A 24 year-old NFL player retired due to concussion risks

This article explains why Chris Borland, a linebacker for the 49ers, retired from the NFL at age 24 due to the high risks of concussions.

One of the NFL's most promising young players has announced that he is quitting professional football today, blaming the risk of concussion and serious brain injury on his decision to walk away from the sport. Chris Borland, linebacker for the San Francisco 49ers, told ESPN that he was retiring because he wanted to do what was best for his health, and didn't think football was "worth the risk." By leaving the league at only 24 years old, after a stellar rookie season, Borland rapidly becomes one of the most damning examples of the NFL's ongoing concussion crisis.

Borland says his decision to quit came from him wanting to "be proactive," leaving the sport while his brain is still healthy. The linebacker began to have doubts about his long-term career as a professional football player in his very first NFL training camp, during which he received a suspected concussion on a running play but decided to play through it in a bid to make the team. He told ESPN "I just thought to myself, 'What am I doing? Is this how I'm going to live my adult life, banging my head, especially with what I've learned and knew about the dangers?'" After the fourth game of his rookie season, Borland told his parents his time as a pro player would be short.

The linebacker told ESPN that he currently feels as sharp as he's ever been, but that he had researched the issue heavily, speaking with concussion researchers and former players, more than 4,500 of whom have sued the NFL for failing to adequately protect them from head injuries during their time in the league.

In his statement, Borland thanked the 49ers, saying the team "truly looked out for players' best interests," but his departure from the league is made even more notable by coinciding with the exit of several prominent young players. Borland was scheduled to be one of the stars of the San Francisco 49ers defense, playing the last season as the heir apparent to Patrick Willis, another top-tier defensive player who chose this year to retire from the sport after developing chronic pain in his feet. He was joined by by Steelers linebacker Jason Worilds, who announced this month that he was retiring from pro football to pursue other interests.

The NFL has had a long-running problem with concussions and head injuries, and its lackluster methods of protecting players, as detailed in the PBS documentary League of Denial. Many who have played the sport have gone on to suffer debilitating brain diseases. A number of players, including standout San Diego Chargers and New England Patriots linebacker Junior Seau, have committed suicide in the years after their retirement. Seau shot himself in the chest so his brain could be studied after his death — after autopsy, it was determined that he had been from chronic traumatic encephalopathy (CTE), a type of degenerative brain damage found in other players.

The NFL has made advances in technology designed to help reduce head injuries, but players such as Jahvid Best, a former first-round draft pick who sued both the NFL and helmet maker Riddell after receiving three concussions in two years, are still receiving knockout blows on the field of play that could disable them in later life. The league has also come under fire for a too-weak concussion protocol that allows clearly woozy players back onto the field. In October last year, Chargers defensive back Jahleel Addae played an entire game after being knocked out on the first play. In the fourth quarter, several hours after taking the blow to the head, Addae seemed to lose control of his body after making another hit, jerking his limbs and stepping awkwardly as he attempted to stay upright.

By stepping away from the sport at 24, Borland will avoid the kind of head injuries that could leave him crippled, with diminished mental faculties, or prone to fly into uncontrollable rages. Meanwhile, instead of pouring its efforts into keeping its players safe, the NFL still appears to be in favor of extending the regular season to a gruelling 18 games, despite arguments from the people who actually play the sport.

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Will sensors be in all helmets by 2015?

A research study is looking into adding sensors into helmets. The results may be strong enough to put sensors into all helmets by 2015.

A pilot program designed to provide more information for concussion research could become more widespread, and put sensors in every helmet by 2015.

According to Tom Pelissero of USA Today, two teams participated in the program for part of last year, and researchers are trying to fine-tune the technology to measure head impact in games.

The work is being done by University of North Carolina researcher Kevin Guskiewicz, who is a member of both league and union safety committees.

“We need a sample of these players across all positions and studying every play type possible,” Guskiewicz said. “So, that’s the next step. Then I hope from there that, if we find (the devices) have utility that could actually help an individual player … my hope would be that we would go league-wide.”

Guskiewicz said the project still needs to be approved by the league and union, and getting that kind of agreement has been an issue in the past.

But he said he was “thrilled” that teams are buying into the idea of collecting data, though hurdles remain.

“I personally believe that there is valuable information to be gained for a player to learn how to perhaps modify his behavior, to track the way in which he’s leading with his head possibly or positioning his body on a certain play type that could help protect him,” Guskiewicz said.

“So, we just sort of have to go through this in a methodical approach to work on the feasibility. This year, I hope that we’re able to move forward with answering some of the questions that we have around potential rules changes, and then the following year, who knows?”

As with most issues, getting players and management to agree to anything is difficult, but if the technology can present a step forward in the accurate diagnosis of concussions and head injuries, then players and the league need to find a way to implement.

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Why no helmet can prevent concussions

This comprehensive article gives an overview of the research that has been done on helmets and concussions, and the article discusses what this research means for football players.

It's a glorious time to be a football fan.

