HBO’s Real Sports Features Concussion Crisis in Youth Football Players

Over the past three years, 17 high school football players have died after sustaining head injuries while playing. A similar situation in the NFL would have caused a national uproar, so how has this been allowed to happen to our youth?

Take a look at trailer for this riveting episode of HBO’s series Real Sports with Bryant Gumbel, which is airing several times on HBO through mid-December 2016, as well as On Demand. The episode as a whole explores why there are such inconsistencies in protecting professional athletes versus the youngest players.

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Significant Head Trauma Can Occur with Repeated Hits, Not Just Concussions

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

CTE’s connection to football has been in the news for five years now, with a debate centered around whether the number of concussions will affect long-term health and well-being of those playing the sport. Likewise, I’m constantly asked by patients and parents what the future effect of this or future concussions will be on their health. A recent study released by researchers at the Boston University School of Medicine (such as Dr. Robert Cantu, Dr. Ann McKee, Chris Nowinski and others) will probably give moms and dads across America a moment of pause before starting a collision sport like football or hockey.

An answer may lie in a concept developed by these researchers called the Cumulative Head Impact Index (CHII). They found individuals who had more hits to their heads—regardless of whether they had a concussion or not, were significantly (i.e., not even close…a large statistic margin) more likely to experience later-life cognitive problems, apathy and depression. The caution here is that the sample size was only 93 individuals and the exposure was only to football.

Helmet-Warning-Label

A football helmet’s health warning sticker is pictured between a U.S. flag and the number 55, in memory of former NFL player Junior Seau; new research suggests that the accumulation of subconcussive hits may have more significant long-term effects than concussions. (© Mike Blake / Reuters/REUTERS)

The next step is for medical providers and concussion specialists to help families begin to connect the dots throughout the developmental hurdles of a child’s life. For example, the health outcomes for two 7th grade beginning hockey players if they have a different history. One student may have fallen off a changing table as an infant and suffered a skull fracture, have been in a motor vehicle accident, and have fallen multiple times during winter sports, while the other 7th grader may not have suffered any head injuries or significant head trauma. Baseline neurocognitive testing like the ImPACT® test might look different on these two young students, and the outcome and recovery time of any current injuries sustained by each of them could be considerably different.

I’ve often said that kids can’t live in a bubble as much as parents are sometimes inclined to want to wrap their kids in bubble wrap. Young people—really, people of all ages—are going to be in car accidents, bike accidents, and slip and fall just going through life. Parents need to make their own unique, informed decision about how much additional risk of physical injury to which they want to expose their child, given his or her medical history and athletic abilities.

“Concussion” Movie is Just the Beginning of the Brain Injury Conversation

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director
and Ann-Marie Sedor, HeadFirst Concussion Care Marketing

The much-anticipated movie “Concussion” is scheduled for release this year on Christmas Day, and already there is Oscar Award talk for Will Smith, who plays the role of Dr. Bennet Omalu. It was Dr. Omalu who discovered the tragic progressive degenerative effects of years of multiple concussions in NFL players, which he named CTE (chronic traumatic encephalopathy).

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Bennet Omalu, M.D., (L) and actor Will Smith attend the screening of the major motion film, “Concussion,” on November 23, 2015. (VALERIE MACON/AFP/Getty Images)

The film highlights the NFL’s initial response of anger and denial. Indeed, since Dr. Omalu’s discovery in 2002, the NFL has experienced lawsuits, exposés, and finger-pointing in general. Now, 13 years later, bystanders have watched the NFL’s reaction to this scientific research unfold in a manner not unlike many stages of grief – first denial, then anger, on to bargaining and, finally, acceptance. (Although, the League is still working on fully coming to terms with this last step.)

For their part, the NFL hasn’t had much reaction to the movie, preferring to keep the controversy at arm’s length. While Dr. Omalu has vocalized his opposition to children playing football until they are legally and emotionally old enough to understand the danger of putting their brains at risk, the NFL can’t afford to lose any of their reported $7+ billion in annual revenue.

Yet, while the debate rages on, two points are patently clear from years of scientific research: that children repeatedly hitting their heads during developmental years is potentially very harmful, and that college and professional football players can face significant health consequences from playing the sport.

But just how serious are families going to be about keeping their children from playing football? Indeed, this is just the beginning of the conversation about brain injuries.

As a community-based concussion clinic that has treated more than 30,000 traumatic brain injury patients over the past three years, HeadFirst Concussion Care has seen multiple reasons for why people sustain concussions. And while football is a violent sport, soccer, lacrosse and hockey also put our youth at risk for head trauma.

