You can’t always protect people from themselves – but coaches of young footballers who return to play on the same day they’ve been concussed should be disciplined. Amazingly, more than a third do go back into action shortly after suffering a head injury, according to a study presented last Friday (Oct. 21) at the annual meeting of the American Academy of Pediatrics’ (AAP).
A HealthDay article noted that concussion guidelines and laws in all states discourage youth athletes from returning to play if they have any signs of concussion after a head injury. But, the findings from this study suggest those rules are often ignored.
Researchers looked at 185 young athletes treated for concussion at a Texas pediatric sports clinic in 2014. They were between the ages of 7 and 18. Forty-seven percent suffered a concussion while playing football and 16 percent while playing soccer, the researchers said.
The study found that 71 (38 percent) of the athletes returned to play on the same day they got a concussion. Those who immediately returned to play after their concussion reported less severe symptoms of dizziness and balance problems immediately after being hurt.
However, by the time they were seen in the clinic these patients were more likely to report the presence and increased severity of nausea, dizziness, balance problems, sensitivity to light and noise, feeling “slowed down,” pressure in the head, confusion, concentration problems and difficulty falling asleep.
While studies presented at meetings tend to be viewed as preliminary until they’ve been published in a peer-reviewed journal, this one strongly suggests “that we still have work to do to change behaviors to protect short- and long-term brain health of youth athletes,” study author Meagan Sabatino, a senior clinical research coordinator at Texas Scottish Rite Hospital for Children in Plano, said in an AAP news release.
“We need to emphasize the message: ‘When in doubt, sit them out — and keep them out — until full recovery,’ ” said study author Dr. Shane Miller, a pediatric sports medicine specialist at the hospital.
And while they’re out, it might be a good idea if they were required to read a ‘playbook’ on the long-term effects of concussion-type head injuries, as exemplified by NFL veterans and others.
Swiss doctors have demonstrated a way to use cartilage from a nose to repair damaged cartilage in a knee. Ten patients underwent the procedure two years ago, and MRIs taken recently showed new growth very similar to the knee’s own cartilage, and patients reported improvements in knee function, reductions in pain, and improvements in quality of life, it was reported on October 22 in The Lancet.
“We have developed a new, promising approach to the treatment of articular cartilage injuries,” said lead researcher Ivan Martin, a professor of tissue engineering at the University of Basel. The articular cartilage is the tissue that covers and protects the ends of the knee bones, and injuries to it can lead to degenerative joint conditions like osteoarthritis.
Although the results of this preliminary trial are encouraging, more research is needed before this technique could become widely available, Martin stressed.
“Before this can be offered to patients as a standard treatment, obviously it needs to be tested in a larger number of patients and in randomized trials with long-term assessment of clinical outcomes,” Martin said.
One joint repair expert welcomed the new approach.
“Treatment of cartilage injuries remains a significant clinical problem, and there is no gold standard treatment and no optimal treatment available,” said Dr. Nicole Rotter, vice chair of the department of otorhinolaryngology at Ulm University in Germany.
Using cells from the nose for joint repair is completely new, added Rotter, who co-wrote an editorial accompanying the study. “Nasal cartilage might be a great source for cartilage repair; however, further clinical studies are required,” she said.
For the study, Martin and colleagues took a small sample of cartilage cells from the patient’s nose bone, then grew more cells by exposing them to growth hormone for two weeks. All the cells were then placed in a membrane of collagen and cultured for two more weeks.
The engineered graft was cut into the right shape and used to replace damaged cartilage after it was surgically removed from the patient’s knee.
With the procedure, only a small sample of cells is taken from the nose, using a local anesthetic. After the knee is repaired, the patient is on crutches for six to eight weeks. It typically takes several months for a full recovery, the researchers said.
No bad reactions were reported, but two serious adverse events unrelated to the procedure occurred — an independent injury in the untreated knee and new cartilage damage in other areas of the treated knee, the researchers said.
Dr. Matthew Hepinstall, an orthopaedic surgeon at Lenox Hill Hospital Center for Joint Preservation and Reconstruction in New York City, welcomed the new findings.
Even small articular cartilage injuries can cause pain, limit walking and running, and restrict joint motion, Hepinstall told HealthDay. “Over time, surrounding healthy cartilage can deteriorate — resulting in arthritis,” he added.
A variety of surgical procedures have been developed to fill “potholes” in articular cartilage, with varying success, he said.
For the last two decades, surgeons have been able to take cartilage cells from the knee, grow them in a lab, and put them back into a patient’s knee, Hepinstall said.
But that procedure requires two operations, Hepinstall noted.
This new study demonstrates the plausibility of taking cartilage cells from the nose in a less invasive procedure that only requires a local anesthetic, he said.
