The blockbuster announcement came across my desk two days ago, but it took me a while to process its full significance. In fact, it may take me a while longer to fully appreciate all of its implications for youth sports.
Dr. Bob Cantu, MomsTeam's first concussion expert from 2000-2008, and someone I have known and respected for more than a decade, is recommending [1] that kids under the age of 14 not participate in collision sports as currently played.
That's right: Dr. Cantu, one of the nation's pre-eminent concussion experts, 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, with Chris Nowinski [2], of the Concussion Legacy Institute (formerly Sports Legacy Institute), will detail in his forthcoming book a recommendation 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), to reduce the risk of developing chronic traumatic encephalopathy (CTE) [3], a degenerative neurological disease which leads over time to personality changes, memory loss, even dementia. Early signs of CTE in the brains of 17- and 18-year olds, says Dr. Cantu, have been detected in the brains of kids who showed no symptoms when they were alive.
"The young brains are more vulnerable, they're less myelinated (the protective sheath - myelin - that develops around neurons), the necks are weaker, the heads are bigger proportionately so the forces that accelerate the brain need not be as high to produce higher acceleration," Cantu told Boston's WCVB-TV.
It's not just concussions that worries Dr. Cantu, its the accumulation of sub-concussive blows: "In fact, we've had a number [of brains] in our center who have had no recognized concussions at all, so its total brain trauma."
"We have millions of youngsters putting their heads into collision sports right now and we don't really know how safe this is for them," Cantu said.
Hopefully, the recommendation from Dr. Cantu will carry the necessary weight to have some real impact (pardon the pun) on the youth sports community. MomsTeam and I have long advocated in favor of a delayed start to playing collision sports. As early as 2006, when my book, Home Team Advantage, was published, I was trumpeting the recommendation of the American Academy of Pediatrics that children wait until middle school to play collision sports like football, and was writing about studies that, even then, showed that a "history of concussions and probably sub-concussive contacts to the head may also be risk factors for late-life memory impairment and mild cognitive impairment."
So what is a parent of a young athlete who has been playing football since he was seven, or who is considering signing up their child for Pee Wee hockey for their child to do?
Take Dr. Cantu's advice seriously. Seriously consider whether allowing your child to play collision sports at an early age is hazardous to their long-term health. Weigh the rewards and benefits of participation in collision sports against the now undeniable risks.
One thing that Dr. Cantu's recommendation makes clear is the need for better training of youth athletes, a view shared by Rosemarie Scolaro Moser, Ph.D., sports neuropsychologist, founder of the Sports Concussion Center of New Jersey, and a MomsTeam expert.
"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," Moser 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. We know that kids' brains are vulnerable, that youth concussion is a public health problem, and that the effects of concussion can be devastating. We also know that sports can play an important role in a child's overall development as a person. The question is, Can we provide the resources and support necessary to make all youth sports safer, whether the sport is considered a collision, contact, or noncontact sport?"
The need for better training of youth and high school football players in proper tackling is a subject I also have been writing about for years. A recent NATA study [4] shows that high school players are at greater risk for concussive events in part because they haven't learned proper tackling techniques. MomsTeam has consistently promoted the efforts of coaches like Bobby Hosea [5] to teach players to use what he 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).
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. Because the risk of concussion triples [6] among younger hockey players in leagues where body checking is allowed, USA Hockey recently banned the practice [7] at the Pee Wee level. Teaching how to absorb body contact in hockey [8] is also something that expert groups, like the American Academy of Pediatrics, recommend as a way to reduce the risk of brain injury.
What I wrote in that same blog post almost two years ago is worth repeating today: "Recent news stories have recounted how parents of football players have been torn about whether they should let their kids continue playing and describe the prospect of long-term injury if they keep playing as 'kind of scary.' Some report having decided not to let their kids play football based on the new evidence."
Again, this is something I faced ten years ago. As I wrote in my book Home Team Advantage and have recounted often on this site, "I ultimately decided to end my son Spencer's football career after his sophomore year in high school because to continue playing, given his history of concussions and learning disabilities, posed, in my view, an unacceptable risk of long-term injury. And this was long before studies began coming out showing just how potentially dangerous football was to a player's long-term mental health."
