2012-10-12




Concussions hit home: Will fear of head injuries reshape youth sports?

By Julie Mack | jmack1@mlive.com
on October 11, 2012 at 7:00 AM, updated October 11, 2012 at 4:13 PM

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CONCUSSIONS HIT HOME

More awareness, fears about playing sports

Football not the only hazardous sport

Nature of head injuries make them hard to diagnose, treat

Head injury sidelines son of state Sen. Tonya Schuitmaker

What latest research says on concussions in young athletes

How concerns may reshape school/youth sports.

What parents can do

Read the complete series

Portage Rocket Football the Titans warm up before the championship game for 7- to 8 year-olds at Waldo Stadium in this 2009 photo.Gazette file photo

OTSEGO, MI -- When the Otsego Rocket Football program started a flag football program three years ago for elementary school students, organizers worried about whether they would get enough participants.

"We figured that we'd be lucky if we got 60 enrolled," said Bryon Campbell, the program's director. "We ended up with more than 100. ... Right now, it's where our largest growth is occurring."

One factor driving flag football, Campbell figures, is parents seeking a safer alternative to tackle football as concerns grow about football-related injuries, especially concussions.

Those parents might have the right idea, according to Tim Hiller, former star quarterback for Western Michigan University and current football coach for Gull Lake High School.

Hiller is actively pushing for the Rocket Footballprogram in Richland to delay tackle football until sixth or seventh grade, and have flag football for younger kids. Currently, boys as young as third grade are playing tackle ball.

"I think what we're finding is that kids that young really aren't ready for contact football," Campbell said. "It also allows coaches to teach better football skills, without having to worry about pads and helmets and all that other stuff."

The promotion of flag football for younger boys is just one example of how concerns about concussions could change youth sports in the near future.

The issue already has had some impact. Two years ago, the Michigan High School Athletic Association mandated that athletes who show signs of a concussion during a game be pulled from competition and be barred from returning until they get a doctor's written permission. This week, Gov. Rick Snyder is expected to sign a bill that would extend that protocol to all organized youth sports.

But the changes aren't likely to stop there. Experts on sports-related concussions are offering a host of ideas on better "concussion management," and they have the ear of parents and sport officials anxious to preserve popular school and community athletic programs while protecting the long-term health of participants.

Asked what changes might be coming down the road, MHSAA spokesman John Johnson said: "This is something we'll be asking our membership about. ... What rule changes can we make to make the game safer without significantly changing the game?"

Reforming football

Julie Mack | jmack1@mlive.com

Football is at the forefront of conversations about sports-related concussions because it is the most popular sport -- and it also may be the most violent.

"While we like to see those big hits on the field, you wince when it's your kid," Campbell said.

Football is the No. 1 recreational activity that sends teenage boys to the hospital with a brain injury, and the rate of concussions in football is more than twice that of soccer and lacrosse.

But for all the focus on concussions, researchers now say the bigger worry in football may be total accumulation of body blows that jolt the head, shaking the brain like a bowl of Jello and traumatizing fragile brain tissue and nerves.

Football players can experience as many as 1,000 impacts or more over the course of season. Researchers say that, in terms of g-forces and stress on the body, playing in a high school football game is comparable to being in a 20- or 30-mph car crash.

Those so-called sub-concussive impacts may not cause concussions, but it appears they can add up and result in damage to the brain. Researchers say they see changes in brain scans of high school football players who have never reported a concussion.

For that reason, experts now say reforms in football need to go beyond reducing concussions and focus instead on the total number of impacts that young athletes experience.

Some ways to do that:

Delay the age for contact football. Hiller proposes to have kids in flag football until middle school, but some say that tackle football shouldn't start until high school. The rationale: It would considerably reduce the number of lifetime impacts for athletes; it would protect boys when their brains are still developing and their necks are weaker, which makes their heads more likely to jolt; and it provides more time to teach proper football technique.

Emphasize proper tackling technique. "I think coaches have to teach players how to hit," Campbell said. "Proper techniques and proper tackling are part of the solution."

Shorten the field for kickoffs. Kickoffs are particularly dangerous because players are running at high speed toward each other. Currently, high school teams kick off at their own 40-yard line; if the kickoff point was moved forward, that would provide less room for players to gather speed and, more importantly, likely result in more touchbacks, where the ball is kicked into the end zone and not returned, eliminating tackling. Johnson of the MHSAA said this idea is being explored by the association.

Limit contact during practices. A player experiences about 12 impacts in a practice compared to about 25 in a game, said Steven Broglio, director of the Neurotrauma Research Laboratory at University of Michigan. Reducing the number of contact practices could significantly lower the number of total impacts over the course of a season. As an alternative, Hiller said that he conducts his contact practices in a more confined space, which limits the speed and force of the hits. He said he also avoids certain drills to "prevent those big collisions."

Set a limit on the number of impacts that individual players can experience. In the same way baseball pitchers are now subjected to "pitch counts," limiting them to a certain number of throws in a game, football players could be subjected to "impact counts." That strategy likely would rely on putting sensors in players' helmets to register the impacts they experience. That technology already exists, but the cost is too prohibitive for now to make helmet sensors a standard part of high school football.

Johnson said he is convinced that tweaks can be made to policies and procedures to address the concerns while preserving tackle football as a high school sport.

"It's not going to kill football," he said about the discussions around sports-related concussions. "It's going to make it safer than ever before.

