Texas quarterback David Ash completed 19 of 34 passes for 190 yards and a touchdown in the Longhorns’ 38-7 win over North Texas on Saturday. He reportedly left the stadium that night feeling fine, but called Texas staff later to report concussion-like symptoms.
Texas head coach Charlie Strong announced Sunday Ash would miss this week’s game against BYU and added that he likely suffered the injury, “on the first hit he took,” meaning he played just about the whole game with a concussion.
This isn’t Ash’s first head injury. In Texas’ season-opener against BYU last season, he suffered a concussion so severe that not only was he unable to participate in the Longhorns’ game against Ole Miss the following week, he wasn’t even allowed to be in the stadium. According to multiple reports, team doctors thought the lights, movement, and other stimulation of the game could set back his recovery.
According to the Mayo Clinic, “rest is the most appropriate way to allow your brain to recover from a concussion. Your doctor will recommend that you physically and mentally rest to recover from a concussion. This means avoiding general physical exertion, including sports or any vigorous activities, until you have no symptoms.”
It’s easy to see why team doctors held Ash out of the game; brain injuries are serious business. If his concussion was bad enough that the bright lights, roaring crowd, and certain stress of a football game could cause further damage or impede his recovery, keeping him away from the stadium seems like the right call as well.
The following week, two weeks after sustaining the initial injury and one week after team doctors thought attending a football game would be too much for him to handle, Ash was back on the field for the Longhorns’ week four matchup with Kansas State. He didn’t even make it to halftime before another hit to the head ended his day, and his season.
If the actions of team doctors are any indication, Ash went from so symptomatic he couldn’t handle being in the stadium one week, to 100% ready to play the next. That’s an impressive recovery — borderline miraculous. Not reported was whether or not Ash practiced at all in the week leading up to the K-State game. If he did, that would mean his recovery timeline was even more accelerated.
Maybe keeping him out of the stadium against Ole Miss was simply a precaution. Maybe team doctors made the 50/50 call to hold him out, and the Texas coaching staff decided if he wasn’t going to play, he shouldn’t even come. Maybe they wanted to be totally, absolutely, 100% sure he was healed before they even let him near the stadium. Maybe.
Maybe you can tell I’m trying to convince myself here?
Doesn’t it seem more likely that Mack Brown felt his leash getting shorter? His Longhorns hadn’t put up a ten-win season since 2009, and the 2006 National Championship Trophy was getting dustier by the day. Maybe Brown saw his team get outscored 27-0 in the second half against Ole Miss, lose for the second week in a row, and realized he needed his quarterback if he was going to keep his job. This is all 100% speculation, but wouldn’t it make more sense?
Whatever the reason for his return, it doesn’t matter. Ash didn’t play another down in 2013 after his second concussion against Kansas State.
With so much talk about the long-term damage caused by multiple concussions, some wondered if he would come back at all. He made it very clear he wasn’t ready to hang up his cleats, “I would have been going through my whole life asking, 'What if?' I don't want to live like that.”
I would have been going through my whole life asking, 'What if?' I don't want to live like that – David Ash
There’s the issue. Concussions aren’t like a torn ACL or broken wrist — injuries that physically prohibit an athlete from participation — but they also aren’t the same as bruised ribs, a jammed finger, or any another 'hurt but not injured' ailment football players are expected to 'tough out.'
Concussions are a weird middle ground. They’re a very serious injury that it’s entirely possible, even common, to play through. The trouble with concussions is in many cases it’s not the first concussion that causes problems — it’s the second, third, fourth, and fifth, ad infinitum.
We’re starting to understand, we say we understand, and yet we continue to ignore mounting evidence about the seriousness of these injuries in favor of an antiquated, 'shake out the cobwebs and man up,' mentality.
This video/article is a microcosm of the sentiment I’m talking about. To summarize, in a 2012 game between Arizona and USC, Arizona quarterback Matt Scott took two hard shots to the head, one immediately after another, as he tried to slide at the end of a run. His head bounced around, hit the turf hard, and when he got up, announcers Joe Tessitore and Matt Millen had the following exchange:
Millen: Matt Scott's throwing up on the 28-yard line.
Tessitore: That's not a good sign…
Millen: That's not good. Get him out of the game.
Tessitore: Any neurologist will tell you that is one of the symptoms and signs of a concussion…is vomiting in reaction to being hit in the head. But he's walking it off right now, out around the fourteen-yard line.
