than at current higher levels of football, such as
the college level and even in the NFL.
So, you know, given all this evidence about repeated hits
to the head, why hasn't USA Football taken steps to further
limit full contact practice for young children?
Dr. Gregory. So the question is a good one, in that we
recognize that tackling causes injuries. If you look at data
that we do have in youth football----
Mr. Schakowsky. My time is up. So why haven't you?
Dr. Gregory. So what we have instituted is ways of trying
to decrease the number of hits that there are. The concern is
if you take it away completely----
Mr. Schakowsky. What about the four times a week?
Dr. Gregory [continuing]. If you take it away completely,
you still have to learn the skill. At the youth level, we don't
have the resources that you have at the high school or college
level to teach the skill. That's what we're trying to do is
teach the skill to learn how to tackle appropriately gradually
over time. That is the goal, to do it well, to protect your
head.
Mr. Hudson [presiding]. Thank you.
At this time, I'll recognize myself for 5 minutes to ask
questions.
Mr. O'Neil, thank you for the work you do. I appreciate the
information you gave us today. You advocate that children under
14 should not be permitted to tackle, and should be limited to
high school athletes. How do we assure that young athletes
learn proper tackling techniques so when they do enter game
situations, that they are not going to resort to distinct or
more dangerous tackling, head down, whatever the case may be?
If they don't get that practice when there's--contact is not as
hard as it would be later, is there a concern of them
internalizing those techniques?
Mr. O'Neil. If staff would, possibly, allow me to queue up
a 17-second video clip----
Mr. Hudson. Sure.
Mr. O'Neil [continuing]. Of Rocky Seto, which is number 24
on our agenda here.
Coach Seto is the guru of tackling. He and Pete Carroll had
devised this system in Seattle that has become the standard in
just 2 years, introduced 2 years ago in the spring. They put
out three videos. And as I say, Coach Seto tours with us.
No, it's not that. It's a--as I say, number 23, Rocky Seto
tackling in shorts. Just to answer your question, Mr. Hudson,
is what we recommend in seventh and eighth grade, is rather
than hitting each other, these boys need to learn in shorts and
T-shirts. They need an introduction to weight training. They
need some strengthening of their necks, which I think all the
scientists here would agree is important in preventing
concussion. They need to learn how to wear the pads and be
ready with this gradual run-up to ninth grade to be prepared
without the many, many collisions involved in youth contact
football.
As we heard from Dr. Ann McKee so eloquently 2 months ago,
it's the cumulative head trauma that causes brain injury. And
you don't want to start that at age 5, which is permissible,
according to some of the organizations represented here today,
boys of 5 years old playing contact football is, in our minds,
quite surprising.
Any luck, Jake?
Mr. Hudson. We'll look at the video after.
Mr. O'Neil. I will be happy to show it to you, Mr. Hudson.
Mr. Hudson. Thank you.
So are there examples of cases where young kids have not
had contact, have been until they reach high school age where
they have been successful and----
Mr. O'Neil. Thank you for asking. Tom Brady, Eli Manning,
Peyton Manning.
Mr. Hudson. I've heard of those folks.
Mr. O'Neil. Archie Manning has waxed eloquently in The
Washington Post here just a few years ago. I think his phrase
was, God, what a great game flag football is.
My son, a quarterback at Tufts University, would not be
playing college football if he hadn't played flag instead of
contact. It taught him everything he needed about reading
defenses, making decisions, making good throws, all the
teamwork, all the character building. Believe me, those who
suggest that those qualities can only be developed in contact
football have not heard my younger son and his teammates in the
back seat of the car, as I drive them around, recounting their
victories in flag football 4 and 5 years ago.
The highlight of their athletic careers, they were already
made football fans for a lifetime. They wore the NFL Jersey in
playing flag. They came out of it healthy with an experience
that has--has made them the young men they are.
Mr. Hudson. Great. Thank you for that.
Coach Teevens, do you have any thoughts on this, just in
terms of if you wait until you are older to start learning
tackle techniques, is that going to be a problem?
Mr. Teevens. If it deprives people of an opportunity, they
are still going to catch up real quickly. One of nine kids, six
boys, we all played football in high school, and that was it,
and all had fairly successful careers. There are a litany of
people that have gone on. I don't think it's absolute. The big
thing is it to educate. If they are going to play a young age,
educate them properly, start slowly and make sure that you
deprive them of as much contact as possible.
