Culture Change: Winning at What Cost?

At the White House’s Healthy Kids and Safe Sports Concussion Summit in May 2014, President Obama said we had to change the culture of the suck-it-up and play-at-all-costs mentality. Unfortunately, that exists even down at the youngest level of sport, but it doesn’t just exist in sports. People often say that sports have a problem, in terms of culture, but society also has a problem. We, as a society, contribute to some of the issues that we see in sports and this play-at-all-costs mentality.

“Culture” includes knowledge, belief, art, law, morals, customs and any other capabilities and habits that are required by an individual as a member of society. It’s a massive thing. When someone says, “Let’s change the culture,” we throw that term out there like we’re going to make it happen overnight. In reality, it takes a generation, or approximately 30 years to change culture. However, there are things we are doing and can do right now to continue a culture shift towards a safer playing environment.

Why is culture change needed? I think when we talk about concussion and traumatic brain injury (TBI) and the issues related to sport we all could think of many reasons why a change is needed. This “win-at-all-costs” mentality is an example that needs to be changed. Again, that’s not just in sport. We see this happen in classrooms and every day life. In terms of concussion specifically, over 50 percent of concussions that happen in sport are never reported and are not medically managed. Depending on what source you read, that can go up to as much as 80 percent.

The reasons for this non-disclosure are most often not wanting to be removed from play, not wanting to let teammates or coaches down and not knowing that the injury was serious enough to report. In some cases, it is also because there was no medical professional presence to disclose the information to. The presence of medical professionals, such as Certified Athletic Trainers can play a significant role in helping to create a more positive culture that would likely make it easier for young athletes to disclose their injuries and even potentially pick up on some injuries that are not disclosed.

Many of concussions get better without any intervention in a relatively short period of time. However, there are many that do not improve. In fact, more recent literature is showing that, at least in younger individuals, around 20% of those who suffer a concussion may take 3 or more weeks to recover. The reality is that if we don’t have injuries that are evaluated in the healthcare system, they are not going to be assessed or managed properly. Injuries that are not properly evaluated and managed, may have worse outcomes down the road.

Recently, I was talking with a 6-year-old boy and his mom. We asked kids that if you got hit in the head or on your body and you don’t feel well, would you still keep participating in your sport. This 6-year-old responded, “I would keep playing.” I said, “Well, why would you keep playing?” He said, “Because my mom told me never to quit.” His mom looked mortified because we all want our kids to not quit, but we mean this as a positive trait. It is a really positive and noble characteristic for people in society to have. However, because he is 6 and he lives in a black-and-white world, “Don’t quit” meant never come out of the game, never come out of practice – no matter the reason.

I was very impressed that his mom immediately started a conversation with him explaining that quitting means walking away with no reason. If you don’t feel well, if something is wrong with your health, it’s okay for you to stop playing and let someone know. This conversation resonated with me and made me truly think about the idea that the way that we talk to young kids and families about the issue has to be very different than what we are saying to the high school athlete and parent. Younger children perceive things differently and their parents play an even bigger role in this though process. In high school athletes, their “don’t quit’ has turned often into “I can’t come out of play because I’m going to let my teammates or coaches down. I’m going to let my family down,” and “I want to win at all costs.”

We have to continue to consider how can we frame the message to help people, and young kids especially, to understand that you’re not quitting when you’re not feeling well or when your health is at risk and you have to stop participating for a given period of time?

There is no quick fix to changing our culture, but we must continue to work together as a team in finding the answers and solutions now, to make a positive change.

Dr. Johna Register-Mihalik, Research Scientist at the Injury Prevention Research Center at UNC-Chapel Hill

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