SportsLetter

Some head impacts in youth football can be severe

A study released by the Virginia Tech-Wake Forest Center for Injury Biomechanics has shown that some head impacts in youth football were "as severe as those seen at the college level," according to ESPN, and that most of those severe hits occurred during practices.

From ESPN:

The authors, led by Stefan M. Duma of the Center for Injury Biomechanics, called for the elimination of high-impact practice drills that do not replicate game situations, such as drills where players are asked to line up and run right at each other.

"Head impact exposure in youth football, particularly at higher severities, can be reduced through evaluating and restructuring practices," they wrote. "This can be achieved through teaching proper tackling techniques and minimizing drills that involve full contact; and instead, focusing on practicing fundamental skill sets needed in football at these young ages."

The sample size was small -- just seven players in a Virginia youth league between the ages of 7 and 8 -- but its findings will help shape the debate about safety measures, and for some, whether children should participate at all, in youth football, which is played by 3.5 million children younger than high school age. The average player in the study sustained 107 head impacts during the course of 9.4 practices and 4.7 games.

Most of those hits were modest in force, as measured by sensors installed in the padding of helmets. But some topped 80 g's, similar to "some of the more severe impacts that college players experience, even though the youth players have less body mass and play at slower speeds," the authors wrote. Boys of grade-school and middle-school age often lack the neck strength of teenagers, among other factors that can make them vulnerable to injury.

In response to the report Jon Butler, the president of Pop Warner, "the Nation's oldest and largest youth football organization," has proposed a rule that likely would limit contact in practices to a third of all practice hours.

Both study author Duma and Chris Nowinski, co-founder of the Sports Legacy Institute, endorsed Butler's proposal.

Said Nowinski,

"I am shocked to see that these children receive levels of brain trauma comparable to college football players," Nowinski said. "At one-third to one-fourth the mass of the average college player, it appears they deliver and receive nearly the same force to the brain on each hit."

He also noted: "The 107 hits (per) season average is likely below what most youth teams in America experience, as each player in this study averaged a total of only 14.1 games and practices combined. The finding that the majority of high level came in practice provides more evidence that football needs to follow the lead of the NFL and Ivy League and restrict hitting in practice."

Certified athletic trainers for high schools

A pilot program to instruct student athletes to recognize "symptoms of potentially life-threatening injuries encompassing the head and neck, heat illness and sudden cardiac arrest" has just graduated its first class in San Diego County and it took a near catastrophic injury on a lacrosse field to make it happen.

In 2009 a lacrosse player at a San Diego high school was injured in a game and was attended to by the school's certified athletic trainer (CAT).  At the time only 35 percent of California high schools employed CATs.

From The Coast News:

[High school lacrosse player] Tommy told Riki Kirchhoff, the high school’s assistant athletic trainer, that he felt fine. Kirchhoff nevertheless insisted that he stay down. After a series of tests, Kirchhoff discovered that Tommy couldn’t feel the back of his head. She stabilized his head and neck, and with input from Dr. Eric Waldrip, a team parent and anesthesiologist who was in the stands, she contacted paramedics.

After arriving at Scripps Memorial Hospital in La Jolla, Tommy was diagnosed with a fracture of the first cervical vertebra, which links the skull to the spine. Doctors explained that had he stood up after the accident, he most likely would have died or become a quadriplegic.

“There are so many things on that day that went right that could’ve gone so wrong,” [Tommy's mother Beth] Mallon said. “All I kept thinking about was what does somebody do when they don’t have these resources? I felt like I couldn’t sit back and not try to change things.”

So the Mallons did something about it:

The Mallons turned their near tragedy into a mission by establishing AIA (Advocates for Injured Athletes), a nonprofit that seeks to ensure that every high school in California has CATs.

Funded with a $25,000 private donation through the Red Cross, they established ASA (Athletes Saving Athletes), a pilot program that provides instruction to 30 student athletes at 10 San Diego County high schools in recognizing symptoms of potentially life-threatening injuries encompassing the head and neck, heat illness and sudden cardiac arrest.