Scott didn’t even leave the field of play. He played out the remainder of the drive, which resulted in a touchdown pass.
Glossing over the coaches, trainers, and team doctors who certainly should have pulled Scott from the game, perhaps the most worrying part of this whole event was the reaction of people watching.
These are just a few of the tweets quoted in the excellent piece by Isaac Rauch from Deadspin linked above:
And shout out to Matt Scott for playing through a concussion. He was puking on the field and kept playing — Nathan Fuell (@natefuell) October 28, 2012
Matt Scott is debatably the toughest quarterback in all of college football, puking his brains out then throwing the game winning touchdown — Seth Pines (@SethTheSolution) October 28, 2012
There is a fine line between tough and stupid, and there might even be some overlap.
We talk about football like it's war because it's supposed to simulate war on some level. Modern day gladiators, fighting for every inch, go out there and kill that guy, sacrifice the body. To play the game as it's meant to be played requires anger. Play scared, you'll get hurt. It's a warrior mentality and it's easy for coaches, trainers, and fans to get caught up in that too.
Not long ago, on football fields from pee wee to professional, you’d hear expressions about head injuries like, ‘he got shook up,’ or ‘dinged,’ or ‘got his bell rung.’ Players were encouraged to, ‘rub some dirt on it,’ ‘shake it off,’ and ‘man up, Nancy.’
These terms are relics of a time when we didn’t fully understand the risks associated with repeatedly smashing your brain against the inside of your skull. The information is out there now. We can't claim ignorance anymore. We’re starting to understand the risks, but for whatever reason, we have yet to take them seriously.
What makes this nonchalant attitude toward concussions so scary is how common they actually are among athletes. From the Mayo Clinic, “among people who are 15 to 24 years old, sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury.”
How many times do you think the following scenario (or something very similar) has played out: A kid in Phoenix watches Matt Scott stay on the field after an obvious concussion, and sees him score a touchdown to guarantee the win for his team. For the next week, all this kid hears from his peers, parents, coaches, sports radio hosts, Sportscenter anchors, and whoever else, is talk about how tough Scott is, what a badass he is, and how he's one hell of a gutsy football player. The kid takes all that to heart.
Then, the next time he 'gets his bell rung' in a pee wee football game, he decides not to tell his coaches. He stays in the game and takes another big hit.
Also from the Mayo Clinic “Second-impact syndrome, a rare but usually fatal syndrome predominantly affecting young male athletes under the age of 18 years, is a devastating consequence of returning athletes to play before complete recovery.”
Rare but usually fatal. Rare but usually fatal. Let that sink in.
In 2004, the Journal of Athletic Training published an article entitled, “National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussions.” After a three-year study of 2,095 NCAA football players from 25 schools, Dr. Kevin M Guskiewicz and seven co-authors from universities and hospitals across the country found, “collegiate athletes had a 3-fold greater risk of suffering a concussion if they had sustained 3 or more previous concussions in a 7-year period and that players with 2 or more previous concussions required a longer time for total symptom resolution after subsequent injuries.”
So once you get one concussion you’re more likely to get another, and the next one you get will take longer to heal. These injuries are a slippery slope, and when someone starts to slide down this slope, they probably won’t like what’s waiting for them at the bottom.
Just last year, the NFL settled for $756 million in concussion-related lawsuits by 4,500+ former players. A focal point of these suits was a condition called chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated brain trauma. CTE can result in forgetfulness, depression, insomnia, impulsivity, suicidal tendencies, and eventually progressive dementia. CTE is common among former NFL players.
A study in the December 2012 edition of the scientific journal Brain, found the number might be as high as 80%. In the study, they, “analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes [and] 21 military veterans (86% of whom were also athletes)[…]” It isn't just big, knockout hits that result in CTE either.
According to the Boston University CTE Center, CTE is, "found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head."
It doesn't take a degree in neuroscience to understand that repeated brain trauma is bad, but one of the biggest reasons we haven't done enough to solve the problem is that we don't know exactly how bad. There is no test for CTE, it can only be diagnosed by postmortem neuropathological analysis during autopsy. Concussions are also notoriously difficult to diagnose.
For as much attention as concussions have garnered in the last few years, there is still so much we don't know. We don't know exactly how violent an impact has to be to cause a concussion. We can't quantify the severity of any brain injury on the field of play. We don't have an objective timeline for how long it takes for a concussion to heal, or if it ever truly heals.
There are some studies which suggest even the repetitive, sub-concussive hits suffered by football and hockey players can change the physical structures of the brain and result in reduced cognition.
