WHEN IN DOUBT, SIT THEM OUT
It’s been a year since Karl Forgues, voted defensive rookie of the year in the Quebec University football league in 2014, quit football. The five-foot-nine, 200-pound linebacker played from the age of 10 until 21, an 11-year career that resulted in five concussions, the last of which was suffered while playing for McGill.
“There were plenty of other hits that left me feeling dizzy, but I didn’t say anything,” said Forgues, who claims he didn’t consider the hits serious enough to warrant reporting or removing himself from the game.
Forgues is in good company, says Scott Delaney, an associate professor at McGill University and team physician for the Montreal Alouettes, Montreal Impact, McGill football and men’s and women’s soccer teams. Delaney’s research of 469 university athletes over 12 months revealed that 20 per cent believed they had suffered a concussion, yet 80 per cent of those concussed decided not to consult with a medical professional and chose to continue playing.
It’s for this reason that Delaney created a concussion contract to be signed by athletes, coaches and team therapists before the start of the season. The contract outlines a concussion symptom checklist and protocol as to when athletes are eligible to return to play, which is read and signed, signifying an understanding of the impact of concussions and their long-term effects on physical and mental wellbeing. Also agreed upon is that athletes be removed from play should a concussion be suspected and only return once they are able to function in the classroom at preconcussion capacity and play and practice symptom-free.
Delaney says signing the contract at the beginning of the season sets the tone and removes the pressure and pushback that doctors and therapists are often subjected to when an athlete is suddenly pulled off the field of play after a suspected concussion.
Not all teams have the luxury of a medical professional on the sidelines who is trained to evaluate athletes who’ve received a hard knock or hit on the head. Nor do they employ trained spotters to sit in the stands and identify hits that could put athletes at risk, a practice more and more pro teams are instituting.
Which leaves making a call on concussions up to coaches and parents, who are often unable to recognize some of the more subtle concussion symptoms. Delaney hopes the concussion contract will get rid of any ambiguity surrounding when to remove athletes from the field of play.
“When in doubt, sit them out,” said Delaney.
Valerie Lam-Hang is the team therapist for McGill’s football and men’s hockey program. She says the concussion contract has provided an opportunity to sit down and talk with athletes about concussions and their consequences.
“We assume that the athletes know about concussions, but how much do they really know? asked Lam-Hang.
Despite plenty of coverage in the news, there’s still a lot of misinformation surrounding concussions. It doesn’t help that the science behind sports-related blows to the head is still evolving. And since the symptoms are varied, change quickly and may not show up until several hours after being hit, it’s not the easiest injury to diagnose and evaluate. Hence the need for a symptom checklist that takes the guesswork out of pulling an athlete from play.
Lam-Hang says most athletes ignore less severe symptoms like a simple headache, and only seek medical attention when the symptoms escalate and their everyday life is affected.
“You can tell who’s looking to the future and who’s not,” said Lam-Hang.
Forgues said he wasn’t plagued with a lot of long-term symptoms but admits to briefly losing consciousness after a hit and experiencing several bouts of memory loss.
“I couldn’t remember the game,” he admitted after one particularly serious hit. “I didn’t remember the plays coach was calling. I didn’t remember my phone number.”
But it was his sister, who works with patients with head trauma, who finally persuaded Forgues it was time to give up football.
“She has 40- and 50-year-old patients who have started to lose touch with reality,” he said. “I didn’t want my concussions to affect my future.”
The decision made, Forgues was nervous about telling his teammates and coaches, but they were surprisingly supportive. It’s this kind of positive reinforcement that makes it easier for athletes to report concussion symptoms. Yet too often they’re afraid of their coach’s reaction to leaving the game. They’re also afraid of losing their spot on the team, a consequence of ceding their position to a teammate for the seven to 10 days it typically takes for concussions to resolve.
It’s for these reasons that signing a concussion contract is also important for coaches. The cornerstone to concussion management is early detection, removal from play, rest until symptoms subside followed by a gradual return to sport. But without the coaches’ support in the process, the culture surrounding concussion won’t change.
Right now, Delaney is piloting his concussion contract at McGill and looking forward to receiving feedback from athletes, coaches and therapists. But his ultimate goal is to have concussion contracts available in leagues everywhere so that athletes can look forward to a healthy future.