Cantu Interview with SportsLetter

Thanks to a heads up serial emailer I was able to not miss this interview of Dr. Robert Cantu, appearing in the SportsLetter – it appears to be written by David Davis.  There were some very good questions and answers, below is a sampling;

SL: When did you first realize that concussions in youth sports were becoming a major problem?

RC: When I was a sideline physician for a high school football team over 30 years ago.  That’s when it occurred to me that we needed some written guidelines for returning our young athletes to the field of play after they suffered a head injury.  That’s what led me to write the first Return to Play Guidelines back in 1986.

I’m a strong supporter of youth sports, but no head trauma is good head trauma.  You cannot condition the brain to taking blows. If you subject the brain to enough head trauma, permanent brain damage may happen.


SL: In your practice today, what are the most common myths — the most common misconceptions — about concussions among youth athletes?  Is it that there has to be a contact sport involved?

RC: I think the number-one most serious misconception is that you have to be rendered unconscious to have suffered a concussion.  More than 90 percent of athletic concussions occur without any loss of consciousness.  There are 26 symptoms associated with concussions, and loss of consciousness is only one of those.

Another very common myth is that concussions become exponentially worse as you accumulate them, so that your first one will be more mild than your second, and your third will be worse than your second one.  That’s just not reality.  The concussions happen to be whatever they are based on the forces involved.  I’ve seen many individuals whose first concussion was much more severe than subsequent ones.


SL: How is a concussion involving a youth athlete different than a concussion involving an adult athlete?

RC: Generally speaking, the young athlete will have symptoms that can be imparted with forces that are much less than the adult athlete deals with.  And, the symptoms for the average youth will last a bit longer than for an adult.  That’s related to the fact that youth brains are particularly vulnerable.  Youth brains do not have myelin coating of the axons, which gives the axons greater strength in adults that do have that coating.  They’re also more susceptible to what we call the “neurometabolic cascade of concussion” — during which time chemicals are released in the brain in a disorderly fashion.


SL: Are children more, or less, vulnerable to concussions and head trauma than adults?  If so, why?

RC: Youngsters have big heads and weak necks, and that bobblehead-doll setup puts them at much greater risk for concussion.  That’s especially true through ages five to eight.  Simply put, youth can’t brace their necks like adults can in a collision.  That’s a huge reason why anyone playing a contact or collision sport — at any age — should be strengthening their neck muscles.


SL: Do children recover differently from concussions than adults?

RC: As a group, youth recover a bit slower than adults.  Because the youngsters’ brain is evolving and growing, often it’s very difficult to measure insults to youngsters as easily as we can measure them in adults.  You can give adults more complex intellectual challenges than you can give to youngsters and thus more readily measure their progress.


SL: There are some tackle football leagues that now involve youngsters as early as age 5.  How would you advise parents whose son wants to play football: Is there a “safe age” for tackle football?

RC: I don’t think parents should bring their kids into tackle football short of high school.  And, if their kid is not well developed and doesn’t have secondary sex characteristics — like hair under their arms and so forth — then I’d say wait until their child is 16 or until they do.

The bottom line is, head trauma can come from tackle football at any age.  We now know that, very occasionally, youngsters sustain g-forces equal to those at the high school and college level.  To me, it’s not appropriate that we’re subjecting their brains to that kind of trauma when the alternative is playing the sport anyway, through flag football, and still learning the skills of tackle football, but practicing those skills on pads and dummies and not getting hit.

The same principal applies to other sports.  They should ban heading the ball in soccer below a certain age and ban body checking in youth hockey until the age of 14.


SL: What do you think of the tackling techniques developed by Train ‘Em Up Academy, supported by USA Football, which teaches kids how to tackle with their heads up, not down, and to avoid head-first tackling?

RC: I think it’s great.  I’m 100 percent behind it.  I’m 100 percent behind reducing the amount of tackling and full contact that goes on in practice.  That’s where the majority of the hits can be eliminated because that’s where the majority of them happen.  Having said that, I think that for these young ages, the right thing to do is to not do the activity itself.

