In response to “Taking the field,” published on Sept. 21.
First, I want to thank the author for writing about a controversial subject that warrants more discerning discussion. The topic of tackle football and concussions seems to go hand-in-hand these days. However, the article omitted a lot of facts about concussions and research, which ultimately led to some inaccurate inferences.
The author writes, “The study indicated that 21 percent of people who played as far as high school football showed mild signs of CTE.” This leads readers to believe 21 percent of all high school football players are walking around with CTE. In truth, the study indicated that out of 14 post-mortem, donated brains (from players who only played football in high school), three of those brains showed mild CTE. In my opinion, a sample size of 14 donated brains isn’t large enough to make a generalized statement about all high school football players.
CTE (chronic traumatic encephalopathy) can only be diagnosed in an autopsy. Dr. Christopher C. Giza, a pediatric neurosurgeon at UCLA who specializes in youth sports and head trauma, reports that current studies are not yet reliable enough to determine a causal link between chronic neurocognitive impairment seen in living professional athletes and the CTE seen in post-mortem brains. However, he does strongly advocate for keeping children safer from repeated head trauma while playing sports because evidence does show repeat concussions lead to prolonged recovery time, especially in children.
Furthermore, despite the media attention on football and head trauma, it is important to know that the highest rate of concussion seen in high school sports isn’t even in football—it’s in girls soccer. In March, The American Academy of Orthopaedic Surgeons conducted a study looking at 40,843 high school athlete injuries over the course of 10 years, of which 6,399 were concussions. This study only looked at football, soccer, basketball, baseball, wrestling (boys only) and softball (girls only).
Regardless of sport or gender, it’s important to understand that concussions can occur in any sport, without even hitting your head. A concussion is a brain movement injury. As Dr. Giza explains, “the brain is like a pickle floating in a pickle jar.” When it gets jolted violently and moves around or hits the side of the jar, it can get injured. As a pediatric physical therapist, I have treated infants who were diagnosed with head trauma from a car accident, yet they were strapped safely in their car seats during the accident. What’s a loving parent to do? Keep our children bubble-wrapped and motionless until they reach the age of 18? Participation in full-contact sports, or any sport for that matter, can be a polarizing issue among parents.
My husband and I have three children. Our 20-year-old daughter played club soccer throughout high school and our two sons (ages 18 and 14) have played tackle football since age seven or eight. In my own personal experience as a spectator of hundreds of youth soccer and football games, I have seen more serious concussions come off the soccer field than the football field. Personally, our one daughter suffered more injuries (including a serious concussion) than both our boys combined. Thankfully, she recovered fully with the guidance of concussion healthcare specialists and a graduated return to learn/return to play protocol. These protocols are now state law as of January. As parents, we have immersed ourselves in concussion education. That knowledge has inadvertently become prevention.
Unfortunately, like in life, even if you do everything right, something bad can happen. A football player in your article stated, “…you have to do everything wrong to get concussed.” This is false. Most concussions I’ve witnessed were due to a “dangerous hit” in football or a “dangerous play” in soccer. In other words, it was circumstance that was probably only preventable with better coaching or refereeing. Referees have the very tough job of keeping games safe. Without adequate control of the game, they can get out of hand and escalate very quickly. Coaches have an even tougher, indirect job of helping to build character through sportsmanship while still teaching players how to play!
As parents, we have to become part of the solution of mitigating the risk of injury and long-term side effects from injuries. Like with anything our young children pursue, they will be more successful with our support. As they grow and get older, we transfer that knowledge to them so they can also advocate for themselves—their own safety—and that of their teammates. This includes advocating for safer environments on the field by speaking up when we witness unsafe coaches or referees. There are countless resources available online regarding concussion awareness. The Center For Disease Control’s “Heads Up” program is a good place to start (cdc.gov/headsup/parents/index.html).
The concussion field of study is very dynamic with research currently ongoing. Right now, the research and laws support this action for a suspected concussion during play:
1. Immediately remove the player from the field.
2. If a trainer is available, have them do a sideline assessment of the player. (Trainers are objective and less likely to want the player back in the game vs. a coach.)
3. If a head injury is suspected, they cannot to return to play.
4. The player must see a doctor—I recommend a concussion specialist—to get diagnosed.
5. Then, the player must start following a graduated (AB-2007 state law) return to play and return to learn (in the classroom) protocol.
6. To return to play, the player will have to see the doctor again for full clearance.
7. Important: even after a mild concussion has been diagnosed, do not give the athlete anything for pain or headache aside from Tylenol. (Most anti-inflammatory meds like Advil are also blood thinners and if there is a slow brain bleed, these medications can cause more bleeding). A bleed can be detected with a computerized tomography (CT) scan. However, most ER doctors will not order a CT scan for concussion diagnosis unless symptoms start to quickly worsen.
In conclusion, as parents, we are always choosing how and what we will support and encourage in our children’s lives. In a culture where it is becoming commonplace to ban running or playing tag during recess because someone may fall or get hurt, I’d like to think we parents can support our children taking calculated risks and recovering from whatever the world throws at them.
Choose resilience over fear.
DNA Moore is a 20-year resident of Malibu. Her three children have gone to school in Malibu. She is currently a licensed physical therapist in the state of California.