Appearing in the USA Today is an article that brings into the forefront the topic we have been discussing for some time here on The Concussion Blog. Although it is easy to target the sport of football, it is not the enemy. Those that run reckless programs and don’t address the ever-growing concerns of catastrophic injuries and concussions are the enemies.
Sport and activity is a must in our society, anything to keep kids and people active as obesity in our society grows. More and more evidence is beginning to support the delay of starting full contact/collision sports including football. This is mainly due to body development but can also be due to brain development.
When reading the article it was refreshing to see that more prominent people are suggesting the EXACT SAME reduction in contact days/hours;
“We are going to look at reducing the number of contact hours in practice and reducing the risk of head contact in practice. … Pop Warner is going to make rule changes to reduce the number of head contacts,” said Chicago neurosurgeon Julian Bailes, chairman of the board.
At Boston’s Sports Legacy Institute, CEO Chris Nowinski also is campaigning for a “hit count” for youths in football and other contact sports. Like a pitch count in baseball, it would limit how many hits a child can take per season and year.
The other aspect of the article that is relevant is the fact that athletic trainers should be available for those participating in collision sports;
When a concussion occurs, the first step is to recognize it. Hitting picks up in high school, but the National Athletic Trainers’ Association reports just 42% of high school athletes have access to athletic trainers. “It’s embarrassing as a society that we allow these sports to be playing without having proper medical coverage out there,” Guskiewicz said.
My opinion is that if you cannot afford an athletic trainer then you cannot afford to have the sport, period.
Everyone needs to wade through the hyperbole (we are guilty of some of it), and find out the answers. There are plenty of resources so take the time to find out.
The Concussion Blog 
Am curious as to who will be conducting the ‘head contact’ measurement, and how will ‘head contact’ be measured?
Also…where is the research that supports the value of ‘hit counts’ ? Am concerned this number is an ILLUSIONARY NUMBER and not clinically or statistically meaningful.
As with concussions / brain injury, there is no known ‘magic concussion number’ or ‘safe’ hit number for determining the presence or avoidance of a brain injury. One concussion may be one to many, as may one hit to the head or whiplash occurrence adversely impacting the brain.
I agree with your concerns, but sadly, I suspect SLI believes that some youths are being hit way too much (especially those that participate in multiple contact and collision sports). My guess is that they hope hit counts will help put in place limits on full contact practices, and might cause some parents to question whether or not their young children should engage in multiple contact/collision sports throughout the year. As a parent, I believe the current state of youth sports is beyond shameful.
Dustin…did not catch spelling error in my reply re “determining” til after the send button was pushed…would you please correct when convenient…thanks
“Those that run reckless programs and don’t address the ever-growing concerns of catastrophic injuries and concussions are the enemies.”
Best line of the post … although for some, “enemies” may not be the word I would use. I would give each program a chance to change … inform them about what they’re doing wrong … if they fail to change, then “enemies” might just be the appropriate term. Personally, based on my son’s experience, I’m very concerned about youth football programs and believe many parents’ fears are well justified.
Guskiewicz is qualified to evaluate whether or not a program is being run safely, but your average parent is not . Coaches will tell you that they emphasize safe tackling, but I doubt if some of them even know what safe tackling techniques are. Often, they don’t know what they don’t know, and some aren’t receptive to new information. I believe it’s likely that a number of youth programs are very unsafe or actually harmful.
To be honest, we have very little information about how these youth leagues are run, and not all of them are associated with Pop Warner or USA Football. There’s essentially no oversight and we don’t have good injury statistics (my guess is that only the more serious concussions are even recognized … and, not everyone takes their child to the doctor when it’s “just a concussion”).
Some of the people running these programs believe they can’t be sued because of the legal protections afforded to volunteers and assumption of risk. Ideally, programs should be run well, injuries should be minimized, and volunteers shouldn’t have to worry about being sued, but I can’t help but wonder exactly what is supposed to serve as the incentive for putting in the extra time and resources to run a good program when there’s no accountability.
Hopefully all the media coverage will prompt parents to start asking questions about the steps taken to keep their children safe.
Am curious how you define the term “SAFE” as participation in sports creates inherent risks that sometimes are predictably significant and deadly…
these serious concerns have been frequently and clearly discussed within the TCB.
unfortunately it seems the history of sport has normalized many injuries…thus it should not be a surprise that concussions/brain injury are normalized by some…
I agree that participation in sports creates inherent risks, as do many other activities such as bike riding, use of playground equipment, etc. With any activity, I believe it’s important to take steps to minimize risks and to take into consideration appropriate age based limitations (for example, children should wear helmets while bike riding and avoid busy streets and younger children require more direct supervision than older children).
