Urgent Action Necessary: Addressing Concussion Risks in Football
Revamped Article:
Young athletes in the USA are seemingly no strangers to head injuries and concussions. The number of emergency room visits for concussions among 8- to 13-year-olds and reported concussions in those aged 14-19 increased by 200% between 2002 and 2012.
In 2012 alone, a staggering 325,000 teenagers visited emergency rooms due to concussions, that's nearly 40 cases an hour.
A single head blow may be troublesome, but additional blows magnify the risk of catastrophic head injury, long-term neurological disability, and permanent brain damage. If left undetected and untreated, concussions and other traumatic brain injuries (TBIs) can be fatal.
The Centers for Disease Control and Prevention (CDC) initiated the "Heads Up" project in 2003 to raise awareness and provide training about TBIs and concussions. In a span of 10 years, they circulated over a million copies of their materials and trained over 1.5 million coaches online.
Despite these efforts, concerns persist.
What is a concussion?
Concussions can be the result of a direct or indirect blow to the head or body. The American Association of Neurological Surgeons (AANS) defines it as "a clinical syndrome characterized by immediate and short-lived alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma."
Approximately one-third of all concussions happen during practice, and 1 in 5 high school athletes will experience a concussion during a single season.
One-third of those who report a sports concussion will have at least one more concussion within a year.
A whopping 5.3 million people in the USA currently live with a TBI-related disability.
Nine out of ten concussions don't involve a loss of consciousness.
Understanding Concussions
The skull holds a protective cushioning, cerebral spinal fluid, which supports the brain much like a shock absorber. In a concussion, the brain moves more rapidly than the fluid inside the skull, potentially causing the brain to strike the inner surface of the skull, resulting in damage.
Rotational concussions occur when the head rotates quickly from side to side, causing the brain tissues to shear and strain. These motions can harm the delicate neural pathways in the brain, resulting in issues with memory, judgment, reflexes, speech, balance, and muscle coordination.
Risks associated with concussions and TBIs include:
- A much greater chance of dying from a subsequent unintentional injury, due to potential changes in cognition and balance.
- A tripling or quadrupling of the risk of suicide.
Mouse studies suggest that young women who have experienced concussions could be more susceptible to alcohol abuse as adults.
Recovery from concussions and TBIs is usually achievable without intervention, but a second incident increases the risk of permanent damage by 39%.
Concussions in football
In the USA, football is the sport that sees concussions occur most frequently. Roughly 47% of sports concussions happen during high school football activities.
The incidence of concussions among footballers is 64-76.8 per 100,000 participants. In boy's ice hockey, the incidence is 54 per 100,000. For girls playing soccer, the rate is 33 per 100,000. Cheerleaders face a rate of 11.5-14 per 100,000.
Considering the massive number of participants, Dr. Paul Auerbach, of the Department of Emergency Medicine at Stanford University School of Medicine in Stanford, CA, and a former team doctor, views football as a "colossally greater cause of significant injuries than boxing."
Signs and symptoms of concussions in football players
The CDC's "Heads up" project lists several signs coaches and players should look out for.
Athletes might experience:
- Headache or pressure in the head
- Nausea or vomiting
- Balance problems or dizziness
- Blurry or double vision
- Sensitivity to light or noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems
- Confusion
- Just not "feeling right" or "feeling down."
To others, the player might appear:
- Dazed or stunned
- Confused about an assignment or position
- Forgetful about an instruction
- Unsure of the game, score, or opponent
- Clumsy in movement
- Slow to answer questions
- Lose consciousness, even momentarily
- Show mood, behavior, or personality changes
- Be unable to remember what happened before or after the hit or fall.
If a concussion is suspected, the CDC recommends the following steps:
- Removing the athlete from play
- Keeping them out of play for the rest of the day
- Seeking approval from an appropriate healthcare professional before allowing the athlete to return to play.
Dr. Auerbach notes that, although a person with a concussion can seem normal within a week, full recovery may take at least 4-6 weeks. Athletes, however, often return to the field before their recovery is complete, typically within 7-10 days. This puts them at risk of further damage.
Return-to-Play laws
Since 2009, "Return-to-Play" laws have been implemented across all 50 states and the District of Columbia to give athletes sufficient time to recover before putting themselves at further risk.
In 2009, a 13-year-old footballer, Zackery Lystedt, sustained a concussion during play. He returned 15 minutes later, but he spent 9 months in a coma afterward. As a result, Washington passed the first "Return-to-Play" Law.
The Washington law (also known as the Zackery Lystedt law) requires that:
- Schools and activities institutions develop concussion guidelines and educational programs
- Parents and players sign a concussion and head injury information sheet every year
- Players are immediately removed from play if they may have a concussion
- Players only return to play when they have written clearance from a specially trained healthcare provider.
Details vary by state. Texas and Arizona, for instance, allow parents to remove their child from play if they suspect a concussion.
Are the Return-to-Play laws enough?
Some experts feel these laws do not provide adequate protection.
Earlier this year, Dr. Auerbach and co-authors published an opinion article entitled "It's time to change the rules." They call for further actions to prevent concussions in football before they occur.
Dr. Auerbach told Medical News Today:
"Return-to-Play laws are a step in the right direction, but they don't go far enough. Based on the evolving knowledge, allowing an athlete to return to play after a concussion within 24 hours doesn't account for the fact that the healing process, even in the absence of ongoing clinical manifestations, may require up to 4 weeks or longer. The healthcare professional who gives permission for an athlete to return to play should be an expert in concussions with a level of understanding comparable to a skilled neurologist."
Dr. Auerbach sees rest and recovery as a good step forward, but he proposes more radical solutions. He suggests changing the game from within, including:
- No "down linemen" in direct opposition at the line of scrimmage
- No tackling of the opponent or intentional striking of the opponent's body with the top part of the helmet
- No forearm blows or "shivers" to the head at the line of scrimmage or while blocking or tackling
- Maximum of 2 days per week for full contact practice, each practice day involving a maximum of 20 plays per player
- If symptoms, a physical exam, or testing suggest a concussion, a player should not play for at least 4 weeks. Before full play, they must progressively return to full contact
- Any coach that allows an athlete to participate with symptoms of concussion will be suspended for three games. A repeat offense will result in suspension for the rest of the season.
Other proposals include a ban on tackling or intentional head blows at the youth level.
Asked why more radical changes to prevent concussions are not being actively pursued, Dr. Auerbach told MNT:
"Owners, sponsors, coaches, parents, and players may not be aware of the clinical manifestations, pathophysiology, natural course, and seriousness of concussions. If they are aware and have a conflict of interest, be it emotional, philosophical, or economic, they may continue to put players at risk by keeping the game similar to its current state of high-impact play."
Dr. Auerbach recognizes that these changes might not be popular, but he insists that they could not only make the game safer but faster and more agile.
- A significant proportion of concussions occur during practice, and a third of those who report a sports concussion will have at least one more concussion within a year.
- In addition to physical impairments, concussions can also lead to a tripling or quadrupling of the risk of suicide.
- Football is the sport that sees concussions occur most frequently, with almost half of all sports concussions happening during high school football activities.
- To ensure proper recovery and prevent further damage, healthcare professionals should be experts in concussions and have a level of understanding comparable to a skilled neurologist.
