The Pop Warner concussion scandal - one that, sadly, occurred right in my backyard here in Massachusetts - has put youth football under the microscope once again.

That a single game allegedly resulted in five concussions, of course, is cause for concern.  That it clearly appears to have been, from everything I have read, the fault of coaches and parents bent on playing on, no matter what the score, no matter what the risk to their own kids' safety, is, not the least bit surprising in an increasingly winner-take-all society.  That the game officials were apparently complicit is a bit of a surprise, although, given the recent trend towards lax rules enforcement in other contact and collision sports, particularly hockey, I that it has surfaced in youth football shouldn't come as a shock, I guess.

But is what happened in that single game reason enough to pull a kid out of football, or never sign him (or her) up in the first place?

I don't think so.

But only if we actually learn something from the incident, not only about concussion safety but about a larger, much more endemic problem: the adults who are running and, in too many cases, ruining, youth sports.  

Simply put, as I have been saying for years, we need to put the word "youth," "games," and "play" back in youth sports. We can't allow anything (winning, home town or team pride, for instance) or anyone, most especially the adults involved  - whether they be the officials who allowed the one-sided contest to continue and who have been appropriately barred from ever officiating another pee wee game, to the coaches, who had the audacity to blame each other for putting player safety at such risk, to the parents, who stood by while player after player was injured and knocked senseless because they wanted their kids to "soldier on" - to compromise player safety. 

Recognizing that the culture of youth sports isn't going to change anytime soon, there is still a lot that we can do right now to make the sport of football safer, at every level. Here are a half-dozen suggestions:  

