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Concussions: More of a silent killer than we knew

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As a youth sports coach, I’m taught to look for concussion symptoms to help a player avoid further damage. However, new research is showing that the damage could already be happening even if a player is showing no outward signs of injury. From the Chicago Tribune:

…[A] new study of an Indiana high school football team hints that some athletes are suffering brain injuries that go undiagnosed, allowing the players to continue getting battered, unaware of the possible cognitive damage that has been done.

Of 21 high school players monitored for a full season by a team of researchers from Purdue University, four players who were never diagnosed with concussions were found to have suffered brain impairment that was at least as bad as that of other players who had been deemed concussed and removed from play.

“They’re not exhibiting any outward sign and they’re continuing to play,” said Thomas Talavage, an associate professor at the Weldon School of Biomedical Engineering at Purdue and the lead researcher on the study. “The cognitive impairment that we observed with them is actually worse than the one observed with the concussed players.”

The report, published in the latest edition of the Journal of Neurotrauma, found that some players received more than 1,800 hits to the head during practices and games, some with a force 20 times greater than what a person would feel while riding a roller coaster.

The research is coming out as the debate rages over what is more damaging: one hard, individual hit, or the cumulative effects of multiple collisions. The science is rapidly pointing to the latter. It helps explain why the brain of the late Cincinnati Bengals wide receiver Chris Henry showed concussion damage, even though he was never diagnosed with such a condition, and why the brain of Penn player Owen Thomas, who committed suicide in August, showed trauma, even though he had never been diagnosed with a concussion.

In the Chicago Tribune article, players and coaches aren’t dismissive of the study’s results. Their worry is more about whether their players and teammates will play hard if they’re worried about head injuries.

“It’s a tough slope because you could end up scaring kids away from even playing football, and you see that a lot,” said Michael Holmes, the football coach at Leo High School in Chicago. “We make our kids conscious of it, but we don’t try to scare them.”

Reilly O’Toole, quarterback at Wheaton [Ill.] Warrenville South High School, said he doesn’t think at all about head injuries.

“If you think about injuries or concussions, that’s when they happen,” he said. “Once you start playing not to get hurt, that’s when you get hurt. It’s a contact sport. If you don’t like contact, you shouldn’t be playing.”

The Purdue researchers aren’t (yet) calling for the end of tackle football, but they are recommend scaling back full-contact practices so kids don’t have to take so many hits.

By the way, the Purdue researchers, citing their continuing study, are not telling the Lafayette Jefferson High players which of the four have signs of, not to put too fine a point on it, brain damage. If it were my kid, I would be demanding to know if mine was one of the four.

Concussions: Why you question letting your kids play football

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My second-grade son has a friend over today who came over after he played a youth league football game. Given all the attention lately about concussions, I felt like I should give him a baseline test before he and my son played in the back yard.

If you watched the NFL the first few weeks in its new, we-care-about-concussions mode, you got a sense of how football at all levels is changing in a hurry now that we know concussions aren’t just dings that make you punch-drunkenly shake the cobwebs.

Two incidents, to me, stand out. One is Stewart Bradley of the Philadelphia Eagles in week one, going back onto the field — stunningly — not long after being unable to walk following a hit. The incident had the NFL reviewing how that happened, though as of this writing the Eagles have not been cited by the league for violating its policies regarding concussion testing and treatment.

Bradley, unable to walk.

The Bradley situation was pretty shocking, and I think it explains a lot about the second concussion-related incident I noticed. During week two’s Chicago Bears-Dallas Cowboys game, Fox’s cameras caught Dallas tight end Jason Witten vociferously arguing with a member of the team’s medical staff, which was refusing to clear him to play after Witten suffered a concussion in the fourth quarter. Actually, the staff couldn’t have cleared him to play if it wanted to — once a concussion is diagnosed, a player is not supposed to come back in the game. And, believe me, after all the flak the NFL and the Eagles took over Bradley, no one is going to let anyone with a concussion back into a game.