The NFL playoffs are underway, the Super Bowl is just weeks away. The national rite of football gives so many people so many exciting moments. Maybe that's why it can be hard to wrap one's mind around one of the game's huge downsides: what it may do to the brains of the young men who play it.

The spotlight on head injuries in sports, particularly football, has grown more intense in recent years. Last fall, the NFL settled for $765 million dollars in a class action lawsuit by former players over concussions, a case heard in Philadelphia.

Last week, a Mississippi father filed a federal class action suit on behalf of all student athletes asking the bodies governing college and high school sports to provide better and more uniform information on concussion risks.

Many of the sports Americans and young adults in particular love to play – not just football, but hockey, soccer and the rest – risk collisions and jolts to the head that can lead to concussions. Sometimes the signs are obvious, as was the case with Emily Panchak and Patrick Crowley, high school athletes in the Wilmington area.

"I didn't get knocked out, but I was crying, and it hurt really bad," says Panchak, who right after a head collision last spring, couldn't remember the bus ride over to the soccer game that day.

"The way I landed, the way I hit the back of my head on the ground, it just riled me pretty bad," recalls Patrick Crowley, Concord Raiders' football captain, of a concussion that put him out of play for several weeks a few years ago.

Injuries can also be more subtle, cautions Rosemarie Scolaro Moser, a neuropsychologist who runs the Sports Concussion Center of New Jersey.

"The problem with a concussion is true symptoms often don't show till hours or days later," Moser recently told The Pulse. "And with youth, they're more vulnerable to a second hit. So for example, if they haven't fully recovered and they get hit again, that second hit, even if it might not have caused a concussion to begin with on its own, can cause serious damage."

Searching for the magic bullet

Trying to change how games are played to avoid collisions has proven difficult and controversial. It has led to a search for the magic bullet, in hopes of sharply reducing the risk of concussion: better equipment. In football, this often means the helmet.

Some companies have marketed claims to young athletes their headgear could be the better mousetrap.

At Schuylkill Valley Sports in Easton, Pa., Mike Morris estimates two to three high school football players per team have come in to buy their own, more expensive, helmet this past season.

"They're looking to get something better," says Morris. "They're just looking for something that will minimize the risk of concussion."

But do any football helmets really cut down the risk of concussion? And are certain models worth the extra money?

What role do helmets play? 

Halfway across the country, Alison Brooks had a similar experience to Mike Morris at Schuylkill Valley Sports. Brooks specializes in sports medicine at the University of Wisconsin. Parents and young athletes kept asking her which helmets they should get. Many were feeling pressure at school to buy newer ones.

So she designed a prospective study, observing over 1,000 high school football players last year who wore the three most common helmets, including some of the newest models. She parsed out the number of reported concussions based on helmet brand, model and age, to see if there was any big variation.

There wasn't.

"You know as best we can tell they all adequately do what they were designed to do, which is prevent skull fractures, prevent intracranial bleeds, prevent superficial scalp and face injuries," Brooks recently told The Pulse. "But there's not any evidence that any one of them is particularly going to reduce your concussion risk."

Brooks' findings are preliminary, and may not account for other possible external factors. But the results don't surprise Robb Rehberg, a concussion specialist and professor of athletic training at William Patterson University in New Jersey. Rehberg thinks some helmets are doing a better job at protecting the head and "attenuating the forces that typically cause concussion," but while helmet design has improved a lot compared to ten years ago none can, nor should, claim to prevent a concussion.

Other research points to similar takeaways.

Evidence limited

In general, scientists don't know how effective helmets are when it comes to concussions in kids ages 5 to 21.

Kristy Arbogast and Susan Margulies reviewed all the evidence to date for a recent Institute of Medicine Report: Sports-Related Concussions in Youth – Improving the Science, Changing the Culture. Margulies, a bioengineer at the University of Pennsylvania, says part of the challenge is the science behind concussions isn't there yet. There's no standard, objective way for actually identifying and reporting them.

"Evidence that a concussion has occurred is really entirely based on the athlete saying that I think I've had a head injury," says Margulies.

So imagine trying to diagnose an ACL tear and come up with a rehab plan solely on the athlete's description of knee pain rather than an MRI, where the actual injury can be objectively visualized. The IOM report points to another major challenge when it comes to identifying concussions: the culture of sports and pressure to hide injuries.

"Probably one of the most important things we stress to the kids is you have to be honest," George Kasonovich recently told The Pulse.

Kasonovich, head football coach at Concord High School in Delaware, says schools have much better protocols nowadays,thanks to improved education, regulations and awarenessregarding concussions. If one is even suspected on the field, a player's out and can't return without a physician's note.

But Kasonovich's mindset isn't universal. And, athletes also face a lot of pressure to hide injuries. Seniors Patrick Crowley and Keyon Powell are Concord's co-captains. Both have suffered from concussions in the past, and had to sit out for several weeks.

"Some of the worst people to talk to about that are your teammates and your friends because they're always going to want you go out there no matter what you're feeling," says Crowley.