1. Coaches need to be part of the solution, not the problem. While there are many coaches who take concussions very seriously, as the Pop Warner incident shows, there are still far too many in this country, from youth football, hockey, soccer, lacrosse or basketball all the way up the ladder to the professional level, who don't. Indeed, fully half of parents with children age 12 to 17 playing school sports admitted in a 2010 survey to knowing a coach who would have a player return to sports too soon after a concussion.  A 2012 survey found that 52% of all coaches mistakenly believe that there is an acceptable amount of head contact (i.e. getting their "bell rung," "seeing stars") young athletes can sustain without potentially causing a serious brain injury, with the percentages of those who felt this way highest among coaches under age 35, male coaches, and paid coaches.  This despite the fact that 9 out of 10 coaches know that most concussions occur without a loss of consciousness. Coaches need to actively, consistently and repeatedly encourage honest self-reporting by athletes of post-concussion signs and symptoms, both their own and those of their teammates (such as by employing the same kind of buddy system football programs often employ to protect athletes from heat illness during hot weather practices and games).  They need to put safety first. If they don't, they should not be allowed to coach. Period. Not suspended for the season. Barred from coaching for life.
2. Parents need to put safety above winning.  Of course, while there are lots of very protective parents, at the other end of the spectrum are some parents who, sad to say, are willing to sacrifice their child's safety and — in the case of concussions, their long term health — at the altar of a winning performance, a touchdown scored, a scholarship won, a pro contract inked. It is not only fathers who fall into this unfortunate category. There are also many moms who are over-invested in their child's athletic success, who enjoy too much doing what sports psychologists call "basking in the reflected glory" of their child's athletic achievements; and who are content to let their child's very identity become wrapped up in sports; and who are unwilling — or unable — to make the decisions that I had to make: to end their child's dream of playing four years of high school sports, to take away something their child cherished, and, in doing so, put their child's very future at risk by allowing him or her to return to contact sports while still experiencing post-concussion symptoms or despite a history of multiple concussions.  Some parents admit that they allow their children to play in such circumstances even though they know about the potential for adverse long-term health consequences, like major depression and permanent cognitive impairment.  One  2010 survey found that fully fifty percent of parents of children age 12 to 17 playing school sports knew a parent who would have their child return to sports too soon after a concussion. A 2012 survey reported that nearly half of all U.S. coaches said they had been pressured by parents to play an injured child during a game. The most notable pressure is coming from parents, and being directed towards paid coaches - demands which may be hindering the coaches' ability to keep player safety as a top priority. 
3. Parents and coaches need more concussion education. Too many parents still think that concussions only occur with a loss of consciousness and/or that it isn't dangerous to play with a concussion.  Indeed, a 2010 national poll by Michigan's C.S. Mott Children's Hospital found that less than one in ten parents (8%) of children playing school sports had read or heard a lot about the effects of repeated concussions, while fully one third (36%) hadn't heard or read anything about the effects of multiple concussions. A 2012 Safe Kids Worldwide survey reported that three out of four coaches want more concussion safety training, but the same survey found that nearly four out of ten (39%) didn't think more injury prevention training would make much of an impact on the rate kids are injured, with nearly half (47%) agreeing with the statement that they had so many other responsibilities as coaches and so little time that they could not focus on injury prevention.  Every person who coaches a sport in which there is a risk of concussion - whether it be football, soccer, lacrosse, hockey, even cheerleading - should be required to take a concussion education course. No ands, ifs, or buts.  In the ideal world, someone trained to recognize the signs and symptoms of concussion should be present at every youth football game, even for 7-year-olds, and, at the high school level, a certified athletic trainer should be on the sideline.  
4. Coaches must learn how to teach safe tackling.  A recent NATA study shows that high school players are at greater risk for concussive events in part because they haven't learned proper tackling techniques. Proper tackling technique needs to be taught at every level, from Pop Warner to high school. At least one concussion expert thinks it might eliminate up to half of football concussions at the youth and high school levels. Youth football players should be taught what coach Bobby Hosea calls "Dip n' Rip", a tackling technique in which a football defender stops the ball carrier with an upward thrust across the chest and shoulders, not by leading with his helmet. Rosemarie Scolaro Moser, Ph.D., sports neuropsychologist, founder of the Sports Concussion Center of New Jersey, and a MomsTeam expert, agrees. "A big consideration in all high risk sports is that at whatever age the youth transitions to contact or collision, whether 12, 14, 16, or 18 years of age, youth athletes will need to be trained to engage in safe, proper contact," she says. "Otherwise, lack of a proper program of training safe contact skill development will essentially defeat the purpose of setting an age designation. That means we will need educated coaches to teach safe and proper skill contact development in practices, so that when the youth athlete transitions to game contact, he or she will be ready, at any age.
5. The rules need to be strictly enforced.  As the Pop Warner concussion scandal revealed, a failure to follow safety rules can unnecessarily put kids at serious risk of injury.  Recent years have seen stricter enforcement of existing rules and numerous rule changes at the professional, college and high school level, all designed, at least in theory, to reduce the risk of concussion. A NFHS rule now requires that a high school football player whose helmet comes off during play to sit out at least one play, which is intended to encourage coaches and equipment managers to make sure helmets fit properly (poorly fitted or helmets with improperly inflated air bladders increases the risk of concussion and more serious brain trauma, say the authors of a recent scientific paper).  The problem is, as the New York Times article on the Pop Warner incident correctly observed, "rules are only as effective as the adults charged with enforcing them."  
6. Full-contact practices need to be reduced.  The NFL and NFL Players Association have agreed to a limit of 14 full-contact practices during the season, less than one per week, primarily to limit exposure to brain trauma.  The Ivy League only allows two full-contact practices per week (rather than the NCAA limit of 5) and two-a-day full-padded practices have been banned, and the governing bodies of youth football have moved to limit full-contact practices, with Dr. Julian Bailes, chairman of Pop Warner's Medical Advisory Board, claiming in an interview with the Boston Globe that the new rules could "eliminate 60-plus percent of the brain impacts or concussions"),  The irony, however, as the Sports Legacy Institute notes, is that the National Federation of High School Associations and state athletic associations have not similarly moved to limit the number of full-contact practices at the high school level, thus exposing such athletes to levels of brain trauma that are considered dangerous and unacceptable for adults! That is simply unacceptable. "The toughest men in the world, NFL players, have asked to be hit in the head fewer times because they recognize there is no such thing as a tough brain. Children, who cannot provide informed consent, have never been asked that question, but I believe their answer would be the same," laments SLI co-founder Chris Nowinski. At the very least, SLI says, high schools could take a cue from pros: hit one fewer day per week.
7. Delay the start of contact/collision sports.  A more controversial approach to preventing brain trauma is advocated by Dr. Robert Cantu, co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine, co-director of the Neurologic Sports Injury Center at Brigham & Women's Hospital, and co-founder of the Sports Legacy Institute. He argues in his new book, Concussions and Our Kids, that kids should delay playing collision sports such as football, hockey and lacrosse (or that the rules be changed to reduce or eliminate head contact, such as flag, not tackle, football and no body-checking in hockey).  A delay in starting such contact sports or eliminating or vastly reducing contact, says Dr. Cantu, would reduce the amount of what he calls "total brain trauma," and with it the risk of long-term brain injury. The American Academy of Pediatrics has long recommended that children wait until middle school to play collision sports like football. (which is what my son did)  Dr. Cantu's views aren't shared, however, by all concussion experts, most notably, Dr. Kevin Guskiewicz of the University of North Carolina. In a recent article in the Charlotte News and Observer, Dr. Guskiewicz said he believed it was important for young athletes to learn how to safely handle contact at an early age and develop those skills against competition of the same size and age. The question, however, is whether the safety advantage gained by learning to perform athletic skills at an early age is offset by the risk of brain trauma caused by repeated blows.  I don't know the answer to that one.

