a house energy and commerce subcommittee look at spore safety and brain injuries in football, hockey, and other sports. nfl and nhl officials talk about the safety steps they have taken.

we'll also hear injury stories from a professional soccer player and a high school student, and medical professionals explain the science behind brain injuries. the hearing is about three hours. >> all right. i want to thank everybody for being here. we're now with the full committee ranking member, the gentleman from california joins us. we now have the ability to start our hearing. i will introduce you after my statement and before you start your testimonies. i will open with my opening statement will stop good morning, jan. good morning. welcome to this morning's hearing. today it is my hope to learn

what steps are being taken to make sports participation safer for all athletes. every day, parents make choices about whether or not to let their son or let their daughter play soccer or what kind of mouthpiece to buy their son for his first day of football. unfortunately, it seems like every day we hear about how participation in certain sports can be dangerous. it is easy to understand how what parents see in the news inevitably affects youth participation in sports. case in point, earlier this year, president obama said publicly that if he had a son, he would not let him play pro football. then the first lady wants us all to move. it seems to conflict. messages. now, we want a better understanding of the innovations they made by sports leagues, equipment manufacturers, and the medical community to make all spore safer. one clear example is the nhl, which has been working hand-in-hand with the union to make us safer, dating back to 1997, a recognize the dangers of

head injuries and took the proactive step of forming a joint concussion committee, additionally, the nhl also established a department of player safety at its headquarters, the first of its kind, bringing professional league. usa hockey and usa football, to organizations that help oversee youth sports in the united states have followed the lead of their professional counterparts by employing a multipronged approach to making participation safer. usa hockey now requires coaches to complete an online education module specific to the age group their coaching at. and that includes safety

information, concussion education, proper techniques. usa football, which is endowed by the generosity of the nfl and the nfl pa, was the first national governing body for the sport to participate in the cdc's heads of concussions in youth sports. initiatives also engaged in providing you with non-tackling alternatives to develop their skills. additional usa football's heads up up all program encompasses six elements meant to make use football safer including coach education and concussion recognition. proactive actions like the ones i just mentioned are exactly what parents need in order to be assured that everything possible is being done to keep their child as safe as possible while they're on the field or ice. who runs the university of nebraska's brain biology and behavior center located inside the huskers football stadium has been developing an mri machine that can be used on game day to assess a head injury.

this would allow medical staff to determine if a player has suffered a concussion, how severe the injury is, and if the player is able to return. the equipment manufacturers are also using technology to make innovation changes to helmets, mouth guards, footwear, and other equipment in order to reduce injuries. i feel confident saying that given the recent rule changes and the rate which technology is advancing, when the contacts for today is likely safer than it has been in the past. however, we must accept there is no silver bullet, no helmet or pat is going to prevent 100% of the injuries 100% of the time. this is why we need to consider a multipronged approach aimed at keeping our kids safer also promoting youth participation, aimed at keeping our kids safer

while still promoting youth participation in sports which involves listening to how leaders like the nfl, nhl, youth leagues and top-tier university researchers are partnering to make progress toward making sport safer. these are the types of innovations and paradigm shifts needed to give parents the assurance that all the possible steps are being taken to improve the safety of their child on the field. i would like to thank our panelists for joining us here today. i would like to thank you for making the trips to washington, d.c. from lincoln, nebraska. and my time is over, so i will recognize the ranking member from illinois. >> thank you. this is a very important hearing on improving spore safety. i look forward to hearing from all of our witnesses on both panels about their experiences, proposals, about how to make spore safer for everyone from children to professional athletes.

athletes are continually becoming bigger and faster and stronger. despite some efforts to make spore safer, much work remains. 300,000 sports related traumatic brain injuries occur annually in the united states. sports are the second leading cause of traumatic brain injury among people aged 15 to 24 years old, second only to motor vehicle accidents. this is a crisis and won the subcommittee should do everything in its power to address. we are going hear today from a high school senior who suffered a severe head injury during a lacrosse game in his sophomore year. despite his impressive recovery, that hit later identified as his third head injury, left him with a limited ability to enjoy the types of activities many of his high school classmates take for granted. his story should serve as a reminder that youth sports injuries can have devastating and lasting consequences.

and we will also hear on the panel from no olympic and world cup soccer champion goalie forced from the field after a career ending dramatic brain injury almost four years ago. her struggle to overcome the physical and psychological injuries that followed illustrate that even our sports heroes are vulnerable to the sports injuries. they should be commended for their courage. thank you. for the recovery, and her willingness to testify on this critical issue. a pro bowl and super bowl winning safety and former member of my hometown chicago bears tragically committed suicide just over three years ago. in doing so, he shot himself in the chest to avoid any impact on his brain, she asked that donated to medical research in

order to allow scientists to study the impact of brain trauma he suffered over his 11 year professional career. it was later disclosed that he suffered from "moderately advanced" case of chronic traumatic encephalopathy, a disease and to repeated blows to the head which can result in memory loss, depression, and dementia. the stories prove that even severe career ending sports injuries can occur at any level of competition and this case should make it puts all of is the impacts of brain trauma go way beyond and athletes days on the field and can become more severe over time. we will also hear today from medical and scientific experts who have studied impacts of brain injuries on athletes of all ages. we will hear about the importance of taking athletes off the field of play as soon as your suspicion of a brain injury , and keeping them off into their cleared by responsible and trained individual. finally, we will hear from the nhl, nfl, the leaks responsible

for mitigating traumatic brain injury in their sports. i hope to hear what they will implement that will reduce the risk of brain injury moving forward. i am not advocating for an end to sports as we know it -- or maybe not exactly as we know it right now. i also feel strongly that 300,000 injuries every year are too many to overlook. we should take reasonable steps to reduce the risk. i look forward to hearing from our witnesses. i hope this will help the subcommittee to better understand the safety risks in sports and what we can and should be doing to limit these risks. i yield back. >> thank you very much. this time i recognize the vice chairman of the committee. >> thank you very much, mr. chairman. thank you for holding this extremely important hearing. i want to thank dr.

