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.
Play it Safe: Basics of Proper Helmet Use
February 4, 2020
Henry Ford Health System
If you or your child plays sports or participates in physically risky activities, wearing a helmet could be lifesaving. While no helmet is concussion-proof, wearing one can help reduce the risk of serious head injuries.
"Helmets are made with materials that help reduce impact to the head, protecting the skull from damage," says Jeffrey Kutcher, M.D., a sports neurologist who treats athletes at the Henry Ford Kutcher Clinic for Concussion and Sports Neurology. "You should be wearing a helmet whether you're playing a contact sport or riding something on a hard surface, such as a bike, scooter, skateboard or rollerblades."
Head Injury Prevention 101: Helmet Buying Basics
All helmets are certified at the same level for multi-use recreational activities. So there's no need to search for a specific seal or rating. Instead, when you're purchasing a helmet — or getting one second-hand — focus on these four factors:
How you’ll use it:
Pay attention to the risks involved with the activity you're doing. If you're biking, skiing or snowboarding, for example, you're wearing a helmet in case you get hit, not because you'll get hit.
There are two types of helmets: single-impact and multiple-impact. Single-impact helmets are made with foam materials that break down when hit as part of their force mitigating strategy. These helmets work well for bicycling, skateboarding, skiing or snowboarding. Multiple-impact helmets, such as those designed for sports like football, hockey and lacrosse, can withstand many hits over an entire season. The materials in these helmets don't break down, but rather compress and regain their original form.
"A helmet may perform better in the lab — for example, the dummy brain will experience 98Gs of force instead of 100Gs — but 2Gs of force probably won't make enough of a difference with a one-time injury," Dr. Kutcher says. "But 2Gs less force per hit for a linebacker who suffers multiple blows on a daily basis for many years? That could make a big difference.”
If football is your sport, the National Football League provides a helmet rating system that assesses helmets based on their ability to mitigate force over time.
How it fits:
Helmets fit differently depending on the make, style and type of sport they’re made for. "The key is making sure the helmet covers the entire skull and doesn't move around when in use," Dr. Kutcher says. The helmet should sit on the head without falling forward or backward. If you're relying only on a chinstrap to keep it in place, you don't have the right fit.
How comfortable it is:
Not all helmet brands fit every head. Helmet designs vary just like running shoes do. When you're shopping for a helmet, make sure it's snug, but not tight or uncomfortable. Comfort is critical, especially for kids. "You don't want a child to develop a negative association with wearing a protective helmet," Dr. Kutcher says.
What condition it’s in:
To get the most protection, your helmet should be in top condition. Do not wear a cracked or broken helmet, or one that has been involved in a crash or similar event (unless it's a multiple-impact design). An impact can crush foam materials. And don't allow the helmet to get too hot or cold — that can cause the materials to break down over time.
Get the Best Helmet Fit for Your Head
Properly wearing a helmet provides the greatest defense against injury — more than any style or brand. To make sure your helmet is secure, follow these rules:
· Measure head circumference: Every helmet brand provides a size chart, along with instructions about how to select the best fit. To get the best measurement, use a cloth tape to measure your head circumference. Place the tape about an inch above the eyebrows, keeping it level from front to back. If the measurement falls between sizes, select the smaller size.
· Pay attention to hairstyles: Make sure to try the helmet on with the hairstyle you'll have during the activity. A long-haired bike rider who gets a short haircut may require a helmet adjustment.
· Watch your vision: The helmet should not block your vision. You should be able to see straight ahead and side to side.
To Wear a Helmet or Not To Wear a Helmet: When to Play It Safe
There are several sports that don't require wearing a helmet. But if you or your child is involved in rugby or soccer, or another sport where helmets are optional, that doesn’t mean you're in the clear.
"It's important to base any decision about whether or not to wear a helmet in conjunction with your sports neurologist," notes Dr. Kutcher. "Your past medical history and current health status may still warrant the use of a helmet."
Unsure whether you're at risk of sustaining a head injury? Get a brain health baseline evaluation. Proper consideration of your brain health includes a physical examination, along with a personal and family medical and neurological history. It also offers you an opportunity to learn how to best protect your head.
Related Topic: 7 Tips for Recovering Mentally After a Sports Injury
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.