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Friday, September 28, 2012

Web Chat: The Risks Of Concussions In Youth Sports

The problem of concussions in professional sports gets a lot more attention now than it used to, especially in the NFL and NHL.

But Dr. Robert Cantu worries that concussions in youth sports aren’t taken as seriously. Cantu is a clinical professor of neurosurgery at the Boston University School of Medicine, and he’s co-author with Mark Hyman of the new book “Concussions and Our Kids: America’s Leading Expert on How to Protect Young Athletes and Keep Sports Safe,” excerpted below.

They write that sometimes in youth sports there’s a “walk it off” attitude among some players and parents and coaches. And that means head injuries in young athletes sometimes go overlooked, even though they can be especially detrimental in kids.

Do you worry about risks to your child in his or her sport? How can we make youth sports safer?

Youth sports expert Mark Hyman weighed in on those issues and more in a live web chat, watch a replay below.


Book Excerpt: ‘Concussions And Our Kids’

By: Dr. Robert Cantu and Mark Hyman

What is a Concussion?

“We need to do something now, this minute. Too many kids are at risk.”
— Dr. Ann McKee (Time)

“We still have this culture where it’s hard to convince people that a concussion is a very serious brain injury.”

— Dawn Comstock, principal investigator, Center for Injury Research and Policy, The Research Institute, Nationwide Children’s Hospital, Ohio State University (Time)

IN THE LATE 1950s, I was a student at Cal-Berkeley and a member of Cal’s baseball team. We were playing Stanford one afternoon, and I came to bat. This was the dark ages before batters wore helmets with ear flaps. Our protection—if you can call it that—was a flimsy liner inside our felt caps.

A pitch came inside and tight, and I didn’t react as quickly as I needed to. The ball caught me flush on the side of the head. The cap and the hard liner were just about worthless. The force of the blow stunned me, and I wobbled a bit as I made my way down the line to first base. This didn’t seem to bother anyone as much as the blood trickling from my ear. It wasn’t really coming from my ear—the force of the pitch had shattered the cap liner, which sliced into my scalp.

The coaches didn’t know that, of course. They took one look at me and thought, “My God, Cantu has a skull fracture! Get him to the hospital!”

In those days, it wouldn’t have occurred to anyone in either dugout that I might have had a concussion. Even at the hospital it wasn’t diagnosed. It’s only looking back with years of experience in this field that I can say—based on my symptoms, which included not knowing where I was for a while, lightheadedness, and a violent headache—that I certainly had a concussion.

We’ve come a long way since those unenlightened times. Now head trauma in sports is a topic that leads nightly newscasts and is debated at every level of amateur and professional sports. I knew that concussions had become something of a national obsession when Jerry Seinfeld built an entire monologue around the question “Why did we invent the helmet?” Normally, there isn’t a lot of humor associated with head trauma of any kind, but Seinfeld’s take is amusing. First, he says, we invented sports, the main feature of which is slamming our heads into each other over and over. Then, “We chose not to avoid these activities but to make little plastic hats so we could continue our head-cracking lifestyles.”

A Concussion Is…

The word derives from the Latin concutere for “to shake violently.” Concussions are just that—a shaking of the brain inside the skull that changes the alertness of the injured person. That change can be relatively mild. (She is slightly dazed.) It can be profound. (She falls unconscious.) Both fall within the definition.

According to the Centers for Disease Control and Prevention, almost four million sports- and recreation-related concussions are recognized every year, with many times that number occurring but going unrecognized. For young people ages fifteen to twenty-four years, sports are the second leading cause of traumatic brain injury behind only motor vehicle crashes. According to research by the New York Times, at least fifty youth football players (high school or younger) from twenty different states have died or sustained serious head injuries on the field since 1997. One study estimates that the likelihood of an athlete in a contact sport experiencing a recognized concussion is as high as 20 percent each season. In my office, there is a very discernible cycle in the number of concussion patients. In the fall (football season) and winter (ice hockey) the numbers go up, sometimes exceeding fifteen new young athletes with a concussion per week. In the spring and summer, they slide back down.

How They Happen

Concussions happen to all types of athletes—young and old, boys and girls, and in every conceivable sport. In a typical year, I see hundreds of children and adolescents in my office. We see more than athletes, of course. Some patients have suffered concussions in traffic accidents, mishaps around the house (they walked into a door), or a slip and fall in the grocery store.

In a chapter later in this book, I offer observations about concussions in “non-collision” sports such as volleyball and tennis that parents—for good reason—do not think of as posing a great risk of concussion. However, there is risk in every sport. I would have to think a long time before naming one that has not sent a single patient to our office at Emerson Hospital in Concord, Massachusetts.

