For many families, going back to school also means going back to sports. Approximately 55% of U.S. school-age children participate in sports each year, and just under 2 million of them will suffer a sport-related concussion over the next year. A recently published research study in JAMA Neurology demonstrated that young athletes with years of participating in contact sports, ranging from amateur to professional, with repetitive head trauma were at increased risk of chronic traumatic encephalopathy.
Researchers looked at the brains of deceased individuals under age 30 who had played contact sports and donated their brains. Of 152 former athletes with a history of repetitive head injuries, 63 had CTE. Those with CTE were disproportionately former U.S. football players and were significantly more likely to have played professional football. However, it’s important to note that several well-done, long-term epidemiologic studies have found no difference in neurodegenerative diseases in high school football players compared to those who did not play football.
Before making the impulsive decision to pull children out of their preferred sports, it is important to put the risk of neurodegenerative disease from contact sports participation in perspective. Parents may look at collision or contact sports like football, ice hockey, rugby and soccer and decide the risk of a concussion or CTE is too great. However, to properly weigh the pros and cons, one must consider the negative impacts of taking children and adolescents out of positive social, physical and emotional activities such as team sports.
Children engaged in team sports learn to lead healthy, active lifestyles, have less stress and anxiety, less depression, enhanced self-esteem and improved academic performance. These children are also less likely to smoke tobacco and consume alcohol and illicit substances. Removing a child from an activity that promotes health and wellness and substituting it with potentially sedentary, solo behavior—such as video games or phone and tablet use—may have detrimental effects.
For those who choose to play, it is important to take head-injury safety precautions. Schools and sports clubs should get baseline evaluations of all athletes before the season begins. Ideally, this should include an assessment of symptoms, neurocognitive evaluation and balance testing using the Sports Concussion Assessment Tool. These baseline evaluations help diagnose a concussion and can also monitor recovery. On-field and locker-room evaluations immediately following the injury can be beneficial in diagnosing a concussion. An evaluation one to two days after the event can also be very helpful, as up to 24% of athletes can have delayed onset of symptoms.
Schools serving students with lower socioeconomic status are less likely to have baseline neurocognitive testing before an athletic season, according to a 2020 study of Massachusetts high schools. Communities should prioritize appropriate evaluations before and during the sports season, regardless of socioeconomic status.
Promoting a culture of safety is everyone’s responsibility, so concussion education for athletes, coaches and parents is critical. Athletes should learn the signs/symptoms of concussion and be advised to report them to their coaches and athletic trainers so they can have early intervention when needed. It is important for athletes to understand the seriousness of concussions and the potential consequences of not reporting them, as opposed to encouraging the idea of “playing through” a concussion or being tough after a head injury.
Student-athletes should always wear appropriate protective equipment, including properly fitted helmets. An improper helmet fit increases the risk of experiencing a concussion and other potentially severe sport-related injuries.
Ideally, certified athletic trainers and coaches should be trained in the latest guidelines in order to appropriately manage the injured athlete. Policies and procedures in the league should be up to date, including current, evidence-based return-to-learn and return-to-play guidelines. There should be a culture that promotes adhering to those guidelines; not doing so can put the athlete at increased risk of a second concussion, persistent post-concussive symptoms and, in rare circumstances, catastrophic neurologic injury.
Common symptoms of concussion include headache, nausea, concentration problems, blurry vision and problems with balance. Additionally, an unexpected drop in an athlete’s grades, changes in behavior or the child’s indication that they just do not feel right should be promptly investigated. Keeping the lines of communication open between the parent/guardian, child and team leadership can keep children safe during the sports season. Evaluation at a nearby concussion center would be the best next step, but if that is not available, seeing any medical professional with experience treating concussions would serve as a reasonable alternative. These professionals don’t have to be physicians, as many neuropsychologists, advanced practice providers and certified athletic trainers have concussion-management experience.
Scanning the brain is typically not necessary since scans are often normal after a concussion. However, there are instances when a child has severe symptoms or neurological findings that make scanning the brain critical. If unsure, one can check the Centers for Disease Control guidelines concerning when to scan a child’s brain.
Once a child has experienced a concussion, it is important to determine whether it is safe to return to play in the future. While there is no magic number of concussions that leads to stopping or changing sports, an in-depth discussion about risks-benefits of continuing to play with an experienced neurologic provider is recommended.
It is most certainly possible for children to engage in contact sports and realize the many positive benefits of team sports participation. These youth athletes just need to do so smartly with guidance from adults, proper concussion education and within a culture of safety in our locker rooms, schools and homes.