These are just the first six that came to mind.  I am sure there are more.  But, as with any tragedy (and yes, I think five concussions in a youth football game is serious enough to warrant being considered in those terms), if we don't learn something from the Pop Warner debacle we will have missed a golden opportunity to make positive changes, to turn lemons into lemonade, and to take the steps that we could take right now, this minute, to make youth football, and all youth sports, safer.  

It's May once again. Time for spring sports, warmer weather, longer days, and, of course, Mother's Day. This year, instead of celebrating mothers with the usual cards and flowers, I have put together a special wish list for the mothers, grand mothers, step mothers and other caregivers in this country with kids playing sports.

Here's this year's list:

I wish that ... instead of being a "No-Mom's Land" in which a mother's only job is to chauffeur the kids to and from practices, support their kids from the bleachers, and run concession stands, youth sports could be a place where as many mothers as fathers are invited to be coaches, administrators, and members of boards of directors of youth sports organizations locally and nationally.

I wish that ... instead of defining competition solely in terms of winning and losing, youth sports could also reflect a mother's belief that, while competition is healthy and necessary, a successful competition is one where all players do their best and respect their teammates, opponents, and the rules.

I wish that ... when a mother signed a child up to play sports, she knew that she would be given a chance to continue playing right through high school, regardless of ability, not excluded by a youth sports system designed to cater to the elite few.

I wish that ... youth sports were a place that provided the kind of nurturing, caring, and inclusive environment mothers know intuitively their children need to grow into confident, competent, empathetic, and emotionally and psychologically healthy adults, instead of a place where physical, emotional and even sexual abuse of children is too often viewed as the price children have to pay in order to play.

I wish that ... mothers could feel safe in challenging the status quo by complaining about safety issues, an abusive coach, an unfair team selection process, the lack of women coaches, or the unhealthy overemphasis on competition, aggressiveness and winning instead of being afraid that, if they speak up, their children will be ostracized.

I wish that ... more mothers felt empowered to just say no, to reject the all too common belief that more (more teams, more practices, more intense and competitive games) and earlier (travel teams at age seven) are better, and instead to trust their intuition that, when it comes to youth sports, less is more.

I wish that ... so many mothers didn't get sucked into the crazy vortex of competitive youth sports, where survival virtually requires that they become overly focused on and invested in their children's athletic success, and were able to find a healthy balance between sports and family life.

I wish that ... youth sports organizations did more to reduce the risk of catastrophic injury or death so that fewer mothers have to spend Mother's Day remembering a child who died because proper safety precautions such as anchoring soccer goal posts, strictly adhering to concussion return-to-play guidelines, and an automatic external defibrillator at every game and practice, were not taken.

If you share my wishes please feel free to share this with all of the mothers in your life. As a Team we can make these wishes come true.

