Instead of national standards, the NCAA leaves much of its decision-making on concussions and other head injuries to its member institutions. ThinkProgress examined hundreds of pages of court filings made public last week and compiled a timeline of the NCAA’s history with concussions. Because it is based primarily on court documents, it is not necessarily comprehensive, but it paints a picture of the NCAA’s unwillingness to act — and its fears of legal liabilities if it did — on the concussion epidemic that was and still is plaguing its sports:
March 31, 1906: The Intercollegiate Athletic Association of the United States is founded to “protect young people from the dangerous and exploitive athletics practices of the time.” It has 62 members and is the result of President Theodore Roosevelt’s efforts to reform safety standards in college athletics.
1933: The NCAA first acknowledges the dangers of concussions in its Medical Handbook for Schools and Colleges, which states that “the seriousness of [concussions] is often overlooked” and that concussions “should not be regarded lightly.” It lays out recommendations for immediate treatment, including rest, constant supervision, and x-rays of the brain as long as headaches persist. It also suggests hospital treatment for players with recurring symptoms until they are symptom-free for 48 hours and recommends that any player who experiences symptoms for longer than 48 hours “should not be permitted to compete for 21 days or longer, if at all.”
December 1937: The American Football Coaches Association states at its annual meeting that “the practice has been too prevalent of allowing players to continue playing after a concussion.”
1982: The NCAA adopts the Injury Surveillance System to “provide current and reliable data on injury trends in intercollegiate athletics.” The committee in charge of the system is tasked with recommending changes in rules, equipment, and coaching techniques to help reduce injury rates.
1994: The NCAA’s Assistant Director of Sports Scientists, Randall Dick, publishes an article that finds that “concussions accounted for at least 60 percent of head injuries in each of the sports monitored.” He calls for sweeping rule changes. Following Dick’s paper, the NCAA adopts its first concussion guidelines in its Handbook. They are non-binding, and the NCAA adopts no new rules to combat the prevalence of concussions in its sports.
1994: The NCAA adopts guidelines outlining protocols for returning to play after a concussion and sideline grading tools. Guideline 20, as the policy is known, is not mandatory.
January 1995: Article 2.2.3 is added to the NCAA Constitution. It states: “It is the responsibility of each member institution to protect the health of, and provide a safe environment for, each of its participating student athletes.”
February 1996: The NCAA Sports Sciences Safety Subcommittee meets in Kansas City and acknowledges “the continued medical and media concerns about concussions in the sport of football.”
August 27, 1996: Three doctors, led by the president of the American Academy of Neurology, write a letter to the NCAA’s executive director saying that concussions were “overlooked as one of the most serious health problems facing amateur and professional athletes.”
1997: The NCAA removes much of Guideline 20 from its handbook, revising it to state only that players “rendered unconscious…should not be permitted to return to the practice or game in which the head injury occurred” and that no player should “be allowed to return to athletics activity while symptomatic.”
1998: The NCAA approves $50,000 in grants for concussion research because “much more research in this area was necessary.”
November 2003: The NCAA-funded research is published in the Journal of the American Medical Association. One study states that “athletes required a full 7 days for postconcussive symptoms to completely return to” normal levels, yet “the largest percentage of collegiate football players were withheld from competition for an average of less than 5 days.” Returning to play that soon, the study suggests, “may increase the risks of recurrent injury, cumulative impairment, or even catastrophic outcome.” A second study by the same authors finds that “players with a history of previous concussions are more likely to have future concussive injuries than those with no history.” Despite funding these studies, the NCAA takes no action to change its rules or amend its Handbook, according to plaintiffs.
2004-2006: ISS data shows that in 2004, 14 percent of all game injuries in women’s soccer are concussions; they account for 6.3 percent in men’s soccer, 7 percent in field hockey, 22 percent in women’s ice hockey, and 18 percent in men’s ice hockey. In 2005-2006, 7 percent of all football injuries were concussions, and a team with 60 game participants experienced a concussion in one of every five games.