As Witten was arguing, Chicago Bears radio announcer Tom Thayer, an offensive lineman on Chicago’s 1985 Super Bowl champs, responded, and I’m paraphrasing, that if players are going to be held out because they get dinged, you’re going to have to get used to players missing a lot of time. Thayer said this with a mix of ruefulness — god knows how many concussions Thayer probably played with in his day — and a sense that maybe, grudgingly, it is about time things changed — god knows how many concussions Thayer probably played with in his day.

As of this writing, I’m enjoying my hometown Indianapolis Colts’ crushing of the New York Giants, but I have to say that Thayer is right — if I may read into his comments — that how we view the game of football is changing, in a hurry. Certainly, many studies have pointed out the concussion risk in numerous youth sports, including my beloved basketball.

But football by design is a collision sport, and many fans of the game are openly wondering why anyone would play it, or let their kids play it, sort of like the way people changed their minds about letting their kids box. (My 13-year-old has suddenly developed an interest in wanting to box. We’ll have to chat about that one.)

The post-concussive horror stories are growing more familiar, with the number of ex-pros who turned out to have brains scrambled like eggs after their years of football. But then you hear about Chris Henry, who turned out to have concussion-related brain damage as an active player. Then you hear about the suicide of Penn player Owen Thomas, who despite never having been diagnosed with a concussion may have had a level of impact-related brain damage enough to cause him to kill himself. Then you hear about a sixth-grade football player in Wisconsin who died of concussion-related injuries.

And then you hear about some youth coaches and parents, who presumably should know better or care more about their kids than the game, pressuring to get their addled children back in games, such as this story told by a physician in the Pittsburgh area to the local Post-Gazette:

Dr. Young cannot forget this episode last fall in his league’s championship game for the youngest local level. Adults with the opposing team asked him to approve their star tailback, whom he said blacked out and fell in the huddle before he threw up. Unconsciousness and nausea are prime indicators for a concussion.

“They wanted me to clear him at halftime,” said Dr. Young, still incredulous almost a year later. “Ultimately, the boy sat out the second half. It was a championship game, an important game in their 6- and 7-year-old season. But it was 6 and 7 year olds.”

I’m glad that my children have no interest in playing football, and I’m thankful now that my parents kept my scrawny ass out of the game. (Then again, I played no-pads tackle frequently in my neighborhoods growing up, so I can’t be smug.)

I’m hardly going to stop watching the game, or declare anyone who puts their kids in the game a bad parent. Hopefully, at the least, youth coaches and parents will keep their eyes out for concussion-related symptoms, and get their kids out of the games before any further damage is done. I’d like to think that when my kids’ friends come over, they’re of sound mind.

Top youth sports stories of the year, part II (the final five)

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First, an apology. When I posted stories Nos. 10-6 for the top 10 youth sports stories of the year, I wrote that the next day, I would post No. 5-1. The first post went up Dec. 28. No second post Dec. 29. Or Dec. 30. Or Dec. 31. Or Jan. 1. I should know better than to promise on a schedule.

I presumed that news on the youth sports beat would be slow (it wasn’t), and that somehow having four kids home on winter vacation would be less than hectic (it wasn’t). Also, I was a tad late getting back from my 1o-year-old daughter’s basketball game today. I was accosted by an angry mother, the same one who tried to rush me at the bench once before, who wanted to know, in my role as a coach, if I knew what the fuck I was doing.

Actually, it was a bit entertaining, her screaming and swearing at me on the walk in front of our gym, as other parents and children stopped in their tracks to watch the entertainment (I, not she, got this view because I was facing the parking lot). Early on, the mom’s boyfriend implored her to get into the car (they had someplace they had to be), but then he turned on another guy when he started yelling at the mom to shut up. Fortunately, no riot ensued, although I wasn’t sure for a minute.

Without getting into all the details about her dispute — mainly, it was about how I was treating her son, the team’s best player and admittedly its biggest hothead — I will say that by the time the director of the basketball program rushed out in 5-degree weather to check out what was going on (he was called out by a dad from my team, who thankfully threw in that I was a nice guy), the conversation had turned civil. The mom just wanted to get her piece out, and she was willing to listen when I explained why I did what I did, that the point of this league wasn’t winning today, and that I hoped I was preparing her son for a leadership role on his school team. Or maybe she was freezing cold and couldn’t summon the energy anymore. I had two advantages: my Upper Peninsula of Michigan blood, and a much warmer coat. Maybe Mike Leach could have learned a little something, no?