"It's basically the pride of it, you don't want to sit on the sideline, you always want to be out there helping your teammates," says Powell.

It makes the job of the school's athletic trainer, Scott Klabunde even trickier. He doesn't joke around.

"I'm not going to lie, I've threatened them," says Klabunde. "It was 'hey, if you really screw this up, you could die.'"

Technology outpacing science

While helmets do protect against head injuries like skull fractures, relying on them to prevent concussions is problematic for another reason: the limitations in how helmets are assessed.

Arbogast, with the Children's Hospital of Philadelphia, says helmet standards and effectiveness have historically been based on a drop test.

"They take a helmet, they put a humanoid head form - a plastic rubber head form in the helmet - and they drop it a given height and measure its acceleration," says Arbogast. "And there are thresholds below which every helmet must meet."

But in the real world you don't always hit your head in a straight line that way. Arbogast and Margulies both say the manor and direction your head moves are big factors in developing a concussion.

"We know it's a combination of linear movements along a straight line and rotational movements," says Arbogast. "But we don't know the specific level, the magnitude of those movements."

"Nodding your head yes verses 'I don't know' are two rotational motions," says Margulies. "They could have very different risks associated with concussion.

Those concussion risks could also vary based on a kids' age and individual experience. No one hit and reaction is alike. The science, they say, just hasn't caught up with the product development.

"And so without that fundamental data we can't really answer a question about whether a given helmet protects against concussion or not," says Arbogast.

"Current helmets may mitigate rotational accelerations, but we're not measuring it now," Margulies adds.

For the recent IOM youth concussion report, Margulies and Arbogast also examined other kinds of protective equipment, like facial masks and mouth guards. They found no evidence those devices reduce concussion risk, though they are important when it comes to protecting against other kinds of injuries.

Their chapter notes that solely relying on helmets as a way to reduce concussions might have another unintended effect, a phenomenon called "risk compensation" which has been studied a lot in safety literature: "the athlete may be emboldened by the increased protection to take additional risks, thus mitigating any benefits of the protective device."

More to preventing concussions

Despite helmet limitations, concussion specialists caution against relying only on that bit of equipment to prevent or lessen the risk of getting a concussion, anyway.

"The helmet isn't all of the story here," says Arbogast. "We need to understand how particular practice methods or aspects of the game might be able to be modified to protect the head."

Arbogast says that includes teaching different tackling techniques, and developing strategies that go well beyond the playing field, in terms of education and following up for when a concussion occurs, to ensure a full a recovery.

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Bonding agent makes helmet hits safer

A polymer, used as a steel bonding agent, could reduce impacts from helmet-to-helmet hits when applied to the inside of helmets by the polymer absorbing the impact from the hit.

One of the most feared football-related injuries is concussion. With the new NFL and NCAA college seasons just about to kick off, fans will be praying that none of their team suffers any serious impact collisions that could end their season or result in memory loss or depression later in life. University of California, Los Angeles (UCLA) biomechanical engineering professor, Vijay Gupta, is testing a special polymer material that when applied to the inside of helmets, can reduce G-force impact by 25 percent.

The special polymer in question started out as a steel bonding agent designed by the professor for US Navy ships eight years ago. It soon became apparent that the joints forged with this material could withstand the impact forces from explosions. Realizing its potential, Gupta and his team at UCLA have started testing 2 mm-thick wafer size strips of the polymer on the inside of football helmets to reinforce the foam padding.

Professor Gupta describes the human head, a three pound brain encased in the hard shell of a skull surrounded by cerebral spinal fluid, as “the best shock-absorbing system you could ever design.” What it was not designed to do, however, is absorb the forces of a helmet-to-helmet collision with a 350 lb defensive tackle capable of covering 40 yards in under five seconds.

The laws of physics tell us that the force of a hit is affected by three factors: body weight, momentum and how quickly the players stop moving. Footballers seem to be getting bigger and faster these days, which is only going to increase the potential for serious injuries during a game.

In response, the UCLA team are experimenting with different formulations of the polymer, altering its rigidity and viscoelasticity, varying its thickness and the placement of the polymer strips inside the helmet. The data from tests utilizing lasers and hammering machines, shows a 25 percent reduction in the force a person would feel from a helmet to helmet clash with the polymer applied. This translates into a similar decrease in the chance of a player suffering a concussion.

“This is a remarkable reduction given that we are adding such a small amount of material that essentially leaves the current helmet unaltered," Gupta said. “If the helmet is altered too much, the concern is that it might affect how players are forced to play and they might not want to wear it.”

Surprisingly, the reduction of G-forces only happens when the polymer is placed inside the helmet on the foam padding. When they applied the special material on the exterior of the helmet the impact forces were increased not reduced.

Sports shoe tests are also being carried out with 1.5 mm-thick inner soles (thinner than existing impact gel soles) made from the polymer. Results show significant advantages in reducing the knee cartilage stresses experienced by regular runners.