Since there is virtually no oversight for many youth sports, and since many legislators are reluctant to impose any guidelines on volunteer run organizations, it truly is up to parents to evaluate whether or not programs are operated in a manner designed to limit injuries … that’s what I meant by “steps taken to keep their children safe.” Even with appropriate safety guidelines, injuries will still occur, however, in the absence of such guidelines, serious injuries become much more likely.
Organized youth sports are a huge part of many children’s lives right now, and parents need to be prepared to evaluate these programs. If more parents asked the questions suggested by sources such as MomsTeam and the Sports Legacy Institute, and elected not to allow their children to participate in any program which doesn’t take safety seriously, then youth sports could very well become both sanner and safer (although injuries would still occur).
The reality of the situation is many parents are currently signing young children up for tackle football camps and leagues for the upcoming season. Parents have been provided with mixed messages through the media about the safety of youth football. If more were aware of the pediatric biomechanical issues addressed at sites such as this, along with the unique concerns for developing brains, then I’m sure many might just decide that flag football would be a better option.
Unfortuantely, I think concussion awareness/prevention is going to take much longer to implement at the youth level than it should, and many children/teens will be injured because the adults in positions of power aren’t willing to take the steps necessary to protect them due to a variety of reasons. Just look at the response to Dustin’s suggestions to limit full contact practice … that should be an easy cost free step to reduce brain trauma exposure for high school athletes, yet there’s so much resistance to change.
To concerned mom:
I don’t think it is an accurate analogy to compare football to bike riding or playground equipment. When biking, the intent of the biker typically is not to engage in physical contact with another biker…or the ground.
More so I also believe it is an weak analogy and a corresponding fallacious argument that often is not challenged and sometimes used as detractor re the concern re football…as our culture has idealized sport participation…while often ignoring the physical, financial, emotional, and social costs of the predictable injury.
As far as the notion of sport participation creating character, sportsmanship and so on, may I suggest you read:
Building Character though Sports: Myth or Possibility ?
Counseling & Values; Apr 1990, Vol. 34 Issue 3, p197
by Timothy J.L. Chandler, PhD and Alan D. Goldberg, PhD
Dr. Brady,
I’m not an advocate for youth tackle football (I don’t even like football). I have made some attempts to make the program held at our school “safer” though, or at the very least to make parents aware of the types of serious injuries their children could sustain while playing. People around here generally think I’m making a big deal about nothing.
It’s not unusual to see kids ride bikes and skateboards without helmets. Dirt bikes, four wheelers and back yard trampolines are also common. Many ride horses, again often without helmets. I’m not comparing any of these activities to football, just trying to explain that many parents here seem to scoff at safety concerns. Some parents aren’t buying the new information about concussions … and think it’s more liberal craziness and attempts at government control and the creation of a nanny state.
I’m just trying to advocate for some reasonable safety guidelines that might have a chance of getting adopted. I’m personally appalled that there’s no oversight for youth sports leagues, and that the people who run programs which don’t meet minimum safety standards aren’t held accountable. I would actually support age based limitations on participation in collision sports.
I do, however, think that many kids enjoy playing sports, and that there can be benefits to sports participation. It’s unfortunate that they often get pushed to perform beyond what their minds and bodies are developmentally prepared for.
I agree that it is not the fault of the sport although some sports are more dangerous than others. There needs to be more attention to detail in regards to safety when participating in a higher risk type of sport like football.
Better training for the coaches in being more aware of this as well as the parents and the players.
Reducing a hit-count that a player accumulates in a practice, game or over a set period of time is looking at a way of prevention. Although, it only takes one hit many times to do the damage and so I don’t think that this would make a significant difference.
Better screening of our athletes before a head/neck injury occurs may help them to deal with it and handle it better when it does occur. Specifically, a better examination that includes spinal examination for proper alignment and adequate upper neck strength would be the smartest thing that we could do for all “contact sports” athletes.
This type of examination would need to be done by a qualified health professional that specializes in this type of care. The only person with the proper training and expertise wound be an Upper Cervical Spine Specialist which is a sub-specialty of chiropractic.
There is a big difference in examination, care, and results from this type of specialized care when compared to that if a medical doctor, physical therapist, and these days even the doctor of osteopathy (who is now a medical doctor as well).
Please excuse the two spelling errors as this was done on an iPhone.