ASA ambassadors, in turn, teach fellow athletes what they’ve learned when they return to school. The class is taught by a CAT with a representative from the Red Cross who certifies participants in CPR and automated external defibrillator.

Explains Rikki Kirchhoff, who now serves on AIA’s Outreach Advisory Board:

“[Tommy’s] injury made me realize that these kids’ lives are in our hands,” she said. “I challenge parents to ask the administrators of their children’s school, ‘Who’s on the sideline taking care of my child?’”

CNN airs documentary on concussions in HS football

CNN's chief medical correspondent, Dr. Sanjay Gupta, examines concussions in high school football in "Dr. Sanjay Gupta Reports: Big Hits, Broken Dreams," which premiers this Sunday, January 29, 2012.

From a Sports Illustrated interview with Dr. Gupta about the documentary:

SI.com: How widespread is the problem?

Gupta: In high school players, it's estimated that about one in 10 players have probably had a concussion. Forty percent of them went back to play in the same game, and sixty percent of players who got knocked out cold by their concussion also went back to play the same day. If you start doing the math, you're talking about tens of thousands of kids every year who are literally taking a gamble. And this time the risk is their brain. Kids who don't know better are willing to gamble their entire futures on a sport that they love.

SI.com: From your research, what did you find most telling?

Gupta: One of the things that I really wanted to ask in the documentary was, if you create a safer game of football, is it still football? And the answer is yes. It can still very much be football if you don't use a three-point stance but you use a two-point stance. If you move the kickoff line five yards farther ahead so you get fewer kick returns -- which are the most dangerous part of the game. The culture is starting to change and it's not taking away from the sport that we are so passionate about.

Concussions in high school football

Grantland's Jonah Lehrer has an excellent piece on concussions in high school football. 

If the sport of football ever dies, it will die from the outside in. It won't be undone by a labor lockout or a broken business model — football owners know how to make money. Instead, the death will start with those furthest from the paychecks, the unpaid high school athletes playing on Friday nights. It will begin with nervous parents reading about brain trauma, with doctors warning about the physics of soft tissue smashing into hard bone, with coaches forced to bench stars for an entire season because of a single concussion. The stadiums will still be full on Sunday, the professionals will still play, the profits will continue. But the sport will be sick.

The sickness will be rooted in football's tragic flaw, which is that it inflicts concussions on its players with devastating frequency. Although estimates vary, several studies suggest that up to 15 percent of football players suffer a mild traumatic brain injury during the season. (The odds are significantly worse for student athletes — the Centers for Disease Control and Prevention estimates that nearly 2 million brain injuries are suffered by teenage players every year.) In fact, the chances of getting a concussion while playing high school football are approximately three times higher than the second most dangerous sport, which is girls' soccer. While such head injuries have long been ignored — until recently, players were resuscitated with smelling salts so they could re-enter the game — it's now clear that these blows have lasting consequences.

The consequences appear to be particularly severe for the adolescent brain. According to a study published last year in Neurosurgery, high school football players who suffered two or more concussions reported mental problems at much higher rates, including headaches, dizziness, and sleeping issues. The scientists describe these symptoms as "neural precursors," warning signs that something in the head has gone seriously wrong.

Lehrer also highlights Mater Dei High School in Orange County, California.  In spite of being on the "leading edge of concussion prevention and treatment for high school football players," the coaching staff at the football powerhouse still struggles "on a daily basis to effectively manage the risk of concussions among their players."

Unfortunately, not every high school football program is as strict about secondary impacts as Mater Dei. According to a 2009 survey of 1,308 concussion incidents reported by school trainers, more than 40 percent of athletes return to the field too quickly. What's worse, the most severe concussions are often ignored: The same survey found that 16 percent of football players who lost consciousness after being hit returned to the field the very same day.