james johnston who will be one of the witnesses who came to my office earlier this morning. thank you. experts generally agree that concussion can be classified as a brain injury ranging in seriousness from mild to dramatic. this interpret disease control states a concussion is caused by a bomb, blow, or jolt to the head or a blow to the body and causes the head to move quickly. according to the cdc, the sports that reported the highest number of traumatic rain injuries are bicycling, football, ground activities, basketball, and soccer. in 2010-2013, the participation rate of children in youth soccer and football dropped considerably. some have pointed to the increased risk of tbi as a result of participating these sports as a reason for the drop in the participation. the increased spotlight on

concussions in sports has resulted in an increased amount of research and brain injuries as well as research on how to improve sports equipment in order to prevent such injuries from occurring. collegiate and professional sports leagues have implemented standards and revised the rules in order to decrease the number of brain injury incidents. the nhl has been required -- has required its players to wear helmets on the ice in the nfl instituted new standards for evaluating concussions on the sidelines after the leak reported an occurrence of 223 concussions in just over 300 games in the 2010 season. state and federal governments have also been involved in tightening safety standards. since 2009, all 50 states and the district of columbia have adopted laws protecting youth and high school athletes from returning to play too soon after suffering a concussion or potential concussion. this hearing will focus on what

more can be done to prevent brain injuries from occurring in sports. this is at the youth level, amateur, and professional level. i look forward to the testimony of our distinguished panels. thank you, mr. chairman. i have two point five minutes remaining. is there any other member on the republican side that would like to speak with an opening statement? i yield back -- >> missouri, do they play sports? [laughter] on behalf of the big ten, i want to welcome rutgers to the big ten. >> thank you very much. >> five minutes to the full ranking member of the energy and commerce committee, mr. waxman. >> thank you very much, mr. chairman. decades ago, many thought that head injury was serious only if a player was completely knocked out unconscious or suffered a severe contusion.

after frequent painful blows, even a young athlete could continue to play. but we now have strong indications that the effects of repeated brain trauma in sports, even those received during one's youth, can accumulate the consequences that are long-term debilitating and even life-threatening. these consequences can stem from injuries once considered minor known as sub concussive blows which may not be accompanied by any immediate adverse symptoms. serious psychological and emotional disorders have been documented among former athletes that have suffered repetitive brain trauma. researchers a number of times have found evidence of the neurodegenerative disease when examining the brain tissue of dozens of deceased former nfl players.

new technologies have enabled to show the metabolic changes in the brain associated with concussions and sub concussive blows. brain injuries in sports can occur in a wide variety of situations, and different athletes' brains may respond to freely to an injury. sports related brain injury is a complex matter. it requires addressing many issues. so when the title of this hearing suggests we take a multifaceted approach to improve sports safety, i could not agree more. first, we need more neuro science research. they can lead to a better understanding of the risk factors and maybe better treatment options for brain injuries.

second, doctors, parents, players need to work together to establish health regulations, game rules in the sporting culture that reflects the seriousness of brain injury and put the athletes help first. third, we must address the health and safety risks associated with the athletic equipment and pursue a better understanding of how the significant might be improved -- three years ago, mr. butterfield and i called for hearings about inadequate testing standards, lacks reconditioning certifications, economic disparities regarding the safety of football helmets used by millions of american athletes. we are to touch on some of those issues today. but i believe those issues very deep it -- a consideration and are likely to get today. the subcommittee chairman mike

consider holding a separate meeting on these matters. i think it is viable the national football league is testifying here today given recent and ongoing disputes the league and its players on this very topic. however, i believe as traders commiserations should also testify -- i also believe others should testify. mr. chairman, today's hearing is important. i appreciate the subcommittee review of sports related brain injuries. i look forward working together with all of us on this issue in the months ahead. thank you for holding the hearing. i look forward to the testimony of the witnesses. i yield back my time. >> still have a minute left with the gentleman from utah wanted to use it.

>> i might just point out that moving physically and conditioning the body is not anywhere near dangerous as subjecting oneself to brain injuries. i don't think they're contradictory. >> interesting, because that issue is we want kids to go out and play. we want them to join youth leagues. >> and we want sports, but we want the mess as possible. >> absolutely. to use your last 26 seconds, this is one of those where jan and i both agreed was necessary. this has been a bipartisan effort. with that, let's move on to our witness panel. i'm going to introduce the entire panel now and then we will start with mr. daly. we are blessed to have the deputy commissioner of nhl. am, the executive director of usa hockey. then we have the senior vice president player health and safety policy national football

league. thank you very much for being here. and the executive director of usa football. then a face of a brain injury, multiple concussions within soccer, briana scurry, a former professional goalkeeper of u.s. women's national soccer team. oh we will have even cover the other face of high school level concussions. with that, mr. daily cover your noun recognized for your five minutes. >> i would like to thank the ranking members to invite me to testify today in the reactive steps the hockey league is taken to make the best perpetual players in the world. it is the only major professional sport with no out

of out of hockey is a physical game. at the nhl level are players wanted to be physical and/or and wanted to be physical. permitting safe and responsible play in our game, the national hockey league working together with the national hockey league players association has gone to elaborate lengths to do that, and will continue to do so. we are pleased to have this opportunity to share with the subcommittee some of the measures enacted in this pursuit. the national hockey league was the first major professional link to a value of players after they incur head injuries. beginning in 1997 the nhl and the nhl concussion program requires that all players on all clubs undergo preseason baseline psychological testing. after he player is diagnosed

with a concussion he goes free and posttest did -- he is tested after the fact to find when he will be able to safely return to play. that is pursuant to the concussion program that narrow psychological testing results had added value and should be taken into account along with player reported symptoms when making return to play conditions and decisions. the nhl and nhl concussion committee has also taken at affirmative and proactive step to issue league wide protocols regarding the diagnosis, management and treatment of concussions. import link of the issuance of warnings to players regarding the risk opportunity to play before the recovery from a prior concussion is complete is an important component of the nhl and concussion committee

