Posts by: CAPP

The NFL, USA Football and 25 other medical organizations and youth sports entities teamed with the CDC in 2007 on the “Heads Up: Concussion in Youth Sports” campaign. The focus of the national “Heads Up”initiative is to improve prevention, recognition, response and management of concussions across all youth sports. A tool kit was developed to provide comprehensive materials to physicians, coaches, parents and athletes. Visit the CDC website now to download the Heads Up: Concussion in Youth Sports toolkit.

Since youth sports administrators play a vital role in sharing educational materials with their coaches, the campaign encourages youth sports program administrators to order and distribute the tool kits to the coaches in their programs at the beginning of the sports season.

The CDC developed partnerships with more than 26 leading health, sports and national organizations. Notably, the NFL is the only participating sports league and USA Football is the only national sports governing body.

Building on the educational outreach of the “Heads Up” initiative and targeting the focus to athletes, the NFL and CDC jointly developed an educational poster regarding concussion prevention, awareness and treatment. The NFL mandated that the poster be prominently displayed in every locker room across the league, making a clear statement about the need for elevated concussion awareness.

As a part of a collective initiative among the NFL, CDC, USA Football and 12 other national sport governing bodies, the NFL created a version of the concussion awareness locker room poster aimed at youth athletes.

A corresponding fact sheet (available in both English and Spanish) for youth athletes is also available. The poster and fact sheet may be downloaded at the CDC’s website.

The NFL created versions of the youth concussion locker room poster and fact sheet customized with each of the 32 NFL teams’ colors and logos. The materials will be distributed to youth athletes from the communities surrounding the stadiums of each team. To view a version of the poster branded for the entire league and CDC, click here. For the fact sheet, click here.

In December 2009 the NFL, in conjunction with the CDC, produced and aired a public service announcement (PSA) devoted to youth athletes as well as their parents and coaches regarding the importance of concussion awareness and the necessary steps to take in order to help prevent, recognize and respond to concussions.

Additional videos and downloadable resources are available on the CDC’s website.

Me and Roger Goodell in his office

Why Roger Goodell invited me to a lunch meeting yesterday

I was asked by NFL staff to attend NFL & USA Football Youth Health & Safety Meeting with about twenty others (concussion safety/parent/sports-social media/press/bloggers) to meet with Roger Goodell and Scott Hallenbeck, USA Football, along top experts in the field of Youth Sports Medicine – Dr. Gerard Gioia Ph. D, Children’s National Medical Center; Division Chief, Dr. Elizabeth Pieroth PsyD, ABPP; Head Injury Consultant, Chicago Bears; Neuropsychologist, and Kelly Sarmiento from Centers for Disease Control and Prevention (CDC). Big name people. I was ready for a first-class PR presentation about how great youth football is and they don’t really need to change… and that is not what I found.

Instead there was heartfelt sincerity by everyone in the room – almost all parents including Dad Goodell and Dad Hallenbeck of youth-sports-playing kids.  And for almost two hours, we talked as just parents… Titles fall away when you share about your children and your fears & hopes for them.

No one has a golden ticket to protect his/her child against a concussion. Despite his paycheck, Goodell cannot buy a better helmet for his child than I can. Despite his sports connections, Hallenbeck cannot protect his kids better than I can my own from a concussion.  We are all vulnerable when it comes to our children and head injuries.  Sadly with concussions, there is truly a level playing field – everyone’s children are potentially at risk on playing fields, playgrounds, gyms, backyards, pools and streets. There is no perfect sport to avoid injury, and there are even concussions in golf and crew (I know of these personally).  And beyond sports, there are concussions in biking, running, horseplay, sledding, climbing trees, backyard fun, etc. We know that the answer is not found in bubble wrapping our kids. There is too much fun and excitement and yummy stuff to be found in the world and especially in sports, so off our children go to the playing fields, the basketball courts, and the baseball diamond.

So is there anything we can do to help our kids in any youth sports? Yes, and the NFL with USA Football want to lead the pack and be the sport that stepped up first to make a difference in a real way.  USA Football believes that in educating parents to know all the same information as the coaches about safety measures, correct tackling methods and proper equipment fittings.  And along with those things as youth sport parents, we need to know how best we can parent on the sidelines, or prepared on the car ride home, or the next morning after a blow that may cause a concussion, to be the best parents we can be and respond if our child needs us.