Basic safety precautions should be mandated for all youth sports/activities. The winning line: “they’re throwing girls 25-30 feet in the air- and sometimes missing them on the way down.”
http://www.mnn.com/family/protection-safety/stories/the-surprising-most-dangerous-sports-for-kids
“”Right now, cheerleading is out of control,” said Dr. Frederick Mueller, director of the National Center for Catastrophic Sport Injury Research at the University of North Carolina. “Kids are practicing all over the place without mats. They practice when they want to, do what they want to, and some coaches aren’t certified and don’t know what they’re doing.”
Cheerleading injuries resulting in emergency room visits have increased almost six times since 1980, to nearly 30,000 in 2008, according to the U.S. Consumer Product Safety Commission.
In most states, high school cheerleading is not considered an official sport, which means it’s not mandated to have the same standards of safety equipment, limits on practice time, or training for coaches in the ways other high school sports are required.
But as Mueller points out, “Cheerleading has changed dramatically, from females jumping up and down and shaking pom-poms to a gymnastics-type event where they’re throwing girls 25-30 feet in the air — and sometimes missing them on the way down.””
USA Football suggests parents asks their children’s coaches about training and concussion awareness. Riddell creates new hangtags (will parents or kids actually see them though … many youth programs supply the youth helmets and they get re-used for a number of years).
http://finance.yahoo.com/news/riddell-football-helmets-concussion-awareness-173500043.html
“Starting today every new Riddell football helmet shipped to retailers and customers will include a hangtag offering concussion education that includes information from the Centers for Disease Control and Prevention (CDC) Heads Up program. Riddell’s concussion education hangtag is the first of its kind among sports helmet manufacturers.”
” … USA Football Executive Director Scott Hallenbeck said. “Every parent who has a child playing youth football should ask their league two questions: ‘How are your coaches trained to teach my child?’ and ‘Are your coaches educated on the symptoms and management of concussion?”
As the President of a youth football league I wanted to say a couple things regarding your post. 1. All of our coaches are required to take a course in concussion recognition. The course shows them how to recognize the signs of a potential concussion. 2. You are correct by saying that helmets are used for several years but must be sent in every two years for recertifacation. As a fellow parent I would recommend that you check the helmet for this sticker. It will be located on the back of the helmet just left of the center line. i would also like to say that helmets have a ten year life and then they must be replaced.
That’s great that all of your coaches take a course in concussion recognition. I hope you provide parents and players with concussion training too.
I have no doubt that there are well run youth football leagues, however, from personal experience, I know there are also programs which aren’t well run.
After my eight-year-old sustained his concussion, since he missed picture day with his team, we decided to take our own pictures at home. When I put his helmet on, we noticed it wasn’t as tight as it had been in the beginning of the season. He had been given a new helmet, so it wasn’t a matter of age or lack of recertification. We hadn’t been provided with the fitting instructions, and I had to call Riddell to figure out what type of helmet he had (there was a sticker inside with helmet identification information). Based on the fitting instructions I found at USA Football, his helmet was one size too large and since the coaches/administrators never mentioned the need to periodically check helmets for proper inflation, the helmet had loosened up after a few weeks of practice.
Considering the serious nature of my son’s injury and the difficulties we encountered with his school and attempting to avoid re-injury, I support Dr. Cantu’s recommendation that children under the age of 14 not play high contact and collision sports as currently played. I see flag football as a better option for younger children due to the vulnerability of developing brains, biomechanical issues, and the general lack of resources for most youth programs.
Realistically, children are going to continue to play tackle football, so it’s imperative that parents realize they need to ask the type of questions USA Football suggests in the Yahoo article. Parents should only put their child in a program that is following all recommended safety steps – from concussion recognition training, proper helmet fitting and maintenance (including frequent inflation checks if applicable), proper tackling technique, limitations on full contact practices/practices in hot weather, and availability of an athletic trainer. (Parents can check the MomsTeam dot com website for additional information on questions that should be asked.)
Perhaps the best football solution for children under a certain age would be … flag football.
http://bleacherreport.com/articles/1194218-why-the-nfl-is-correct-with-their-flag-football-initiative
“There are few youth sports programs as engaging, dynamic and intelligent as the NFL’s flag football initiative.
Launched all the way back in 1996, it seems that never has the program been more important than it is right now. See, there is this perfect storm surrounding football that makes flag football a key piece of the current NFL empire.
Childhood obesity in the United States has tripled in the last 30 years. In fact, more than one-third of children and adolescents are obese across the country.
The NFL has been avid in its efforts to raise awareness and get kids active through both flag football and its Play 60 campaign, which encourages children to get outside and play at least one hour every single day.”