citizens option. this is provided regularly to all of the constituencies in our league of including players, all personal, and nhl officials. in addition to enforcing additional player rules, and more stringently penalizing conduct of a several new rules have been adopted. you're not allowed to hit the head when other contact is unavoidable. with respect to the fighting issue in particular, while it remains a small part of the game of its role is finishing. 75% of the 2013-2 thousand 40

regular-season and 68% of the games played happen obliquely free of fighting. the highest percent since the 2005, 2006. the number of major penalties assessed providing down 50% from last season, and on 31% from the 19 -- 2009-2010 season. in this important area in be the league's intention to discuss any playing world pages regarding fighting darkly with the nhl players association. alternately it is in the hands of the department of safety cover the first link department of its kind of professional sports with this department monitors everyone apart to 131 regular-season games plus all or playoffs games and assesses every hits in a replay to make sure that the links standards for safety and responsible play are being adhered to. when the department determines that the standard has been violent, awful mental discipline is assessed in the form of a

suspension or a fine, and the department creates a video thanks points to our players and our fans why the behavior merited punishment. the cumulative effect of these efforts has begun to change the culture of the game in a positive way, as we can see on a nightly basis layers avoiding dangerous plays a gratuitous contact that they no doubt would have engaged in just a few short years ago. since the adoption of a mandatory helmet rule in 1979 to the nhl together with the nhl pa has an continue to oppose a series of additional regulation carting a player equipment regarding to player safety generally but also to head injuries more specifically, including most recently a rule adopted prior to the start of start of the season requiring face shields for all incoming players. each of the four international concussion in sports conferences between 2001-2012, in support of

the federal and state legislative initiatives regarding concussions, and the support and assistance in the development of concussion education for grants for youth and junior age hockey players. to summarize, while worker a amazing that there is considerable work to be done for the national league has been and will remain absolutely committed to promoting the safety of its players. we firmly believe it is not only the right thing to do for our players but it is the right thing to do for our business, both in terms of promoting participation at the use hockey level, and in maximizing interest by fans and consumers of the sport at the professional level. i thank the chairman of the ranking member, and subcommittee members for your time and invitation and speaking to you this morning. >> thank you. >> thank you chairman, ranking members, and distinguished members of the subcommittee.

it is a privilege to be with you today to discuss issue that is a drop for artist of a everyday and u.s. hockey, the safety of our participant both on and off the ice. we have adapted well to changing environments over time and we had to particularly as we wish to thank, who guided a great deal of our decision-making. a chief medical officer, who is the head of sports medicine at the mayo clinic in rochester, minnesota, and the other is the chair of our safety and protective equipment committee. that committee has been existence for 40 years. it is an important group, helping to guide our board in making it decisions. we have a risk management committee, which is concerned with the safety of the playing environment and the surrounding area. in 1999, in cooperation with figures getting we began an organization called serving the american ranks, or dark, which is essentially a trade and education organization for ice facilities focusing on a variety of operational aspects including safety issues in drinks. in the safety of our

participants, we positively affect the landscape through three primary areas, education, rules and enforcement, and risk management. education related to safety happens on an ongoing basis in u.s. hockey, and we will use the many avenues to mitigate. we have direct electronic vacation with every single home, every player, and prepared from area official, every comment in our organization through database. we are constantly communication with them with educational bulletins and is. our coaches have a huge influence and providing a safe and responsible environment, and i am a coeducation -- in our current coaching education environment, we have the gold standard. two seasons ago we added an online educational module that is age-specific in nature, which also contains critical safety information including concussion education. officials obviously play a very

important part and how our game is made safe as welcomed and they receive regular evaluation and education electronically in our video clips and also access to our national reporting system which tracks penalties to help us understand and assess behavior trends. when annual e-mail posters to every ice facility in the country to help deliver our messaging and over the years that poster has focused on topics like concussion prevention, concussion education, laying rules, and disease, and our heads up don't check program. we have adapted the rules to the game on an ongoing basis for mouthguard and held issues to rules aimed at limiting dangerous behavior. another recent modification in usa hockey game in june of 2011 when our board voted to change the allowable age for body checking games from the peewee or 811-12 level up to the bantam age group of 13-14.

this was done despite many voices around the country in opposition to change, which no one seems to like. research based on both athlete development and safety guided our board decision. it is worth noting that two years later, hockey canada followed our lead. regarding equipment safety, usa hockey took a significant step in 1978 when it called for the creation of the hockey equipment certification council, or hecc. we seek out hockey clement for product certification. it is the same procedure that football uses and certifying its helmets. it is a completely independent body the above doctors, engineers, testers, sports bureau, and lawyers. it validates the manufacturers and indication that the equipment they produce has been produced -- tested and meets the

requirements of the safety standards. before closing i would like to share with you briefly our newest off i safety program called safe sport following the lead of the olympic committee, this is to protect our participants on policies regarding hazing, zero tolerance, locker room supervision and abuse of any kind. in the early 1990's we were when the very first use words organizations to required screening of all adults that have access to our youth. our 34 affiliated associations each have a volunteer safe sport coordinator that helps us as boots on the ground to provide the safest possible environment for our participants. our sport is tremendous and its growth in the last 25 years, doubling the number of youth players we have as we continue to provide opportunities for young people to we know that we have the responsible or to make argument safe as possible, and

we will only continue to grow if we are successful in doing so. >> thank you. mr. miller, you're recognized for your five minutes. >> chairman terry, ranking members, and members of the subcommittee, i appreciate the opportunity to testify this morning on the behalf of the national football league, and i commend the getty for -- the committee for digging up this issue. commissioner has stated repeatedly that he spent more time on health and safety of our board than any other issue that comes before him. football has our day vital place in the resume of american life, there are nearly 6 million children who play football across our country. another 1.1 million that play in high school, 75,000 in college, and so whether distance games in our backyard, at thanksgiving, or games late in our local

parks, or friday night high school games, saturdays with college, or hopefully plenty of people watching the nfl on sundays and mondays and occasionally thursdays, football plays a significant role in our lives. we take that popularity seriously. with it comes a great deal of responsibility. that is what we risk -- we embrace. we understand that the decisions we make affects all levels of football. i appreciate the opportunity to share the nfl's work with the subcommittee on the health and safety of our athletes to play our game. football has always evolved of the rules have always change them and so i would like to share with the subcommittee a few examples of that over the last couple of years, and the effect that that has had on our level. it has only been a couple of years ago that we changed the kickoff line, because we identified that as the single most dangerous play as root -- as responded to the number of concussions. we decrease it by 45% by moving it five yards.