So now, here I am, safe at home, no one yelling at me (yet), so I’ll take a few minutes to sum up the top five youth sports stories of the year.

5. Girls, girls, girls

Nearly 40 years after the passage of Title IX, requiring schools receiving public money to offer equal opportunities (in sports and elsewhere) to boys and girls, we’re still fighting about what that means. The most notable cases were in Indiana and Florida. The Indiana High School Athletic Association folded quickly, and correctly, when a lawsuit was filed on behalf of a 14-year-old girl who wanted to try out for her high school baseball team, but was told state rules required her to play the “equal” sports of girls’ softball. She didn’t make the team, but of course that wasn’t the point.

By the way, with no litigation involved Emily Montgomery of Vincennes (Ind.) Rivet played left field for the school’s baseball team, which made it to the Class A state final before losing. Montgomery also played in the Class A state finals for girls’ basketball, too. Her brother asked her to join the baseball team for a practical reason — the school has only 92 students and otherwise would have had only 10 members.

Meanwhile, in Florida, things were a little more contentious.

A lawsuit filed by lead attorney Nancy Hogshead-Makar, a former Olympic swimmer, fought the state high school athletic association’s scheduling cuts to all sports except football and cheerleading, in the name of saving money as the state’s property tax collections went south with the housing market (which was no longer coming south). The lawsuit alleged Title IX violations because the cuts were not made equally. Originally, the Florida High School Athletic Association said they were, because, get this, football officially is a coed sport. Hey, just because only three girls out of 36,000 players are on rosters isn’t because chicks aren’t invited! (And you can’t cut cheerleading, because if you have football, you gotta have cheerleaders.)

Dutifully embarrassed, the FHSAA dropped the football-as-coed-sport nonsense and stopped the statewide cuts. Although, speaking of cuts, that brings us to our No. 4 story…

4. The economy’s effect on youth sports

Florida was one of multiple states that looked at cutting sports schedules statewide as a means of saving money. Although few did, a lot of cuts happened at the local level, most famously in Grove City, Ohio, where all extracurricular activities were cut after voters multiple times rejected tax increases (and then came back when they finally approved one). Schools nationwide implemented pay-to-play programs, meaning students were charged a fee when they previously were not in order to play sports.

However, the down economy did not necessarily mean that fewer children were playing. In fact, many cities nationwide were building large youth sports facilities in hopes of attracting tournaments that could fill up local hotels and restaurants, and fill up tax coffers hurting from the closing of the local plant.

3. 100-0

Dallas Morning News reporter Barry Horn happened to look at his newspaper’s girls’ basketball box scores and noticed something unusual: Covenant School 100, Dallas Academy 0. So he did a nice little story about Dallas Academy, a private school geared toward kids with learning disabilities, and one that has had athletic success. About 663,000 first-day page views later, 100-0 was a Rorschach test about sportsmanship. Did Covenant coach Micah Grimes run up the score by playing pressing defense for too long? Or was Dallas Academy responsible for preparing a team well enough so it didn’t get smoked 100-0? (Complicating matters was that Dallas Academy often was portrayed as a team of Special Olympians, when in fact the disabilities ran to the likes of ADHD and dyslexia.)

Blowout scores are endemic to girls’ basketball, where the quality of talent, coaching and commitment vary widely from school to school in comparison to boys’ sports. But all the bad publicity about 100-0, and Grimes’ public statement against his school’s apology for it, led to the coach’s firing in January, two weeks after the game. Meaning, Mike Leach was not the only Texas coach in 2009 to get canned after refusing to apologize.

A post-script: in December, Dallas Academy got its first victory since 2001-02, aided by a new team member who scored 31 of its 34 points in a 34-33 triumph. Another post-script: Dallas Academy also dropped out of the Texas Association of Private and Parochial Schools, meaning that Covenant was no longer forced to face it in association play.