Aside from the sporting world, professor Gupta’s polymer could also find lifesaving applications on the battlefield in protecting combatants from the lethal forces of explosions.

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Concussion myths

This article discusses myths parents believe on concussions in football, and tells what the truth is.

What are some things to clear up before kids hit the fields this fall?

One myth is that if an athlete hasn't blacked out or lost consciousness, they haven't suffered a concussion.

In only about 10 percent of concussion cases does the person lose consciousness. Just because a young athlete doesn't black out does not mean that their brain has not been injured. Symptoms may include headaches, a sensation of pressure in the head, dizziness, nausea as well as mood changes, sleep disruption or loss of memory. In the article on our ParentMap website, we have more information on symptoms.

People often believe that if a child suffers a concussion, adults will know immediately.

In fact, symptoms can take minutes, hours, even a couple of days to develop. This is why it is so critical for an athlete to be benched until they can be evaluated by a certified trainer or medical professional.

Most tragedies due to concussions are preventable as long as the athlete is not exposed to further head trauma.  After a bad first hit, a second hit, even if smaller in force, can have catastrophic results such as second-impact syndrome.

Sanctioned football practices started last week, and that's what we always focus on, but are football players the only ones who need to know about the signs of concussions?

No, that's another thing to dispel. While football has the highest rate of concussion, lacrosse and hockey have high numbers -- and so do girls' soccer, lacrosse and basketball. It's not just a boy thing.

In fact, in sports where the rules of contact are the same for girls and boys, such as soccer and basketball, girls have higher rates of concussion. There are differing theories for why this is, but no definitive research to explain it.

We hear about companies making safer helmets. Do they make a difference?

No. As the University of Washington/Harborview Medical Center doctors in the Seattle Sports Concussion program will tell you over and over again, there is no such thing as a helmet that prevents concussions. Helmets can prevent skull fractures, but compare a mild traumatic brain injury to shaking Jello inside a Tupperware container. Nothing on the outside of the skull can prevent the brain inside from slamming into the hard bones of the skull.

If an adult isn't sure if a child has suffered a concussion, is it better to be safe than sorry and have them sit out?

Yes. In fact, with the Lystedt Law that's been in effect four years now, coaches who even suspect a child has suffered a concussion must pull the athlete until they get properly evaluated by a medical professional. And they have to get medical approval before returning to play. That too is key, because if their brain has not healed and they get hit again, that can be catastrophic.

Before they return to play, are they fine to go about as long as they're not doing the sport?

No, mental rest is actually very important to recovery. Doctors treating concussions will say no TV, video games, test-taking or studying because that can slow the brain's healing.

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Concussions Occur In Youth Football Primarily During Practice, Not Games

A study claims that the majority of concussions in youth football happen during practices rather than during games.

Less contact during practice could mean a lot less exposure to head injuries for young football players, according to researchers at Wake Forest Baptist Medical Center and Virginia Tech.

Their study of 50 youth-league players ages 9 to 12 -- the largest ever conducted to measure the effects of head impacts in youth football -- found that contact in practice, not games, was the most significant variable when the number and force of head hits incurred over the course of a season were measured. Numerous studies in this area have been done on high school and college players, but those findings do not necessarily apply to younger players.

Though more than 70 percent of the football players in the United States are under age 14, there is no clear, scientifically based understanding of the effect of repeated blows to the head in young players, said Steven Rowson, Ph.D., assistant professor at the Virginia Tech-Wake Forest University School of Biomedical Engineering and lead author of the study, which is published in the current online edition of the Annals of Biomedical Engineering.

To quantify youth football players' exposure to head impacts in practices and games over the course of a single season, the researchers employed sensors in the helmets of 50 players on three teams in two different leagues.

The sensors were installed on an elastic base inside the helmet so that they remained in contact with the head throughout the duration of head impact, allowing for measurement of head acceleration rather than that of the helmet. Data from the sensors were transmitted wirelessly to a computer on the sideline and processed to measure both the linear and rotational head acceleration caused by each impact. All data were analyzed on an individual player basis and then averaged to represent the exposure level of a typical 9- to12-year-old football player.

The most important finding was that substantial differences existed among the three teams for both frequency and intensity of the impacts, Rowson said. For the entire season, players on team A experienced an average of 37 to 46 percent fewer impacts than players on teams B and C. For example, the average player on team A experienced 158 impacts during the season, compared to 294 and 251 on the other two teams. This can be attributed to several factors, but the primary reason was that team A had fewer practices during the season than teams B and C, the study showed. During games, impact frequency and acceleration magnitudes were not significantly different among the teams.

In addition, team A competed in a league that had implemented Pop Warner rule changes, including a limit on contact during practice sessions. Teams B and C had no such restrictions.

Although the practice contacts were limited, there were no differences in the head acceleration magnitudes measured in the games between all three teams. The 95 percent head accelerations ranged from 41 g to 45 g for all three teams and were not significantly different. These data show that limiting contact in practices does not create an adverse effect in games.