Many patients get well over two to three weeks, pretty much as expected. Other cases take unexpected turns. Mario was an eleven-year-old kid making one of those typical recoveries. After his concussion, he had a number of symptoms. We held him back from sports, gym, and physical activity. He was also under restrictions regarding his schoolwork. Just as he was about ready to resume normal activity, Mario hit his head on a bedpost and suffered another concussion. The process started all over again. I can’t count the number of stories like that. Unfortunately, they happen a lot.

Concussions in sports occur when an athlete is slammed and makes sudden and forceful contact. That contact can be with the ground, court, or pool deck. It also can be with a batted ball, a thrown ball, a kicked ball, a goalpost (football), the boards (hockey), the scorer’s table (basketball), and of course another player. Dylan Mello, a high school soccer and ice hockey player from Rhode Island, suffered a severe concussion in a collision with a player who smashed him with the plaster cast on his arm.

Concussions can and frequently do occur without any contact with the head. Rather, the player’s body receives a jolt that causes his shoulders and head to change speed or direction violently. It’s the whiplash effect. Inside the skull, the brain shifts in the cerebrospinal fluid and bangs against the inside of the skull. Even falling from five or six feet and landing upright, if it’s unexpected, and therefore jarring, can send a shock through the spine and shake the head with a force that may cause a concussion. Concussions that are the most damaging to the brain tend to be the ones that involve a direct blow to the head, however. When you’re struck in the head, the forces generated are about fifty times greater than being struck in another part of the body.

With such a blow, the brain pushes forward until it crashes into the skull, reverses, and bumps against the back of the skull.

Excerpted from CONCUSSIONS AND OUR KIDS, © 2012 by Robert Cantu and Mark Hyman. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved.

Guests For Our Radio Broadcast

  • Dr. Robert Cantu, clinical professor of neurosurgery at the Boston University School of Medicine
  • Jon Butler, executive director of Pop Warner Football

Guest For Our Live Web Chat

  • Mark Hyman, sports journalist and author whose books include “Until It Hurts: America’s Obsession with Youth Sports and How it Harms Our Kids” and “The Most Expensive Game in Town: The Rising Cost of Youth Sports and the Toll on Today’s Families.” He is co-author with Robert Cantu of “Concussions and Our Kids: America’s Leading Expert on How to Protect Young Athletes and Keep Sports Safe.” Hyman teaches in the sports management program at the George Washington University.

Please follow our community rules when engaging in comment discussion on this site.
  • Jan

    My question is this: how do we get sports like Girls Lacrosse to take the helmet issue seriously before some is killed from a brain injury?  My 14 year old daughter has had 4 concussions, 3 from lacrosse balls to the head, and she is now out of sports for good with debilitations.  When communicating with the national and regional lacrosse associations, I was told that helmets make the girls play more “agressively” and since they have different rules than the guys (who wear helmets) they don’t want to either 1) encourage agression in girls or 2) have to change the rules. Such poppycock!  What kind of information can lead to meaningful change before a death gets their attention? 

    • Ande_new

      This summer I posed the same question to the trainer for the us women’s lacrosse team and he told me if the game was played correctly there would be no concussions. He’s not had one concussion on his team at the top level. My contention is that not everyone knows how to play correctly AND I have seen the girls who are used to playing aggressive soccer come over to lax and play the same way, which is not how it used to be. It was usually field hockey and lacrosse that went together. Two stick sports played similarly. Now it’s soccer lax. Two totally different games. Put the helmets on when they are young, take them off later if you must.

      • Joslyn Shehab

        I am a parent of a new high school freshman female lacrosse player and have great concerns about concussions.  Even playing within the girl rules, it is easy to get hit in the head with the very hard and fast thrown ball.  If anyone has ever been hit by one of these balls, you would understand.  Is there any talk of adding helmets by the people leading girls lacrosse organizations?  Where is everyone on this?

        Joslyn

        • jryanhn

          Hi @5d3792a3e88bdaed5b9409674d491fa1:disqus 

            Mark Hyman had a response to a similar question in our live web chat — you can read the question (a mother who had a daughter suffer numerous lacrosse concussions) in the live web chat box above, but here is his answer. Mark writes:

          “My conversations with lacrosse officials at the national and local levels inevitably lead to the explanation you have cited. Helmets in girls’ lacrosse will change the game. They will result in more risk of head trauma, not less. Those who advocate for helmets are well-intended, but do not understand the sport.

