Youth Football and the Risk of Brain Injury

Are We OK with Youth Football and the Risk of Brain Injury?

Young football players are at greater risk of brain injury than we know or “than many parents and coaches would find acceptable,” according to two health researchers writing for the Washington Post recently.

The two experts, Robert C. Cantu, a neurologist at Boston University and Mark Hyman, a professor of sports management at George Washington University, state that adults who played tackle football as children were more likely to deal with emotional and cognitive challenges in later life, based on research by Boston University’s Chronic Traumatic Encephalopathy Center.

In youth tackle football, many players sustain blows to the head that do not cause concussions or other obvious symptoms. But the repeated blows may be causing long-term harm.

“The nature of subconcussive hits is that they’re a problem years after they occur,” Cantu and Hyman write. “When they’re happening, no one notices. It’s the accumulation of micro hits that trigger damaging changes years later.”

The two acknowledge that some people question whether the research shows a connection between youth tackle football and head injury. They agree that more research is needed to answer questions. They acknowledge those who say youth football is unsurpassed as a character-builder for children, a proving ground for perseverance and toughness.

But they say a question that looms over all is: Do we accept head injury as inevitable and live with the chance that youth players when they grow up will face higher risk of emotional and cognitive challenges?

What Do We Know About Head Injury and Youth Football?

Over the last several years, all 50 states and Washington, D.C. have adopted “concussion laws” requiring youth and high school sports players to leave a game after a head injury and establishing criteria for returning to play.

But, the Washington Post essay asserts, the BU studies show that brain injury was linked not to concussions but to long-term exposure to repeated subconcussive hits – blows to the head that happen on almost every play in football and are also part of other contact sports.

Long-term exposure to subconcussive hits has been associated with chronic traumatic encephalopathy (CTE) in more than 100 former National Football League players. It also has been found in college athletes and even several high school athletes, the article says.

CTE is a neurodegenerative brain disease that cannot currently be diagnosed in a living person (though research at Mount Sinai in New York and at Boston University may be making progress on that front).

Common symptoms of CTE generally show up in early middle age and include problems with judgment, reasoning, problem solving, impulse control and aggression. Additional symptoms include memory loss, confusion, depression, suicidality, parkinsonism, and eventually progressive dementia.

In the studies cited in the Post essay, researchers found that:

• Adults who played before age 12 experienced cognitive deficits and behavioral and mood problems a full 13 years earlier than those starting football at 12 or older. For every year younger a child played tackle football, the start of cognitive problems occurred 2.4 years earlier and behavioral and mood problems started 2.5 years earlier.
• Starting as a player in a youth tackle football league before age 12 corresponded with increased odds for clinical depression, apathy and executive function problems – for example, diminished insight, judgment and multitasking.
• Researchers at Wake Forest University found measurable brain changes comparable to mild traumatic brain injury (TBI) in children ages 8 to 13 after a single season of playing youth football, though none had any signs or symptoms of concussion.

Cantu and Hyman repeat a suggestion they first made in a 2012 book that children should not play tackle football until age 14 and should play flag football when younger. They say that since 2012 participation in youth tackle football has declined and flag football has grown in popularity but “by no means is youth tackle football on its last legs.”

According to the National Federation of State High School Associations, high school football teams drew 1 million players in 2017-2018, and “this debate has yet to cross the 50-yard line.”

New York’s Youth Football Concussion Education and Other Sports Injuries

Gov. Andrew Cuomo signed a bill into law September 3 requiring the New York Department of Health to produce an informational packet on concussions and sub-concussive blows to the head and the health effects associated with them. The packet is to be distributed by sports program organizers to the parents or guardians of children playing tackle football and posted online, according to the NY Post.

The law is effective in December (90 days after being signed) and applies to “any practice, game or other activity which involves engaging in tackle football and which is organized by a school, adult, or public or private league or other entity whose purpose is to allow children to participate in contact football.”

The Health Department says nearly 4,000 New York youths ages 19 and younger sustain sports-related traumatic injuries annually.

The Sports Medicine Department at the Ichan School of Medicine at Mount Sinai says sports injuries in children and adolescents most commonly include:

• Apophysitis, a form of elbow pain in young people sometimes called “little league elbow.”
• Tendonitis caused by a blow or overuse of the elbow, knee, shoulder, thumb or wrist.
• Sprains or strains, which are overstretching or tears to ligaments around a joint.
• Broken bones, including stress fractures, in an arm, leg or foot.

New York Times personal health columnist Jane E. Brody wrote in 2018 that reducing the injury risk in youth sports requires taking into account the physical and physiological differences between children and adults. These differences can leave youngsters more vulnerable to injury and an injury may sour them on participating in the future.

Citing experts, Brody says physically, children have less coordination, strength and stamina than adults, and “children’s bones, muscles, tendons and ligaments are still growing,” which makes them more susceptible to injury.

Parents and coaches must create an atmosphere of healthy competition, and all young athletes should strive to be in good physical condition for their chosen sports, Brody says. To avoid stress injuries, children should play multiple sports and different positions so they’re not doing the same motions with their bodies over and over again. Every child should always use proper protective gear, such as helmets. Games should start with a warm-up to avoid damage to “cold” tissues.

And, says Brody, “Children should never be encouraged to play through pain, nor should persistent pain be ignored, experts insist.”

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