The Brain

Youth Football Needs Medical Standard of Care

December 14, 2012  • Dr. Robb Rehberg

As the season for youth and high school football draws to a close, one could argue that it’s been one of the most memorable in history. But not for the reasons one might suspect such as spectacular displays of athleticism, broken records, classic rivalries, or nail-biting finishes. No, this season was memorable for the increased focus on player safety, especially regarding concussion. It’s been a topic of discussion everywhere – from the sidelines to the stands, and from the living room to the athletic training room. Player safety has been featured on television, in print, and on the web. With the abundance of new laws, compelling research, and new league rules designed to protect young athletes, the topic of safety in American football likely has not received this much attention since Teddy Roosevelt threatened to abolish the sport over 100 years ago due to its brutality.

Many experts believe the game can be made safer. Eliminating kickoffs, limiting contact in practice, and establishing a minimum age for tackle football are just some of the suggestions currently being discussed. Yet some coaches, parents, and players bristle at the idea of making any changes to the game, citing the belief that the game is safer at the youth level because players hit with less intensity. However, recent research has revealed that forces most commonly seen in collegiate and professional football – forces equivalent to motor vehicle crashes – have been recorded in the helmets of seven-year-old players. Other compelling research is beginning to show the link between repetitive hits and long-term brain injury known as Chronic Traumatic Encephalopathy (CTE). While this new research begins to answer certain questions, it raises others, as research often does. The most important question still left unanswered is this: what can we do TODAY to protect our athletes?

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Legislation Alone Won’t Make the Game Safer
Over the past four years, 39 states have passed concussion legislation. And while well-intended legislation may play a role in management of concussions, legislation alone is not a panacea. In many states, legislation falls far short of protecting youth and high school athletes for several reasons. Consider the fact that most concussion laws address how to recognize and manage concussion, but not how to prevent it. Moreover, many concussion laws have no teeth, as penalties for non-compliance are not established. As a result, school districts and programs have been apathetic and slow to adopt policies required by law. Some concussion laws only apply to high school and not youth sports, while others pertain to public educational institutions and not private schools. Legislation helps, but it alone won’t make the game safer.

Education is Key
Education of parents, athletes, coaches, and health care providers is included in most state laws and league rules. But when it comes to education, one size does not fit all. Targeted education must be provided for all levels. Coaches need to be educated to recognize concussion symptoms and take action, but they must also be educated in the prevention of concussion through sound coaching techniques. Parents and athletes must also be educated in concussion symptoms, but their perspectives on the issue are very different and require different content. Pamphlets and informational sheets on concussion – which are identified in many state laws as the only required method of educating parents and athletes – are largely ineffective. Just ask any parent whose child has brought home a blizzard of flyers, pamphlets, and permission slips from school. Quality, targeted, and accessible education is an essential tool in combating the concussion issue.

Appropriate medical coverage
It’s time for schools and athletic programs to make athlete safety and health a priority. One way to do this is to establish and maintain a standard of care that includes having athletic trainers on-site. Athletic trainers are licensed health care providers who work with physicians and specialize in the prevention, diagnosis, and intervention of emergency, acute, and chronic medical conditions, including concussion. Recent research indicates that in high schools with athletic trainers, more concussions are identified and there are fewer overall injuries. All professional and NCAA athletes in the US have access to athletic trainers, yet less than half of high schools that offer interscholastic athletics employ them. Instead, coaches are asked to assume this role with minimal training. Schools must stop making excuses as to why they cannot provide appropriate medical coverage for their student athletes, and parents need to demand that such coverage is provided for their children.

All of these issues and more can all result in a culture change that can have a significant impact in athlete safety at all levels. Some may say that sadly, it takes a tragic event to drive culture change. If the latest research is any indication, those tragic events are happening right in front of us on football fields everywhere. We just can’t see them.

Dr. Rehberg is an associate professor and coordinator of athletic training clinical education at William Paterson University, and also serves as executive director of Sport Safety International. He attended our roundtable discussion on the safety of playing football on November 9. Check out our recap and video from that discussion here.