There are people who argue that you have to start your kid at the earliest age possible — with the best of trainers and the best of coaches and the best of equipment — if they’re ever going to reach the elite level.  That’s nonsense.  They are going to be much better at a young age, at least compared to someone who doesn’t receive that sort of training, but when they get to the college age, it’s essentially the genetic makeup that’s going to determine whether or not they’re going to play at the elite level.

I use [New England Patriots quarterback] Tom Brady as an example about this.  His dad kept him out of tackle football until he was in high school.  It hasn’t seemed to hurt his career too much.


SL: In the book, you discuss several safety recommendations for youth athletes.  What are key recommendations that you advocate for protecting young athletes from the dangers of head trauma?

RC: I think that every high school should have a certified athletic trainer.  If they don’t have one, the high school should seriously consider whether they should be competing in collision sports.  I know that many schools are facing financial challenges, but they might be able to have that trainer be a teacher and teach physical education or some other subject.

And with the last sample I will encourage you to go to the link and read the entire Q&A.  Quick side note, with the last information from the National Athletic Trainers Association, 42% of high schools have AT’s.  That amounts to roughly 4 MILLION high school kids that DO NOT have access to an athletic trainer.

8 thoughts on “Cantu Interview with SportsLetter

  1. Michael Hopper October 8, 2012 / 12:55

    Fantastic! And yes the number of schools without an athletic trainer continues to drive me nuts… someday it will happen…

    Every Athlete Deserves an Athletic Trainer

    • lifeafterthegame October 8, 2012 / 13:46

      Athletic trainers are important if they are trained right. Example: while on the sidelines photographing a HS football game a few weeks ago, I hear the AT tell another student trainer to “give Tylenol to him for his head” referring to the QB who took a hit earlier in the game and continued to play.
      How can we expect Trainers to do the right thing when they are teaching student trainers the wrong thing.

      • Eric Nussbaum October 8, 2012 / 14:34

        The hope is that there are way more ATs who realize the significance of the traumatic brain injury and the AT who recommends Tylenol and put them back into the game are the exception. The same holds true for every physician who sees a concussed athlete but doesn’t recognize the symptoms, clears them to return, doesn’t follow the recommended guidelines and current protocols. The bottom line is that there needs to be athletic trainers on the sidelines. They are a necessity. They are standard of care, not a luxury. Period.

      • Tommy Dean (@CSolutionsLLC) October 12, 2012 / 09:30

        That scenario blows my mind! I’m not saying it didn’t happen…I’m just saying that that in fact is an issue. It seems more prevalent nowadays that the AT is under the microscope as the primary healthcare provider. The AT’s ability to make an educated decision should never come into question, but it sadly has. I am of the opinion that most young AT’s these days (and even some of the old school AT’s) are decision driven by politics and emotion. I would put myself right in the middle and of the mindset that I have no emotion when it comes to making a decision. It’s very unpopular to hold a kid out if the situation calls for it, but it’s ultimately what’s best for the athlete (and quite frankly for everyone involved because of the litigious society we live in). Our job as AT’s is not to “hold kids out” because we feel empowered by that type of authority, but it is our job to do what’s (at the end of the day) in the best interest of the athlete as it relates to their safety.

        I always tell my parents that I would rather be wrong for holding a kid out for an injury than to have them question me as to why I allowed them to go back to activity when the risk far outweighed the reward.

        I think this topic can be a whole separate conversation within itself. I think this AT should be questioned on that decision if it already hasn’t been done.


  2. Dustin and others,

    Am curious- in Dr. Cantu’s text or other writings, does he reveal / discuss his overall brain injury evaluation process along with the specific evaluation procedures that he may utilize in ruling in / ruling out if an individual has sustained a brain injury / concussion?

    Thank you for your consideration.

  3. KyleBates October 15, 2012 / 13:20

    Hi I was just wondering how many people know exactly what these student athletes are taking? Now a days it is so easy to get PED’s(performance enhancing drugs) especially with all the attention that they were getting in the media. Do we know exactly what these athlete’s have taken during the day before/after workouts, before/after games…..I would be very interested to see what the correlation between athlete’s taking these to get the extra edge and athlete’s that are not taking these. A lot of what I am reading about is high level of sport and I refuse to believe that these athlete’s are not taking anything. From creatine to ephedra I can’t help but wonder if our athlete’s don’t realize the potential risk they are putting themselves in for taking these PED’s.

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