Mr. Hudson. Thank you for that.
Dr. Gregory, you have anything you want to share on this?
Dr. Gregory. I'll only add in that I think if you are going
to take the contact away, that the education piece on how to
tackle is imperative, and that is the challenge for us in youth
sports without the resources. I will also add that USA Football
administers the largest flag football league in the country,
and so, we are proponents of flag football. It isn't USA tackle
football; it is USA Football, which is all inclusive. And so, I
think it's important that we promote flag football as well.
Mr. Hudson. Thank you.
Let's go back to Mr. O'Neil. You organization is trying to
change the culture of high school football advocating this
limited contact, more akin to what's being used at the
professional level. Is your testimony--or in your testimony,
highlight the fact that only one State has adopted your
standards so far? In light of the successful outcomes in that
State, have others expressed interest?
Mr. O'Neil. It's a good question, Mr. Hudson. What we need
is more participation from the State governing bodies around
the country. And the word is traveling. We find that when the
State governing body gets behind it, as happened in California
2 years ago, a piece of legislation passed there for the first
time in any State limiting contact on the practice field.
But they invited us out for a tour. Coach Seto of the
Seahawks, Coach Teevens, Anthony Munoz, Warren Moon, we hit
four cities in 2 days, and we had enormous participation
because the CIF, which governs athletics in California, made it
mandatory for every State--for every coach in the State. So we
saw 1,200 coaches in 2 days. We are going to Alabama in July,
same thing occurred there.
A very enlightened State, an executive director who
understands, has made our clinic, after seeing us last year,
mandatory for every coach in the State. So we will greet a
ballroom full of more than 1,000 coaches in Alabama on July the
20th.
Mr. Hudson. Great. I've got 15 seconds. Any opposition
you've received? You want to briefly describe that?
Mr. O'Neil. Oh, absolutely. I've dragged Coach Teevens to
places where there were 450 coaches at a convention, and at our
session, 20 showed up, and the other 430 were standing out in
the hallway saying that they didn't want to hear it right now.
Absolutely. It's not like we're having raging success. It's
very mixed around the country, and will be until, as I say,
until the State governing bodies at least give us a hearing and
mandate that all the stakeholders, not just the coaches, come
into the room and hear what we have to say and see it on video.
When they do, we almost never fail to convert.
Mr. Hudson. Great. Thank you.
At this time, I'll recognize Mr. Pallone for 5 minutes for
any questions he may have.
Mr. Pallone. Thank you. Earlier this year, the Ivy League
received significant press attention for their move to
eliminate tackling during regular season practices. And the
league now has no contact practices during the regular season,
as well as strict rules about the amount of contact and
practice during the spring and preseason. So I wanted to ask
Mr. Teevens--if I'm pronouncing it correctly--you implemented
these changes at Dartmouth several years before they were
adopted by the Ivy League. What motivate you to reduce the
amount of contact in your practices, and what was the initial
reaction when you proposed those changes?
Mr. Teevens. Well, the injury rate was the stimulus, and we
just had too many guys going down, like what's the story,
concussion, all that type of thing resurfacing, and it just
struck me we can do this in a better way, watching what we did
during research on tackling, and we started to do it. It was
not well received. Still not well received by an awful lot of
people. I did make a recommendation through Robin Harris at the
Ivy level, and it was a 5-minute discussion. All of the coaches
that played against Dartmouth, they know how we played, they
know how effectively we tackle, and the vote was unanimous. It
was progressive in mindset to say Hey, this is the direction we
should travel.
Mr. Pallone. And how have the rates of head injuries
changed since you implemented these no-contact policies? Have
you seen any other benefits?
Mr. Teevens. Five years ago, I was, like, most programs in
the country, maybe 15 to 20 during the course of the year, and
this past season we had two--two preexisting situations, both
young men that can no longer participate. Our defense, which
was nationally ranked, had zero concussion this year. Spring
practice last 2 years, if my numbers are correct, we've had
zero in spring practice, and that's similar to concussion
season in college football.
Mr. Pallone. Great. In your opinion, are full contact
practices necessary to ensure success on game day and for
athletes' future careers?