that number has faded in successive years. we have seen a greater emphasis on eliminating helmet hits on our game. there is a system of fines and suspensions, not to mention penalties as a result of that. these are the sorts of things that we are looking to do to change the culture of our sport is played. we encourage players to lower the target so that they tackled, we've ever sent through our coaching that there are better ways to go about what they are doing. we have seen the results. the past year alone, between 2012 and 2013 the nfl has seen a decrease in the number concussions by 13%. now that is not in the ring, that is a trend, and it is one that we find encouraging but there's more work to be done as we begin to change the culture of the sport as it relates to that.

we've added other protocols to our sidelines to take care of our players. there's one rule that governs the and that is that medical concerns will always have competitive once. we have added unaffiliated, conversion -- unaffiliated from a positions on our sidelines. we have added trainers and skyboxes or little purpose of watching the game and coley down to the sideline if they identify an injury to mention the players attended to appropriately. we have mandated uniform sideband protocols across all of our team so that everyone is working on the same playbook, those protocols are based on internationally expected guidelines. we know as we change the culture of our sport as relates to health and safety we have an impact beyond. let me cite two samples of that. there had the program among other offerings are changing the game at our parks and communities around the country,

literally asterisk big. the populated of these programs, which i will not deal scott's thunder on have been tremendous. we are proud supporter, and we are proud of his work regularly. in addition, the nfl used as an inspiration a young man named zach who was a 13-year-old youth football player in washington state several years ago who suffered that is traffic injuries. he was returned to play too soon after suffering a concussion, and he still struggles with the challenges that come from that. his advocates were able to pass the new concussion law in washington state, which are commissioner said we will replicate in all 50 states around this country to make sure that all youth sports, not just the bulk of our played more safely. that given the coaches are aware of the risks of concussions, they are removed from play should appear they suffered a

concussion, and i'll richard weigel in medical professional has cleared them. just this month with the 50th state has that law, and now the nfl is solely responsible for that work, and we're happy to lead in the state to get this done. i wanted to mention two other components. we're proud to work with the cdc, promoting concussions material that cannot 2 million of kids, posters, and locker rooms. we've also invested tens of millions of dollars in research. $30 million with the nih which is the artist grants that the nfl had ever given. the first 12 million and -- $12 million of that have gone out to study dramatic brain injury, and we have a partnership with under armour and an electric to improve the diagnosis and treatment of concussion. find better ways to protect against concussion in the first place. these are ongoing issues and ones that we think are going to yield significant successes in a short amount of time. i apologize for exceeding the

limit, but i appreciate the time. >> mr. hollenbeck. >> thank you for the invitation to testify. u.s. football creates import standards rooted in education price cool football. we stand with experts in medicine, child advocacy and support to believe that education changes behavior for the better. this is precisely what we are seeing for our heads up the ball program, which is already benefiting wanted 25% of youth football leagues across the country in its first 14 months. we expect to double that this year. we advance safety derivatives based on his by independent experts, we also lead fun and dynamic instructional initiatives for young football layers and as well is a noncontact flag football program. aspects of our work resigned in my written testimony. the remainder of my time will be showing a video of how has a football programs are improving

player safety within the fairfax county public school system which earned high marks from parents, coaches, administrators in its first season of a and paid close attention to hearing from the athletic directors of the schools on how this program is making a difference. ♪ [video clip] >> when coaches get to the high school level, i think they assume that everybody who plays knows how to play, and they're going to be under friday night lights, anything is going to be great just like it is on tv. it is not like that. you're good to get kids who have never played before, and you're worried to get coaches that have never coached before. you really need to be able to teach coaches how to coach. >> through the had the program, what you do, three pillars. concussion awareness, properly

controlling equipment, and the proper aspects of tackling. >> it was a no-brainer to get involved with usa but all and the heads-up program, and go through a progression of tackling. they are learning how did keep their head up and not to lead with their helmet. they are taught that from the beginning. it has limited the amount of concussions we have had this year. we have worked on tackling from day one. >> squeeze, beat, low. >> the coaches have completely bought in and endorse what we are doing.

>> elbows high. >> what we did not anticipate was how aggressive that the coaches association here in her jenny went after it. we saw the need to make the game better and safer and we ran with it. the old days of the ammonium tabs are gone, and that is a good thing. >> heads-up football has allowed concussions to be a topic of conversation in a positive way. >> it is standardized, it becomes a much more consistent way of teaching the game. >> the kind of instruction gives my staff in line. >> you are seeing a distinct improvement and reduction in injury. i think that says a lot about the program. >> what this has really done, because we are hands-on with the parents, we're showing them how the progression lows, where teaching them the terminology as well. it brings a level of comfort to them. >> it is really good that all the coaches are learning how to teach the proper techniques of doing it right to these kids.

what i was never taught this. >> in our family room he will show us and demonstrate on his dad the techniques that he is learning. his coach has not only employed the technique of the they keep asking their kids to do it correctly. it shows they care about the kids, i am not worried about whether or not he's going to get hurt on the pill because i know that his safety is just as important to them as it is jimmy -- to me. >> this is a vital piece not only of our football program but of our athletic program in fairfax county. >> good. >> all the top cross programs are talking about what are we going to do overall in a very positive way. >> we agree with the mission of usa football and that is to allow her students to participate in competitive athletics and learn so many wonderful life skills, and do it in a way that is healthy. >> i can truly look at apparent

and say this is what we have done, this is what heads-up football has brought to fairfax county schools. it is an awesome opportunity for coaches and parents and kids and officials and everybody to get on the same page to help kids. >> if you're an administrator in a high school, your being asked a question on how you're making this favor for my kids, and we can answer that now. ♪ >> thank you. we appreciate you being here, your it recognized for five minutes. >> thank you very much. i am 42 years old. i served as a starting goalkeeper for the united states women's national soccer team for

the years of 1994 to 2008. during that time i helped to lead the team and winning to 11 old metals, in 1996 atlanta games and 2004 athens games, and late 173 international games over 15 years for the united states. that is a record among female goalkeepers. in the summer of 1999, my 20 amazing teammates and i captured the hearts of america by beating china in a healthy kick shootout alive in front of 90,000 screaming fans at the rose bowl in pasadena, california. i was the one that made the single safe --save before she took off her shirt. i will that you will remember where you were at that moment. it was the kind of event that fans forms eyes forever for the better. my passion and my mission with soccer, my ultimate reward was living my dreams and inspiring the dreams of countless others. today, i'm here before you to share my new mission with you.

