An explosive book was published last month that exposes the concussion crisis in the NFL. "League of Denial" by two brothers, Mark Fainaru-Wada and Steve Fainaru, who are reporters for ESPN, takes a critical look at how the NFL ignored for decades the long-term debilitating effects of concussion on thousands of players. They use statistics, interviews, anecdotal stories of particular players, and a review of hundreds of documents referring to the effects of concussion leading to chronic traumatic encephalopathy (CTE). The leading expert on the subject is Ann McKee, who in 2012 examined the brains of 34 former NFL players discovering 33 showed evidence of CTE. As she put it, when questioned on the extent of the problem, "I don’t think everyone has it, but it’s going to be a shockingly high percentage." Her assessment is borne out by a study of high school athletes in the 2008-2009 academic year by Meehan, d’Hemecourt and Comstock in the American Journal of Sports Medicine. They looked at 544 athletes in various sports, both men and women. Of the players they examined in each of nine sports, they discovered that 56.8 percent of football players had suffered a documented concussion. The next highest percentage was surprisingly girls soccer with 11.6 percent compared to boys soccer with 6.6 percent. Wrestling and girls basketball follow with 7.4 percent and 7 percent, respectively. Girls do suffer more concussions and have a longer recovery time, which has been largely ignored in the discussions about head injuries. Most news stories focus on injuries to boys and men, but the statistics show that we should be closely monitoring females. A 2008 study by Northwestern University showed that 29,167 girls compared to 20,929 boys had concussions in 2005. Given that more boys participate in high school sports than girls and given that boys play football, having the highest percentage of concussion per player population, we should be not only cautiously aware, but seriously attend to the condition in women.
Dr. Ann McKee figures prominently in another book by Robert Cantu, M.D. and Mark Hyman, "Concussions and Our Kids," which, as the title implies, explores the causes, effects, recovery and prevention of concussions in youth athletes. Dr. Cantu is one of the founders of the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University. Dr. McKee performed studies on the brains of scores of athletes who had died either unexpectedly or from self-inflicted wounds finding widespread abnormalities in those brains. Dr. McKee takes the view that, "We need to do something now, this minute. Too many kids are at risk." Of course, she sees the worst case scenarios, athletes who suffered from CTE, most of them competing at the professional level with intense practices, games and training. However, Dr. Cantu sees mostly young people in his practice who have their routines and dreams shattered by the effects of a concussion. Mark Fainaru-Wada in an interview on "The Daily Show" admitted that he loved the game of football and "its violence" even as he had studied the widespread incidents and after-effects of concussions in those players. As he put it, "They are adult players who now willingly understand and take the risks, so there is no reason for fans to feel guilty." What he neglects to understand is that in order to get to the level of NFL membership, players have to come up through the ranks beginning with youth football, where the risk for concussion is just as great and where the players are too young to make informed decisions on their participation. Where will the new generation of tough NFL players come from if not from the networks of youth, high school and college teams? Parents have the primary responsibility to decide which sports their kids will play, how intensely and for how long.
Recently our local NBC affiliate went around to various football games to interview parents after a particularly devastating study on concussion was published. Sticking microphones in front of these parents during games, the reporters asked, "Knowing how serious concussions can be, why do you let your son play football?" Naturally, the responses all tended to the defensive since their parenting had been directly challenged publicly. I wish the reporters had asked instead, "Does your school have a concussion policy?" or "Has your child ever suffered a concussion and how did you handle it?" Obviously, most parents are aware of the possibility of brain injuries in sports, but many may not be aware of the symptoms and proper treatment of these injuries. The choice to allow our kids to play sports, especially sports with a high degree of concussion consequences, can’t be totally dictated by the possibility of any injury. If it was, no one would play. The more responsible approach will be to educate ourselves on how to recognize and treat these injuries.
