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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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5 Concussion Myths Debunked
February 28, 2020
Henry Ford Health System
Awareness about the dangers of concussions is at an all-time high. In response, athletic organizations — from Pop Warner football (a nonprofit program for kids 5 to 16) to USA Hockey — have safe-play protocols in place. But misconceptions about injury — prevention, management and return to play — are still all too common.
"It's great that parents, coaches and athletes are focused on the potential for concussions, but they also need to be aware of the complexities involved in evaluating, diagnosing and managing concussion," says Jeffrey Kutcher, M.D., a sports neurologist who treats athletes at the Henry Ford Kutcher Clinic for Concussion and Sports Neurology.
The best way to get the knowledge you need? Learn how to separate fact from fiction.
Separating Concussion Fact From Fiction
Here’s the truth behind five common concussion myths:
Myth #1: Concussions are only caused by blows to the head.
Concussions happen in response to force. While they often result from a blow to the head, they can also occur after a hit to the neck, shoulders or anywhere else on the body. To cause brain injury, the force of the impact only needs to cause the head to move rapidly back and forth (think whiplash from a car crash or a spill down the stairs).
Myth #2: Concussions always involve a loss of consciousness.
A very small percentage of all concussions, 10 percent or less, result in a loss of consciousness. For the remaining injuries, parents, coaches and medical providers should watch for additional symptoms such as:
· Confusion
· Balance problems
· Slurred speech
· Physical complaints including headache, nausea and vomiting.
Myth #3: You should keep a person awake overnight after a concussion has occurred.
It's important to observe and interact with a recently concussed person for the first few hours to recognize the potential signs of a more serious injury. However, if they are interacting normally after four hours, it’s okay to let them sleep. If you have any doubts or questions, always err on the side of caution and seek medical attention.
Myth #4: After a concussion, kids should avoid digital media until they feel better.
Unless digital activities or screen time significantly worsen symptoms, there's no reason to avoid them. "You shouldn't force people who have suffered a concussion to rest too much — or deprive them of sensory input — if they are comfortable engaging in activity," Dr. Kutcher says. What’s more, taking away activities that bring a person joy or keep them socially connected could end up prolonging their recovery by creating additional symptoms.
Myth #5: All physical activity should be avoided after a concussion.
It’s important to rest for the first two to three days after a concussion. However, you need to be careful not to rest too much or avoid all activity for too long.
Engaging in physical, mental and social activities can be beneficial. But knowing how much to do and when to take it easy can be difficult. If you have any questions, consult a sports neurologist for specific recommendations.
Ground Rules for Concussion Prevention and Management
When it comes to preventing concussion, common sense offers the greatest impact, Dr. Kutcher notes. He recommends starting with these four tenets:
- Whenever possible, limit the amount of contact in practices and games.
- Wear proper fitting and certified helmets or other head protection whenever appropriate.
- Spread contact drills out over time as much as possible.
- Practice good technique and play by the rules.
Athletes — especially those who play contact sports — should undergo an annual neurological evaluation that includes a comprehensive, focused neurological history and examination. This information provides a critical point of reference for medical professionals.
Knowing the truth about concussions — including what to watch for and what to do if one occurs — is really the best game plan.
Dr. Jeffrey Kutcher is a sports neurologist at the Henry Ford Concussion and Sports Neurology Clinic and the global director of the Kutcher Clinic.
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.