"It is striking that you can cut head impacts for a player in half just by modifying practice, and it does not seem to change the game," said Alexander Powers, M.D., assistant professor of neurosurgery at Wake Forest Baptist and co-author of the study. "This may be very important in kids where brains are developing."

Coaching style also had a major influence on factors such as the types of drills used in practice and the plays called in games, which would likely contribute to the differences in the head impact exposure that players experienced, the authors reported. "We hope that the findings will help improve the safety of youth football through rule changes to limit contact in practices, coach training and equipment design, especially in developing youth-specific helmets to better reduce accelerations from head impacts," Rowson said.

Funding for the study was provided by the Childress Institute for Pediatric Trauma, the National Highway Traffic Safety Administration and the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences.

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Concussion protection from helmets: There is no safest football helmet

Regardless of how new or old and expensive or inexpensive a helmet is, they all provide the same level of protection from concussions.

Given the recent controversies over concussions in the NFL, you're probably a little leery about letting your kid play football. We can't blame you. Even future Hall of Famer Kurt Warner told the "Dan Patrick Show" last year that he'd be scared for his sons' safety if they followed their gridiron dreams.

Concussions are a problem for football players, from the pro ranks right on down to pony leaguers. Teenage boys suffer the most sports-related traumatic brain injuries – including concussions – each year, most of which stem from playing football or crashing bicycles. No question: There's risk involved in sending your son out to get pummeled at the 50-yard line, so you want him to sport the best helmet available. Just don't get lured into shelling out big bucks or pressuring his school to buy the latest and greatest helmet. According to a new study, safest does not mean newest, flashiest, or most expensive.

Researchers tracked more than 1,300 high school football players throughout the 2012 season and found that all helmets, regardless of brand, model, or whether they were shiny-new or up to 10 years old, offered the same protection from concussions. Which means that when one brand claims its helmets are safer than the competitors' – or that its spendiest model is the best you can get – it's basically an empty ploy for your pocketbook, says lead researcher Timothy McGuine of the University of Wisconsin Health Sports Medicine Center.

According to McGuine, football helmets are tested and strictly regulated by the National Operating Committee on Standards for Athletic Equipment. To make sure they stay in prime working order, all helmets sold to schools must be serviced by the manufacturer every two years and pitched after 10. The result: "Not one NOCSAE-approved helmet is bad," McGuine says. "They're all hard shells with slightly different padding and fixation systems, but to say one is better than another just isn't true."

Given his findings, McGuine says to rest easy when it comes to helmet quality and your kid's concussion risk. Yes, brain injuries are always possible in contact sports, but he's confident football players' heads are as safe as they can be with today's helmets, regardless of whether they cost $250 or $850.

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Helmet type does not lower concussion risk

A new study shows that the helmet type, whether new or old, or extremely pricey or not, does not significantly change the risk of concussion.

Newer, heavier and more expensive football helmets will not lower a player's risk of concussion, new research finds.

A study of more than 1,300 players on football teams at 36 Wisconsin high schools found that players wearing older helmets received just as much protection from concussion as players with flashy new models, said study author Timothy McGuine, senior scientist and research coordinator for the University of Wisconsin Health Sports Medicine Center in Madison.

"The helmet technology is advanced as it can be. They've done a wonderful job. We don't have skull fractures in football," he said. "But I don't know how much padding can be put in to prevent the brain from sloshing around inside the cranium."

This research, to be presented Saturday at the American Orthopaedic Society for Sports Medicine's annual meeting in Chicago, comes at a time when some sports equipment manufacturers are marketing expensive football helmets amid claims that they offer better protection against concussion than earlier models, McGuine said.

"They're all being touted as the next best thing to prevent sports injuries, and it really puts the squeeze on athletic directors and coaches," he said. "Some companies are going right to the parents and saying, 'We know it's too expensive for the school to pay for it, so you should pay for this helmet to protect your child.'"

About 40,000 U.S. high school football players receive a concussion, which is a form of mild traumatic brain injury, every year during play or practice, McGuine said.

As part of the study, licensed athletic trainers at each high school kept detailed records during the 2012 football season. This included recording the safety equipment used by each player, including mouth guards, the number of games and practices in which each player participated, and the number of sports-related concussions sustained.

The players wore helmets manufactured by Riddell, Schutt and Xenith.

Out of 1,332 players tracked, 115 sustained a concussion during the season, McGuine reported.

Researchers found no difference in the rate of concussion by either the type of helmet worn or the helmet's age.

"We found the actual incidence of concussion was not more for players wearing the newest helmets versus wearing helmets 3, 4 or 5 years old," McGuine said. "We also looked at [concussion] severity by helmet model. No difference there, either."

The study also found that players who wore a specialized or custom-fitted mouth guard actually had a higher risk of concussion than players who wore a generic mouth guard provided by their school.

"Should parents pay $30 for a mouth guard to protect their son against concussion, or just use the $1 mouth guard the school provides?" McGuine asked.