Mr. Teevens. No, I don't believe so. To the point of
imminent contact, you can do everything you need to; you can
replicate tackling styles on bags and pads and with sleds, and
I really believe and I tried to convince high school coaches of
this as well. You can do it at any level. I've got a 3-year-old
grandson. I have him tackle pads off the side of the couch, and
see he gets it. And I think that, again, crawl, walk, run,
mindset can introduce skill sets that would be helpful down the
road, but don't have to be practiced live that frequently.
Mr. Pallone. Now, given the research, do you think that
engaging in full contact practices three, four, five times a
week bear significant risk for young athletes?
Mr. Teevens. Without question. The more you hit, the
greater--the greater the risk of injury. And by just
eliminating, we've seen that, quite frankly, in all aspects of
our game; shoulders, necks, backs, arms have diminished
appreciably, and it's made up a better football program.
Mr. Pallone. Well, thank you.
I wanted to ask Mr. O'Neil. We've seen many different rule
changes being implemented across sports, across leagues, across
States. There has been some criticism that these rule changes
upset the integrity of the game. What do you think about the
recent announcement that Pop Warner is eliminating kickoffs and
kick returns? Will that prevent brain injuries, in your
opinion?
Mr. O'Neil. Good question, Mr. Pallone. My reaction is this
is Pop Warner's way of saying that grade school boys are not
capable, physically, of playing the game the way it's designed.
This is--they are making our argument. They are making the
argument that these boys should be converted to flag football
until they reach a physical maturity at 14 or 15 to play the
game the way it's structured. We advocate no basic changes in
the game. We also say, there will not be any further rule
changes that we don't believe that will make the game
noticeably less dangerous. The game is the game. We don't
advocate any major change to it, but we do say very strongly,
boys in grade school are not nearly prepared to play it the way
it's designed, the way adults play it. And, therefore, both
boys and girls ought to be playing flag football until boys
make a transition, if they choose, to play contact in ninth
grade.
Mr. Pallone. So just so I understand, you're not
recommending--you don't think any other changes would better
protect the kids other than if they continue with the present
play?
Mr. O'Neil. Mr. Pallone, it won't be football if we
continue to strip away the kick return, the punt return, the
three-point stance, there are any number of proposals out
there. We are opposed to all of them. We think that those are
ways--likewise, heads-up tackling, heads-up tackling is an
attempt to somehow sanitize the very difficult, very physical
act of tackling. It can't be done. Tackling is tackling. Rocky
Seto's Seahawks' tackling defines it exactly as it's done, and
should be done, at the three levels of football where the game
should be played. If boys can't tackle the way the technique
was designed, they shouldn't be playing contact football; they
should be playing flag until such point as they are ready
physically to play.
Mr. Pallone. I thank you.
Mr. Hudson. I thank the gentleman. At this time, I'll
recognize my colleague from Virginia.
Mr. Griffith. Thank you. Thank you, Mr. Chairman.
I do apologize. I took my jacket off and over ran to vote,
ran back in the rain, and I got wet. So I took by jacket off. I
do apologize for that.
Mr. Hudson. You're forgiven.
Mr. Griffith. Mr. O'Neil, my boys are 8 and 10. My 10-year-
old tried tackle football. When my 8-year-old was 7, he played
flag. It's not available for him now. Have you all done some
studies here? In all your testimony, have you done some studies
on how many kids, because they are not ready to do tackle,
actually drop out of the sport?
Mr. O'Neil. It's a very--we haven't, sir, but it's a very,
very good point. Football loses any number of good candidates
for the fact that we throw these boys in unprepared physically
at a young age.
There is a sound bite--I'm now adding sound bites that I
would like to play for you when we finish. But I have 1 minute
of John Madden, my former colleague at CBS, the coach and
broadcaster. He tells a story wherein his son coached ninth
grade football at a school in California for 15 years. And John
said to him, if you take a boy who did not play contact youth
football, and he's a pretty good athlete, match him up against
the boy who did play contact football through grade school, how
long would it take the boy who did not play to catch up with
the skills of the boy who did? Joe Madden, his son, said to
him, One week. One week it would take him to catch up to what
supposedly had been learned by a youth contact player those 8
years that he took all that head trauma from age 5 to 13.