my new mission is to provide a new face and voice to those who have had and may suffer the long and difficult recovery of a devastating traumatic brain injury and concussion. my life story reads like a script from oprah winfrey's where are they now. like many of oprah's guest i too have been lost in deep black laces with my face in the dirt, and have only recently begun to claw my way back to my life. on april 25, 2010, my life changed forever. during that day i played a women's professional game against the philadelphia independence in philadelphia and in that game iso deford medic rain injury that ended my beloved soccer career. that was four years ago. i struggled with intense piercing headaches that were so bad that by the evening and was

all i could do not to cry myself to sleep. i had to take naps on a daily basis just because my sleep was so disrupted. i could not concentrate, and i was very moody. i felt completely disconnected from everything and everyone. i was anxious, and depressed. every day, i wondered if i would ever get better. i recently moved to washington dc to have bilateral occipital nerve surgery at georgetown, to eliminate severe headaches that plagued me daily. fortunately, this surgery seems to work, but i'm still being treated for lack of concentration, balance issues, memory loss, and anxiety. i personally and intentionally had my concussion recovery story documented by media

outlets by usa today, the washington post, and brainline.org, to bring a ray of hope to those suffering like me. in september i was alarmed to learn that the number of reported cases of concussions in soccer was second-highest in the united states, with only america's football having more cases. additionally, a recent article published in november stated that one of two youth soccer players will suffer a concussion while playing. i feel the numbers of reported cases are likely understated. they did not designate those who suffered multiple concussions like i have. statistics like these have solidified my urgency of purpose, to shed light on the high frequency of concussions in use, and a devastating emotional

toll that prolonged symptoms often cause, yet are too frequently dismissed. i sincerely hope that my presence here today will inspire increased awareness, understanding, and assistance to help the thousands of young tbi sufferers across this country. i thank you you all for allowing me to testify. >> thank you very much. that was powerful. this is our opportunity now, each of us have five minutes, to ask you questions. let me ask you this one. i too was shocked to learn that soccer had the second most concussions, which is a really dominant youth sport. are you seeing changes within

soccer, and unlike there is an obvious top to bottom connection that we heard from the nhl and the nfl, is there anything like that occurring in soccer? >> thank you for the question. i too was very surprised to read that statistic very i think it is so high in part because of the explosion of players that are playing soccer now in the last 10 years. i am not finding that soccer has completely grasped the harm or the situation like usa football and hockey have. hopefully the governing body for soccer will start to see that there is a great injury for -- danger and having too many head

injuries is a bad part of this. >> good game in winning over china. it was a great game. we all remember that. now to mr. miller. the nfl has seriously undertaken an effort to get the return to play guidelines adopted in can you tell us more about what the guidelines are and how they are developed? >> yes. the model law that was passed out of washington state and taint three primary elements, the first of which would be that parents and the kids would have to sign off on an education sheet to understand the risks

before they were allowed to participate. a child who appeared to have suffered a head injury must be removed from playing immediately, in other words the coaches were asked to act conservatively. a licensed medical evaluator had a turk -- had to return every child to play. all of these laws a very new, and so i know that there are some academics were studying them to see their success. i know there's one anecdote in washington state, the one that had the first one. in the years after the law was passed they did not see a single brain injury, or any blood on the brain of any signal football where -- football player in washington. that is anecdotal and more work

is to be done, and i commend those states that are going back and making their laws more strict because they need to be added to the youth level. >> thank you for the question. have you seen a reduction in concussion at usa hockey after implementing new techniques? >> we don't have the same statistical data. we were talking to the same company to do that sort of thing

. we have focused on research, education, and rules enforcement. we know that a lot of sports at the youth level suffer from a misplaced macho attitude. a lot of coaches think they are coaching at the professional level. that is very important. we have been very strict about returning to play rules. we. the same thing. when in doubt, sit them out. one of the big challenges as quality control. cannot give in to act the same way. because of our emphasis in preventing head injuries and how

to recognize them and how to respond to them and making sure this is a medical decision, the number is dropping. >> great. you are recognized for your five minutes. >> my granddaughter has played ayso soccer from the first time she could hear it now she's is on a traveling high school team. i am very concerned about what you are saying. even more concerned now after you are saying that soccer seems to lag behind other sports. there have been studies that compared the rates every ported concussions from male and female athlete that tend to show female athletes have a higher rate of reported concussions than male athletes in the same sports. what would you say that we need

to do immediately? i do worry about her now. and what could happen. what would your advice be to female athletes, female soccer players and to those who coach and treat them? >> i too find that statistic very alarming. i think one of the things that needs to occur with soccer is officials and referees, coaches need to take their heads out of the sand a little bit and realize this is something that is plaguing our sports as well. the video that was played earlier was a fantastic example of where to start. you teach the coaches the proper way to teach the players how to head and do certain drills to make sure the coaches know how to teach his chances of letting

players run around out there and letting the ball hit them and instill -- instead teach them how to head the ball and 6 -- improved the strength of the head muscles. part of the issue is that they are not as strong as the mail counterparts. that needs to occur. there needs to be in understanding and in education of what you are looking for when a head injury does occur. >> i do not know if soccer is the only sport where you quite deliberately use the head. is that an inherent problem? >> obviously that scenario you will have something highly probable that will happen. if you teach it properly you are going to have the head injuries no matter what you do. i think certain things that happened during the situation is not the only time when concussions occur.