The American Medical Society of Sports Medicine released a position statement in January that said hard sports helmets can prevent impact injuries such as lacerations or fractures but have not been shown to reduce the incidence or severity of concussions, said Dr. Anne-Felicia Ambrose, medical director of the traumatic brain injury unit in the department of rehabilitation medicine at Mount Sinai Medical Center in New York City.

"In terms of equipment, there really isn't that much more we can do," Ambrose said. "Where we have a lot of potential for reducing concussion is the way the game is played."

Altering the rules of football games and the guidelines governing practice sessions can make the game safer and prevent concussions, she said.

For example, limiting contact between players outside of competition is one means of reducing concussions, she said. "A lot more concussions occur during practice, when coaches cannot have their eyes on everyone on the field," Ambrose said. "The chance of impact is increased."

McGuine agreed. "I don't see any reason for kids to have full tackle on practice days," he said.

Coaches and athletic trainers also can help reduce injuries by properly fitting each player's helmet at the start of the season and checking the fit every week, he added.

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One fifth of 7th-12th graders claim to have had traumatic brain injury

An interesting study shows that one out of five 7th through 12th graders said they have had traumatic brain injury during their lives.

One in five adolescents surveyed in Ontario said they have suffered a traumatic brain injury that left them unconscious for five minutes or required them to be hospitalized overnight, a statistic researchers in Toronto say is much higher than previously thought.

Sports such as ice hockey and soccer accounted for more than half the injuries, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael's Hospital.

Traumatic brain injuries, such as concussions, were reported more often by males than females, by those with lower school grades and by those who used alcohol or cannabis in the previous 12 months, she said.

The study was to be published Wednesday (June 26) in theJournal of the American Medical Association.

Dr. Ilie said this is one of the first studies of traumatic brain injury to focus only on adolescents and to include all of their self-reported TBIs. Most previous studies based their reporting only on hospital records. Concussion is the most common form of traumatic brain injury.

The data used in the study were from the 2011 Ontario Student Drug Use and Health Survey (OSDUHS) developed by the Centre for Addiction and Mental Health. The survey, one of the longest ongoing school surveys in the world, contains responses from almost 9,000 students from Grades 7-12 in publicly funded schools across Ontario. The OSDUHS began as a drug use survey, but is now a broader study of adolescent health and well-being. For the first time in 2011, questions about traumatic brain injury were added to the survey.

"The questions about TBI were added to the OSDUHS because there were no current data on prevalence in the adolescent population," said Dr. Robert Mann, a senior scientist at CAMH and director of the OSDUHS. "Early research has indicated that there may be links between TBIs and mental health and substance use during adolescence -- we plan to study this in the near future."

The survey found that 20 per cent of adolescents in Ontario said they had had a traumatic brain injury in their lifetime. It found that 5.6 per cent of them had had such an injury in the past 12 months.

Dr. Ilie said this suggests the prevalence of TBI among young people is much higher than previously known, because many head injuries remain uncounted when they are not being reported to parents, teachers, sports coaches or health care workers. In Canada, 50 per cent of all injuries that kill and disable youth involve a TBI.

This new research found that 46.9 per cent of the TBIs reported by adolescent females occurred during sports (e.g., hockey, skate boarding); the figure was 63.5 per cent for males.

Students who reported drinking alcohol occasionally/frequently and those who reported using cannabis 10 or more times over the past 12 months had more than five times and more than three the odds, respectively, of acquiring a traumatic brain injury in the past 12 months than students who reported abstinence. The survey also showed that students who reported overall poor grades at school (below 60 per cent) had almost four times the odds of a lifetime acquired brain injury than students who reported grades at or above 90 per cent.

"Traumatic brain injury is preventable," said Dr. Ilie. "If we know who is more vulnerable, when and how these injuries are occurring, we can talk to students, coaches, and parents about it. We can take preventive action and find viable solutions to reduce their occurrence and long-term effects."

Brain injuries among adolescents are particularly concerning because their brains are still developing. There is growing evidence that people who have had one or more concussions are at greater risk of future concussions, and evidence that multiple brain injuries can result in lasting cognitive impairment, substance use, mental health and physical health harms.

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More concussions in youth football happen during games, not practice

A new study shows that in youth football, more concussions occur during games instead of during practice.

Sports-related concussion has been referred to as an "epidemic" by the Centers for Disease Control and Prevention. Emergency department visits for concussions have increased 62% between 2001 and 2009. Despite the lack of data regarding the rates of concussions in youth football (children aged 8-12 years), concerns have been raised about the sport being dangerous for this age group. In a new study scheduled for publication in The Journal of Pediatrics, researchers analyzed the incidence rates of concussion in youth football players in this age group and found a significantly higher incidence during games compared to practice sessions.

