Health and the Head

The drumbeat for child and youth exercise is slowly intensifying as we try to create more and more ways to promote active lifestyles. In addition to lots of education directed at kids, parents and pediatricians, there are many policy solutions proposed, such as finding ways to encourage more children to walk to school, and requiring that PE classes have a minimum amount of actual movement. Rates of exercise among youth and adults have remained unchanged or dropped slightly in recent years; significant social changes will be required to get more people moving.

With that as background, it is ironic that those kids who are most active put themselves at risk in a way that couch potatoes do not. I’m talking about sports-related concussion, or traumatic brain injury (TBI). TBI comes with a range of severity, from short term (a few days to a few weeks) symptoms to permanent disability to death; 90% of deaths from sports-related head injury were among high school or younger players. Because a concussion isn't always accompanied by unconsciousness, many times players and coaches think it is ok for a player to return after a brief rest. This sometimes adds increased insult, making minor TBI more severe and consequential.  In addition to direct health consequences of TBI, sports-related head injury has social effects.  One study found that high school athletes with a history of two or more concussions had lower GPAs than similar athletes with no TBI history.

We hear a lot about high profile professional athletes, particularly in football, suffering brain injuries on the field in violent collisions with other players. The spotlight is shining on the sports leagues (particularly the National Football League) to see if they take serious action to try to prevent concussions and to keep players off the field until independent medical experts give them clearance to return.

It is only a short jump from professional football concussions to TBI among college and younger youth in organized sports and other activities.   From 2001 through 2005, there were about 250,000 8-19 year olds visiting emergency rooms for sports-related concussion injury.  In middle and high schools, football is the sport with the highest risk for concussion. For girls, soccer is the most risky. Risk and actual TBI come during games, but also during the longer exposure times of practices. Outside organized team sports, bicycle riding has the highest risk for TBI among leisure exercise activity.

Unfortunately it is not likely that sports-related concussion can be fully prevented. Whether it is aggressive contact sports like football or hockey, or fast, vigorous and close contact sports like soccer or basketball, or baseball, with a projectile sometimes aimed at or near players’ heads, these injuries are going to occur, unless most competitive team sports end. 

Not only is it impossible to prevent serious force impacting the heads of players, it is also impossible to prevent injury. There is growing public pressure to promote helmet use in soccer, skiing, and bicycle riding. Unfortunately, helmet technology still is not able to protect fully against TBI. Playing rules can help to minimize head collisions, but complete prevention is illusive. It is also absolutely critical to promote secondary prevention, where all involved recognize the possibility that concussion may have occurred, and take precautions appropriate for the high stakes involved. The CDC has a program called Heads Up, designed to help coaches, school officials, and parents make better decisions regarding TBI.

The sports enterprise is full of metaphors and inspiring object lessons to inform everyday life. These references usually have to do with giving complete and total effort to winning (Take one for the team!"), to sacrificing for the sake of a team effort ("There is no I in team!"), to long, lonely practicing of skills("Practice with a purpose, play with a passion!"). These are all values that serve life well. However, concussion is not a time for players to give themselves for the team, to leave it all on the field. The educational task is to help all - players, coaches, parents, spectators - to recognize and respect the serious consequences of TBI.