2. The trial of David Jason Stinson

Stinson was indicted last January in Louisville, Ky., on reckless homicide charges after one his Pleasure Ridge Park High School football players, 15-year-old Max Gilpin, collapsed and died in an August 2008 practice. Gilpin was ruled to have died from overheating, and Stinson (by then the former Pleasure Ridge Park coach) became what was believed to be the first coach in the nation to face criminal charges for a player’s practice- or game-related death.

Youth and school coaches nationwide watched Stinson’s case closely (and some did more than that, contributing to his legal defense fund) for fear that they could be next if something terrible happened on their watch. After all, the case against Stinson was built mainly on him making his players run “gassers” at the end of a practice in 94-degree heat-index weather, and Stinson’s bluster that he was going to keep his team running until somebody quit, and his allegedly denying players water. Sounds harsh, but it also sounds like what 90 percent of coaches have done at some point.

It turned out that it took the jury only 90 minutes to acquit Stinson, in part because of evidence Gilpin took Adderall and creatine, both of which can cause quicker dehydration. (A civil suit filed by Gilpin’s parents, however, is still in play.) Still, his case, if nothing else, got a lot of coaches and authorities to take heat and dehydration more seriously, including in Kentucky, where the state legislature beefed up rules on access to trainers and handling sports in the heat.

But even despite the tragedy of a teenager’s death, Stinson and Gilpin didn’t turn out to be the top youth sports story of the year, or even the top youth sports-related health issue of the year. That honor goes to…

1. Concussions

No longer is a player who gets a little foggy someone who is “dinged.” From pro leagues on down, concussions — brain injuries — are being taken seriously more than they ever have. Let’s put it this way: had alleged prima donna Adam James been allegedly locked in a room by his head coach, Mike Leach, because he had a bruised sternum, Leach might be coaching Texas Tech in the Alamo Bowl, being played as I type this, instead of preparing his lawsuit against the school for firing him.

Washington this year became the first state to require young athletes diagnosed with concussions to get medical clearance before returning to action, and bills regarding concussion safety have been introduced in the U.S. House and Senate. It’s not just football players suffering — one girl speaking out in favor of the Senate bill is a 16-year-old who quit basketball after 11 concussions. Eleven!

Concussions aren’t just a story confined to 2009. It goes to the top spot because they will be a topic of conversation and debate for years to come. Already, there’s discussion of what the future of football will be, or how long it has one, because of the prevalance of concussions.

Also, I can’t leave this topic without acknowledging the hard work of Alan Schwarz of the New York Times, who has covered concussions thoroughly for years, and might just be single-handedly responsible for this whole conversation we’re having about them. There are going to be people who literally will owe their lives to him.

Ain’t that a kick in the head

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If you’ve been watching the Detroit Red Wings-Chicago Blackhawks NHL Western Conference final series, your teeth might still be rattling over the hit Detroit’s Niklas Kronwall put on the Hawks’ Martin (or as everyone in Chicago calls him, Marty, because 90 percent of Chicago males are named either Marty or Mike) Havlat in game three. It’s why they coach hockey players to keep their heads up, lest you lose yours.

Havlat suffered a concussion (as far as we can guess, because the NHL won’t say). He was out cold for at least two minutes. And yet Chicago’s leading scorer suited up for game four. Concussion specialist Michael Czarnota, the neuropsychology consultant for the Canadian Hockey League, told CBCSports.ca he was “shocked” to see Havlat back.

But he shouldn’t have been surprised. It’s endemic in all levels of hockey, the sports Czarnota points to as having the most concussions, to have players come back after what is more than getting your bell rung — it’s a serious brain injury.

On May 27, three days after Havlat’s post-concussive return, a study by a Toronto physician found that youth coaches, parents and players knew little about concussions, including whether it is a good idea to return to the ice soon after having one. (The right answer: no.) Among the study’s findings, which I’ve taken from a press release:

Up to two-thirds of players had the mistaken impression that a player does not have to lose consciousness to have suffered a concussion. One quarter of adults and up to half of children could not identify any symptoms of a concussion or could name only one symptom of a concussion. About one-half of players and one-fifth of adults mistakenly believed concussions are treated with medication or physical therapy. About one-quarter of all players did not know if an athlete experiencing symptoms of a concussion should continue playing.