Anthony P. Kontos, PhD, and colleagues from the University of Pittsburgh and Cornell University studied 468 participants, 8-12 years of age, from 4 youth tackle football leagues, consisting of 18 teams. Player exposures were recorded for both games and practices. There were 11,338 total player exposures during the study period, with 20 medically-diagnosed concussions involving 20 different participants; 2 concussions occurred during practice and 18 occurred during games. Players aged 11-12 years were almost 3 times more likely to have a concussion than players aged 8-10 years. The majority of concussions involved helmet-to-helmet contact, and 95% involved players in skilled positions (e.g., running back, quarterback, linebacker). The incidence rate during games was approximately 2 times higher than previously reported, whereas the practice rate was comparable or even lower than previous findings. Overall, players were 26 times more likely to suffer a concussion in a game than in practice.

In the US, approximately 3 million youth participate in tackle football. In light of concerns regarding concussions, Pop Warner, the largest organized league with 425,000 participants, recently limited contact practice time to reduce concussions. However, contact practice time is when proper tackling technique can be taught and reinforced in a controlled environment. According to Dr. Kontos, "Limiting contact practice in youth football may not only have little effect on reducing concussions, but may instead actually increase the incidence of concussions in games via reduced time learning proper tackling in practice." A better approach to reducing concussions in youth football may be to focus on awareness and education among youth football administrators, coaches, parents, and players.

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Comparing old-fashioned leather and modern football helmets

A study comparing old-fashioned leather helmets and modern helmets found that modern helmets provide much more protection than leather helmets.

Researchers at the Center for Injury Biomechanics at Virginia Tech in Blacksburg, Virginia compared the relative safety afforded by two 1930-vintage leather football helmets and 10 modern football helmets during impacts to players' heads. These researchers found that all 10 modern helmets provided significantly more protection than leather helmets used in the first half of the twentieth century, and demonstrated that differences also exist between modern helmets.

Details on their methods and findings are found in "Biomechanical performance of leather and modern football helmets. Technical note," by Steven Rowson, a research assistant professor. Ray W. Daniel, a biomedical engineering graduate student, and Stefan M. Duma, professor and head of the Virginia Tech -- Wake Forest School of Biomedical Engineering, published today online, ahead of print, in theJournal of Neurosurgery.

The authors evaluated leather and modern football helmets by performing a series of 20 drop tests that represent a variety of impacts that could occur during a football game. An anthropometric head form was placed on an adjustable mount suspended from an overhead carriage. Each helmet in turn was placed on the head form, which was dropped in a controlled fashion from heights of 12, 24, 36, 48, and 60 inches onto a standardized anvil to simulate impacts delivered from blows to the head during play. The head form was placed in four different positions before impact simulation -- front, side, rear, and top according to which surface of the head form faced downward -- so that linear acceleration of the helmeted head form in each position could be measured.

Drop tests were used to measure the performance of two Hutch H-18 leather football helmets and 10 modern football helmets that differed in model, manufacturer, and 2011 Virginia Tech Helmet Rating™. The measures were: 5 stars, best available; 4 stars, very good; 3 stars, good, 2 stars, adequate; 1 star, marginal; and no star, not recommended.

Each modern helmet was subjected to all 20 drop tests (four impact locations at five drop heights). Each vintage leather helmet was subjected to 12 drop tests; the 48- and 60-inch drop tests were not undertaken because it was feared that accelerations from those heights might damage the head form when covered by vintage helmets. Drop testing of modern helmets was conducted during an earlier study, at which time the modern helmets were assigned star ratings. Drop testing of vintage helmets was undertaken for the present investigation.

The ten modern helmets were split into two groups: six helmets with a four- or five-star rating in the first group and four helmets with a three-star or lower rating in the second group. The two vintage helmets constituted a third helmet group. Based on the results of the drop tests, the researchers calculated each helmet group's average peak accelerations for each head form position and each drop height.

Rowson and colleagues found that vintage leather helmets were associated with substantially greater peak accelerations for each drop height than all modern helmets. In addition, the researchers found modern helmets reduced the concussion risk by 45 percent for the 24-inch drop height and 96 percent for the 36-inch drop height. Modern helmets with lower star ratings had greater peak accelerations for each drop height than modern helmets with higher star ratings, and the differences in peak accelerations between the two modern helmet groups increased with each increase in drop height. All comparisons were statistically significant at a level of p < 0.001.

The authors state that the purpose of the technical note is to provide insight as to how a previous study (Bartsch A et al. Impact test comparisons of 20th and 21st century American football helmets. Laboratory investigation. J Neurosurg 116:222-233, 2012) could find little difference between older and modern helmets with respect to head impact doses and head injury risks at the severity level of subconcussive injury.

Rowson and his coauthors state that they offer "biomechanical analysis based on helmet testing methodologies that compare relative helmet performance." The source of their disagreement with the Bartsch study centers on the different methods used by the authors of the two studies. Much of the discussion explains how differences in impact testing methodologies can influence the resulting data.

In an editorial companying the paper by Rowson and his colleagues ("Editorial. Leather football helmets," by Adam Bartsch, Edward Benzel, M.D., Vincent Miele, M.D., and Vikas Prakash, also published today online, ahead of print in the Journal of Neurosurgery, Bartsch and his colleagues defend the study they published in the Journal of Neurosurgery in 2012 and state that differences in results between the two studies are based on the different testing methodologies used by the two groups of researchers and the resulting head motions that were induced.