And again, this is just half of the dialogue. HeadFirst’s data shows that traumatic brain injuries sustained while playing organized sports with a concussion protocol in place (high school or college sports) account for a relatively small percentage of our patients. In fact, in as many as 80 percent of our patients, concussions are sustained by other mechanisms of injury. These include non-organized sports-related injuries (bike riding, skateboarding, trampolining, skiing, pick-up or other informal recreational games), slips and falls, motor vehicle accidents, and assaults.

The key message is that the people must understand that traumatic brain injuries can happen to anyone, anywhere, at any time. Not just kids. Not just athletes. And certainly, not just NFL players. And since anyone is at risk, everyone must understand the proper protocols for healing an injured brain.

On a final note to end the year, my holiday wish is that families, schools, and employers begin to talk about head injuries and follow traumatic brain injury protocols to keep all children and adults safe.

When Is the Right Age for a Child to Specialize in a Sport?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

How many times have you seen parents running their kids from one sporting event to the next? Parents and kids feel the pressure to stay on the best team, with the best trainer, and the best coach to continue to progress in their sport.

At what age should a child or teen begin to specialize in a sport? Should kids go the route of gymnastics and figure skating and focus exclusively at an early age or should specialization be held off until high school or college when bodies and minds begin to fully form and develop?

An excellent article on the Steve Nash Basketball Blog addresses these questions and more.

Sports-Kids

Having been in the military, I had the benefit of having my children participate in school systems and sports programs up and down th
e Eastern seaboard. School systems and sports programs are not all the same. The culture within these communities created by principals, athletic directors, teachers, coaches, athletes and parents were a direct result of their collective focus and values.

As a psychologist, what I have found interesting is that the value system of sports and athletics tends to mirror one another. Within one community, children are not cut from a sports team – all children up to 9th grade may be able to try out and play on any team without getting cut. In the same community, children may not receive letter grades – or “competitive grades” – until the 8th grade.

Elsewhere, however, I’ve seen children cut from teams and competing for spots as early as 1st grade, when they also begin receiving competitive letter grades.

As with many things, the trick is in finding the right balance. Children in 1st grade cognitively can’t keep score and focus on the tasks of what they need to do on the field. What does a “D” in reading really mean to a first grader? A summary letter grade is an abstract concept that doesn’t teach very young children that they need to read more to improve their proficiency. The same applies to sports. An older child can understand the causes and consequences of a low letter grade, be it in academics or sports. But is waiting until 9th grade to be cut from a team too long to teach the lesson that life is competitive?

Another factor to consider are that traumatic brain injuries (concussions) will interrupt an athlete’s season and training. The type of community a child is living in and the focus of the coach, parents, athletic trainers, administrators, and other adults working, training and living with these young athletes can affect treatment outcomes in case of a concussion. Is your community one that is fostering hyper-competition that is focused on the top one percent or does it focus on age-appropriate health and well-being of all its children and how they all can benefit from athletic competition?

How Much Do Athletes Know About Concussion Symptoms?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Only a few studies have ever been conducted to examine the efforts that hospitals, universities and communities are making to educate children about the symptoms of a traumatic brain injury. Fortunately, the University of Florida is one of the few institutions who has done some work in this area. Their recent survey of 334 varsity high school football players from 11 Florida high schools uncovered some interesting, yet unsurprising, results.

Footballs - Question Mark

The conclusion that University of Florida researchers drew was that most of the high schoolers did not know or could not associate some of the symptoms that they might experience with a concussion, including nausea, neck pain, and trouble concentrating.

In fact, even with parents or guardians signing a consent form indicating they discussed concussion awareness with their child, nearly half of the study’s athletes suggested they had not.

At HeadFirst Concussion Care, our own research team recently conducted a brief survey at a local high school during the athletes’ annual sports physicals.

Our team asked high schoolers if they knew the difference between various medical injuries, including orthopedic injuries, cardiac emergencies, mTBI’s, and dehydration.

We found that these youth athletes had some knowledge of mTBI but we also learned that many of the teenagers in our sample were uninformed about dehydration and cardiac emergencies.

Conducting this research is so important because it shapes the ways we can improve our education and training.  Knowledge is the most important key to reducing the number of concussions, especially multiple traumas.

Monitoring educational programs in high schools, middle schools and recreation programs is extremely important to HeadFirst so we can find out where to direct our educational efforts to keep children, parents and coaches informed.

HeadFirst-Doc-is-InIs it OK to drink alcohol or smoke a joint ever now and then with a mTBI?

As a former military guy, I’m nearly duty-bound to remind others that using cannabis is still illegal in Maryland. This, in itself, should provide additional motivation for avoiding the drug.