Other sports

Concerns about sports-related concussions isn't limited to football.

Hockey, soccer, lacrosse, basketball and baseball are among sports in which thousands of concussions are reported each year.

In his new book, "Concussions and Our Kids: America's Leading Expert on How to Protect Young Athletes and Keep Sports Safe," Dr. Robert Cantu offers a list of suggested reforms for youth sports:

No body checking in youth hockey before age 14.

No heading in soccer before 14;

Mandate helmets in field hockey and girls' lacrosse;

Hold sports officials to a higher standard;

For youth baseball, require chin straps and restrict the headfirst slide.

Cantu, a Boston physician who is a nationally recognized expert in sports-related head injuries, applauded recent changes in youth hockey: USA Hockey has banned body checks below age 13 and Hockey Canada has banned checking to the head at any level of amateur hockey.

In regards to soccer, Cantu points out that more high school soccer players suffer more concussions than basketball, baseball, wrestling and softball players combined.

"Most of that risk comes from one play: the act of heading the ball," Cantu writes.

On average, a young athlete experiences about a g-force of 20 when his or her head hits a soccer ball -- about the same g-force as the typical impact in football. But the real problem, say Cantu and others, is not the head hitting the ball but the head hitting another head -- or the elbow or shoulder -- of an opposing player.

Rachel Gallap, 13, wears head protection while playing for the Kingdom Soccer team. Ava Wood, 13, with Kalamazoo Soccer Club, is on the right.Mark Bugnaski / Gazette

Melissa Hucko, a Portage resident and mother of a 14-year-old soccer player, says that's what she sees.

"The coach talks to them about how to hit the ball with their heads to avoid injury, but most of the time it is from bumping heads or getting kicked in the head," Hucko said.

Dr. Thomas Goodwin, a specialist in sports medicine with Pro-Med Physicians, a Kalamazoo-area practice affiliated with Borgess Health, said the most serious sports-related concussion he's seen involved a girl injured in a head-to-head collision playing soccer.

"She was a straight-A kid whose grades dropped to Cs and Ds," Goodwin said. "She never really recovered; she was a different kid. It was really sad."

As for the recommendation on better officiating, Hiller said he's seeing that already. "I'm seeing more officials calling helmet-to-helmet hits," he said.

Other changes in policies, procedures

In addition to changing rules of specific sports, there are three other reforms that are occurring in schools and community sport organizations.

The first is to have athletes, especially those in contact sports, take a baseline cognitive test at the beginning of the season.

This consists of a computer test of memory and other cognitive skills. Then if an athlete experiences a possible concussion, he or she takes the computer test again as part of diagnosing whether an injury occurred and to gauge when the athlete is ready to return to play.

School systems that administer such tests to high school athlete include Portage, Mattawan, Gull Lake and Vicksburg. It is not given in Kalamazoo Public Schools, the region's biggest school district.

"More schools are doing it every year," Gull Lake's Hiller said.

A question on ImPACT, a computer program that tests memory and other cognitive skills in student athletes. The test is administered at some area school to athletes in contact sports to provide a baseline reading at the beginning of the season. Then if an athlete experiences a possible concussion, they take the test again as part of diagnosing whether an injury occurred. Gazette file

The baseline tests can actually help athletes with concussions return to play faster. That's because the cognitive test is a standard part of a doctor's diagnosis and a baseline test taken before the concussion can provide some certainty on when the athlete has recovered.

Another reform is ensuring that young athletes have access to an athletic trainer. Currently, less than half of U.S. high schools have a trainer, according to the National Athletic Trainers' Association.

Hiller acknowledged that the expense of a trainer may seem onerous for smaller schools, but he also said that having a trainer on staff is invaluable.

"I think having a trainer at every high school is a must," Hiller said. "I rely heavily on our trainer to give me advice on playing injured players, and she is able to evaluate their injuries far better than I ever could. Most coaches, though CPR trained, are not medical professionals. The well being of someone's son or daughter should not be in the hands of someone who is not a medical professional. Athletic trainers are essential."

The third reform is ensuring coaches, parents and students have the proper attitude about concussions -- i.e., they recognize the importance of identifying the injury and keeping the athlete out of competition until he or she is fully recovered.

"The biggest thing is creating the environment where the kids feel comfortable with saying, 'Coach, I don't feel right,' " Hiller said.

Jim Murray, athletic director for Portage Central High School, said awareness among parents also is critical, since symptoms of a concussion don't always surface immediately and escape the coach and/or trainer. There's also the issue of teenagers who don't reveal the symptoms they're experiencing.

"If an athlete doesn't tell us," the coaching staff may not recognize that an injury has occurred, Murray said.

In that sense, "parents have a big responsibility, no question about it," Murray said. That includes emphasizing to their children the importance of reporting symptoms, keeping an eye out for signs of a concussion, and monitoring the recovery process if a concussion occurs.

Murray said he wouldn't be surprised to see changes in high school sports in the near future to address concerns about concussions, pointing out that sports have adapted numerous times over the years to various safety concerns.

"I can remember a time when players didn't wear helmets in the National Hockey League," said Murray, a former hockey coach. "We continue to add more and more padding, more and more protective equipment.

"How things are going to look five years from now, it's hard to tell," he said. "We're in the stage now of the more we learn, the more we find out what we still need to learn."

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