NFHS Voice: No HS Football Link to CTE
October 21, 2019
By Karissa Niehoff
NFHS Executive Director
When it comes to the long-term effects of concussions in sports, there is a wide range of information published – almost on a daily basis. Unfortunately, much of the media coverage as it relates to high school sports – and particularly the sport of football – is misleading.
Last week, the Concussion Legacy Foundation introduced its new public-service announcement that compared youth football dangers to smoking. As the pre-teen football players puff on cigarettes, the voiceover says, “Tackle football is like smoking, the younger I start, the longer I’m exposed to danger.”
The “Tackle Can Wait” campaign by the foundation is an attempt to steer children under the age of 14 into flag football. Although establishing a finite age may be difficult, reducing contact at youth levels is certainly a positive. USA Football is doing just that nationally through its Football Development Model. Likewise, the 51 member state associations of the National Federation of State High School Associations (NFHS) have enacted limitations on contact during preseason and practice sessions.
Our concern is the term “exposed to danger.” These types of messages continue to spread unwarranted fear to parents of high school student-athletes. The “danger” refers to reports that players who incur repeated concussions can develop chronic traumatic encephalopathy (CTE).
A 2017 study from the Journal of American Medical Association (JAMA) linked CTE in the brains of deceased National Football League players. Even if this report is accurate, these are individuals who endured repeated blows to the head for 20 to 25 years BEFORE any concussion protocols were in place.
Less publicized is a study by Dr. Munro Cullum and his colleagues at the Peter O’Donnell Jr. Brain Institute, which is a part of the University of Texas Southwestern Medical Center in Dallas. Cullum’s group studied 35 former NFL players age 50 and older who had sustained multiple concussions throughout their careers. The findings showed no significant association between the length of the individuals’ careers, the number of concussions and their cognitive function later in life.
Two studies, two different conclusions. Regardless of the outcome, however, they are not applicable to kids playing football before and during high school. There is absolutely no linkage to CTE at these levels, and the word “danger” should not be a part of the discussion.
A more applicable and significant study was also published in JAMA in 2017. In a study of about 4,000 men who graduated from Wisconsin high schools in 1957, there was no difference in cognitive function or decline between those who played football and those who did not as they reached 65 years of age. We would assume the majority of these individuals discontinued football after high school.
With more than one million boys – and girls – playing the contact sport of football each year, severe injuries do occur from time to time, but parents should know that efforts to lessen the risk of a catastrophic injury, including head injuries, have never been stronger than they are today.
In fact, new data from the National High School Sports-Related Injury Surveillance Study indicates some positive trends in concussion rates. The study, which was released in the American Academy of Pediatrics online issue of Pediatrics last week, indicated that concussion rates during football practices dropped from 5.47 to 4.44 concussions per 10,000 athletic exposures between the 2013-14 and 2017-18 seasons.
In addition, repeat concussion rates across all sports declined from 0.47 to 0.28 per 10,000 exposures during the same time period.
Concussion laws are in place in every state. All NFHS sports rules books have concussion management protocols. Helmet-to-helmet hits are not allowed in football. Limits on contact in preseason and practice in football are in place in every state.
After considering all the available research, we encourage parents to let their kids play their sport of choice in high school, but we would discourage moving away from football – or any contact sport – solely based on the fear of developing CTE later in life.
Dr. Karissa L. Niehoff is in her second year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.
Add Rest Days to Your Workout Routine
June 2, 2020
Henry Ford Health System
Whether you're new to exercise or a seasoned enthusiast, it's tempting to adopt an all-go, no-quit attitude. This is especially common when you're are trying to achieve a fitness goal. Maybe you want to run a 5K, or maybe you have 10 pounds you want to shed before going on vacation.
"Whatever the driver, it's important to remember that scheduling time for rest and rejuvenation is a critical component of any workout regimen," says James Moeller, M.D., a sports medicine specialist at Henry Ford Health System.
Building in Rest Days
From high-intensity interval training (HIIT) and spin to barre and Zumba, popular workouts increasingly push exercisers to go faster, longer, stronger. This prolonged physical stress can lead to overuse injuries, such as stress fractures, muscle strains and joint pain. Excessive exercise can also lead to hormonal changes, disrupted sleep patterns, decreased immunity and mood swings.
“Working out, especially resistance training, breaks tissues down, causing microscopic damage,” Dr. Moeller says. "Rest days allow your muscles time to rebuild."
So how much rest do you really need? There isn't a one-size-fits-all prescription. Factors like your age, fitness level, the intensity of your workout and the amount of training you do weekly will impact the amount of recovery time you need. But there are some basic guidelines for rest days:
1. Go easy: Rest is a relative term. "It's not just sitting on the couch with an iced tea," says Dr. Moeller. "You may still be exercising on 'rest' days, but at a lower intensity." Maybe you go for a brisk walk or ride your bike to work. Take a yoga class or do some dynamic stretching. The key is to make sure you're not overworking the same body parts.
2. Get sufficient sleep: Sleep is a key component of muscle repair and rebuilding. During sleep, your body’s production of growth hormone increases. Not getting quality shuteye thwarts your body's production of growth hormone and can impact your performance.
3. Give overtaxed muscles a break: You don't need to skip the gym on specific days each week, but you do need to rotate which body parts you're working. The general rule is to give muscles 48 hours to recover after a workout. So it's a good idea to take two to three days off before working the same muscle groups again.
4. Stay hydrated: Make sure to restore lost fluids before, during and after a workout. Dehydration can lead to overheating, headaches and muscle fatigue, among other ailments. You don’t need a sports drink; water is best. "Sports drinks aren't required unless you're getting into very high intensity activity, or exercising for more than one hour at a time," Dr. Moeller says.
5. Pay attention to your body: A lot of people try to work out through pain and fatigue. If there's a heaviness to your movements, or if you feel like your muscles are not responding appropriately to the stress you're providing, take a time out. "It's really about learning to read your body's signals," says Dr. Moeller.
Health authorities and news headlines widely publicize the health benefits of exercise — and the consequences of inactivity. The American Heart Association recommends that adults get at least 150 minutes of moderate-intensity exercise per week, plus strength training two or three days per week. Less discussed are the negative effects of not allowing your body sufficient time to rest.
Getting sufficient rest between workouts is just as important as participating in regular exercise. "Both are part of the total process required to build strength, endurance and muscle mass," Dr. Moeller says.
Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan.
Visit henryford.com/sports or call (313) 972-4216 for an appointment within 24 business hours.