Mr. Griffith. And I appreciate that.
I am going to have to move on.
Dr. Comstock, I was intrigued with your testimony about
young women have more concussions than young men. Do you find
that to be true? Do you have an--is that true through all age
groups, middle school, high school, and college?
Dr. Comstock. So in the age groups that we have, good
surveillance data, it has been consistent, both with my data
and other good surveillance systems, so across slightly
different populations and the high school and collegiate age
group. We, in the middle school and younger age group, we only
have very small studies of like one league or one school
district. Based on those, it appears it's also so on the
underage groups, but we don't have national data to answer that
question.
Mr. Griffith. I appreciate it. I'm sorry we have some
limited time here.
Mr. Stenersen--I apologize for my pronunciation--U.S.
Lacrosse has invested in the development and deployment of the
sports first standardized coaching and officiating education
curricula. In your testimony, you observed that properly
trained coaches and officials are the most effective
interventions for players' safety. Is that conclusion based, at
least in part, on the changes you've seen in injury rates since
deploying the curriculum?
Mr. Stenersen. In part, yes. But it's--it's more based on
kind of our fundamental belief that if you can't teach a sport
correctly, and according to the rules, the outcomes are going
to be not what you want.
So--and I would add that part of the challenge we see that
hasn't been mentioned yet is in youth sports such as soccer and
lacrosse and ice hockey, I think we are seeing a significant
privatization of the sport, which means that kids are playing
more frequently, more games, at younger age levels. And that
privatization in sports specialization is compounding this
concern in our sport.
Mr. Griffith. OK. I appreciate that. You also mention that
one of the biggest challenges is getting youth leagues in State
high school associations to buy in to your standards. Why do
you think this is a challenge? If you can be quick, I would
appreciate it.
Mr. Stenersen. Culture and tradition.
Mr. Griffith. OK. And I have to tell you, the good news is
my 16-year-old daughter had a concussion this year, and they
pulled her out for about 2 weeks. And, you know, she got it
playing lacrosse.
Mr. Margarucci, I've only got a minute left. Is there
something you haven't had an opportunity to touch on that you'd
like to? Because by the time I get a question out, the time
would be up.
Mr. Margarucci. No.
Mr. Griffith. Would you agree with these folks that the
more we can do to train folks on how to do it right and how to
do the checks right or the hits right----
Mr. Margarucci. Yes. We have a lot of that built into your
coaching education, the checking progression and everything
like that already, which we've had.
Mr. Griffith. And do you have the same buy-in difficulties
that Mr. Stenersen indicated he was having?
Mr. Margarucci. Yes, to a degree. Not all high school
associations, hockey leagues, are governed by USA Hockey, and
so we don't have any influence there.
Mr. Griffith. Right.
Mr. Margarucci. So, again, there's no uniformity,
sometimes, amongst those leagues.
Mr. Griffith. And there is a lot of privatization, not only
do you all have that, but Mr. Stenersen mentioned that, and my
8-year-old is also playing youth lacrosse, and that's
completely outside the city rec league any of the high schools
or any of the school systems. It's a private institution.
Listen, I came back because I thought this was an extremely
important hearing. I appreciate all of your testimony, and
we'll continue to work on this. And I yield back, Mr. Chairman.
Mr. Hudson. I thank the gentleman. At this time, I'll
recognize Mr. Tonko for 5 minutes.
Mr. Tonko. Thank you, Mr. Chair. And I appreciate all of
our witnesses being here today and having this panel of expert
witnesses is a good opportunity to have dialogue on how we can
further enhance the safety of youth sports.
I would like to ask some questions about changes to rules
governing contact, especially for kids.
And, Dr. Gregory, you are here as a member of the USA
Football's medical advisory committee. What can you tell us
about the guideline changes USA Football has made to make the
sport safer for young athletes?
Dr. Gregory. Well, as you're probably aware, there are
practice guidelines now in place to limit contact, which has,
as part of the heads-up program, shown good evidence of
decreasing injury, and that is limiting contact to 30 minutes
per practice, no more than four practices a week, and no more
than 2 hours in total length of practice.
So, decreasing the number of potential hits, which has been
shown to occur by limiting the amount of time.
Mr. Tonko. Thank you. And it's my understanding that USA
Football does not operate its own teams?