As a dad, I’m stunned that more private schools in the area don’t conduct mandatory random drug tests.

Research is still ongoing, but adding chemicals to the brain, including cannabis, when it is injured and recovering would most likely add to one’s recovery time. I recommend staying away from all brain stimulants and depressants while recovering from an mTBI. This includes not only cannabis and alcohol, but also caffeine products.  — Dr. D.

How Well Do Football Helmets Protect Players from Concussions?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

One of the most common questions that I get from parents is “How well will my child’s helmet protect against concussion?”

The elusive answer appears to have been provided at the 2014 American Academy of Neurology’s annual meeting. In a study co-authored by Frank Conidi, MD, DO, MS, director of the Florida Center for Headache and Sports Neurology, Assistant Clinical Professor of Neurology at Florida State University College of Medicine, the standard drop test was modified to measure linear and rotational responses in crash test dummies to repeated 12 mile-per-hour impacts.

Conidi, who is also the vice chair of the American Academy of Neurology’s Sports Neurology Section, and his colleagues conducted 330 tests to measure how well 10 popular football helmet designs protected against traumatic brain injury, including: Adams a2000, Rawlings Quantum, Riddell 360, Riddell Revolution, Riddell Revolution Speed, Riddell VSR4, Schutt Air Advantage, Schutt DNA Pro+, Xenith X1 and Xenith X2.

They found that helmets do protect the player from massive injuries like skull fractures in the range of 70 to 80 percent but provide little to no protection against concussion in the range of 10 to 15 percent.

Why is that? While the helmet does its job in disbursing the impact of a hard hit across the helmet to greatly reduce the risk of a skull fracture at one specific site, a helmet cannot stop the brain from shaking inside the skull, thus providing little to no protection against a concussion.

In fact, the team of scientists found that football helmets, on average, reduce the risk of traumatic brain injury by only 20 percent compared to not wearing a helmet. Added to these statistics, Conidi says, “Alarmingly, those that offered the least protection are among the most popular on the field.”

One of the best tools we have available is neurocognitive baseline testing. With the beginning of the school year upon us, please remember to get your child baseline tested. Headfirst Concussion Care offers free ImPACT® baseline testing. Please call 1-855-748-4868 (SIT-IT-OUT) or visit us online to arrange your child’s appointment.

Helmet-Collision

Fall Sports are a Great Time to Learn About Concussion Symptoms

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Fall sports are right around the corner, which means doctors will see an uptick in the number of traumatic brain injuries.

Here are a few tips for parents to keep their kids safe throughout the season:

#1 – Get educated on concussions and mild traumatic brain injury. Learn what the symptoms are so if your child is experiencing some difficulties, you‘ll be able to identify the problem.  Common symptoms following a concussion are:
•    Physical – headache, dizziness, balance problems, fatigue, light and noise sensitivity
•    Cognitive – problems concentrating or remembering information, feeling foggy, and feeling slowed down
•    Emotional – feeling more irritable or sad, feeling more nervous or feeling more overwhelmed
•    Sleep – feeling drowsy, sleeping to little or too much, and trouble falling asleep

#2 – Talk with your kids about concussions. Let them know about the symptoms and that they should tell their coach and yourself if they aren’t feeling well after a game or practice

#3 – Focus on the goal of why your child is playing sports. Great goals include:
•    the importance of team work
•    discipline (especially if that effort can be translated into the classroom)
•    making friends and getting some exercise.

Keep it in perspective that most of children are not focused on the pros – they’re in sports for the sheer love of playing. If your child is injured, please take a conservative approach and wait until he or she is completely healed (without the above-listed symptoms) before returning to competitive athletic competition.

#4. Familiarize yourself with Maryland law regarding concussion. Every state now has concussion laws regulating traumatic brain injuries in youth sports. These laws generally have three major components: to educate parents, coaches and players about concussions; to remove the athlete from play if he or she is suspected of having a concussion; and to ensure the child is cleared by a medical provider to return to play.

#5. Familiarize yourself with the policies of your child’s school and team. Make sure that your son or daughter gets baseline neuro-cognitive testing in the unfortunate event they do sustain an injury. Doctors can look back and see what your child’s performance was like prior to the sports season.

We have thousands of visits a month to treat head traumas.  I am often asked if sports are worth it. Absolutely! Kids learn leadership, companionship, competition, exercise, emotional balance, and many other values and benefits of sports. The primary danger with a head injury is returning too soon before the injury has had a chance to heal itself. Play it safe. And remember, when in doubt sit it out.

HeadFirst Concussion Care - Fall Sports - Concussions