mine happened when i was going for a lowball from my left. the player came and hit me in the side of the head with her knee. it has nothing to do with heading at all. this is not part of that. >> i would love to get your advice as we go forward. anything that i can do out of this body. i worry about my granddaughter. i wanted to ask you a question. retired nfl players face some of the most serious health challenges of any spport but benefits are not on a par with major league rays fall or the national basketball association despite the fact that the nfl has more than $9 billion in annual revenue. does the nfl yet provide

lifetime health insurance for former players who did not play under the current collective bargaining? >> no. they are able to continue their metal -- medical coverage when they leave a key cane -- when they leave the game. in the most recent bug argument there were a million dollars that went to the players who went in pre-1993. all of our programs are collectively bargained. during each iteration you have seen changes and improvements made to the programs for retired players including this year. a screening program. >> professional baseball and basketball to provide lifetime health insurance for former players. while i understand the plan,

what could be the plan to not provide lifetime health insurance for former players. >> all of our policies are collectively bargained. the improvements that we have seen as far as care for the retired players whether they be the plan that you mentioned which accounts for any player who suffers from a diagnosis of dimension or those that help join in hip replacements, those are improvements and made it available to players. in addition to another of other practices including help lines. a have additional programs. >> i yield back. >> you are recognized for five minutes. >> thank you very much. the changes that you have made in recent years, the rules change something trees penalties, suspensions for role

violations, reducing full contact practice days, can you share data egg you have that this has has a positive impact on incidents that may encourage leaders at other levels of football? >> absolutely. we're happy to share with the committees and greater information that i can offer. the most interesting number is when you count up the number of all of the concussions that were diagnosed in games and practices preseason and postseason. you see a 13% decrease in year-over-year. >> 13% each year? >> yes. the emphasis has been on eliminating this on the game. these are a significant cause of the injury. in the circumstances we have seen a decrease in the number of

concussions by 23% in the past year. there's a lot more work to be done. those could change year over year. >> i'm happy to hit that further. >> i think we would. this is very helpful. i hope the improvements continued. i believe your testimony indicated that if team high schools and -- in 10 districts -- and 10 districts participate in a pilot program last year and that you're anticipating a 500 to 5000 road this fall. i would imagine high school football is the football that most of us have experience either through ourselves or through a child or a son.

this is part of the american tradition. what are your plans for getting more school football programs at the high school level to participate? what is your outreach entail? how do schools across the country learn about your program? the purpose of this hearing is multifaceted. one of the purposes is to inform high schools across the country about your program as the video indicated occurs here next-door in northern virginia. >> one of the common themes we are hearing is inconsistency. football is probably the most fragmented of all the sports. even at the high school level there are significant challenges. what we are trying to strive for is consistent technique of technique and terminology. now getting out to these youth programs as well as high school programs, the good news is they are being responsive. they are being asked as was mentioned in the video what are

you doing about this >> it is a combination. we're talking to state associations. we are talking to coach associations. we are recommending athletic are his. national ptas involved. we are looking at every conceivable channel to look at the importance of changing behavior. this has been incredibly influentially. we now have the big ten. the acc. the ncaa. we will have all college, says involved and everyone will be involved with these that help influence high school coaches and program in -- programs to help change behavior. >> think you. if there is one message i wish to leave this morning and my five minutes of rationing is that i will hope that all of

those involved at your level of football would examine what you are suggesting. that touches virtually all of the american people. i commend you cannot for the testimony. thank you. >> the that is why we have nhl youth hockey the. -- hockey. it does seem like it trickles out. it gets pushed down to the youth. that was by design. the gentleman from utah is now recognized for your five minutes. >> thank you. i first want to echo something he said in his opening statement. the main sound obvious. this is a complicated issue. there's a lot of complexities.

there is a lot we do not know about. brain science. i think we can all re: the notion that this is an issue that significant investment research is something. it is beyond concussions. it is sports. this is an important issue that is well complicated. i would ask mr. miller. can you walk us to the steps? has one brought more information to the nfl? how has the lead responded? how have you positioned yourself to address the issues of concussions? if you could walk us through this? >> the point you made that the science has evolved on urological issues in

neurodegenerative disease is one where it is is a terrific lineup and it can talk to you. we rely on the outside advice a very well-known, respected neurosciencts and how about to change again to reflect that. that is how we ended up creating a unified concussion protocol for our sideline. that is how we ended up with additional concussion experts on the sidelines based on the outsiders who tell us this is the best way to handle your players. this is what you would do if you follow the advice strictly. >> is this position that do not exist 20 years ago? >> it did not exist 20 years ago. i'm proud to be in the world. it is an exciting one. >> have just the one other

question that may be a little different topic. i have communicated with the nfl about concerns in the issues of human growth hormone testing. i know something real in the last effort here there is agreement to agree later. it had not come together and do something important in can you give us a update on what is going on and on testing for human growth hormone? we do not have human growth hormone testing yet. the league has been ready. unfortunately, our players association has thrown up obstacles. it is fair to say excuses for a time. it also goes to the health and safety of the sport. you do not know where the stuff is coming from and who is giving it to players or players. this is dangerous.

it is the wrong example. this is an important issue for us and when we are sorry has not gotten accomplished yet. >> since he was here had to ask the question. >> i think this is why we wanted to have the association here. that was a pretty strong criticism that you just made. it would have been nice to have the players as well to respond. cut i will have to interject. they were asked and they declined. that is not accurate. they were contacted before yesterday. >> i have one question. where are these things only? where do you see these things going over the next five or 10 or 12 years? do you have some things on the horizon we can be looking

forward to? >> as part of the scientific research we entered into, we set aside innovation challenges. the first was to promote new ideas and how to better diagnose concussions. there are no subject it tests now. we have people from 27 different countries offer ideas. we eventually rewarded dickstein of them. in addition we just completed another challenge that goes around how to protect the brain better. we have more than 40,000 people from 110 countries out on the website. we are reviewing these now. i think that they has there's a lot more attention paid to this and hopefully we're one of the act tours you're going to see chant -- all of these places. >> i appreciate that.