Dr. Gregory. That is correct. So we can only make
suggestions to the leagues that are underneath us. The same
problem that all youth sports have. We want these leagues to
follow our recommendations, but we can't enforce them.
Mr. Tonko. So, in other words, there's--it's just a
recommendation? There's no way to implement those guidelines?
Dr. Gregory. There's no way to enforce it. We've got to get
buy-in, just like what my other colleagues have talked about
here. By showing them that it works, get buy-in from these
youth coaches.
Mr. Tonko. And, Dr. Gregory, have you been monitoring the
rate of injuries, particularly head injuries since implementing
these changes?
Dr. Gregory. So in the three areas that we showed with the
dataless youth football study, the Fairfax County information
here, and in South Bend, Indiana, the programs that implemented
the heads-up football, which is the educational proponent and
the practice limitations, all injuries, head injuries, all went
down in both practice and games.
Mr. Tonko. Do you have any--do you know anything more than
that, other than dropping in----
Dr. Gregory. Well, I gave the numbers already, but I can
give them to you again.
Mr. Tonko. OK. No, just as long as the committee has them--
--
Dr. Gregory. Yes.
Mr. Tonko [continuing]. That will be fine.
And we have heard from Coach Teevens about his success at
Dartmouth in eliminating contact practices and from Mr. O'Neil
about practice like pros advocacy for additional rule changes
to reduce contact, particularly for young players. The whole
Ivy League has now eliminated contact practices, and the NFL
allows only 14 contact practices over the 18-week regular
season.
Dr. Talavage--did I say that correctly?
Dr. Talavage. Talavage.
Mr. Tonko. Talavage, I'm sorry. What do these measures,
like reducing the number of contact practices and giving
players longer rests between such practices do for players, in
particular, what is the effect as it relates to the brain?
Dr. Talavage. The more time off they have, the more
opportunity there is for the body's restorative practices to
repair any damage that's occurred from being hit. So the more
time you can give them off, the less likely they are to be
impaired, the less likely they are to be injured in the future.
Mr. Tonko. Thank you.
And, Dr. Gregory, given what the science is telling us, why
has USA Football not considered stricter rules or guidelines to
reduce or eliminate contact for young players?
Dr. Gregory. So what I will tell you is that what has been
demonstrated, both at Dartmouth and then high school level, is
it's fairly new, and I would say it's very compelling, and the
challenge is can we replicate this at the youth level without
the resources that they have at the collegiate and high school
level? And that's the difficulty. And, again, we can make
recommendations; we can't enforce it. So for us, we have to
make sure that if we make a recommendation like that, that we
back that up by understanding that it can be implemented if we
recommend it. And that's--that's what we need the resources to
do.
Mr. Tonko. And yesterday, Pop Warner announced that it
would eliminate kickoffs and kick returns to reduce head
injuries. It will also reduce contact practice time from 33
percent to 25 percent.
Dr. Talavage, do you think these measures will be effective
at reducing head injuries for kids?
Dr. Talavage. They are a good start. We'll say that much.
The main issue, I think, just to tie back to one quick comment
from before, is that eliminating one or two or three or four
big hits per game isn't going to have a terribly substantial
effect. I'd be more excited about the reduction in the contact
practice time.
Mr. Tonko. OK. So those are--those would be the first
additional changes that you would encourage?
Dr. Talavage. Yes.
Mr. Tonko. Dr. Gregory, is USA Football considering similar
measures?
Dr. Gregory. Considering--say that again.
Mr. Tonko. Is USA Football considering similar measures as
those introduced by Pop Warner?
Dr. Gregory. Well, so one of the things that's pretty clear
is this is an evolving game, so this is definitely up for
consideration. And rule implementations like this would be
looked at and studied and see if--if it does, indeed, have the
same effect to youth that it has at other levels.
Mr. Tonko. Thank you.
Finally, earlier this month, committee Democrats sent a
letter to Scott Hallenbeck, executive director of USA Football,
about how the organization is ensuring the safety of young
football players in addressing the risk posed by both
concussive and subconcussive hits. We have asked for a response
by May 25th.
Dr. Gregory, can you confirm that USA Football will provide
the committee with a response by that date?
Dr. Gregory. I can confirm that. Thank you.
Mr. Hudson. Thank you.
