Controversial findings
With so much at stake (approximately 3 million youth play tackle football annually, along with 100,000 collegiate, and 1.3 million high school participants (1)), and with so much unknown about concussions, the study has, not surprisingly, generated considerable controversy in both the medical and football communities.
Expanding on the study's main finding, Michael Collins, a study co-author and executive and clinical director of the UPMC concussion program seem to go out of his way in an interview with the Pittsburgh Post-Gazette to criticize Pop Warner: "limiting contact at practice in Pop Warner is short-sighted," he said, "because practice is an opportunity to teach proper technique, for kids to learn how to do this the right way."
Of the 18,000 concussion patients who visit the UPMC clinic every year, Collins said, "the worst cases I see are kids who on August 15 ... decide to go out for football without ever learning the sport. The don't know how to tackle or play, they get lit up."
No surprisingly, there was immediate pushback from Pop Warner. Julian Bailes, M.D., co-director of the NorthShore University HealthSystem Neurological Institute in Chicago and chair of Pop Warner youth football's medical advisory board, told USA Today that the study's suggestion that Pop Warner had gotten it wrong when it moved in 2012 to limit contact in practices was "erroneous" and sent a "bad message" to players, coaches, and parents.
Bailes told the Post-Gazette, "Those who played and coached the game know it's very possible to still teach technique without going head-to-head full contact. If they're implying you need head-to-head full contact to learn proper technique, I disagree and think they are erroneous in that conclusion."
Indeed, Bailes went so far as to tell USA Today that "to think more hitting your brain is good for you or doesn't make any difference if you do it in practice is asinine."
Also expressing reservations about the study's main conclusion was Bennett Omalu, MD, one of the leading forensic pathologists in the field, well-known for his post-mortem research on head trauma. "The very basic medical principle, research or no research, is 'Do no harm,'" Dr. Omalu told the Post-Gazette.
"Anybody who tells me that willfully exposing the brains of children to repeated impact is something good, I would humbly disagree with that person. I am not an advocate for the idea that football should be banned or not played -- I am not that extreme. I stand with Pop Warner, and I stand with caution. Limit the exposure of children from repeated blows to the head in whatever activity they do."
While not surprised by the study's finding that the vast majority of concussions occur in games, Jon Butler, executive director of Pop Warner, was not expecting the UPMC researchers' suggestion that not enough contact in practice may be detrimental. "It surprises me that they say limiting contact in practice may have a reverse effect, essentially," Butler told USA Today, noting that much of the teaching of proper tackling technique is done at slow speeds without full contact.
Calling the kettle black?
Surprisingly, neither Bailes, Omalu, nor Butler criticized the study for making the logical leap in implying a cause-and-effect relationship between the amount of practice time and the concussion rate in youth football games that data collected, essentially by Collins' own admission, simply cannot support.
Collins suggested that Pop Warner had acted in 2012 to limit contact practices precipitously, "without there being a shred of scientific data." At the same time, however, he admitted that more research was needed, including whether youth sports teams that implement USA Football's Heads Up football program have fewer concussions. In doing so, Collins, for all practical purposes, acknowledged that the data in the current study did not support its broad conclusion because in order to establish that that the amount of time spent in practice learning to tackle leads to more concussions in games, much less that reducing the amount of time spent learning to tackle in practice makes matters worse, the study would have had been designed from the start to test those hypotheses, which it simply did not.
Thus for Collins to criticize Pop Warner, because "It's science. It's not getting up and talking about doing this and doing that without having evidence," when the data in the study simply does not support a finding of a cause-and-effect relationship, one could argue, is a case of the pot calling the kettle black.