2007: In the Journal of Athletic Training, Randall Dick publishes the following data:
2004-2009: ISS data estimates that NCAA athletes suffered a total of 29,255 concussions in a six-year period. 16,277 occurred in football.
2009: The National Football League adopts guidelines prohibiting players from returning to games or practices if they exhibit signs of concussions. The National Federation of State High School Associations requires officials to remove players suspected of suffering a concussion.
December 2009: The Committee on Safeguards and Medical Aspects of Sports recommends that the NCAA Playing Rules Oversight Panel consider adopting standardized concussion rules. It suggests that the rule read that any athlete “who exhibits signs, symptoms, or behaviors consistent with a concussion…shall be immediately removed from practice or competition and shall not return to play until cleared by a physician or her/his designee.” The NCAA’s Associate Director of Playing Rules Administration, Ty Halpin, says that “the rules could be problematic; certainly some liability issues with somehow having game officials be responsible for returning to game action.”
January 2010: The Committee on Safeguards and Medical Aspects of Sports formally requests that the Playing Rules Oversight Panel adopt standardized concussion treatment rules. The Playing Rules Oversight Panel formally rejects the Committee’s recommendations. NCAA Medical Director David Klossner urges Halpin and other rules officials to reconsider. Halpin sends an email to a colleague, saying, “Dave is hot/heavy on the concussion stuff. He’s been trying to force our rules committees to put in rules that are not good — I think I’ve finally convinced him to calm down.”
Later that month, Klossner sends rules officials guidelines to be distributed to coaches and included in the rulebook. NCAA officials express concerns about liability. “Won’t someone (i.e. officials) be liable even if this language just appears in the Appendix?” one asks in an email. Another, Assistant Director of Playing Rules Administration Teresa Smith, asks: “And, what about the NCAA? Would we be protecting/helping the organization by not providing the information?”
February 2010: The NCAA forms a Concussion Working Group that meets in Indianapolis. It discusses the policies of other leagues and considers putting forth legislative changes that would call for a uniform concussion policy.
2010: The NCAA’s government relations director, Abe Frank, asks Klossner whether concussion rules for youth sports included in proposed federal legislation would go farther than the NCAA’s guidelines. Klossner responds: “Well since we don’t currently require anything all steps are higher than ours.”
April 2010: The NCAA holds its first concussion summit. It presents results of a survey of its athletic trainers that shows that only 66 percent of its schools performed baseline concussion testing and than less than 50 percent required a physician to see all athletes who suffered concussions. 39 percent did not establish guidelines on how long athletes should sit out before returning to play, and nearly half said they allow students to return to play in the same game in which he or she suffered a concussion. The summit’s original recommendations call for continuing education for players, coaches, and medical trainers as well as the monitoring of progress of such programs. None are adopted.
The summit’s final proposal recommends that the NCAA consider legislation requiring schools to adopt a concussion management plan. It also recommends the NCAA “consider adding language to the NCAA Student-Athlete Statement in which student-athletes accept the responsibility for reporting their injuries…including signs and symptoms of concussions.”
April 29, 2010: The NCAA adopts a Concussion Management Policy that requires member schools to develop a concussion management plan for the 2010-2011 school year.
October 2010: The NCAA’s director of enforcement, Chris Strobel, acknowledges that while the NCAA now requires schools to develop a concussion management plan, it has no intentions of enforcing the policy. “The legislation was specifically written to require institutions to have a plan and describe what minimum components had to be part of the plan — not about enforcing whether or not they were following their plan — except for those isolated circumstances of systemic or blatant violations,” Strobel writes.
April 2013: As part of concussion litigation brought by former athletes, Klossner testifies at a deposition that schools are not required to submit their concussion management plans to the NCAA, that the NCAA is not monitoring whether schools have actually developed such plans, and that, to his knowledge, the NCAA has not disciplined those schools that do not yet have a concussion management plan in place.