Both Goodell and Hallenbeck spoke as the leaders that they are about their personal commitment to educate parents and young athletes “about the importance of protecting their bodies and provide them with the resources necessary to do so.” The program they presented, the smart phone App I got to see, and the medical people they have on their team, all combined to be a powerful force to change youth football for the better… and hopefully be an example of a concussion initiative for other sports – soccer, cheering leading, baseball, hockey, BMX, skateboarding, etc. If today was just a preview of what is to come, we will raise a sport-loving, football-playing generation of kids who will wonder how we ever managed to survive without iPhones, TV remotes and concussion-aware football programs.

I have been a volunteer football coach and President of the Westport PAL Football program for the last 17 years. I have been a certified US football coach and a league affiliate for the last several years. In 2007 I began to look at concussion in youth football and how (if anything) we can do to make the game safer and the experience of kids a better one. In 2007 PAL football recorded 30 concussions in one season. In the 2011 season we recorded a record low of 5 concussions in practice. Since that time, I have helped implement a policy in the Fairfield County Football League that all coaches must have concussion training annually. As I do not have any children, my goal is help get as many children playing the great game of football and make it as safe as possible.

We brought in Chris Nowinski to conduct training’s on concussions for all the PAL coaches, parents and players at least 4 times a year. In addition to these training’s, We reduced the amount of contact in practice, changed how we taught the game of football, added a trainer and implemented a new tackling system.

Click for a copy of an independent study by Sports Legacy Institute to show the success Westport PAL has had in reducing the amount of concussion in youth football.

I am more than happy to discuss this with you further and help in any way we can to help make the experience for our youth a better and safer one.

Please feel free to contact me if you have any questions.


Carmen A. Roda

Director of Youth Sports

Westport PAL


The Westport Way: Westport PAL Concussion Consulting Case Study


Westport Police Athletic League (PAL) Youth Sports Director Carmen Roda’s primary goal has been to make youth sports “the best and safest experience for the kids.” With new information showing the concussion problem requires new thinking and strategies for youth sports programs, Roda turned to the non-profit Sports Legacy Institute (SLI) in 2007 to provide the training and guidance that would make Westport PAL arguably the most concussion-safe program in the country.

In 2007, Westport PAL had 30 concussions in practice and games out of nearly 250 football players.

By instituting what they call the “Westport Way,” by 2011 Westport PAL had cut their diagnosed concussions in football by 70%, reduced brain trauma exposure by 50%, and increased enrollment in football and all sports. The case study below explains how Westport PAL and SLI were able to achieve this unprecedented success.


SLI is a 501(c)(3) non-profit organization founded in June 2007 by concussion expert Dr. Robert Cantu, MD, and former Harvard football player and author of Head Games: Football’s Concussion Crisis, Chris Nowinski in reaction to new medical research revealing that concussions and brain trauma in sports had become a public health crisis.  In 2008, SLI partnered with Boston University School of Medicine to form the Center for the Study of Traumatic Encephalopathy (CSTE) (, which is dedicated to the study of Chronic Traumatic Encephalopathy (CTE), a progressive degenerative brain disease that appears to be linked to repetitive concussive and sub-concussive brain injuries and can cause loss of memory, depression and behavior change, and eventually can lead to dementia. The mission of the Sports Legacy Institute is to advance the study, treatment, and prevention of brain trauma in athletes and other at-risk groups.

The Westport PAL is a 503-c non-profit organization that sponsors several community based youth athletic programs. Currently, the Westport PAL sponsors Boys and Girls Basketball, Cheerleading, Boys and Girls Lacrosse, Tackle Football, Flag Football, Track and Wrestling, The total enrollment for all of these dynamic programs is 1,200 kids and comprised of about 1,000 Westport families.

Forming the Relationship

Chris Nowinski was first contacted by Tom Barrecas, a Westport PAL Board of Director, at the time, who voiced his concern about the safety of his football league. Barreca introduced Roda to Chris’s book Head Games: Football’s Concussion Crisis. After reading the book, Roda expressed his desire to work closely with SLI to develop the safest youth sports program in the nation. Barrecas helped facilitate the first concussion education training session for all the head coaches in the Westport PAL Football Program.

After listening to the information Nowinski presented to the football coaches, Westport PAL knew they could be playing football much more safely and wanted the guidance of the experts to develop a plan and put it into action.