While Mater Dei has radically altered its response to concussions — "I look back and I can't believe the way it used to be," [trainer Mike] Fernandez says — the school is increasingly focused on concussion prevention, if only because there is little to do in the aftermath of a brain injury but wait. "I think there used to be an attitude that concussions were an inevitable part of football, like ankle sprains," Fernandez says. "And maybe they are. But we still need to do everything possible to keep them from happening."

Parents demand new high school football helmets

Parents at a Boston-area high school have asked the school district to replace football helmets they say are "putting their teens at risk," according to Boston.com

Arlington High School had 12 football players leave games this year with suspected head injuries; there were seven confirmed concussions.

Stephen Harrington, director of the Arlington Athletics Foundation, complained that many of the district's football helmets are more than 10 years old, referring to them as "junk."  Last week Harrington presented parents' concerns to a School Committee which says it is now "looking into the matter."

The high school's athletic director said that "every helmet has been certified for use by the manufacturers, Riddell and Xenith.” 

That wasn't enough for one parent, though.  From Boston.com:

Rich MacDonald said he spent $400 on a newer helmet for his 15-year-old son Jeff to use while playing for the junior varsity team at Arlington High School this year.

Unfortunately, MacDonald said, his son took a hit during the first game of the season that resulted in a concussion and prevented him from playing the rest of the year. He said his son had to be taken by ambulance to Massachusetts General Hospital and missed considerable school time as well as football.

MacDonald said he was pleased with the way the school district handled the injury. But he said he was afraid to put his son in Arlington High School’s equipment and is glad he bought the newer helmet.

“For all I know, it may have saved his life,’’ MacDonald said. “Buying that helmet is no question the best $400 I’ve ever spent in my life.’’

Prevention of sudden death in sports

The National Athletic Trainers' Association (NATA) and its Youth Sports Safety Alliance hosted the third annual Youth Sports Safety Summit this week in Washington, D.C., which was attended by some 65 members of sports and health organizations.

According to Athletic Business one of the objectives of the gathering was to review an advance release of NATA’s new position statement on safety in sports titled “Preventing Sudden Death in Sports.”

From Athletic Business:

To be published in the February 2012 issue of the Journal of Athletic Training, the statement outlines 10 major health conditions and causes of sudden death among athletes, while also providing updated recommendations to ensure better prevention and treatment of sports injuries. According to NATA, which hosted the summit, this is the first time an association has provided such condensed information in one document to help medical professionals, coaches, parents and others make more effective and efficient return-to-play and care decisions.

Also from Athletic Business:

While concussion legislation has passed in 36 states, concussions are not the only problem in youth sports. In fact, the leading cause of death from youth sports is sudden cardiac arrest, which is addressed in the statement along with asthma, catastrophic brain injuries, cervical spine injuries, diabetes, exertional heat stroke, exertional hyponatremia, exertional sickling, lightning and head-down contact in football. High school athletes suffer two million injuries every year, NATA says, resulting in 500,000 doctor visits and 30,000 hospitalizations. In 2010, 50 young athletes died on the playing field, and 40 have died so far in 2011 — including six athletes and one adult coach in August.

The article also includes a few of the recommendations from the statement that will be formerly published in February.

Study says that even small hits to the head can damage

Preliminary research out of the University of Rochester Medical Center (URMC) states that,

the brain scans of high school football and hockey players showed subtle injury -- even if they did not suffer a concussion – after taking routine hits to the head during the normal course of play ...

The study, published online in the journal Magnetic Resonance Imaging, involved only nine athletes, but was "unique," according to a URMC press release, because,

... it was able to compare brain scans from the same player, pre-season and post-season.  Most other studies compare the injured brain of one person to the normal brain of another person from a control group.

Said lead author Jeffrey Bazarian, M.D., M.P.H., associate professor of Emergency Medicine at URMC,

“Although this was a very small study, if confirmed it could have broad implications for youth sports …The challenge is to determine whether a critical number of head hits exists above which this type of brain injury appears, and then to get players and coaches to agree to limit play when an athlete approached that number.”