Mr. Tonko. With that, I yield back.
Mr. Hudson. Thank you, sir.
At this point, we'll recognize Ms. Clarke for 5 minutes.
Ms. Clarke. Thank you, very much, Mr. Chairman.
I thank our ranking member. I thank our witnesses for
bringing your expertise before us today.
I'd like to talk about the change in culture. As we
approach the issue, we have to address sports culture and the
attitude of toughness. For a long time, kids have watched their
idols deliver the hardest hits on the field and get the most
fights on the ice. As we make changes to play and practice, we
also need to ensure that that permeates the culture of sports
as well.
Look, my first question, Mr. Teevens, is do you believe
that players are convinced of the importance of reporting
concussions?
Mr. Teevens. I think they are getting there. I think it's
incumbent upon the coaching staff to make players aware that
it's oK for coaching staff members, says, Hey, you tough guy,
the old school mind set, players may not respond if it's opened
and it's oK, culture sports it, they will report.
Ms. Clarke. OK. And do you believe that the coaches and the
medical staffs at the higher levels of play take concussions
seriously?
Mr. Teevens. I think they do. I think coaching profession
is conservative, and a lot of guys that have played less than 5
years ago, or started coaching 5 years ago or greater, they
grew up in a time when you didn't self-report; you didn't know
about concussive head injury, and a lot of people teach what
they were taught as players. That's part of the culture that
needs to change. It's a different time.
Ms. Clarke. There needs to be a disruption.
Do you think that we have been successful in spreading that
message?
Mr. Teevens. Not as successful as we need to be, and the
broader the better. Again, limiting the injury is--it's what
we're all about.
Ms. Clarke. Mr. O'Neil, the same questions. How can we
convince players and coaches to report concussions and treat
them seriously?
Mr. O'Neil. Ms. Clarke, it's a great question. And I'd say
this to you, when we do our clinics around the country, we have
quantified the 19 cases of suspected second impact syndrome
that you heard about earlier this morning. We tell those
stories in detail with video of the players involved. We tell
the stories of catastrophic injury in an effort to scare
straight through the coaches these young boys who need this
information.
I show my son's concussions as an example. I showed how he
lied about his symptoms, did everything to stay on the field.
Only when confronted with an impact test that showed he had
failed the cognitive efficiency index test, only then did he
admit that, yes, he was suffering a concussion and he was going
to have to miss 3 or 4 weeks of play.
It is a huge problem still in high school football, and we
think it's a subject about which we need to be direct with
players. We tell these stories to the coaches, and we give them
the video. We encourage the coaches to tell the players the
story of what catastrophic injury can be in their lives if they
don't report, self-report, and self-diagnose.
Ms. Clarke. Many kids try to model their behavior after the
athlete they revere. We need to ensure that the athletes at the
highest level of play, college and pro, are sending the right
messages about taking brain trauma seriously.
So, Mr. Teevens and Mr. O'Neil, what can the college and
professional athletes and leagues do in carrying that message
forward?
Mr. Teevens. I think the coaches would have to drive that
message. I say frequently, unless we change the way we coach
the game, we won't have a game to coach. And putting into
place--we have an MVP, a mobile virtual player tackling device,
that has been tremendous, because we now replicate a moving
target at no risk of injury to the player tackling it. Steps
like that.
The players will follow the direction of the coaching
staffs, and I think coaching to coaches is absolutely critical
to get our message across.
Mr. O'Neil. Ms. Clarke, what's effective for us is when we
take these Hall of Famers around the country, Warren Moon tells
the audience, he suffered his first concussion at the age of 7
on a practice field in California, needlessly, not in a game,
in a practice at the age of 7, and tells his personal story
about hiding symptoms and then coming to a recognition later in
his career how foolish that was.
We take Anthony Munoz around, and he tells a story of
playing for a coach in Cincinnati who wanted to hit and hit and
hit every single day, even the day before games on a Saturday.
They're hitting each other in goal lines and short yardages
drills before a Sunday game. Then he said we had a new coach,
and that coach took our approach, which is virtually no contact
during the week. And he said, we won both ways, but he said I
sure felt a lot better and my teammates did, too, in that
second approach, which is so much more effective.
Ms. Clarke. Any of you have any comments about what you
think the fans should be requiring of this sport?