Concussions can occur without any head-to-head contact, but those types of concussions usually result in the most severe and long-lasting effects. Concussions can happen with any type of jolt to the brain stem or brain itself that could be due to things such as a jarring leap to the ground, whiplash, sudden twist of the neck or shaking of the brain. There are four main categories of symptoms:
o Cognitive: Feeling in a fog, difficulty in remembering things, poor concentration
o Emotional: Nervousness, irritability, sadness to the point of depression including thoughts of suicide
o Sleep Disorders: Trouble falling asleep and sleeping more or less than usual
o Somatic: Headaches, nausea, vomiting, sensitivity to light and noise, dizzy spells, problems with balance, visual problems
The latter are the symptoms most commonly associated with a concussion and are the usual immediate signs, but just because these pass doesn’t mean that the concussion wasn’t severe or is "over." Most effects of a concussion can last for days, weeks and even longer. The standard recovery period is 7-10 days of rest from all activities including diminished academic participation. We rest the body, but really it is the brain we need to rest. We need to remove as much stimulus to the brain as possible in order to give it time to heal. This is the element few doctors, coaches and parents consider. However, Dr. Cantu states that this could be the most important aspect of avoiding the long-term effects of a concussion, including CTE. We parents need to be aware of and address all the symptoms.
We also can’t assume that a "real" concussion requires that a player be unconscious for a period of time. Going out cold is definitely a serious condition and can be a clear signal that we need to be diligent in treatment. However, many concussions don’t result in a black out, which is why so many go unreported. Therefore we have to look at other symptoms. Athletic trainers and coaches need to be well-versed in how to assess concussive episodes. Many organizations provide laminated cards with key points and questions for detecting concussions. The most comprehensive test has been endorsed by several sports organizations, including FIFA. Called the Sports Concussion Assessment Test 2 (SCAT2
), it seems overwhelming but is exactly what coaches and trainers should be administering on the sidelines. The test gives scores that help assessors detail in a more objective manner what used to be done totally subjectively. Many evaluators have expressed amazement at how detailed the assessment is and how it quickly pinpoints serious conditions that would have been previously overlooked. Parents should ask their clubs to print this off and have it kept on the sidelines in the coach’s bag for every practice and game. Most importantly, adults need to err to the side of caution until a child can be assessed by a doctor. That means no reentry to a game with even the slightest concern about a concussion.
Now comes the most important question, the question those reporters asked, but it is not being offered to invoke defensiveness: Why do we let our kids play sports that could result in serious, debilitating, even long-term injury? The answer is simple – because kids need to play sports. The benefits far outweigh the anecdotal and statistical data conjured up by the number of studies done in recent years. Kids develop better physically and cognitively when engaged in sports, they learn important lessons about success, failure, collaboration and sacrifice, and they have fun. The real issue is how we mitigate the injury issues that come with doing sports. We have to make sure that kids have the best safety equipment and training possible, that coaches are well-versed in proper management of potential injuries, and that proper emergency equipment be available either on site such a body boards and first aid kits or readily available such as ambulances and EMTs. We also need to be willing to insist that our children take a much-needed interruption from playing should any injury occur until completely cleared to reenter the sport by a physician. Big games will come and go, but a child’s health needs nurturing and protection since it is the only health he or she will have for a lifetime. With all the attention now being paid to the issue of CTE in NFL players, there will certainly be even more research on how to prevent and treat concussions which can only benefit our children. Most importantly, we can’t just be focused on boys receiving concussions or on football being the primary culprit. We need to be vigilant for our girls and for all sports as well.
Some children are more prone to concussive events and unfortunately they may not be able to continue playing the sport they love. Two of my grandsons play football and one plays lacrosse, both of which have concussion issues. My oldest grandson, who is 13, has a teammate who has already suffered his third concussion. His grandfather is a college football coach and he lives in Columbus, Ohio, home to Ohio State, so leaving the game will be difficult. However, this is a decision his parents may have to face soon. There are other activities with less risk for concussion, and athletic children should be able to make a transition to another sport. We have to be prepared to counsel our children properly without taking into account our own dashed dreams for their athletic career. As a nation, we have not taken concussions seriously enough, but over the past five years a number of significant studies have highlighted not only the extent of the episodes but the possible prevention and treatment of concussions. This serious attention to brain injury hasn’t completely trickled down to youth sports, but it has made important changes. As a parent you can ask what your sports organization, club, team and high school have as policies concerning concussion. You can demand that they keep up with the latest studies and standards, including offering them the SCAT2. Significantly you need to be the advocate for your child’s safety no matter what the policies might be. If you expect a higher standard don’t be afraid to demand it for your child. We don’t want our child lying on a medical examiner’s slab at age 50 due to complications from years of concussive episodes and CTE. We’d rather our children were healthy enough to become the medical examiner or any other profession beyond the decade they might be able to play professional sports. In the eight decades of most people’s lives, that’s a tiny sliver of time for a particular achievement, and no one’s achievement needs to be measured solely by athletic prowess.