Health advocates working to prevent athlete concussions: Student, professional players at risk
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* Lindsey Wahowiak

NFL rookie Chris Borland made headlines this spring when the San Francisco 49ers linebacker announced he was quitting professional football after just one season, citing his concerns about the potential health risks of repetitive head injuries.

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Youth play football while wearing helmets and other protective gear to prevent injuries. Concussions are a concern for players at both the student and professional athlete level.

Photo by ActionPics, courtesy iStockphoto

This summer, the University of Minnesota Golden Gophers announced that Olympic silver medalist Amanda Kessel would miss her final year of women’s ice hockey due to a concussion she sustained playing for the women’s national team.

More and more, head injuries and their long-term effects on athletes are at the forefront of the discussions surrounding sports and the implications for children who play them.

In 2010, the Centers for Disease Control and Prevention reported that traumatic brain injury, whether mild or severe, caused about 2.5 million emergency department visits, hospitalizations or deaths. Since then, that number has increased, though head injuries themselves might not have, said Steve Broglio, PhD, ATC, associate professor of kinesiology at the University of Michigan.

“The rates aren’t going up; the reporting is going up, and the economic cost is growing, too,” said Broglio, who is on staff at the University of Michigan Injury Center.

Traumatic brain injury, a disruption of normal brain function caused by a bump or blow to the head, often called a concussion, already has a significant cost. According to a study published in the May/June issue of the *Journal of Head Trauma Rehabilitation,* 2009 estimates showed that the lifetime cost of fatal, hospitalized and non-hospitalized traumatic brain injuries was about $221 billion. Those costs do not factor in lost days at school or work, or extended time spent on either due to long-term effects of head injury.

Public health advocates are stepping up to prevent traumatic brain injuries, or at least prevent their side effects, which include difficulty concentrating or thinking clearly, headaches, irritability, anxiety or sadness. Such injuries have also been linked to sleep issues, lethargy, vision problems and sensitivity to light. And they can include long-term risks for depression, epilepsy, Parkinson’s disease, Alzheimer’s disease and other health issues. According to the Boston University’s Chronic Traumatic Encephalopathy Center, which conducts research through the university’s Brain Bank in collaboration with U.S. Veterans Affairs and Sports Legacy Institute, the vast majority of former NFL players whose brains were donated for research showed signs of the degenerative disease linked to repeated concussions.

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Hockey player Amanda Kessel ended her college playing career following a concussion. Head injuries can cause long-term mental and physical health problems.

Photo courtesy Paul Gilham, Getty Images

Part of the issue surrounding concussions, however, is the relative lack of research on them. Researchers do not know how many or which head injuries can lead to early-onset Alzheimer’s disease, for example. High-profile cases have led the NFL, NHL and even NBA to enact concussion guidelines for players, but very few adults are professional athletes. However, millions of children play sports while growing up, said Larry Cohen, MSW, executive director of the Prevention Institute and an APHA member.

“While we need more research and more information, we can’t let our kids be the guinea pigs while we figure it out,” Cohen told *The Nation’s Health.* “Kids’ heads can’t just be collateral damage.”

To prevent serious injuries in student athletes, CDC launched Heads Up, a campaign to help parents, coaches, school professionals and health care providers recognize the signs of head injuries in young athletes. For example, the campaign provides fact sheets for the adults involved in children’s sports, each targeting what adults can do to spot possible head injuries, particularly coaches, who have the most contact with children during games. The fact sheets are also broken up by children’s ages, highlighting the importance of healing for young brains.

The campaign also outlines the importance of head injury prevention and the healing of concussions, as young athletes who have had one concussion are more likely to have another, according to CDC.

Heads Up campaign resources include online training courses, customizable materials, an app and public service announcements to share, as well as traumatic brain injury survivor stories.

Other programs are working to educate the players themselves. University of New Hampshire researcher Erik Swartz, PhD, ATC, won an NFL Head Health Challenges grant, part of a $3.5 million initiative to fight brain injuries, to study how helmetless practices could teach the school’s football players to hit without using their heads.