SLI – Westport PAL Timeline


  • Education: Nowinski speaks to all head coaches and educates them about concussions


  • Education: Nowinski speaks to all head and assistant coaches
  • Policy: Westport PAL institutes CDC “Heads Up” Remove/Return to play guidelines


  • Education: SLI Advanced Concussion Training required for all head and assistant coaches, parents invited
  • Medical Infrastructure: Certified athletic trainers now mandatory at all football practices and games;
  • Education: All coaches and trainers issued a CDC “Heads Up” Concussion packet


  • Education: SLI Advanced Concussion Training mandatory for all coaches, parents
  • Policy: Reduced amount of full contact in practice;
  • Policy: Concussion/ Return to play policy established and all parents given an additional one page handout;
  • Equipment: Equipment certified and reconditioned annually


  • Education: SLI Advanced Concussion Training mandatory for all coaches, parents; expanded education to Lacrosse programs
  • Training: Implemented new tackling techniques in practice

Getting Buy In

For the Westport PAL to be “the best and safest experience for the kids”, Roda knew he would need to make sure he had support from the coaches, parents, and supporters of the league to make the once considered ‘radical’ changes he wanted to make. Roda also knew that education and openness would be key in preventing and dealing with resistance. Once the parents, coaches, and supporters of the league learned what they don’t know about concussions, his efforts to change and improve the programs would explain themselves.

Westport PAL continued to sponsor SLI concussion education each fall and spring for the PAL, gradually expanding mandatory attendance from head coaches to all head and assistant coaches to include parents and eventually opening it up to the entire town and inviting surrounding communities in 2011. In seeing the success in Westport, the Fairfield County Football League (FCFL) developed a police that all coaches must attend this training annually. Through education, people realized the magnitude of the concussion issue and that everything the League was implementing was directly benefitting the health and safety of the children enrolled in the program.

Westport PAL wanted to develop their staff to be the best possible coaches for people’s most prized possessions, their children. Westport PAL set the foundation for coaches and parents to form a partnership. Roda wanted parents and coaches to realize they are all working together to make youth sports the best and safest experience for the young athletes. Making sure everyone was on the same page was a very important first step in bringing SLI to the Westport PAL to offer their consulting services.

2010 On the Field Changes and Results

The greatest opportunity a football coach has to reduce concussions is by reducing hits in practice. It’s often the most difficult to implement, as historically coaches has associated hitting in practice with proper preparation, toughness, and winning. The reality, however, is that all those things can be accomplished with dramatically fewer repetitions of drills that create brain trauma. The benefit of less hitting in practice goes beyond concussions; research is showing subconcussive trauma (hits that don’t cause any symptoms) may also damage the brain and impair function.

Prior to 2010, players were dressed in full pads everyday and would be participating in scrimmages for a portion of every practice. After SLI’s training, Roda knew he could achieve the same success on the playing fields with less force and trauma to the athletes’ heads by focusing on technique, strategy and tactics. To reduce the number of hits the athletes were experiencing in practice, he started working with his coaches to utilize bags more often and decrease the number and extent of full contact practices.

Roda received immediate criticism that the program would not be able to achieve the typical high level of success they typically see because of the changes in format and structure of the practices. By the end of the season, when the team was playing in the championship game, coaches, parents, and supporters had officially been convinced that teams can be equally successful with less full contact practices. Overall, the players were having more fun thanks to the support and teamwork by the coaches.

Concussions were reduced by an impressive 50%, which is even more impressive considering Westport PAL had added an athletic trainer, who with all else being equal should have been diagnosed more concussions.


2007: 30 concussions in games and practices

2010: 11 concussions in practices, 5 concussions in games, fewer overall injuries

2011 On the Field Changes and Results

With buy-in from the coaches and the learnings experienced in 2010, the following season practice structures included even less contact. In 2011, the Westport PAL Football teams practiced under a new tackling system that was based solely on technique. By focusing on mechanics at half-speed, without pads, athletes were still able to learn to tackle safely without suffering repeated blows to the head. For every six hours of practice, approximately two of them are spent on tackling and with the focus on technique and strategy. When it came to game time, they had not missed a beat, and Westport PAL continued to find their way to the top of standings.


2007: 30 concussions in games and practices

2010: 11 concussions in practices, 5 concussions in games, fewer overall injuries

2011: 5 concussions in practices, 4 concussions in games, even fewer overall injuries

Other Positive Outcomes

As the community began to hear about the implementations Westport was making in order to create the safest league possible, enrollment numbers increased. By keeping parents, coaches, trainers, and all parties involved with the league informed and involved from the start, they built strong relationships with the common goal of keeping the children safe. Thanks to the coaches presenting these changes in a supportive, positive, energetic manner, the children are also having more fun with the new practice structure and drills. The response from the children, coaches and parents has been tremendously positive.