Pennsylvania governor signs concussion bill into law

Pennsylvania Governor Tom Corbett today signed into law the Safety in Youth Sports Act, which hopes to "increases awareness and prevention of head injuries among athletes in school-sponsored athletics," according to The Patriot News.

The Morning Call reported,

The legislation sponsored by Sen. Pat Browne, R-Lehigh, bars students competing in interscholastic sports, club athletics and cheerleading from returning to the activity after suffering a concussion until they've been evaluated and cleared for play by a medical professional.

"Scholastic athletics is a necessary and important part of the scholastic experience, but character-building and competition means nothing if our students are not safe," Browne said.

When the law takes effect July 1, 2012, Pennsylvania will be one of many states that has sports-related concussion legislation.

Warm-up exercise can reduce leg injuries in female athletes

Coaches who led their female high school basketball and soccer players in "neuromuscular warm-up" exercises before practices saw a reduction in the number of noncontact leg injuries amongst their players, according to researchers from the Feinberg School of Medicine, Northwestern University and Children's Memorial Hospital, Chicago and published in Archives of Pediatrics & Adolescent Medicine.

Prior to the 2006-07 sports season, 90 coaches from Chicago public high schools offering girls' basketball or soccer attended a two-hour training session where coaches "learned how to implement the full 20-minute neuromuscular warm-up before team practices and an abbreviated version (dynamic motion exercises only) before games," according to the published research.

Of the 1,492 female athletes who took part, 737 were part of the "intervention group" that performed the new warm-up exercises with their coaches and 755 athletes were part of a control group that continued using the warm-up procedures they had always used.

An article in Medical News Today summarized the findings:

-The control group - 96 leg injuries

-The intervention group - 50 leg injuries

-The control group - 13 girls with two leg injuries

-The intervention group - 2 girls with two leg injuries

-All the non-contact leg injuries that needed surgical intervention occurred only in the control group

-There was a slightly (insignificantly) lower rate of acute-onset leg injury in teams that used warm-up more frequently

The researchers calculated that it costs approximately $80 per coach to train a group of 15 to 20 of them - making the program feasible in a mainly low-income, urban population.

From Archives of Pediatrics & Adolescent Medicine:

In conclusion, to our knowledge, this is the first randomized controlled study to demonstrate that (1) high school coaches in a mixed-ethnicity, predominantly low-income, urban population can implement a neuromuscular warm-up; (2) the warm-up reduces noncontact LE injuries, including ACL injuries, in female basketball and soccer athletes in this population; (3) the effect is likely dose related; and (4) coach training seems cost-effective. These findings suggest that NMT [neuromuscular training] should be routine in girls' high school soccer and basketball.

More Senate hearings on preventing concussions in youth sports

Last week Senator Tom Udall and the Senate Commerce Committee held a hearing to "examine the brain injury epidemic and questionable advertising for products that claim to protect athletes against concussions."

ABC News reported,

Sports are an important part of youth culture, but the risks of concussions need to be addressed, former athletes, neurologists and a representative from the Committee on Standards for Athletic Equipment (NOCSAE) told members of the Senate Commerce Committee on Capitol Hill today … Educating athletes, coaches and parents is the most immediate way to prevent the harm concussions cause, the panel said.

On his website, Senator Udall concluded,

I think we all agree that being active and participating in sports is important for kids of all ages on many levels. But considering that sports are the second leading cause of traumatic brain injuries between the ages of 15 to 24-years-old, we also need to take a serious look at how to protect athletes from head injuries. The last thing we want is for student athletes who are already at risk of concussions to be over-confident on the field due to misleading information about their protective gear.

We heard excellent testimony at today's hearing ... But it's clear we still have much to do in order to ensure our kids, coaches and parents are aware of the dangers of concussions and that the equipment they use is as safe as possible, without exaggerated claims of protection.