With all these missing pieces, how could we know when it is okay for a concussed player to return to the game? The NCAA concussion guidelines say, "athletes diagnosed with sport-related concussion must be removed from play and must not return to sport-related activity for at least one calendar day and are to be evaluated by a health care provider with expertise in sport-related concussion."
One calendar day. And remember, these are guidelines, not rules.
Athletes diagnosed with sport-related concussion must be removed from play and must not return to sport-related activity for at least one calendar day – NCAA Concussion Guidelines
So what is to be done? Who is responsible? The NCAA has done everything in their power to make sure it isn’t them.
The NCAA concussion guidelines page says, “diagnosis, management, and return to play determinations for the college student-athlete are the responsibility of the institution’s athletic trainer (working under the supervision of a physician) and the team physician.”
They don’t want to be on the hook for a massive lawsuit like one the NFL went through, so they defer the responsibility of managing concussed players to schools. Across 1,200 NCAA schools, consistency is impossible.
The NCAA recommends schools administer a test to each athlete to determine a baseline for cognitive function. That way, when the player suffers a head injury, the test can be re-administered and the results compared with the player’s baseline reading to help determine if they might have suffered a concussion.
Trainers also look for symptoms like loss of consciousness, dilated pupils, confusion, slurring words, memory loss, nausea, vomiting, ringing in the ears, and headaches when their players take a hit, but these symptoms must be self-reported for the player to be treated. These tests are totally qualitative, none are consistent, and symptoms can be covered up by a very determined player.
Another study in the Journal of Athletic Training found that forward-thinking athletes will sometimes sandbag or tank their baseline cognitive evaluation to give themselves a better chance of passing when they get a concussion.
When you take the competitive fire an athlete must have to even make it to the collegiate level; combine it with the immense pressure they're under from coaches, teammates, parents, friends, fans, and themselves to perform; and add the mental fog of a concussion, you get players who will do anything to stay on the field. No matter the cost.
Concussions are the elephant in the locker room. Players need to feel invincible to succeed at this violent game, and admitting weakness is the antithesis of everything a football player is "supposed to be." So they don’t. But no one is stronger than a brain injury, and we need to stop telling our players, sons, and little brothers that they should try to be.
I love football as much or more than the next guy. I watch college football for work, then I watch NFL football to relax — football is my work, my hobby, and my passion, but it's getting harder for me to put morality aside.
Yes, it's a violent contact sport, and yes, it always has been, but that doesn't mean we can't make changes to improve player safety while maintaining the spirit of the game.
When I hear people talk about how, "all these rule changes are ruining the game," I wonder to myself which rules they're talking about specifically. Was it the one that made it illegal for defensive players to strike opponents in the head, neck, or face in the 1930s? The one that mandated helmets in 1942? Or was it the 1962 rule that made grabbing the facemask illegal? How about the one against targeting a quarterback's knees, changed in 1989?
Which good ole days are we talking about here? The ones where players regularly died on the field of play? Or was it when players washed their pain pills down with beer before games?
The fact is, football has been evolving since day one and it is now safer, more exciting, and more popular than ever. Change isn't always a bad thing.
I’m afraid I already know what has to happen before any meaningful changes will be made. A player, either college or professional, will have to be seriously injured or killed on national television. A player like David Ash or Matt Scott will have to stay on the field after a concussion, take another big hit, and never walk off.
I hope it doesn’t ever come to this. I really do. But players keep getting bigger, hits keep getting more violent, and if we don’t start taking this seriously, I’m afraid it’s only a matter of time until something forces us to.
Ultimately, the complicated question of who is responsible and what should be done has a pretty simple answer. It's not up to doctors, coaches, the NCAA, the NFL, or the government. It's up to us — every football fan, parent, trainer, coach, and player — to educate ourselves and our players about the signs, symptoms, and risks associated with concussions, and to change how we as a society view traumatic brain injuries. New helmets will help, rule changes will help, but if we continue to treat this game like it's life or death, then for some it will be.
What David Ash did Saturday night, calling the Texas staff after the game to report his symptoms, is a huge step in the right direction. Hopefully this indicates a shift in thinking and a better understanding of the potential consequences of these injuries.
I hope Ash makes a full recovery and is able to come back and play again. He's an exciting player and seems like a good kid. More than that though, I hope we all understand that maybe he shouldn't, and that he wouldn't be any less of a football player or any less of a man if he doesn't.