Not only are players of American football who are between six and 14 years of age at risk for head injuries, a recent study revealed they are more at risk of high-impact injuries during practice sessions than during actual games.
“High-magnitude head impacts are more likely to result in concussion,” said study co-author Steven Rowson, an assistant professor with Virginia Tech’s Center for Injury Biomechanics.
It’s estimated that up to 3.8 million sports-related concussions occur each year, the study authors said. And, football has been linked to the highest risk of brain injuries in team sports, according to the study.
While most research has focused on high school, college and professional football players, kids 14 and under are estimated to make up 70 percent of all football players in the United States.
And, those youngsters may be more at risk than older players, one expert noted.
“We know that kids in general — particularly adolescents — take longer on average than adults to recover from concussion,” said Anthony Kontos. He’s the research director with the Sports Medicine Concussion Program at the University of Pittsburgh.
“We don’t yet know the effects of concussions on the maturation and developmental processes in the brains of children and adolescents,” he explained.
Rowson noted that research such as this study can help develop better prevention approaches. “And by reducing players’ exposure to these impacts, concussions in youth football can be reduced.”
The new study hoped to understand when football players in the 6-14 age group suffer the most head impacts.
To find the answer, researchers outfitted 34 players on two teams in Blacksburg, Va., with helmet devices that measure the movement of the head in impacts. The average age of the children was 10.
The researchers tracked almost 7,000 impacts. Of those, 408 (6 percent) had the highest accelerations. Tackling and blocking drills accounted for 86 percent of all these high-level impacts, even though they made up just 22 percent of practice time.
“We found that impact rates between practices and games were largely consistent,” said study author Eamon Campolettano. He’s a graduate student at Virginia Tech.
“However, teams practice significantly more than they play games. This means that players are exposed to a greater number of head impacts in practice than in games,” Campolettano said.
A drill called “King of the Circle” produced the most head impacts (25 to 68 per hour).
“In King of the Circle, all players but one stand in a large circle,” Campolettano said. “The remaining player is in the middle of the circle and rushes at a player on the perimeter. Each player gets three opportunities to be the rusher in this drill.”
Should this particular drill be eliminated? The rate of high magnitude impacts,”are very different than what players experience during games, suggesting it may not be necessary to practice this drill,” Rowson added.
What about eliminating other kinds of drills that cause head impacts? Kontos cautioned that concussions can occur at lower magnitudes than the highest level in the study.
“And, there are times when very high magnitudes do not result in concussion,” Kontos said. Indeed, none of the players suffered a concussion during the time of the study.
Instead of eliminating tackling drills, he said, “teams and coaches can use progressive approaches to teach proper tackling technique as advocated by USA Football and other programs.”
“Importantly, we want to teach kids safe tackling technique with limited exposure to impacts to the brain. But it should be in a way that allows kids to then tackle properly when they play games, which are faster and involve a more dynamic environment,” Kontos said.
Another option is to eliminate youth football entirely or encourage parents to take their kids out of the game. But Kontos disagrees with this approach.
“We need to balance concerns about concussion risk in sports with the benefits from playing youth sports including improved cardiovascular health, maintaining a healthy weight, and psychosocial benefits such as teamwork and self-confidence,” Kontos said.
Tyler Sash was a very talented football player. A star, and an all-star, during his three-year career as an University of Iowa Hawkeye, a Super Bowl ring winner in the first of his two seasons as a New York Giant, Sash died last September at age 27 – a victim, it was recently revealed, of chronic traumatic encephalopathy (CTE), which is directly linked to the type of repeated brain trauma that is crippling and killing an increasing number of footballers.
It doesn’t have to happen, and shouldn’t be allowed to.
And there’s an amazing simple way to stop that type of injury – which can only be diagnosed after the victim is dead – but chances are, this step won’t be taken.
Why? For the same reason fighting will always remain an inherent part of ice hockey: The fans love to see their football heroes smash so hard into each other that the collisions can be heard, and almost be felt, in the stands, and on couches across the country. And fans love to see hockey players mix it up to the point where bodies are broken and the ice is splattered with blood.
Tyler Sash played only 23 regular season and four post-season games as a Giant. By the time he was released by the Giants, for violating the NFL’s policy against using Adderol, a powerful pain medication he was taking to deal with a serious shoulder injury, he had suffered, during his football career, at least five concussions. There is no way to calculate how many he suffered overall in the 16 years he played the game. (Look at that from a different angle: The fact he played for so many years, in a lifespan of 27 years, he didn’t play for only 11 years.)
When representative from Boston University and the Concussion Legacy Foundation advised members of his family last week that CTE caused his death, they were, while still sad that they lost him so young, nevertheless relieved to know the cause of it. And, in hindsight, the cause of some of the many symptoms he’d manifested in recent years: Memory loss, minor temper issues and bouts of confusion, they told The New York Times.