The technique, called the Helmetless Tackle Training Technique, teaches players to hit while protecting their own heads, a practice that then carries over to games. The two-year research program will document the decrease in head injuries, as well as where impacts occur on players’ heads.

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Children enjoy a game of soccer. A CDC campaign, Heads Up, helps parents, coaches, school professionals and health care providers recognize the signs of head injuries in young athletes.

Photo by Christopher Futcher, courtesy iStockphoto

## Laws keep injured players off field

Over the past six years, head injury prevention has left the field and landed in the legislature. Washington was the first state to enact a Lystedt Law, named after Zackery Lystedt, a high school football player who was left with permanent disabilities after sustaining a concussion in 2006 and returning to the field too soon. Lystedt laws are designed to prohibit young athletes who sustain concussions from returning to the field until they get an all-clear from a medical professional.

Since Washington’s law was enacted in 2009, every state in the U.S. has adopted some form of student-athlete concussion laws, said Teresa Gibson, PhD, senior director at Truven Health Analytics and faculty research associate at Harvard Medical School. Gibson, who has studied the effects of the laws and published her findings in research published online in December in *JAMA Pediatrics,* said that so far, the laws seem to be doing their job.

“The biggest thing that we found is that it seems like the legislation worked,” Gibson said. “We saw an increase in office visits and neurologist visits. I think we’re seeing a promising trend here with practices that pull kids out when they have a head injury, and making sure they’re not going back in too early.”

Broglio, who worked on the study with Gibson, also noted that changing the rules of contact sports could help decrease players’ risks for head injury at any age. For example, the American Association of Pediatrics has called for hockey to ban body checking in players younger than 15. USA Hockey, the national governing body of the sport, raised the minimum age for checking from 11 to 13 for the 2011-12 season.

That is just a start for Cohen, who sees a need to change rules for professional athletes first. Some sports have already taken action. For example, while basketball has a low incidence of head injuries, the NBA enacted its concussion policy in the 2011-12 season.

The trickle-down effect from such rule changes will protect not only the relatively small number of professional athletes who play for a living, but the millions of young people who play sports across the country as well. Possible changes could include reducing or eliminating heading in soccer, Cohen suggested.

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Researchers at Vicis, who are looking for a way to build better, safer helmets, conduct an impact test.

Photo courtesy Vicis

“If everybody plays the same way, it’s still competitive,” he said. “It wouldn’t change the sport that much, but it would probably have a much more positive impact.”

Many brain injury steps are reactive, meaning they protect players after they have already had a concussion. But some steps are being taken to stop head injuries before they happen.

Samuel Browd, MD, PhD, an APHA member, said better helmets could be the answer. Browd, an associate professor of neurological surgery at the University of Washington, attending pediatric neurosurgeon at Seattle Children’s Hospital and medical director of Seattle Children’s Sports Concussion Program, sees many childhood head injuries in his practice. Part of his job includes making decisions on when to recommend players give up a sport after a traumatic brain injury. Sometimes the end of a student athlete’s career means scholarships are lost — and with them, access to a college education.

Helmet changes may be able to prevent head injuries, Browd suggested. It has been awhile since major innovations have been made in helmet equipment, he noted.

Browd has teamed up with Per Reinhall, PhD, the chair of the University of Washington’s Department of Mechanical Engineering, and Dave Marver, MBA, a medical technology entrepreneur, to form Vicis, a company focused on building a better football helmet. By improving the foam and other materials to make a helmet, Browd said their product is now in prototype trials. Their helmets will be used in the NFL in the 2016-17 season, he added, and they hope to reduce concussion rates by 50 percent in a few years.

“If you reduce the force by 5 percent, you reduce risk by 40 percent,” Browd said. “With pretty small reductions in force, you could have a pretty dramatic drop in the concussion rate.”

For more information about CDC’s Heads Up campaign, visit [www.cdc.gov/headsup](http://www.cdc.gov/headsup).

*Editor’s note: This article was corrected post-publication.*

*   Copyright The Nation’s Health, American Public Health Association