i will yield back. >> the gentleman from kentucky is a recognized for five minutes. this might have been the only soccer game i watch him talk to finish. >> my daughter was interested in soccer. we are interested. >> no pun intended. >> i went over my head. i am sorry. what a great sporting events. it is one of the great moments. to be part of that is something special. it was special because it was you were underdogs. you were determined. you brought it up saying not die. maybe a little exuberance. it was a great moments. i appreciate you doing that and sharing. when i play high school football is a claim to athletic prowess,

we practice this. i'm number one time in the south we are all running water breaks. we went to the water break. he falls. he knocks all of the watcher over. the coach says if you do not know how to handle that we will not have water today. that was over 30 years ago. that would never happen anywhere today. there was a louisville young man who passed away on a football field. the coach went to trial over it and turned out he was not it. i think the awareness and things i would describe in my youth would never happen on a football field. at least i hope it went in. we still have these injuries. you talked about your injury being in soccer you're wearing cleats in short camps and they sure. somebody hit you in the side of the head with their need. i watch a lot of football.

they now have targeting. if you are in college the ball you're ejected from the game for targeting. a lot of the injuries where a knee hits you in the son of the head. i do not know how you change that kinds of techniques. >> thank you for the question. that is very relevant. my head when i watched last night again on video, it does not seem to be a hit that would have taken me out of the game. as it was, i got hit and there was a few minutes later before i came out. there was not even a foul called actually. that is part of the problem. sometimes a hit is a glancing blow and it does not seem to be

anything that is a big deal. for me, my main focus is what is done after a hit occurs. and to keep children and young players off the hitch -- pitch after a blow to assess them to see if they're ready to go play or not. i think that is the key for me and why i'm speaking out about this. i've been around the country talking to different organizations. i'm finding that kids are getting concussions in a short. of time because they are returning the play too soon. that is where i think a lot of the awareness and education can help. >> you should do everything you can to stop the head-to-head and so forth. they will pull them in tv over and over. someone might jon runyan hits the side of someone else. it is incidental.

i guess you are right. you cannot prevent that from happening. >> i think that is right. one of the recommendations by the fourth conference was to look at the playing rules of the game. in our case we have done that as well. create the best possible situation. in a context for there will be injuries. there will be hit to the head. the problems will occur. we want to make sure we are treating them appropriately. that is where it shifts. >> i was sitting on the edge of the cal meaning and moving. hopefully you fell my assistance and were able to help us win one for our team. thank you very much. i yelled back. i'm glad to meet you.

>> now the gentleman from maryland is recognized for five minutes. >> thank you for the hearing and thanks to our panel. i had a quick question about whether the school district that you have been working with has that effect did by -- affected the liability policies that they maintained as a jurisdiction? is there any trend that may be getting pushed by the example? they may say previously i would have provided an liability coverage to your school district based on these measures. it is this -- it is with what we do. now that there is still this

program that enhances the safety of students and young people, we want to see that you have implemented that in your district or else we are not going to provide the policy coverage or we are going to charge you a higher premium. you get a discount off of your premium as a school district because you have implemented these kinds of measures. i ask that because i think that increase awareness of some of the risks for some of these boards injuries may lead to pressure in terms of liability on school districts. you will get some that may choose a style and a premium that gets charged to push the program out.

they do not want the liability that comes with it. i am just wondering if you are fair of that kind of act or how the liability concerns interject with the safety efforts that are underway. >> thank you for the question. at the high school level we are on the front one-yard line marching down the field. i will mention that we are having very positive conversations with the state of maryland right now. we have a lot to do right now. we have not seen anything from a liability or insurance concern with fairfax county. a worked very closely with all of their schools about the issues. they told us they have the appropriate coverage. at the youth level, we are absolutely seeing the insurance

industry at large and really the largest provider of casualty in liability insurance forward and actually stated that if they participate in the heads of football programs they would receive a discounted program and a more comprehensive coverage. we are actually saying a positive response by the insurance industry which has its merits. >> i yield back. are there any insurance liabilities at usa hockey? >> there are plenty of insurance liabilities. unlike usa football, our participants are all assured by us as a national organization. whether it is player accident insurance or catastrophic or liability, all of that is heart of what our members pay as a membership fee for.

those premiums are obviously based upon the number of claims. that is another business reason why it is in all of our best interest to try to come up with every tech need, every is, every policy that we possibly can to make our game safer. the number one is the safety of the human beings playing our sport. there are good business dreams -- reasons for us to want to do this safer. >> thank you. thank you for your leadership in holding this hearing. i appreciate the diverse panel that is gathered here and important insights you're able to provide. according to the cdc, 175 thousand sports related concussions impact athletes every year. i think today's hearing has been constructive and helping us move

forwards. this was taken to pass concussion laws. my home state of eleanor, education board throughout the state work with the illinois high school association to adopt guidelines that raise awareness of symptoms and ensure students receive proper treatment. encouraging the professional sports league to take steps to address concussions not in their own ranks and also working with leagues to bring this. last week they kicked off a pilot program to provide certified athletic trainers at three high school stadiums during chicago public school games. these are important to combating this issue. i find the steps to the comforting. i would like to ask.

let's talk about the equipment issue. where are we at in terms of what kind of areas of where we were a few years ago. what do you think we should make? is this backed by medical science? is this going into this idea? >> thank you for the question. it is a very important issue. the equipment issue is a very important issue. it is something we are all kissed him with our players association. we have a set committee part of our joint health and safety committee. we look at all aspects of equipment and how it relates to head injuries. how they can approve equipment

and perhaps reduce the amount of head injuries we have. we passed some rules over time with respect to some of the equipment we have seen with having both in the shoulder area and the elbow area and those potentially causing head injuries. we have these in the areas of player equipment. the helmet issue is an important issue and hockey in terms of preventing concussions. one of the things we're looking to work with our manufacturers on his research and trends of dealing with the rotational forces that can cause concussions particularly in a sport like hot and -- hockey and whether those can be developed more accurately. >> there is a great deal where we rely on the national hockey league be the leader and a lot

of what they do is of benefit to us in a trickle-down fashion. as i mentioned in my opening testimony, we do have a protective equipment committee of 40 years standing. they do look at tabor i a t of issues. the face mask is something that is mandatory. it is not in the national hockey league. >> i'm going to have to cut you off just because of time. >> football comments were designed to prevent against goal factors and they do a happy list job for that. they were not designed to protect against concussions. we are not there yet. the league is doing what they can to inspire that. the other thing we do is we do regular helmet testing in concert with our friends at the players association.

