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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.
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Put a Stop to Recurring Injuries
May 5, 2020
By Nick Parkinson, M.Ed., AT, ATC, TSAC-F
Henry Ford Health System
Recurring injuries happen — and they're especially common among single-sport athletes or people who focus on one type of exercise, like runners. The reason: You're working the same muscles repeatedly. The end result: Your joints, muscles and tissues get worn out.
Breaking Down Recurring Injuries
Overuse injuries are a big deal. Continuing to re-injure the same muscle groups can take you out of the game entirely and limit your ability to participate in other activities. Here's what you need to know about these all-to-common ailments:
What are Recurring Injuries?
Recurring injuries, also called repetitive and overuse injuries, are injuries that happen repeatedly in the same location. Think along the lines of tendinitis, stress fractures, shin splints and even carpal tunnel syndrome. Common sites include ankles, knees, hips and shoulders.
Who is at Risk for Repetitive Injuries?
Overuse injuries can happen to anyone, but they're more likely to occur among workers who do repetitive motions and single-sport athletes. The risk of these injuries also increases with age. They're more likely to occur if you don't recognize the impact aging can have on your muscles, joints and tissues and modify your activities accordingly.
Why Do Recurring Injuries Happen?
Recurring injuries happen when you overuse the same muscles without sufficient recovery. It's simple body mechanics: If you continue using compromised muscles, you're more likely to get reinjured. And once you get stuck in that same biomechanic loop, it's nearly impossible to recover without changing your routine and learning new techniques.
How Can You Prevent Recurring Injuries?
All sports have a risk of injury. The key is paying attention to your body and taking the appropriate steps to minimize your risk. Here's how:
• Use appropriate gear. Make sure you're wearing appropriate protective gear for the activity you're participating in and choose the right footwear.
• Alternate muscle groups. Instead of focusing on one type of exercise, switch things up. Incorporate low-impact activities, such as swimming, biking and water sports, and make sure you're not overloading any particular muscle group.
• Take rest days. It's important to give your muscles, joints and tissues time to recover. Two days of rest each week is best. If you play a sport, plan to have at least one off day per week and at least one month off per year.
• Strengthen muscles. Conditioning exercises can help strengthen the muscles you need to perform various activities.
• Use proper form. Overuse injuries are sometimes related to improper form during activity. Work with a professional to ensure you're using proper body mechanics and get back to your usual activities gradually.
Play it Safe
The best way to avoid recurrent injuries is to not get injured in the first place. Recover during the season — even if it means missing out on some play. It's better to show up to a game healthy but undertrained than to power through an injury and risk reinjury.
Talk to your doctor before starting a new activity or ramping up your current routine. If you're at risk of developing a recurrent injury, a professional can provide you with a workout regimen that can help prevent injury.
Most important: Don't let an overuse injury prevent you from being physically active. Instead, listen to your body, consult a professional and pace yourself. Treatment may involve avoiding a specific activity for a period of time, along with hot and cold therapy, massage and focused rehabilitation.
Nick Parkinson, M.Ed., AT, ATC, TSAC-F, is the Supervisor of Athletic Training with Henry Ford Sports Medicine and also leads Sports Performance training at the William Clay Ford Center for Athletic Medicine. Learn more about Nick.
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.