My take on youth football leagues – you have (a) coaches and administrators (generally moms or other parents) with unknown backgrounds and training, (b) younger athletes more subject to concussions due to biomechanical issues, (c) resource limitations which can mean no access to athletic trainers or appropriate medical care, (d) developing brains which take longer to heal from concussions with the potential for developmental delays following more severe injuries, and (e) athletes who may not be capable of clearly identifying, recognizing or describing their symptoms.
Now, here’s an example of what parents are being told via the media:
http://triblive.com/sports/1856033-85/football-concussion-parents-game-youth-sport-steelers-feel-played-cindrich
“Michael Collins, a clinical psychologist who runs the renowned UPMC Sports Medicine Concussion Program, said neither parents nor youth athletes should fear playing football or any contact sports.”
“Collins and Hallenbeck would love to see balance established, with the focus of many — parents, former players, the media — squarely on football and concussion.
“The pendulum has swung from one extreme — smelling salts, holding up fingers — and now it’s wildly to the right — getting rid of football altogether — and the reality is somewhere in between.””
The linked article was at Irv Muchnick’s site … “Best safeguard against head trauma? Don’t play.”
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2012/05/24/SP9P1ON415.DTL
“”I think Kurt Warner is 100 percent correct,” Brady Sr. said. “He’s there to protect his children, and these other people who are weighing in are not addressing the issue of whether it’s safe or not for kids.”
This is a critical point. Younger players have less developed bodies and brains. Their leagues have fewer medical resources than the NFL, making them less able to monitor brain trauma. Even if youth leagues upgraded their capacity to identify concussions, they would be addressing a limited piece of the risk.
Concussions are probably not the sole cause of chronic traumatic encephalopathy, or CTE, the condition identified in deceased players whose brains have been studied.”
This sports doctor (okay, he’s a podiatrist, which I believe concentrates on an area of the body as far from the head as possible) seems to feel that football is unsafe and warns parents to make decisions wisely:
http://triblocal.com/lisle/community/stories/2012/05/the-sports-doctor-football-unsafe-at-any-age/
“We all knew in sports medicine the physical orthopaedic toll a collision sport like football involves. The brain injuries, the potential catastrophic consequences of these head hits? THAT’S DIFFERENT! Now that the reality has hit the sport so hard, parents are facing the decision whether to allow their kids to play- at any age. The dementia, the suicides, the debilitated players – IT’S SCARY. I have to admit, that I’ve been a fan, and am still a fan (go Bears!) of football BUT– now we know the reality– as presently structured– there is NO WAY to predict and NO WAY to protect the head from this consistent trauma. It’s a “crap shoot,” we don’t know how many hits, how often, how young causes concern. Experts used to feel that numerous concussions were the concern, that those “bell ringing hits” we’re the at risk concerns– NOW the reality is no one knows how the “routine” collisions” without getting concussions per se will affect these young players.”
“It’s a bummer, but it’s the truth, “Football” as we know it is UNSAFE AT ANY AGE! Parents–make your decisions wisely!”
Jamal Lewis “cringes when he watches youth football,” because it’s all about hitting.” He’s not the first to compare football to a dog fight, but he may be the first to say that about the youngest level of play. USA Football may very well have good intentions about cleaning up youth football, but I can’t help but wonder how quickly parents can expect to see changes. Out of the 3 million children that play, how many are laying down the foundations for suffering from CTE later in life as we’re waiting for concussion awareness, limitations on hitting, and proper tackling instruction to trickle down to them?
http://www.cleveland.com/science/index.ssf/2012/05/former_browns_running_back_jam.html
“Sometimes now, he cringes when he watches youth football. “I can take you around here in Atlanta and you would think you were at a dog fight,” he says. “You’re trying to break kids and make them tough. You want your team to intimidate everybody else’s team, and it’s all about hitting.”
He tries to temper that message, with his own youth team and in talks with parents, coaches and players. He emphasizes proper tackling techniques – no lowering the head – and the importance of removing players from games after head blows, getting proper medical attention, and watching them closely through the season for behavioral changes.
Choosing not to play is OK, too.
A couple of years ago, Lewis’s son, then 6, took up his father’s sport. He played tight end and nose guard on a team that won a championship.
“At the end of the season,” Lewis says, “I asked him if he was going to play again, and he said no. I [asked] why, and he said, ‘I keep getting headaches, and I get tired of getting headaches.’ When he said that, I was like, no problem.””
http://www.themonitor.com/sports/josiah-61150-doesn-mark.html
“Josiah Cantu barely cracks the 4-foot mark in full pads and cleats. The 8-year-old doesn’t say much when asked questions. That could be mistaken for shyness, but he knows what his job is.
“I like to hit,” he says when asked about what he likes about football. “When I hit them they fall down.””