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.

Be Cautious of New Products or Research That Promise to Prevent or Heal Concussions

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

Periodically when I’m seeing patients in our HeadFirst concussion clinics, parents will ask me about a different brain trauma-related studies that they’ve heard about. These questions range from studies about concussion-healing chocolate milk to eye tracking devices to the effectiveness of helmets and different sports bands preventing head injuries. Presently, NO concussion treatments have been approved by the United States Food and Drug Administration (FDA). Likewise, the FDA has yet to approve of any devices that prevent concussions in the first place. No helmets, no mouth guards, no sports band or other piece of technology in any way shape or form has been demonstrated to completely prevent concussions.

I typically advise parents to be extremely cautious with new research or technology, or with the promises of concussion treatment. Instead, parents should seek out a concussion specialist who has years of experience treating these injuries and utilizes multiple methods in their assessment, diagnosis, and treatment planning.

Refreshing Delicious Chocolate Milk

Can chocolate milk heal concussions? Don’t count on it.

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 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).

US-ENTERTAINMENT-SCREENING-CONCUSSION

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.

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.

What Are We Teaching Our Kids?

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

Former pro football player Jim McMahon and pro hockey player Jeremy Roenick (below), both of whom suffered concussions during their careers, are joining up to raise awareness about the dangers of concussions at all levels of sports. Their foundation, Players Against Concussions, is planning event sponsorships and has already launched three advisory boards that include leaders in youth sports, research and medicine, and current and former pro athletes.

mcmahon-roenick

Roenick acknowledged that, as long as kids are going to play sports, concussions are not going to go away, but the duo is hoping to educate everyone in sports – from the athletes, to the parents, to the coaches – that early treatment is the best approach.

As Roenick says, “It’s the lack of education that causes people to have problems later in life.” And he’s absolutely right. After all, education is a cornerstone of the HeadFirst program.

As a parent, doctor and scientist, I have several thoughts both after reading this article and, coincidentally, watching a Pop Warner football game over the weekend that left me realizing how far we need to go with the educational process.

More doctors and researchers and educators need to go to Pop Warner football games. While watching 8-year-olds play this past weekend, parents were high-fiving and jumping up and down like they were watching older, more advanced kids at a high school state final or NCAA playoff game.

There were the cheerleader parents, the sideline coach parents, and the parents living vicariously through their kids. But, I’m not sure any of them had safety as their top priority.

As a parent, I wondered, “What are you folks thinking and what’s the point of this game? What are you teaching your kids because they’re watching you jump around!”

As a doctor and coach, I silently asked, “How is your emotional yelling toward these young children affecting them?”

As a scientist, I wonder about our educational efforts for concussion awareness going and also how states compare to one another? I was just traveling not too long ago to another state (I won’t say where but I have extended family in New Jersey) and considered how we could use different states’ “best practices” to help all of us improve our educational programs. This is certainly something to consider.

Be sure to check out next week’s blog when I’ll review some of our results from educational surveys of high school athletes here in Maryland regarding mTBI.

HeadFirst-Doc-is-InAt the Pop Warner game last weekend, I did witness one hard hit. The player was flagged for “targeting” another player and helmet-to-helmet contact. Prior to high school youth players, should be flagged for “improper tackling technique” – helmet-to-helmet contact. Refs, coaches and parents can then instruct the child on the proper football technique.   — 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

To Play or Not to Play (Football)? It’s the Parents’ Decision

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

In my years as an Athletic Trainer, I’ve had the opportunity to interact with many parents, helping them to foster a safe sports environment for their children and to guide a few of them through the road to recover after an injury. During these exchanges I always felt competent in my guidance, and leaning on my research-based medical practices, I provided sound advice. But this past summer I ‘ve added a new perspective to my consultation résumé… I became a Dad.

As I hold my new baby boy, my thoughts go back to these families as I can now empathize with their fears of letting their children leave the safety of mom’s and dad’s arms and expand their world. Watching Alex grow from this tiny baby who I could hold in the palms of my hands into the beginnings of a sturdy little boy, I find myself thinking about one of the most common questions asked of me by parents while sitting in a clinic with their injured son or daughter: “With all the injuries in sports, should I continue to encourage my child to participate in athletics?”

The answer was always an emphatic ‘YES!’ I explained how, in my opinion, the benefits of athletics clearly outweigh the risks of injury and the lessons learned can last long into their future. Inevitably, the follow-up question was always “What about going back to football”? Ah, always a little more challenging of a question… or should it not have been?

Years ago, as an athlete, I would have expressed my opinions emphatically about how football teaches the principles of teamwork, commitment and self-confidence while placing demands on the athlete that are not only physical but require a level of grit determination found only on the gridiron under the Friday night lights. But as a sports medical professional, and now as a parent, would I still provide this same advice to myself if my son decides to play?

I have heard from many new parents who say they would never allow their child to play football because they don’t want them to get a concussion, which is usually followed by “my son or daughter will play soccer because it’s ‘much safer.’” At this point, parents are usually looking for a nod of confirmation.

It seems popular nowadays to listen to all the ‘soft’ studies reported by the media that directly relate concussions and other catastrophic injuries to playing football. In my experience, the hard numbers show that concussions are not solely a football problem. My professional responsibilities inherently place me directly around young injured athletes in many different sports and activities and I have seen concussions in all of them.

Heads Up: Concussion in Football

This is also a good time to mention that most of the concussions I have seen over the past few years did not occur during a sport at all…
…kid got hit in the head with a drum mallet during marching band
…whole family suffered concussions from a motor vehicle accident
…kid said he got hit by a shelf
…sledding accidents, trampoline mishaps… and on the list goes.

We’ll never be able to fully protect our kids from the world, but we CAN demand a higher level of safety from those responsible for our children. We CAN and SHOULD educate ourselves — and our children — about the injuries that can occur during sports and prepare ourselves for if and when they occur. We CAN be truthful on our kid’s sports physicals and go further than the minimum requirements. We CAN inquire about baselines for concussions and pre-participation strength and agility training to prepare our kids for the physical demands of the sport. Injuries cannot be prevented, but the risk can be minimized with preparation.

My profession allows me to be at the forefront of this preparation, to be an advocate for safety, and to educate anyone willing to listen. And I can say that many athletic associations are taking notice of the rise in injury awareness and utilizing their authority to help protect our kids.

My message here in this post is convey to parents that even a dad in the “business”— one that has access to all the data and research — still struggles with the decision on whether I will allow my son to play football.

Now for the toughest part: my answer.

Let’s just say I’m lucky that I have another seven to ten years of research until I have to make this decision, but I will say something inside me is excited to start finding those permission slips in the bottom of his backpack.