Westport PAL has become a leader in the community, developing a model for great success of their youth athletes in a very safe environment. Over the course of the last two years, by inviting surrounding communities and other athletic leagues to join them for concussion education and to watch practices first hand, Westport PAL has made athletes in other programs safer and earned the respect of their colleagues.

The success of the partnership SLI and Westport have developed has garnered recognition from the media. Dr. Sanjay Gupta of CNN has recently traveled to Westport to and promoted the Westport Way as the future of youth football.


Exciting news! has been invited by the National Football League (NFL) to participate in a forum to discuss making youth sports safer. The event will be held tomorrow at NFL headquarters in New York City. The panel of speakers for the event includes:

  • NFL Commissioner Roger Goodell
  • Scott Hallenbeck, USA Football Executive Director
  • Dr. Elizabeth Pieroth, Board Certified Neuropsychologist, Head Injury Consultant to the Chicago Bears
  • Kelly Sarmiento, Health Communications Specialist, Centers for Disease Control and Prevention

Will report back with news from the event. Please email or call me with any questions you have.

“You go out; your hands go up.”

I found this video a few months ago and tracked down the researcher, Dr. Hosseini, who had an student who loved youtube collect these clips.  Dr. Hosseini wishes to have this information out into the public but he is not a marketer and has other projects which is currently working on in his research.  He has given me permission to share the video and the following links.

The fencing response is an unnatural position of the arms following a concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended (typically into the air) for a period lasting up to several seconds after the impact. The Fencing Response is often observed during athletic competition involving contact, such as football, hockey, rugby, boxing and martial arts. It is used as an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification for events including, but not limited to, on-field and/or bystander observations of sports-related head injuries.


For more information, please visit: or google search “fencing response”

Source: Hosseini, A. H., and J. Lifshitz. Brain Injury Forces of Moderate Magnitude Elicit the Fencing Response. Med. Sci. Sports Exerc., Vol. 41, No. 9, pp. 1687–1697, 2009.

Audio: Rob Dougan – Clubbed to Death (Kurayamino Variation)

This video is intended for educational purposes. It aims to broaden public awareness of traumatic brain injuries as well as physical indicators of such head injuries, especially with respect to those occurring with high-contact sports. All clips were gathered from the YouTube public domain.


Source: Reposted with permission by the author, Dr. Andrew Blecher

“Would I let my son play football?”

It’s a question that more and more parents are asking themselves these days. There are some people out there who say, “No way!”

Football is way too violent and should be abolished as a sport. Even some NFL players admit that they would not let their own sons play football. Then there are others, fierce advocates who think football is a wonderful game with tremendous benefits to its participants and think all of the media hype about injuries are just overrated scare tactics and headline grabbers.

But the majority of us are probably somewhere in the middle and aren’t quite sure what to think. So why don’t we spend a little time sifting through all the facts and emotions and see if we can make some logical decisions about the subject. I have an interesting perspective in that I am a sports medicine physician who is a true fan of the game, has played the game, has sustained injuries and has a son of my own.

Thus I can see the argument from all sides. Let’s start with the physician side. My job is taking care of injured athletes. I see patients with fractures, sprains, strains, overuse injuries, head injuries, concussions, trauma, you name it. During the months of August, September, October and November, I probably see more patients than I do for the entire remainder of the year. Why? Football season.

I make a living off of injured football players. I see the devastating injuries that come in and sideline a football player for a week or a month or a year or even end his athletic career. I see the injuries acutely on the sidelines of games, I see them later in my office, and I even see them years after that.

I see the ex-football players who are in their 40s who have the arthritic knees of an 80-year-old. I see them in their 50s after five or six spine surgeries. And what about the growing numbers of middle-aged ex-football players who are developing cognitive decline from the multiple concussions and head trauma?Dementia, CTE, chronic headaches, depression, the list goes on and on. It’s not just long-term orthopedic problems anymore. It’s not just the chronic knee pain or back pain. These athletes suffer from cognitive, psychological, psychiatric, social, emotional and daily functional problems that even lead some to take their own lives. From this perspective it is easy to ask oneself the simple question: Is it worth it?Especially when I have a 4-year-old son who is so innocent and has his whole life ahead of him. I ask myself: Is this what I want for him? On the other hand, football is a beautiful game. It is the No. 1 sport in America for a reason. Not only is there the physical strength, speed, technique and skill that it develops in its athletes, but it also provides a structure to develop other skills. Learning about hard work, strategy, teamwork, social and trust building skills, these are all life lessons that provide our youngsters with tools to not only tackle their opponent, but to tackle life.