But as I said then, and say again now, "I am not now and have never suggested that parents simply refuse to let their children play football. But parents do need to make the decision based on complete information; information which they still do not have." (but is rapidly becoming available, as researchers in Boston, at Purdue University [9], the University of North Carolina and Virginia Tech, find out more and more about the link between sub-concussive blows and short- and long-term brain injury)
As I said then, "More research is needed over a longer period of time before we will know - if we will ever know - just how dangerous football is to the human brain - particularly the developing brain of a youth, middle school or high school player. There is not now and never will be a one-size-fits-all answer. It is likely that the American obsession with football will continue for decades to come. But at the very least we ... need to continue to provide the very best information."
Words that, in light of Dr. Cantu's new recommendation, resonate even more clearly today.
February 16, 2012 update: Dr. Cantu's recommendations aren't shared, however, by all concussion experts, most notably, Dr. Kevin Guskiewicz of the University of North Carolina. In a 2012 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 that is the same size and age.
"Bob and I don't disagree on much, but we do on this," Guskiewicz told the News-Observer.
The question 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.
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."
Cantu said after treating many young athletes with concussions, 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."
Here's a video of Dr. Guskiewicz explaining his position at the NATA youth sports safety summit in Washington, D.C. in December 2011:
[10]October 25, 2015 update: The American Academy of Pediatrics new Policy Statement on Tackling in Youth Football [11] contains this first-rate summary of the positions espoused by Drs. Cantu and Guskiewicz:
Some physicians have recently argued that because the brain is in a rapid period of development during youth, contact should be eliminated from football until a certain age. Others have argued, however, that eliminating contact at a young age would prevent young athletes from learning the skills required to tackle, absorb a tackle, and fall to the ground safely. Then, when contact is later introduced, athletes will be ill prepared and forced to learn these skills at an age where they are bigger, faster, stronger, more coordinated, and capable of delivering more forceful blows. Some have suggested that this might increase the risk of injuryand have argued the correct contact techniques should be taught at the earliest organized level.
Noting the absence of research showing the effect of delaying the age at which tackling is introduced to football on the risk of injury, and research going both ways on the effect of delaying the age at which body checking is introduced in hockey, the AAP decided that tha further research was needed before informed recommendations could be made. The statement emphasized, however, that, in the event leagues did delay the introduction of tackling, increased emphasis be placed on teaching proper tackling technique, as well as the teaching of the skills necessary to evade tackles and absorb contact while being tackled (which was accompanied by the caveat: that it was "unclear" whether the neuromuscular control necessary to performing them could be adequately learned in the absence of contact beginning at an earlier age.
In addition, a brand new study, also published online today in the International Journal of Sports Physical Therapy [12], reports that a season of subconcussive contact in football was not detrimental to cognitive and balance scores of 8- to 12-year-old youth football players on the Child‐SCAT3 [13].
Links:
[1] http://www.thebostonchannel.com/health/29168930/detail.html
[2] https://www.momsteam.com/node/3831
[3] https://www.momsteam.com/node/3289
[4] https://www.momsteam.com/node/2744
[5] https://www.momsteam.com/node/2958
[6] https://www.momsteam.com/node/3041
[7] https://www.momsteam.com/node/3284
[8] https://www.momsteam.com/node/3016
[9] https://www.momsteam.com/purdue-studies-show-repetitive-head-impacts-in-high-school-football-damage-brain
[10] http://fast.wistia.com/embed/iframe/496ec83be6?videoWidth=640&videoHeight=360&controlsVisibleOnLoad=true&autoPlay=true&popover=true&plugin[postRoll][version]=v1&plugin[postRoll][text]=For more youth sports safety information, click here.&plugin[postRoll][link]=http://www.momsteam.com/health-safety&plugin[postRoll][style][backgroundColor]=#080808&plugin[postRoll][style][color]=#3dcaed&plugin[postRoll][style][fontSize]=36px&plugin[postRoll][style][fontFamily]=Gill Sans, Helvetica, Arial, sans-serif&plugin[socialbar][version]=v1&plugin[socialbar][buttons]=embed-email-twitter-googlePlus-facebook&plugin[socialbar][tweetText]=Conctact sports good or bad (td)
[11] https://www.momsteam.com/health-safety/pediatrics-group-refuses-to-endorse-outright-ban-on-tackling-in-high-school-youth-football
[12] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595920/
[13] https://www.momsteam.com/health-safety/sport-concussion-assessment-tool-evaluation-and-management