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About Brooke:

Brooke de Lench is a youth sports parenting expert, the founder of MomsTeam.com, producer/director of The Smartest Team: Making High School Sports Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (Harper Collins)

For those of you who may be wondering why you haven't seen a blog from me in recent weeks, there is a simple answer: I have been head down (pardon the pun) finishing up MomsTEAM's high school football concussion documentary, The Smartest Team.

Two news items on the subject of brain trauma in high school football, however, hit my desk over the past week which deserve comment.

The first, during the run-up to the Super Bowl in New Orleans, was the call by the Sports Legacy Institute urging state high school athletic associations to ban off-season full-contact practices, something MomsTEAM has supported for years.

The second was the introduction by Illinois state representative Carol Sente of legislation which would limit the number of full-contact practices in high school football during the season to one (again, a step that we have supported in the past, although not, I must admit, to the extent of limiting such practices to just one).

As those of you who follow the concussion issue know, there is a growing body of evidence which suggests that brain trauma to football players can result, not just from violent helmet-on-helmet collisions hard enough to lead to concussions but from the cumulative effect of less forceful, but repetitive, subconcussive blows.

Up to now, however, no steps have been taken to limit such trauma at the high school level. According to research compiled by SLI, no state high school association sets any limits on in-season full-contact practice days; while 19 states explicitly ban offseason full-contact practices, 29 allow them, either in the spring or summer, ranging from an unspecified number of days to 14 days in Wyoming, 17 days in Florida, 18 days in Texas, 20 days in Illinois, 3 weeks in Mississippi. 

As a result, high school football players were exposed during the 2012 season to levels of brain trauma considered dangerous and unacceptable for adults and younger players, this despite the fact that studies show that the developing brain of teenagers is likely more susceptible and vulnerable to diffuse brain injury than college and pro athletes.

Why high school football has been so resistant to change is anyone's guess.  It is all the more surprising given the fact that, two years ago, the NFL eliminated offseason full-contact practices and reduced the number of full-contact practice days during the season to 14, less than one per week; that, at the college level, the Ivy League acted before the 2011 season to reduce the number of full-contact practices per week to two from the NCAA limit of five and banned two-a-day full-padded practices during the pre-season; and that, in June 2012, rules limiting full-contact practices were enacted by Pop Warner at the youth level.

I wholeheartedly agree with Isaiah Kacyvenski, a member of the SLI board of directors, when he said last week that there are many changes that are "urgently needed in youth and high school football to make it safer."  Indeed, there are steps to make the sport safer for our kids which MomsTEAM has been talking about for years; steps that The Smartest Team will show can be implemented right now. 

But I am not sure I agree with Kacyvenski when he calls a ban on off-season practices, "low hanging fruit."  If it was, the practices would have been already banned.

Whether any states will move to ban pre-season full-contact practices or enact laws to reduce the number of such practices during the season, only time will tell.

But I am glad that others have joined me in calling for these steps to be taken.  The time to act is now!

April 27, 2013 update: The Executive Board of the Arizona Interscholastic Association voted on April 15, 2013 to limit contact practice (padded athletes in contact with each other) in the pre-season to no more than 1/2 of practices, and to no more than 1/3 of practice time in the regular season. On April 21, 2013, the Medical Advisory Committee of the University Interscholastic League (UIL), which, despite its name, is the governing body for high school sports in Texas, unanimously recommended limiting football programs to 90 minutes of full-contact, game-speed practices (with tackling and blocking to the ground) per player per week during the regular season and playoffs.  On April 22, 2013, the Washington Interscholastic Athletic Association announced an amendment to its rules to limit to 10 the number of padded, full-contact practices at the end of spring sports (including seven-on-seven competition and summer team camps) and a total of 20 days under the supervision of the coaching staff.  For a blog discussing these developments, click here.

 

It's hard to believe that, after over a year of hard work, MomsTEAM's high school football documentary, "The Smartest Team, is finally being released! 