          The good news is attitudes are changing, slowly. In Concussions and Our Kids, Steve Stenerson, president and CEO of US Lacrosse, comes out in favor of a minimalist helmet for girls. Sort of like a bike helmet. It’s not enough in my judgment, but it’s a start. In Concussions and Our Kids, by the way, Dr. Cantu comes out squarely in favor of a girls’ helmet that would “cover the head completely.”

          As for what concerned parents can do, keep doing what you’re doing. Speak up.”

    • Pattieod

      I never understood why the girls don’t wear helmets for lacrosse.  I played very aggressive lacrosse in junior high, and may have given someone a concussion.  In what was probably a wise move, they put me in the goalie cage, but the goalie at that time wore a mask but no helmet, and I got a concussion myself when a ball flung into the goal during practice bounced back and hit me in the back of the head.  

    • jryanhn

      Hi @d3543d00bce14a6be7b0beb294e969c1:disqus , youth sports expert Mark Hyman responded to your question in our live web chat. You can read his answer in the live web chat box above, but I’ll post it here too:

      Mark Hyman: Thanks for the question, Jan. I’m sorry to hear about your daughter’s experience. 

      My conversations with lacrosse officials at the national and local levels inevitably lead to the explanation you have cited. Helmets in girls’ lacrosse will change the game. They will result in more risk of head trauma, not less. Those who advocate for helmets are well-intended, but do not understand the sport.

      The good news is attitudes are changing, slowly. In Concussions and Our Kids, Steve Stenerson, president and CEO of US Lacrosse, comes out in favor of a minimalist helmet for girls. Sort of like a bike helmet. It’s not enough in my judgment, but it’s a start. In Concussions and Our Kids, by the way, Dr. Cantu comes out squarely in favor of a girls’ helmet that would “cover the head completely.”

      As for what concerned parents can do, keep doing what you’re doing. Speak up.

  • John Ratliff

    I have used a helmet in bicycling for many years.  I have had several bike accidents, and one was particularly traumatic, with a concussion which rendered me unconscious for about 30 minutes.  I was wearing a helmet, the emergency physician said that if I had not worn that helmet that day, and was unlucky, I would have lived.  Here are photos of the helmet:

    http://i3.photobucket.com/albums/y76/yaquinaguy/Helmet1.jpg

    http://i3.photobucket.com/albums/y76/yaquinaguy/061706-1.jpg

    http://i3.photobucket.com/albums/y76/yaquinaguy/Helmet4.jpg

    I am a safety professional, and have been writing about helmet use for bicyclists for years on BikeForum.com.  Many of the posters there are against helmet use, and say “helmets cannot prevent concussions”.  My reply is that while helmets cannot prevent concussions, they can lesson their effects in a particular situation verses a bare head hit.  Do you have any studies which validate my assertions, or thoughts on mitigating the effects of concussions by helmet use?

  • Pam

    Dr Cantu mentioned an array of symptons resulting from concusion injuries.  If athletes and former high school athletes are experiencing some of the symptoms mentioned, what can and should they do to reduce or eliminate the effects of the concussion injuries.  What action, in terms of medical treatment, should they be taking.  Can current symptons be traced back to concussion injuries?  What treatment is available?  Could you name medical facilities or medical practitioners who are working on reducing the symptons?

  • Photogike

    My 21year old daughter was rear ended while stopped. She was hit at 50mph by a truck and went into the car in frount. She appeared ok but now 4-6 weeks in she is having classic signs of a concussion. Cat scan in ER was fine so we took her to the primary Dr. And she thinks it is a virus. As parents we are confused and don’t know if we should persure another Dr? Is this too long for a concussion to show signs? A serior in college she may not have seen the signs? Thank You if you can help? Besr Regards, Ike

  • John Ratliff

    I need to explain the below center photo.  I had meant to post this photo:

    http://i3.photobucket.com/albums/y76/yaquinaguy/Helmet3.jpg

    The other photo below shows a boy on a gurney about to be loaded onto an ambulance.  The boy had been hit by a van, and the van’s tire came to rest on his helmeted head.  He was freed by fire and rescue personnel, and taken to a hospital.  In this case, the car’s wheel had actually pinned his head, and the helmet allowed him to  survive that accident.  Here are a few more pictures and write-ups from that accident:

    http://i3.photobucket.com/albums/y76/yaquinaguy/RoseburgHelmet-1.jpg

    http://i3.photobucket.com/albums/y76/yaquinaguy/061706-driver.jpg

    http://i3.photobucket.com/albums/y76/yaquinaguy/071606-Page-1-cropped.jpg

    http://i3.photobucket.com/albums/y76/yaquinaguy/071706-modified.jpg

  • Inbox

    My son plays Lacrosse in high school. Where do you rate the risk factor for this sport.