From a spectator perspective it is also a fascinating game to watch. The strategy of the play calling and the intricacy of the formations, the feat of skill of an amazing catch, the excitement of an interception and of course the energizing violence of a hard fumble-causing tackle. Finally, for the athletes themselves there is also the social status of being a football player on the high school or collegiate level. And for some there is the lure of playing professional football with all of the fame and fortune and opportunity that it provides. For many it is the last hope and a way out of an otherwise troublesome life. So how do we balance these two perspectives?

Well, as with any decision in life we must weigh the risks and rewards. So let’s take a logical look at the risks. There is tremendous risk in football. Every year football players in this country die from head trauma or sudden cardiac death or heat illness. Also injuries leading to paralysis and permanent disability are not as rare as we would hope. But what are the true relative risks? It is a fact that head trauma is more common in bicycling than it is in football. Football is then closely followed by playground accidents. Concussions may have a higher incidence in girls soccer than in football. What about the risk of death?

There is a higher risk of dying in a car accident on the way to football practice than there is of dying at practice. So what do we do? If we hold our kids out of football, do we then also stop them from riding their bikes, playing in playgrounds, playing soccer and driving in cars? That would be a very radical and overprotective decision. If we can’t eliminate risk, then we should try to reduce the risks as much as possible. How do we reduce risks in football? There are many ways.

Perhaps the greatest is education and awareness. Proper pre-participation screening, heat illness prevention, proper equipment, proper tackling technique, concussion baseline testing and injury monitoring, and there are many others. We also reduce risk by reducing exposure. Limiting the number of hits by limiting full contact practices will reduce injury rates. Rule changes such as on kickoffs will change play dynamics and reduce injury exposure as well. Penalizing dangerous technique such as hits to the head and hits on defenseless receivers and fining flagrant acts of dangerous unsportsmanlike conduct will also reduce risk.

Changing the culture of the game will also go a long way toward limiting violence and increasing injury reporting and monitoring. Should the violence completely disappear? Should the game be more about pure skill and less about physicality? It probably shouldn’t. After all, what does a non-violent, non-physical football game look like: It’s called the Pro Bowl. And nobody watches it. So I don’t think the game needs to be radically changed and the violence completely eliminated, but clearly there does need to be change. Luckily that change has finally arrived.

Football has gone through periods of significant change in the past. From being saved from extinction by Teddy Roosevelt in 1905, to the development of the forward pass, to the fearlessness of the hard-helmeted athlete, there have certainly been many periods of change. I think we have now arrived upon another one. An age of enlightenment so to speak. An awareness of the importance of injury prevention and a culture change of what it means to be an injured athlete. I do not think that the game of football that has been played over the last decade will be the same as that played by my 4-year-old when it is his turn.

So what of my 4-year-old? I have given many lectures on concussed athletes. I have lectured to parents, athletes, coaches, doctors, athletic trainers, pretty much to anyone who is willing to listen. I speak to small groups and I speak at national meetings. I warn people of the dangers of concussions and their long-term consequences. I talk specifically about football as a collision sport and the risks of the sub-concussive events.

The pure repetitive hitting of the head that occurs with almost every block or every tackle. The micro head trauma that occurs about 4,000 times during a high school or collegiate career that no helmet or headgear can protect against. These head collisions may not cause any symptoms at the time, but we are learning that it is these very repetitive head collisions that are likely what truly leads to the cognitive decline, the dementia and the CTE. So inevitably I get asked at the end of every lecture, “If these head collisions are unavoidable, and this is the nature of the game, and we know the long-term outcome risks . . . would you let your son play football?”

So what is my answer? In my own risk vs. reward calculation I come up with a qualified yes. I believe that playing football has tremendous value but it also has tremendous risk. If not football, then my son would probably want to play some other risky sport instead like motocross, and there is no way that I am letting him get on a motorcycle. So as a parent what do I do? When that day comes that my son says, “Dad, I want to play football.” How do I respond?

I will educate my son and make sure that he is well aware of the risk vs. reward decision himself. If he decides on his own that he wants to play, then I will help him personally and I will also help his community to make sure that there is adequate injury awareness and prevention. I will also encourage him to practice risk averse behavior both in his technique as well as in his attitude. Finally, I will make him aware of the risks of the repetitive head collisions and I will encourage him to play a position that does not emphasize this.

I will hope that he doesn’t want to be a lineman or a linebacker or a running back. But ultimately the answer will be, “Yes.”

