In The Tipping Point by Malcolm Gladwell, he notes that there are 3 rules of epidemics (in this case, the galvanizing of support for concussion awareness/understanding): 1) the Law of the Few, 2) the Stickiness Factor, 3) the Power of Context. Concussions and all brain injury are issues that need to become epidemics to gain any real level of support. Support that is now seriously lacking. I will try to apply each of these 3 rules to concussion/brain injury understanding and awareness.

1) The Law of the Few. Gladwell talks about a Paul Revere’s midnight ride and further breaks down this rule into 3 parts (Mavens, Connectors and Salesmen). It seems to me that telling people they need to know learn something or they should support something, inevitably spawns a level of resentment, however subconscious this is and however well-meaning someone is to a cause. Guilt is not a sales technique that will keep people interested and it doesn’t encourage people to spread the message. With the huge sports media and others constantly bringing up the issue, concussions have been a prevailing issue in hockey and football, not because of any Stickiness Factor, but due to saturation. Concussions in sports have become like Airwalk sneakers. They went from an esoteric issue for contact sports to mainstream. Of course, brain injury is important at any level and in any type of sport. And in life. However, concussions seem to be resigned to an issue that with which only ‘some people’ are concerned and they shouldn’t ‘ruin the game’ as it is now. I understand the irony of having a blog about concussions and then writing about saturation of the issue. My point is that this “Law of the Few” applies to sports themselves. If one trendy, innovative team in football or hockey embraces the issue, that will do more good than media or league commissioners ramming it down their throats. Or as Gladwell notes, “the nature of the messenger.”

2) The Stickiness Factor. Seasame Street and Blue’s Clues are the examples Gladwell uses to discuss this ‘rule’. His point is that the message needs to be focused and the audience must be known. Concussions and brain injury suffer from a prime example of the “clutter” problem – basically, saturation. Too many messengers and messages, making it difficult for any one message to stick. You’d think that athletes, banging heads and the universal nature of brain injury would give its understanding some stickiness, but obviously not. With all of the coverage, a lot of it is very superficial and used as more of a time-filler than anything else, what has been lost is the simple message that concussion and brain injury CAN effect any part of your life and that EVERY brain injury is different. Pro athletes should not be given the same message as children. It would be better to show pro athletes people in their sport, people that they may know personally, who have had concussions or other brain injuries. Show them how it happened and  let them know that the way they hit or the way they ready themselves for a hit can be tweaked and they will better avoid brain injury. Some really young kids will still heed to “I told you to” as an effectively sticky message, while older youth players can be shown concussive hits to athletes they emulate, in their sports and at their positions, and if punishment for certain offences in their sport are strictly implemented (even if it’s not “fair”), then that, too, will stick.

3) The Power of Context. Starting off talking about Bernie Goetz, Gladwell transitions to a more light-hearted, The Divine Secrets of the Ya-Ya Sisterhood and having a group max size of 150. This ‘rule’ is about environmental and group influences and it’s the chapter part of Gladwell’s book that got me thinking about how this all relates to understanding concussions. He explains how crime in New York City in the 1980s was mitigated by changes to the environment (the appearance and cleanliness of the subway) and how it becomes difficult for a group larger than about 150 to influence all of its members. One of the main environmental influences in contact sports is the hitting and the toughness of its players. Unlike New york City subway cars, contact sports can’t be cleaned up completely without taking away the aspect of the game that draws many players. In hockey, football and other contact sports, the context is very difficult to change, but again, maybe one innovative and trendy team can change the context in their organization. A single team, management and all would likely mean numbers small enough to influence. If the entire organization has a more complete understanding of brain injury, then its importance will be easily known to all. Have doctors come in and talk to the players and management about brain injury. Have everyone together in one room to hear it. Don’t have just one, make it a monthly, mandatory thing for all players and management. Include more intensive mandatory sessions in pre-season. It’s the primary risk all pro athletes in contact sports take, so at least tell them what they are risking and how to better protect themselves and others. For youth, most teams can’t afford to have doctors come in to talk to their players. That’s what parents, coaches and local sports associations are for. Instead of having adults preach to them about playing safe, the concussion/brain injury issue is probably one in which the best approach is top-down. If younger players see the professionals they emulate playing in a less reckless or dangerous style, then they would have no incentive to play dangerously themselves.

Cancer, heart conditions and other well-known health problems are known to the public. For centuries it has been known that people suffer these conditions and diseases (how best to treat them has not). Everybody knows someone well who has died or has had their life effected by these conditions. Therefore, they are easily relatable and everyone wants to support them. It has also been known for centuries that getting a knock in the head was bad and had confusing and comical, immediate and temporary effects. It is only now being understood that brain injury has varying, long-lasting and permanent effects. So, brain injury is an issue that is late to the ‘raising awareness’ game and although everybody knows someone well who has died or has had their life effected, most people don’t know what the cause was.

Brain injury, generally and concussion, specifically, are not problems for which there is a cure. Knocks on the head are going to happen. Take it from me, even helmets won’t completely prevent severe traumatic brain injuries, but they will help reduce the likelihood of a concussion. While walking down the street or standing in your backyard, there is nothing stopping a random bird from dive bombing into your head, but people don’t panic going outside and they don’t stand on the corner yelling to warn people of the impending danger. If you saw someone doing that, you’d think they were crazy, because it’s not rational.

Since it is a ‘new’ problem, brain injury awareness has skipped a lot of stages and has jumped straight to the panic stage. This is a horrible place to start! The most important steps, understanding causes and effects have been glossed over and it’s been left to standing on the corner yelling about the attacking birds.