The study also found that in Canada, hockey players ages 5-17 “have about 2.8 concussions per 1,000 player-hours of ice hockey while university and elite amateur players sustain rates of 4.2 and 6.6 concussions per 1,000 player hours.”

The study was released only two weeks after Washington Gov. Christine Gregoire signed a bill requiring any youth showing signs of a concussion to get clearance from a medical professional before playing again. That was inspired by Zackery Lystedt, who at 13 suffered a hard hit in a football game, went back in, and then was hit a second time and put into a coma for 30 days.

The Toronto study also was released the same day USA Today ran a story about former NHL star Keith Primeau pledging (along with 120 athletes) to donate his brain after his death to a medical study looking at chronic traumatic encephalopathy. That is a degenerative brain disease similar to Alzheimer’s, found in people who have had multiple concussions. Primeau warned of the risks of concussions — to the point he won’t let his kids play football:

Concussions can be very hard to detect since not everyone passes out. Nausea, blurry vision and confusion are other symptoms. Within the past several years, increased awareness about concussions and “post-concussion syndrome” has led most professional and college teams to start using computer-based programs that measure attention, memory, processing speed and reaction time to one-hundredth of a second.

It is too costly for most high schools and youth programs, where it could help coaches and trainers identify problems and sideline players. Concussions account for almost one in 10 sports injuries for people ages 15 to 24, according to the Centers for Disease Control and Prevention.

Yet nearly 41% of high school athletes return to action too soon after concussions.

Primeau endured a career of blows to his head but adds that he won’t forget one that knocked him out:

“I spent the night in the hospital, flew the next day and was back in the lineup that day. That was the beginning of my demise.”

He now knows resting — and not playing until the concussion is healed — can help prevent long-term damage. He has started to use tests to determine if his athletes have concussions and has made decisions to keep kids off the ice.

“I can tell when a child has suffered a concussion,” he says. “I do not put them back on the ice. I’ve told parents I’m not putting their child back in. And I’ve actually had instances where parents will want to go in a different direction and the kids will go out on the ice and get sick.”

And other times, players are not honest. That was true of Primeau’s oldest son, Correy, who plays club-level hockey for Neumann College in Aston, Pa., and respects his father’s concerns.

“I played once with a concussion last year,” Correy says. “I wouldn’t do it again. I had trouble afterward for about a week, but I just didn’t want to let my team down at the time.”

As for Martin Havlat, who left game four after eight minutes when he took another hard hit, other hockey players are saying he was crazy — and a bad influence — for suiting up again. From the Toronto Globe and Mail:

Under the NHL’s absurd don’t-ask/don’t-tell policy governing injury disclosure in the postseason, no one will say for sure if Havlat was concussed. So it was left for media voices to speculate. Speaking on The Fan 590 in Toronto, former NHL defenceman Jeff Beukeboom– whose career was ended by severe post-concussion symptoms– decried Havlat’s rapid return.

“I think it sets a very bad example for the kids,” said Beukeboom, who feels players will be vulnerable to coercion by teams if there’s the false impression of a quick remedy after a concussion.

TSN’s Bob McKenzie– whose son has battled post-concussion syndrome from a hockey incident– was vocal on both radio and TV questioning … Havlat rushing back into play.

“The seven-day rule is actually from when the athlete is symptom-free,” McKenzie [said]. “But if he has a headache for three days after being hit, he’s supposed to wait seven days from the time he was symptom-free, not from when he was hit in the head.

“All of this is aimed at protecting the brain, which doesn’t respond well to second impact. In fact, there’s a condition called, I think, second-impact syndrome. If a concussed athlete, say Havlat, goes back into game action when his brain is concussed, if the brain gets a second contact directly on the same part of the brain, death can be instantaneous.”

Expect the debate to continue in the media so long as the NHL remains in denial about head shots.

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