A Nurse Explains High Risk of Brain Injury Among Young Football Players

A concussion can have serious consequences, especially among young football players. A concussion may be mild or severe, or an accident may not result in concussion, but repeated impacts on the head can lead to long-term brain injury, termed as chronic traumatic encephalopathy (CTE). A nurse explains current data on concussions in football, origin of CTE, and recommendations for educating coaches, parents and players on the risks, treatment, and long-term management of concussions. The following article demonstrates that a decade old safety guidelines still hold value to football play among youth.

The Occurrence and Treatment of Concussions

A concussion occurs when a force is transmitted to the brain, causing it to shift rapidly within the skull, such as whiplash injury. Headache, dizziness, irritability, or nausea are common symptoms. The player may experience sleep disturbances and problems with concentration. Neurocognitive testing is undertaken to evaluate medical symptoms, as concussions do not appear in imaging testing such as MRI. Concussions are treated with physical and cognitive rest, by taking a break from screen time and homework for 7–10 days, in general. It may take longer for young children, or those who have a history of ADHD or migraine.

Registered nurse, Hepler explains that the long-term safety of football is controversial and according to a Bloomberg Politics poll, more than 50% of the Americans would not want their children to play football due to the risk of head injuries. Data available at HealthResearchFunding.org indicates that:

• Concussion rates in children under 19 have doubled over the last ten years.
• Concussions that occur due to helmet-to-helmet can go undiagnosed and cause permanent brain damage

Omalu and the Discovery of Chronic Traumatic Encephalopathy (CTE)

Subconcussive hits do not result in concussions and are sustained during repeated blows to the head. Subconcussive hits can lead to chronic traumatic encephalopathy (CTE), a progressive degenerative brain disease, generally found in athletes as a result of repeated trauma.

CTE was first recorded by forensic pathologist, Bennet Omalu in 2002 from the autopsy of the deceased football player, Mike Webster, and the emergence of similar reports later led to the book and 2015 film, “Concussion”. Omalu explained that advanced neurocognitive and radiological studies in children can provide evidence of brain damage at cellular level even without any symptoms or reported concussions.

Other physicians were in disagreement with Omalu, and argued that there is no evidence that children should be stopped from playing football and advised that the play requires understanding and applying the proper technique and using proper fitting equipment. Others advocate exposure to non-impact football, accompanied by strengthening exercises (core and neck strengthening) during practice.

Nurse Recommendations for Youth Playing Football

Recommendations for children and youth playing football include:

• Mandatory education for coaches about concussion symptoms, including the importance of removal of player when head injury is suspected, and written medical clearance for return to play
• All laws and regulations may not cover all risks for players, therefore, finding and implementing the right age-appropriate laws is essential
• Sports medicine physicians may recommend the head up tackling technique is recommended as it may reduce concussion risk (American Academy of Pediatrics)
• ImPACT neurocognitive test is recommended for players before the football season or when signs of concussion are observed. ImPACT testing is a 20–30 minutes test and measures reaction time and visual and verbal memory. The ImPACT test, in conjunction with medical evaluation is integral to making a diagnosis
• Properly fitted protected equipment must be enforced, and the child must be educated about the symptoms of concussion. On suspecting a concussion, the child must be taught to report the coach and the parent about it to be removed from the game and evaluated by a registered healthcare professional
• The physician’s recommendations about concussion must be followed, such as cognitive and physical rest, so as not to delay recovery. An initial concussion puts the child at risk of subsequent concussions. When a player returns to play before the concussion has fully healed, there is a higher risk of complications.

References

Hepler, L. (2016). Football & Concussion: Worth the Risk?. CHOC Children’s. https://www.choc.org/news/football-concussion-worth-risk/