It’s a problem that is festering in college football. Somehow, some way players that have suffered a concussion are being allowed to return to the field after their symptoms have dissipated, but long before modern science suggests that their brain has healed.
It’s a problem that Dr. Brian Hainline is well-aware of; a problem that he has been hoping, one day, to resolve. That one day may have come in San Antonio last month at the NCAA Convention when the Power 5 conferences approved a rule, which provides school medical professionals with “unchallengeable autonomous authority” in deciding when an athlete may return to play after a concussion.
In theory, the new rule puts a wall between athletic department officials, such as coaches, who may return players to the gridiron before their brain has had a chance to heal and the medical professional charged with making such a decision. Furthermore, the new law prevents athletic department personnel from having hiring, retention, or dismissal authority over team doctors or athletic trainers.
A day before the announcement was made, we sat down with Dr. Hainline at the convention for a short interview.
Question: Is it fair to say that if you suffered a concussion and now are symptom free, that doesn’t mean the brain has healed?
Answer: That’s correct.
Q: Yet we are still seeing student athletes return to the field soon after a concussion. What is being done to shed light on this problem?
A: We are addressing it with our ongoing study of concussion with the Department of Defense. (With the study), we think we will be able to define that parameters of neurobiological recovery. We are going through the first round of data analysis now. We won’t have to wait 20 years for this. We will have the first presentation on the data in the spring and I think this will change how we manage concussions.
Q: There are questions being raised about whether the medical professional within the athletic department, who is clearing the student athlete, should be independent. Where do you side on this?
A: Ten years ago, it would have been unheard of to talk about this publicly. FBS autonomy legislation involving medical professionals may be the most important piece of legislation in NCAA history because it gives unchallengeable autonomous authority to the primary athletics health care provider. And it defines who the primary athletics health care providers are. There is a pathway to decouple sports medicine from the athletics department. There’s an infrastructure pathway that has to be developed as well. There are some model schools that do that right now, namely Princeton and Boston University. Their athletic staff report outside the athletic department to student health services.
Q: Is there enough awareness about the issue of return to learn as opposed to just return to play?
A: I think it is getting there in the interassociation guideline and then subsequently in the concussion safety protocol legislation. In the checklist that we have, we devote more space to return to learn than we do return to play. That’s because it is actually more complex. You really need an interdisciplinary team at the front end of this. You need to be certain that the faculty is as well-versed in this as the athletic staff. Some faculty are not. There attitudes might be old-fashioned. Like, suck it up, so to speak. So, it is a very comprehensive protocol. It is consensus based. We don’t have all the science yet. But I think the awareness is much greater than it was even a year ago.
Q: How close are we to identifying the genetic markers for those especially susceptible to concussion?
A: The question is, is it genetics? Is it multiple genetic predispositions? Is it epigenetics? I don’t think it is simple. We’re actually studying multiple genetic markers. I have a feeling it is going to be a combination. I don’t think it is going to be one genetic marker.
Q: How close are we to being able to identify CTE in the living?
A: That’s a big issue. One of things we are doing is actively trying to extend the study to 35 to 50 years. We think there is a way, while extending it, to add a high-research component to assess for CTE. Boston University won the NIH grant, and is looking for a way to diagnose CTE in living people. I am actually on the medical advisory board of that study. All this points to the fact that there is a great spirit of collaboration out there. We are not working in silos any more. It is refreshing.