True to its name and that of this website, The Smartest Team was a group effort, which would not have been possible without the support of the entire Newcastle, Oklahoma football community, from the school superintendent to the athletic director and head football coach, from the athletic trainer to the parents (especially, Kerali Davis) and, of course, the players themselves.  It would not have been possible without the contributions of our on-screen experts, Drs. Congeni, Meehan, Moser, and Cronin; and, last but not least, without the contributions of a talented and dedicated post-production staff, especially Taylor and Lauren Lench at Lench Films, and MomsTEAM Senior Editor, Lindsay Barton. 

​Our intent in making the documentary was to provide a visual way for the football community to understand all of the things it can do to make a football player safer through an emphasis on a set of principles - what we call the Six Pillars -  which football communities, large and small, can use as a foundation in the development of a sound concussion risk management program.
​
We see the documentary as a jumping off point.  We don't underestimate the enormity of the challenge of making football as safe a sport as it can be.  We know that it will require an ongoing commitment by all stakeholders. As our understanding of traumatic brain injury and technology evolves and changes, the ways in which football responds to the concussion challenge must evolve and change as well.  

But we also know that, as The Smartest Team shows, there are steps that can be taken to make the game safer, right now. Whether it can be safe enough is up to parents to decide; that the decision on whether to allow their child to start playing football -  and when - or to stop playing football, and when, is theirs, and theirs alone.  But we want that decision to be informed by objective information, not by a "sky is falling" hysteria. 

Past, present, and future 

I envisioned The Smartest Team as a blueprint for a concussion risk management program; not by any means the only one, of course, but one that we believe fairly and objectively reflects:

Where we have come:

• A sport in which players were taught to block and tackle using their heads;
• A sport in which players were simply asked whether they felt okay, and if they said yes, then they could go play;
• A sport in which concussion management was cookie-cutter, one-size fits all, where how long a player was held out depended on the "grade" of concussion, and where there was no gradual return to play. 

Where we are:

• A sport in which, as in all contact and collision sports, there is still a huge education gap about concussions;
• A sport in which players, as in other contact and collision sports, remain reluctant to report their own concussions, much less those of teammates;
• A sport in which, as Coach Bobby Hosea says in the documentary, the way tackling is taught is too often a "‘Heinz 57' approach;" 
• A sport in which athletes too often return to play before their brains have been given the cognitive and physical rest needed to fully heal; and
• A sport in which our understanding of what causes some players to suffer concussion and not others, of the mechanisms that lead to traumatic brain injury, how to reliably identify concussion on the sports sideline, how to know when it is safe to return an athlete to play after concussion, and the effects of repetitive subconcussive blows, while light years ahead of where we were 15, 10, 5, or even 1 year ago, is still incomplete.

Where we are going:

• A sport in which there is a standardized, heads-up approach to tackling and blocking; 
• A sport in which there is better enforcement of existing rules against helmet-to-helmet contact and new rules are enacted to reduce the risk of concussion and catastrophic head, neck and spine injuries, such as the NFL's recently enacted ban on ball carriers and defenders using their head as the initial point of contact in the open field; 
• A sport in which a certified athletic trainer is on the sideline at every high school football game and practice; 
• A sport where sideline assessment screening tools allow for more informed "return from play" decisionmaking; 
• A sport which takes advantage of technological, equipment, and product innovation advances, such as impact sensors to help in the early identification of concussion, that can help make the sport safer; 
• A sport where conservative treatment and cautious return to play take precedence over a win-at-all-costs attitude; 
• A sport where a better understanding of the risks of long-term brain damage from repetitive sub-concussive blows spurs a concerted effort to limit total brain trauma, such as by eliminating off-season full-contact practices and imposing limits on the number of such practices during the pre-season and over the course of the season.

​As we have from our founding in 2000, MomsTEAM remains committed to doing what we can to arm youth sports parents with well-researched and practical information and advice from a team of world-class experts and journalists, not just about concussions but about every aspect of the youth sports experience. 

We are confident that working together, we can, like the entire football community in Newcastle, Oklahoma, all become part of The Smartest Team.

Yesterday, the last day of what has been a very long, yet rewarding year as the publisher of MomsTEAM, I took some time to read many of the blog entries that I and our other bloggers contributed during the past year, and reviewing 365 days of Facebook and Twitter posts.