That same report said that at the time of his death, his mother, Barnetta Sash, told police her son had seemed disoriented, wasn’t sleeping well and had been dealing with allergies. Bouts of disorientation and other symptoms of CTE had been noticed for several years by friends and colleagues.
At the time of his death, Sash was taking – and improperly mixing – two strong pain medications to deal with a shoulder injury and others. The Iowa State Medical Examiner’s office said those drugs were the direct cause of his death, and his history of painful injuries was a contributing factor. But overall, the CTE appears to have been the major contributor in that it interfered with his reasoning and factored into his inability to appropriately monitor his meds.
A 2013 Frontline report compared concussion risks and rates between high school footballers and NFL players. That report showed high schoolers are far more likely to suffer concussions than are the pros, in part because of their inexperience and in part of teens’ ‘nothing can happen to me’ mindset.
Frontline was reporting on a study conducted by the Institute of Medicine and funded by the NFL. It was said to have found that in most cases, concussions symptoms disappear within two weeks. But, they noted, “In 10 to 20 percent of individuals … concussive symptoms persist for a number of weeks, months, or even years.” Right through to unusually early deaths, they could have added.
“With Tyler being so young, it’s very surprising to me,” said linebacker A.J. Edds, who played at Iowa with Sash in 2008 and 2009, to The (Des Moines) Register. “But when you start looking back and connecting the dots, some of the symptoms and signs were there.
“It’s eye-opening. It tells you about the state and the standing of what football is continuing to do to guys, not just physically but mentally as well.”
CTE is measured on a four-point scale. Sash was said to have been at level two – comparable to that of former NFL hall-of-famer Junior Seau, who committed suicide in 2012 at age 43.
He was far from alone as a fatal victim of CTE: Wikipedia cites some 21 NFL players (including Seau and Sash) who were diagnosed, post mortem, as CTE victims. Another eight players are suspected of having the affliction. And that’s just NFL players.
Last December, Time magazine quoted Bennet Omalu, a Nigeria-born neuropathologist, as saying that, “In my opinion, taking professional football players as a cohort, I think over 90% of American football players suffer from this disease. Over 90% of players who play to the professional level have some degree of this disease. I have not examined any brain of a retired football player that came back negative.”
Dr. Omalu first discovered CTE in an NFL player when he saw the debilitating disease in the brain of Mike Webster, a Hall of Fame center for the Pittsburgh Steelers who died in 2002. This finding sparked a chain of events that ultimately forced the NFL to settle a class-action lawsuit from retired players and raised unprecedented awareness of the dangers of football head trauma, Time said.
A separate Time report provided a more in-depth look at CPE. Watch the video.
Reversing that, so 90% of NFL players are not likely to be suffering from CTE, could be easily accomplished, but it would require a mind re-set on the part of fans and players that, in all likelihood, is unlikely to occur.
What to do? Simple: Take away footballers’ helmets!
Soccer and rugby players are bare-headed, and they don’t have anything like the concussion issue footballers do. They — ‘the big they’ — might also want to consider scaling back the uniforms, not so far that footballers are, like soccer players, wearing shorts (which wouldn’t work at all in our climate!), but something with a lot less padding, reducing the temptations to smash into each other the way they do now.
Soccer is the world’s most popular spectator sport. It attracts millions more fans than American football could ever dream of drawing to its relatively small number of stadiums.
With today’s technology, it is possible to stream ads on TV screens – and even on stadium scoreboards or wherever – so that sport could be as incredibly profitably as American football is.
Without a helmet, or a bit of padding, in sight.
The fact that children – from before high school age – are encouraged to play a game that could, if a surprisingly short number of years, result in their death, is unconscionable. The fact that adults are encouraged, by outrageous payments running to millions of dollars per contract, to put their lives at risk from CTE is equally unconscionable.
Boxing is about as bad: Muhammad Ali, who I had the pleasure of spending two-plus on-on-one hours with 12 days before he became world champion, is a victim of Parkinson’s disease, another brain affliction that can be caused by repetitive head bangs, which Ali absorbed a lot of.
It was about the time he got into the professional boxing ‘game’, in the early 1960’s, that scientists were pinning down brain chemical causes of Parkinson’s. Much has been learned about Parkinson’s in the interval, including the fact that welders are, because of gases they are exposed to, at much higher risk of developing Parkinson’s than are, say, farmers, carpenters, or bookkeepers.
America needs farmers, carpenters and bookkeepers. It does NOT professional boxers. It does NOT need heavily-suited high school and professional footballers.
America does not need, nor should it permit, the ongoing physical damage to players, the emotional damage to families, and the enormous (often futile) cost to the healthcare system that easily avoidable football injuries cause.