Mr. Teevens. I think fans should be aware of it as well,
and it's not gladiatorial, it's we have someone's child who is
playing the game, and understand some of those big hits. The
rules of the game don't dictate taking people out of play by
force and injury. It's just get them on the ground. And if
there is understanding that long term, people can be in
jeopardy if we don't change the way we approach the game.
Dr. Gregory. The other thing I would add is that the media
which is on ESPN, the Hits of the Week, are not good hits, if
you ask us. Right? That's what's being shown as a highlight.
That's not the goal. We've got to change that.
Ms. Clarke. We have to change the culture, then, that
requires that everyone that is participating and reveres this
game.
With that, I yield back. Thank you, Mr. Chairman.
Mr. Hudson. I thank the gentlelady. I ask unanimous consent
that the Institute of Medicine, National Research Council
report entitled ``Sports-Related Concussions in Youth:
Improving the Science, Changing the Culture'' be introduced
into the record.
Without objection, the document will be entered in the
record.\1\
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\1\ The information has been retained in committee files and also
is available at http://docs.house.gov/meetings/IF/IF02/20160513/
104914/HHRG-114-IF02-20160513-SD099.pdf.
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I also want to do another promotion of the briefing that
Congressman Butterfield and I are hosting on pediatric trauma,
May 24th. Encourage all my colleagues and any interested
parties to attend that briefing.
And, in conclusion, I would like to thank all of you,
witnesses and the Members who participated in today's hearing.
A very important issue. I think we've gained a lot of insight
today.
I remind Members they have 10 business days to submit
questions for the record. I ask all witnesses to agree to
respond promptly to those questions.
With that, the subcommittee is adjourned.
[Whereupon, at 12:19 p.m., the subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
Prepared statement of Hon. Fred Upton
This hearing marks the second event of the committee's
comprehensive review of concussions. We first had a roundtable
discussion in March that highlighted not only the gaps in our
scientific and medical understanding of these injuries but also
the risks they pose to all members of society. These injuries
occur not only on the field of play or in service to the
Nation, but also in the school yard, in auto accidents, or even
something as simple as slipping on a patch of ice. They do not
discriminate.
There are no easy answers when it comes to head trauma. It
may take time for research to provide the concrete answers the
public demands but that is not an excuse for inaction. There
has been tremendous progress in the last decade but we can, and
must, do more. And this must be a collective effort as no one
individual, group, or organization can solve this public health
challenge.
We are here today to examine what is being done to protect
one the largest at-risk populations for concussions, youth
athletes. Every year, in Michigan and across the country, tens
of millions of children compete in youth sports. From community
recreational teams to elite travel clubs, children have
countless opportunities to engage in athletic competition.
These activities provide tremendous benefits to our children,
influencing their physical and psychological health, academic
performance, and social well-being--both now and in the future.
Despite these benefits, with everything we see in the press
about concussions and the long-term effects of head injuries,
countless parents are asking themselves, is it safe for my
child to play sports?
This is a difficult question to answer. To start, we know
relatively little about the prevalence, effects, and long-term
outcomes of concussions or head injuries in pediatric
populations, including youth sports. This group has been
dramatically underrepresented in existing research. Do children
respond differently than adults? How does the developing brain
respond? Does it heal faster or does it create long-term
effects? These are just a few of the many questions science
simply cannot answer at this point.
In the absence of scientific answers, we look for
opportunities to limit exposure to head injuries. Due to the
nature of concussions, management of these injuries is
difficult even in controlled settings such as pro sports where
you have individual leagues with a limited number of teams and
athletes. At the youth level, there are thousands of leagues,
organizations, and clubs--making the challenge exponentially
more difficult and harder to control. The adoption and
enforcement of rules, policies, or education programs often
depends on the commitment of individual leagues, teams,
coaches, parents, and athletes.
Some progress has occurred in recent years as a number of
leagues and organizations are taking steps to limit contact in
practice and games. Others are conducting outreach and
education to improve awareness and understanding for coaches,
parents, and athletes. Whether these efforts are effective or
go far enough remains a question and one that we should
continue to evaluate. Collectively, however, these efforts
reflect a growing shift in the culture of sports regarding
concussions and head injuries. Today's discussion is an
important step in the right direction.
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