They state that their study simulated both linear and rotational head motion, whereas the drop test used by Rowson and colleagues provided mainly linear head motion. Bartsch and colleagues reiterate that their data demonstrated test conditions akin to common on-field impact scenarios, which cause both linear and rotational head motion. These researchers call for continued examination of experimental protocols that may lead to better quantification of helmet performance during simulated on-field conditions.

In their response to the editorial, Rowson and colleagues discuss points of difference and agreement between the two sets of researchers and their methodologies.

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High school athletes claim they will continue to play with a concussion

A study of high school football players show that they would continue playing football after a concussion.

Many high school football players say it's OK to play with a concussion even though they know they are at risk of serious injury, according to a study to be presented Monday, May 6, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.

The study of 120 high school football players in the Cincinnati area also found that one-quarter had suffered a concussion, and more than half acknowledged they would continue to play with symptoms of a concussion.

"These attitudes could leave young athletes vulnerable to injury from sports-related concussions," said study co-author Brit Anderson, MD, pediatric emergency medicine fellow at Cincinnati Children's Hospital Medical Center.

Dr. Anderson and her colleagues administered two surveys to the athletes to measure their knowledge of concussions and symptoms as well as their attitudes about playing after a head injury.

Survey results showed that 70 percent of the players had been educated about concussions, and most could identify common signs and symptoms. Headache was identified as a symptom by 93 percent, dizziness by 89 percent, difficulty remembering and sensitivity to light/sound by 78 percent, difficulty concentrating by 76 percent and feeling in a fog by 53 percent.

While 91 percent recognized a risk of serious injury if they returned to play too quickly, only half would always or sometimes report their concussion symptoms to their coach.

"Despite their knowledge, many athletes in our sample reported that they would not tell their coach about symptoms and would continue to play," Dr. Anderson said. "A small percentage even responded that athletes have a responsibility to play in important games with a concussion."

The researchers found no association between a student's knowledge score and attitude score on the surveys. "In other words, athletes who had more knowledge about concussions were not more likely to report symptoms," Dr. Anderson said.

"Although further study needs to be done," she concluded, "it is possible that concussion education alone may not be enough to promote safe concussion behaviors in high school football players."

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What parents should know about concussions

This article reviews the signs and symptoms of concussions that parents of athletes should be aware of. - JR

Parents of young athletes know that along with the many benefits of participating in sports, there comes a certain amount of injury risk. And while most would agree that the benefits of being active and involved in athletics outweigh those risks, it’s important to make sure your child gets proper treatment if an injury occurs. As more evidence surfaces about long-term health challenges related to concussions, it’s especially crucial that parents bring themselves up to speed on the proper procedures for caring for an athlete who experiences a concussion.

The most important thing parents need to know about concussions is that if an athlete exhibits any signs or experiences any symptoms of a concussion, he or she should be immediately removed from play. While this recommendation is nothing new, the American Academy of Neurology (AAN) is again emphasizing its importance with the release of its updated 2013 sports concussion evidence-based guidelines.

“Among the most important recommendations the academy is making is that any athlete suspected of experiencing a concussion should immediately be removed from play,” says Christopher C. Giza, MD, co-author of the AAN guidelines. “We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”

For parents unfamiliar with concussion signs and symptoms, they include:

* Headache and sensitivity to light or sound

* Changes to balance, coordination and reaction time

* Changes in memory, judgment, speech and sleep

* Loss of consciousness or a “blackout” (happens in less than 10 percent of cases)

Removal from play is just the first step in properly treating a concussion. After a player who is exhibiting concussion signs or having concussion symptoms is removed, it’s equally important that the player be examined by a licensed health care professional trained in diagnosing and managing concussions. “Being seen by a trained professional is extremely important after a concussion,” says Jeffrey S. Kutcher, MD, co-author of the AAN guidelines. “If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor.”

If your athlete is diagnosed with a concussion, it’s extremely important to follow the recommendations of the health care professional, and the athlete should not be permitted to resume any sports-related activities until he or she is cleared by a licensed health care professional to do so. Parents, coaches and officials should all work together to see that the health care professional’s recommendations are followed, ensuring the best possible short- and long-term outcome for the athlete.

Parents, coaches and officials should familiarize themselves with concussion protocols before they ever get to the field or court, but the AAN also offers a smartphone app should you need to review them. The Concussion Quick Check app can be downloaded free of charge and provides a handy guide to making sure your athlete gets the proper care.

In addition to emphasizing proper care for athletes exhibiting concussion symptoms, the new AAN guidelines include the following concussion-related findings:

* Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.

* An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.

* The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.

* There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained.

* Licensed health professionals trained in diagnosing and managing concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions, and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion.

* Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.

* Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.

To view the entire AAN concussion report and find more concussion resources, visit www.aan.com/concussion.

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