7. Delay start of contact/collision sports
One way to prevent brain trauma is to limit an athlete's exposure to the impacts that might result in traumatic brain injury by delaying the start of contact sports or changing the rules for younger players, as suggested by some concussion experts and commentators.
Football
In his 2012 book, Concussions and Our Kids, [8] Dr. Robert Cantu recommends that kids delay playing tackle football until age 14. A delay in starting such contact sports or eliminating or vastly reducing contact, argues Cantu, will reduce the risk of athletes developing chronic traumatic encephalopathy (C.T.E.), which leads over time to personality changes, memory loss, even dementia. Early signs of C.T.E. have been detected in the brains of 17- and 18-year olds, says Dr. Cantu, who showed no symptoms when they were alive. Dr. Cantu was not the first to make such a recommendation: the American Academy of Pediatrics has long recommended that children wait until middle school to play collision sports like football.
Dr. Cantu's views aren't shared, however, by all concussion experts, most notably, Dr. Kevin Guskiewicz of the University of North Carolina. In an 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.
"Bob and I don't disagree on much, but we do on this," Guskiewicz told the News and Observer.
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.[1]
Guskiewicz believes it is much safer for young players to learn how to safely play games when they are small, rather than wait until they enter high school."The youth league players generally are close to the same size and are about the same age," Guskiewicz said. "If you wait until the kids are freshmen in high school, you might have a 130-pound player competing with a 300-pound player. The forces can be tremendous. I believe it is safer for the players to learn at younger ages."
Dr. Cantu nevertheless believes, after treating many young athletes with concussions, that it is essential to find ways to avoid blows to the head.
"That's where Kevin and I differ," Cantu said. "I'm treating these children and I've seen them miss school for a week, a month, a semester, even a year because of post-concussion symptoms.
"It doesn't make sense to me to be subjecting young individuals to traumatic head injury. There's no head injury that's a good one, and you can't play collision sports without accumulating head injuries. To allow children to play with no informed consent of the dangers is inexcusable. To allow children to play in collision sports with the rules as they are written should not be allowed."
[For a video of Dr. Guskiewicz explaining his position at the NATA youth sports safety summit in Washington, D.C. in December 2011, click here.]
[Updates: In October 2015, the American Academy of Pediatrics issued a Policy Statement on Tackling in Football in which it declined to endorse a recommendation that tackling be delayed to any particular age]
Soccer
Some concussion experts and former players are also urging middle schools and under-14 soccer leagues to eliminate heading in the sport as a way of reducing concussions. Dubbed the Safer Soccer Campaign, and bearing the tagline "U14 - No Header, No Brainer", the year-old campaign by the Boston-based Concussion Legacy Institute (CLI) (formerly Sports Legacy Institute) and the Santa Clara Institute of Sports Law and Ethics (ISLE) is spearheaded by three former US Women's National Team players (ISLE board member, Brandi Chastain, and teammates Cindy Parlow Cone and Joy Fawcett), along with CLI medical director Dr. Cantu, and co-founder and Executive Director, Chris Nowinski.
In a June 25, 2014 press release [39] Chastain recommends a ban on heading before age 14 and encourages coaches and parents to consider the risks of heading before high school or age 14 in age-based leagues "while we wait for more research to clarify [that] risk."
In an accompanying "White Paper" [40] on the group's website, however, Dr. Cantu, Mr. Nowinski, and CLI's Educational and Research Program Manager, Cliff Robbins, aren't content to wait, asserting flatly that the "scientific evidence paints a clear picture that heading a soccer ball will result in more concussions and repeated subconcussive trauma, which can have long term neurological consequences in both adolescents and adults."
Indeed, in a July 24, 2014 blog post, [41] Jack Bowen of ISLE, relying on what he refers to as "the heavy hitters" from CLI who have provided the science, goes so far as to suggest that the ban on soccer heading before age 14 proposed by CLI and ISLE "is not just in the best interests of children but one of moral necessity." In other words, says Bowen argues, that to fail to do so "would be to act immorally."
A ban on heading in soccer below U-14 is viewed in a 2015 study [42] not only as culturally unacceptable in a sport that has been allowed to become more physical over time, but as a less effective way to prevent concussions than by reducing athlete-athlete contact across all phases of the game through better enforcement of existing rules (see #2 above), enhanced education of athletes on the rules of the game, and improved coaching (see #1 above). Indeed, the study, by a team of researchers headed by the country's leading expert on high school sports injuries, Dr. Dawn Comstock,* and published online in the Journal of the American Medical Association - Pediatrics, flatly concludes, based on a review of ten years of data, that a simple ban on heading is likely not the most effective way to prevent concussions in youth soccer.
On November 9, 2015, U.S. Soccer, the national governing body for soccer in the U.S., announced that it was banning heading for ages 10 and below and imposing limits on heading in practices for athletes ages 11 through 13. Those rules apply only to development programs and academies under its control; for youth soccer programs it does not directly control, the rules are recommendations only.]
* In the interest of transparency, and to avoid any suggestion of bias in reporting this story, it should be noted that Dr. Comstock is an uncompensated member of MomsTEAM Institute's Board of Advisors, which is developing best practice youth sports health and safety checklists, including youth soccer, for the Institute's SmartTeamsTM program. It remains to be seen where the Institute will ultimately come down on the issue of the age at which heading in soccer can safely begin, or whether, as banning heading is the best way to reduce concussions at the youth level, as CLI proposes, or via better rules enforcement, enhanced education of players, and better coaching, as Dr. Comstock recommends.
For a comprehensive review of the research on heading in soccer, click here.
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