High school concussions are not limited to football

tstevens@newsobserver.comNovember 11, 2012 

  • Concussion myths A. If you’re not knocked unconscious, it isn’t a concussion. Wrong. Ninety percent of the people who have concussions do not lose consciousness. B. Helmets prevent most concussions. Wrong. Helmets are important, but no helmet can prevent a concussion. Concussions are caused by jarring the brain. C. The next concussion is always more serious than the last. Wrong. Every concussion is unique. Multiple concussions are a reason for concern because they can lower the brain’s resistance to the next concussion. D. Three concussions and your child’s athletic career is over. Wrong. There is no magic number. A player should be completely symptom free before returning to play. F. Boys have more concussions than girls. Wrong. A 2007 study indicated that in high school soccer, the girls’ concussion rate is 68 percent higher than the boys’ concussion rate in the same sport. In high school basketball, research indicates the girls’ rate is three times the boys’ rate. G. Mouth guards prevent concussions. Wrong. There is no scientific evidence for the claim. Source: “Concussions and Our Kids” by Dr. Robert Cantu
  • More information Simple tests parents can do There is no surefire test that parents can use to determine whether their child needs to see a medical professional for a possible traumatic brain injury, but parents should be observant and ask their child about how he or she is feeling. Is there a headache? Are the headaches getting worse? Is it hard to concentrate? Does homework cause a headache? A simple test: A. What was the score of the last game? B. What team were you playing? C. What color jerseys was the other team wearing? D. Name four unrelated words and ask your child to repeat them. Wait 2 minutes and ask them to repeat them again. E. Name six digits and ask your child to repeat them. Then ask your child to repeat the digits backward.   Suggestions to make sports safer for children A. No tackle football before age 14 B. No body checking in hockey before age 14 C. Require helmets in field hockey and girls’ lacrosse D. No heading in soccer until age 14. E. Require chin straps for baseball helmets and eliminate head-first sliding F. Hold game officials to a higher standard. Keeping players as safe as possible should be the No. 1 priority. Source: “Concussions and Our Kids” by Dr. Robert Cantu

Concussions are commonly associated with big bodies, big hits and football.

But that sort of thinking puts children in jeopardy, said Dr. Robert Cantu, one of the world’s leading experts on traumatic brain injuries, because concussions also occur in soccer, baseball, softball and even cheerleading. And it doesn’t take a big hit to the head to cause a concussion, he said.

“No head trauma is a good head trauma,” Cantu said in a recent interview from Boston. “If I could pick one thing that I wish everyone understood, it would be that no head trauma is a good head trauma.”

More than 4 million sports- and recreation-related concussions are identified each year, according to the Centers for Disease Control and Prevention, but Cantu said many times that number go undiagnosed.

Football and ice hockey have the highest risk of concussion among young players. A recent study indicated that there are approximately 67,000 diagnosed concussions among high school football players each year, but Cantu, whose new book “Concussions and Our Kids” stresses that common sense solutions can make sports safer for young athletes, wants parents and coaches to understand that concussions occur regularly in many sports.

According to Cantu:

• The person at the top of a cheerleader pyramid is 10 times more likely to suffer a concussion or a catastrophic injury than a football player. “I can’t imagine many things as risky as throwing someone 20 feet in the air with only a few sets of arms between her and a hardwood floor,” Cantu writes.

The National Center for Catastrophic Sport Injury Research at the University of North Carolina noted that there were two high school cheerleading catastrophic injuries during the 2009-2010 school year and the American Association of Neurological Surgeons estimated there were 10,000 concussions in 2011 among cheerleaders, gymnasts and dancers.

• Head-first slides and helmets without straps should be banned in baseball.

• More high school soccer players had concussions in 2010 than basketball, baseball, wrestling and softball players combined, according to the Center for Injury Research and Policy (CIRP) in Columbus, Ohio. Female high school soccer players suffered 25,953 concussions in 2010 and males had 20,247. For comparison, male basketball players had 11,013 concussions.

A concussion is a disruption of the normal chemical activity in the brain and is caused by the brain being jarred. Concussions can cause sensitivity to light or sound, headaches, loss of memory, dizziness, balance problems, confusion, drowsiness, nausea, difficulty in concentration and other problems. Concussion symptoms disappear within seven to 10 days in approximately 80 percent of cases, but symptoms may remain for weeks, months and, occasionally, for years.

Heading and helmets

Cantu said 90 percent of the soccer-related concussions that he treats are related to heading accidents and he believes eliminating heading in soccer until players are 14 years old would move soccer from among the most dangerous sports for concussions to among the safest.

Cantu said he is not so concerned about the ball hitting the players’ heads (only 7 percent of female soccer injuries come from head-to-ball contact, according to the CIRP), but he is very concerned with elbows, shoulders, knees, heads and other body parts smashing into players’ heads as they attempt to head the ball.


In baseball and softball, sliding head-first is inherently dangerous and should be eliminated on the youth level, said Cantu, who is chief of neurosurgery and chairman of the Department of Surgery at Emerson Hospital in Concord, Mass. The chance of the ball and the head arriving at the same moment or the head crashing into another player are too great to allow the use of head-first slides, he said.

The danger is heightened by the use of helmets that can easily fall off during play. Why don’t baseball batting helmets have a chin strap?

“Probably because helmets have always been made without a strap,” he said. “If helmets were made by someone who had operated on a hematoma in a child’s brain, the helmets would have straps.”

Cantu also said all field hockey and lacrosse players should wear helmets.

“Does anyone really believe the girls are safer because they don’t have a helmet on?” Cantu said.

Despite arguments by some in the sports that there would be more blows to the head if field hockey players and female lacrosse players wore helmets, Cantu believes that if you hand athletes sticks and encourage them to swing them, there has to be protection for the head. “But helmets eventually will be mandatory in these two sports,” he said. “There are too many facial injuries, fractured skulls and concussions that could have been prevented. The change will be made soon, so why not make it now?”

Long-term impact

Cantu doesn’t want children to stop playing sports but he wants them to play as safely as possible.

Children are much more susceptible to concussions than adults. Their heads are proportionately larger and their brains still are developing. Cantu is emphatic that children younger than 14 should not play collision sports. He believes ice hockey should ban contact in leagues for children until age 14 and that children shouldn’t play tackle football until they are 14.

“By age fourteen, our necks are strong and our overall strength is sufficient to keep the head steady when slammed at the line of scrimmage,” he writes. “Brains have matured too.”

Other experts, including the University of North Carolina’s Kevin Guskiewicz, believe it may be safer to begin athletes in football at an earlier age when they are playing against players their own size and age. Proper techniques can be developed more safely under these circumstances, he said.

Guskiewicz notes the huge difference in size and strength among high school players can pose increased risks of head injury if athletes do not learn proper techniques earlier in their athletic careers.

In his book, Cantu tells stories of parents who protested his prescribed period of limited physical activity to give the brain time to heal, because the recovery period would take the child out of the lineup.

Cantu stressed that proper care is needed and that all concussions should be taken seriously. A parent who urges a young athlete to ignore headaches and other concussion symptoms is putting their child at risk.

“It is important for children to be involved in sports,” Cantu said. “I enjoy sports very much. But we need to keep the proper perspective. The child’s status on the team isn’t as important as their health. Sports are great. They can teach great values. But parents have to think about the health of their child.”

Stevens: 919-829-8910

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