  • http://www.facebook.com/profile.php?id=739705324 Adam Brabant

    I’m curious what your guest from Pop Warner has to say about the kid who broke his neck in a Pop Warner game.  He  is now a quadriplegic and cannot afford his family cannot afford his medical bills.  Does Pop Warner have insurance to cover their players injuries?  Why are they fighting their responcibility to help this poor kid out?

  • Sleslie03

    I am a cognitive therapist that is using Neurofeedback with clients who have had multiple concussions. Most of them are no longer able to play because they have had so many. We have had great results in terms of reduced headaches, better sleep, less foggy thinking, better executive functioning. I am wondering if this might be a good thing to do after the first concussion and if so how soon do you think it would be good to do it. I am wondering if the athlete would feel better before their brain has healed and therefore put themselves in more danger.

  • jdwalkerPHHS85

    I
    played contact football from 7 to 17 (10 years) and that was my football
    career.  The coaches and my experience
    playing the game helped shape who I am today. 
    Yes, I suffered a concussion and my brain was rattled around through
    contact, but that was part of the game. 
    If I had waited to play high school football I would have played three
    years.  There are a very small percentage
    of players that go beyond high school so limiting the time you can play as a
    youth seems as unfair.  I was taught not
    to use my head when I hit people and that’s how I coached my players in Pop
    Warner Football.  Rather than take away
    the opportunity to play a sport promote the proper techniques. 

  • http://profile.yahoo.com/SOCYYKYL3WRMTYRS6VFTKLITXA edward

    when my 19 yr old son was 4 he fell at a playground climbing structure and hit the back
    of his head on a wood step. the sound was terrifying. he did in fact become disoriented and within the hr we had him at the hosp. where we were told he had fractured his skull. Since that time he has been diagnosed with add…body dismorphia…and ocd. He was absolutely incapable of sitting down to do homework and subsequently did not finish high school. today he uses drugs and alcohol to deal with the torment of his multiple disorders. We have had him to therapists, psychiatrists, rehabs etc. If in fact the cause of my sons afflictions was a concussion, what, after all these years, can we do to help him?

  • Abilene

    I am a mental health therapist seeing an adult patient with anorexia for several years.  She sustained a concussion during a sports activity over this last year.  She is still symptomatic with headaches and dizziness, sensitivity to noise, and concentration and memory impairment.  Although she has symptomatically improved over time, she has relapsed in her eating disorder as her standard methods of coping through exercise are very limited.  Can you tell me what impact calorie restriction to around 900 calories per day will impact the healing process and recovery from her concussion?

  • Lhennessey

    My son is home from school right now trying to rest his brain as he heals from a concussion he received after the whistle was blown at a hockey game. (BTW, the ref didn’t see it so nothing happened to the boy who decided to crush him into the boards when he wasn’t looking.) The prescription: after he did the baseline test a year and a half ago he took the post-injury test. Now his prescription: do nothing. This 13-year old boy addicted to sports who can’t sit still is supposed to sit in his bedroom with the lights down low and stare at the ceiling. Do not do anything that uses your brain. Really? Is there possibly another prescription to heal from this? Not only is he going insane, but I am too!

    • jryanhn

      Hi @e0703f3b60ec7a8a1821da3e7bdbff49:disqus , What a frustrating situation, to say the least. Our concussion expert Mark Hyman responded to your question in our live web chat box above, I’ll also post his comment here:

      Mark Hyman: Hi-
      I will share with you a short passage from the book from Dr. Cantu:

      “Rest is the hallmark of concussion therapy. The best we can do for patients is to shut things down physically and cognitively. That doesn’t mean going into a dark room and staying in bed. That would run the rest of your body. Generally speaking, it means reducing the thinking and reasoning in a patient’s life as much as needed so that symptoms are not provoked.”

      Best of luck @lhennessey:disqus 

      -Jill Ryan, H&N

  • It

    This interview was teribble! The king of kids football is given half the time in this interview to defend his point of “well if they didn’t get it from football they would get it from riding a bike.” I thought this might be a serious story but it turned into an add for some crazy thing called pop-warner.

  • Harvey Mt. (James Wilson)

    Read “Pop Warner Probes ‘Bounties!’” The Wall Street Journal Saturday-Sunday Sept 29/30. Page A3.
    Someone’s been ‘brainwashed!’ All these nobel coaches protecting their young charges. Ha!

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