First, a confession: I began 2012 vowing to write a blog every day. Like many who make New Year's resolutions, I started out with the best of intentions, and kept up a pretty good pace in the first month or so of the year, but then a major opportunity presented itself - a plea for help from a football mom in Oklahoma - that made a daily blog no longer possible. (More about that in a moment)

Second, I realized from my year-end-review just how blessed MomsTEAM and I have been this past year to be part of a wonderful community of sports parents, coaches, and experts, all working hard every day to do what we can to make sure that our kids, from pre-schoolers to college, have the very best - and safest - youth sports experience possible. I wish I could personally thank everyone who has contributed to MomsTEAM over the past year, indeed over the past twelve years, whether it be by writing an article or blog, "liking" us on Facebook, re-Tweeting a Tweet, or by sending an email. Thanks to all of you.

Third, I have a renewed sense of purpose in doing what I can to meet the very real challenges we face in achieving MomsTEAM's mission of making youth sports saner, safer, less stressful and more inclusive. Unlike some of my colleagues, whose focus seems to be in pointing out all that is wrong about youth sports, one even wondering whether "[our kids] might be better off at home, in the basement, playing sports video games," I choose to take more of a glass half-full, proactive approach. Even in the most horrendous youth sports stories from the past year, there are lessons to be learned that can help us provide a better sports experience for our kids. Where others see problems, I see challenges which we must redouble our efforts to overcome.

From the day the MomsTEAM website went live back in August 2000, our goal has always been to not just identify and chronicle problems, but to offer sports parents, coaches, and administrators practical advice on how to solve those problems, whether it be on preventing psychological, sexual or physical abuse or what a young athlete needs to eat and drink to perform at their best in the classroom and on the field. As one of our longtime readers wrote me in a recent e-mail, "You all at MomsTeam always keep your heads calm while everyone else is running around claiming the sky is falling."

One article from the past year that particularly stands out for me as illustrative of the MomsTEAM approach was about alleged emotional abuse by a youth hockey coach of a set of nine-year old twin boys in a town not too far from our corporate office in Boston, Massachusetts. Instead of simply rehashing the story - which had made quite a splash in the local media - we viewed it as a chance to not only tell a cautionary tale, exposing what we called youth hockey's "dirty little secret" - a culture in which emotional abuse by coaches of young players is considered the norm, and anyone trying to change it is ostracized - but to propose concrete steps to change the culture in order to better protect the fragile psyches of young athletes. We received hundreds of emails and voice mails thanking MomsTEAM for tackling a very tough and controversial subject, and believe that the world of youth ice hockey is a safer place for our having run the story.

Knock, knock 

The subject of concussions in sports, especially in football, and the risks that they pose, dominated the news again in 2012, as it has for a number of years, but, here again, MomsTEAM's approach has been geared to providing information to youths sports parents, not just about the dangers of concussion, but about how the risks can - and cannot - be minimized, and practical advice on how, through early identification and conservative management, we can meet the challenges concussion pose to our children's short- and long-term health.

Which brings me back to the football mom in Oklahoma and the reason I wasn't able to reach my goal for 2012 of a daily blog. When she emailed me in February asking me to set up a concussion risk management program for the football team at the local high school, I saw not just another request for help similar to countless others MomsTEAM receives each year, but a chance to take concussion education to a whole level; to use her request as a springboard for a football concussion documentary; not a film to scare the daylights out of parents about the dangers of concussions - which are real and very serious - but to continue to be champions of awareness and education; to emphasize safety over sensationalism; to show communities across the country how, if everyone works as a team, those risks can be and are being minimized in a way that preserves and strengthens the American institution that is high school football and honors the millions who watch or play the sport under Friday night lights.

So, for most of the past year, I have thus been devoting big chunks of my time working with a football-centric community in Oklahoma to produce The Smartest Team (if you haven't seen the trailer, click here). Now that filming is over and post-production is nearing completion, I will be sharing more about the experience in future blogs, and in talks around the country.

Working on the film made 2012 a very special year. Its release promises to make 2013 even more special, as part of our ongoing work to keep youth athletes safe and in the game.

Happy New Year from all of us at MomsTEAM.