we can inform them of which ones are working best. >> i would just trickle-down. we are working closely with the fitness industry association and the new football council. we are working together with how we can improve things. >> we do not wear equipment and our sport. i do want to commend your state for their illinois youth soccer association. they are taking a real lead in concussion awareness. i just did an event in chicago last weekend for the association and talking about concussions. organization is doing a great job. in terms of equipment for my sport, we do not have anything that is widely used. hopefully in the future there will be something to help. >> the gentleman in west virginia is recognized for five minutes. >> i had to slip out for another meeting. maybe some of these questions have been asked. if you could help me out on this.

is there anything that we can learn from the defense department with concussions, injuries that we're are hearing from when we talked to our troops? is there some way we are all talking to each other? if you could help out with that. >> we're very happy with our relationship we have fostered. this is with returning active service members to talk about cultural issues. what is it about the ball or the military that makes it difficult to make them removed themselves. we found a great deal of reticence on behalf of both populations. it instills a question as to how you get someone to talk about or to tell their team a you do not

look right and you should get out a field. we learned a lot from that. we meet regularly with the army to talk about what they are doing from a science perspective. we share the ideas in science we have. they do with us as well. it has proved to be a very cooperative and beneficial arrangement. >> anyone else wants to arrange with that in our military? >> the second question has to do with states have worker compensation programs to deal with various disorders and injuries. if my state, it is treated in a way that people do not have to take legal action to get help through the workers comp row graham. -- program. is that something that would be a benefit in this program?

a friend am i am has been -- of mine has been quite a few years in litigation with the nfl. it is so cumbersome. we've also had a east coast hockey league team in our city. we see some of the injuries. we hear from some of the players about the injury. is there a time we should have a workers comp program for brain injuries? should that be included? they are not required to follow litigation to get help. >> my case actually is a workers comp case. ed gone through workers comp to get the different dock yours to see different techniques that will help me. that is part of my situation am part of the reason why i have taken so long. every time something is

suggested or recommended i have to go back to the insurance companies to get permission to do it. sometimes it takes a hearing to get everything to move forward. maybe streamlining that would be of great help. you talked about how we can help the military service people who have tbi's. one of the best things i think would help is more of the psychological anxiety and panic attacks to make sure sure each person that comes back through the military get help in that area, the emotional side of it, not just the physical. that would be very helpful. >> any other thoughts? >> workers compensation law are very different. professional athletes are specifically excluded. it is certainly a mechanism that an increasing number of our

athletes are using in cases where they have debilitating injuries from their careers. >> what was your recommendation? you're saying yes? >> i guess what i would say is i think it is generally available to our for more -- former athletes currently. some of what we're hearing is differently from that. that is why i want to raise it. thank you for your comments about that. i yield back the balance of my time. >> the gentleman from florida. you recognize. >> thank you for holding this very important hearing. i wanted to specifically thank you for speaking out. in make so much of a difference. thank you for your sacrifice. you're going to make a real difference in kids lives.

i also want to get back to the protective gear. how does the youth protetive helmet in paris for safety, quality to the nfl and nhl? can you give me an opinion on that? >> so. i'm certainly no expert on exactly how that compares. they set the standards. all the helmets have to pass that standard. they would say the gobi avenue evan be on that. how it compares to an nfl hammock -- helmet is lighter. the padding is appropriate. i do not know the exact details. it is sufficient based on standards.

they are transitioning into what may be into high school or adult comments. i am aware that the technology is improving in helmet and shoulder pads. >> we worked on a program with the consumer product safety commission. we need to put money toward reconditioning helmets for youth leagues. they have budget constraints, as many do, and did i get around to updating their helmets frequently enough. we put a fair amount of money in that. addressing those needs we know a new helmet is better than an old helmets. most important of all is that they learn how to fit the helmets.

that is going to be the number one safety peace. we are aware of these issues. we are trying to make a difference there as well. >> the high school helmet is not as safe as the nfl? you do have a program to help. is that correct? >> i do not know. >> i know the kids play high school football. the parent will purchase a better quality home and for their child. it is about the kids that soon not have the money. it is so very important. every kid deserves the proper equipment. >> also, can i hear from the

hockey as well? >> at the youth level of the helmet is good as the national hockey league. the only thing different is sized or they had to be certified by the council. you cannot use a helmet that is more than three years old. i would first echo mr. miller's comments that helmets in our sports as well are principally designed to prevent school factors and not to prevent discussions. sometimes they can disperse forth in a way that does prevent purpose. we also have regulations that we make available to our equipment managers and our players with replacing of helmet. each player is essentially asked to replace his home, at least once a season. and his road team home and at least two times a season.

frequent replacing of helmets is for our league as well. >> do they know which size fits the child? have they been briefed on those particular issues? >> i agree that it is a a difference maker. it is a fundamental part of what they had. >> this is a cornerstone of our heads of football program. you have found that they do not know how to properly fit equipment. it is a very important elements. >> thank you or that. >> the nfl hockey stars would

have the waste on baseball, asked the ball. there looked up to by some children. do you have program so you can speak? can you go and speak on these particular issues? >> our players are terrific at this topic. one of the elements we included or offered up was actually what we call an ambassador. for leagues that were thoroughly -- that were early adopters then we get visits in consultation with a retired nfl player. we are trying to do this. they are around the facility more. they interact with players. they were thrilled to participate in helpful ways.

>> if anyone want to answer that question you'll have to do it by writing. oh you have a question? i am sorry. >> i am sorry i am late. i met another hearing. i understand the nfl participated in a program initiated by the consumer products they initiative to help them in low income communities. i really want to commend that. it is going to cost a lot more money to get to the point where all kids around the country who played football no longer where old helmet that are likely