“Yes, son, I will let you play football. Now let’s go outside and practice your field goal kicking.”

Dr. Andrew Blecher is a board certified sports medicine physician at the Southern California Orthopedic Institute. He provides concussion management for both amateur and professional athletes including youth sports, high school and college, and he also has experience as a physician in the NFL as well as for the Los Angeles X-Games. Dr. Blecher is also the director of the SCORE Concussion program, which, in partnership with the Wells Fargo Play it Safe Program, provides comprehensive concussion insurance coverage for 10 Los Angeles-area high schools. You can also follow him on Twitter for the latest concussion information: @the_jockdoc

July 1, 2012



Katherine searches the web every day to find and update Sports CAPP’s BEST EVER resources for her twitter followers and people who follow her on my blog and FB pages. Here are the July Sports’ CAPP BEST EVER:

Best video ever

Best app ever

Best online FREE Training where you get a certificate

Best article ever on kids and football (reprinted on our site with permission)

School medical professionals play an important role in the health of all students.  Recognizing the signs and symptoms of concussion is important, as is managing their return to school post-injury.  Here are some key facts:

  • Some students may not experience or report symptoms until hours or days after the injury.
  • Most young people with a concussion will recover quickly and fully.
  • But for some, concussion signs and symptoms can last for days, weeks, or longer.


CDC’s guide for school professionals: helping students return to school after concussion  

Each year hundreds of thousands of K-12 students sustain a concussion as a result of a fall, motor-vehicle crash, collision on the playground or sports field, or other activity. Most will recover quickly and fully. However, school professionals, like you, will often be challenged with helping return a student to school who may still be experiencing concussion symptoms—symptoms that can result in learning problems and poor academic performance.

Knowledge of a concussion’s potential effects on a student, and appropriate management of the return-to-school process, is critical for helping students recover from a concussion.


National Association of School Nurses

Concussions: The Role of the School Nurse  

It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as school nurse) is an essential member of the team addressing concussions. As the school-based clinical professional on the team, the school nurse has the knowledge and skills to provide concussion prevention education to parents, students and staff; identify suspected concussions; and help guide the student’s post-concussion graduated academic and activity re-entry process.  The school nurse collaborates with the team of stakeholders including health care providers, school staff, athletic trainers, and parents.


CDC’s Heads Up to Schools: Know Your Concussion ABC’s
Children and adolescents are among those at greatest risk for concussion. Concussions can result from a fall, or any time a student’s head comes into contact with a hard object, such as the floor, a desk, or another student’s head or body. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education(PE) class, playground time, or school-based sports activities.


Signs/symptoms checklist This sheet is printable for school nurses or coaches to use when a kid has a possible head injury.


CDC’s Heads Up to Clinicians: video training 
Heads Up To Clinicians: Addressing Concussion in Sports among Kids and Teens is the focus of a new concussion training program produced by the CDC Foundation with a grant from the NFL. The course includes information that will guide medical professionals in the diagnosis and management of concussions in youth athletes on the sideline, in the office, in the training room, or in the emergency department.

The five video modules include:

  • Course overview and introduction
  • Pathophysiology of concussions
  • Diagnosing a concussion
  • Management of concussions
  • Preventing concussions

1 week of prescribed rest helps both early in recovery and weeks or months after injury


Because a concussion impacts the brain’s cognitive functions (those that involve thinking, concentrating, learning and reasoning), most concussion experts1,2 believe that limiting an athlete’s scholastic and other cognitive activities to allow the brain time to heal helps in recovery.  But, while cognitve rest is considered the “cornerstone” of concussion management, there has been until now no empirical evidence to support such treatment recommendation.

Now there is.

In a soon-to-be-published study of concussed high school students reported in the Journal of Pediatrics,researchers – led by MomsTeam concussion expert neuropsychologist Rosemarie Scolaro Moser, PhD – found that, after one week of strict cognitive and physical rest (see box below), concussed athletes scored significantly better on neurocognitive tests and reported statistically significant decreases in the number and severity of post-concussion symptoms.

The beneficial effects of the week of rest were seen whether the rest came soon after a concussion or weeks to months later. Indeed, more than a quarter of the sample which continued to experience concussion symptoms past the 31-day mark (defined by some as the point at which post-concussion syndrome is diagnosed) still demonstrated improvements with prescribed rest which were comparable to those experienced by concussed athletes in the study who were still in the early stages of concussion recovery.

“Our results represent the first data documenting the efficacy of prescribed rest for the treatment of post-concussion symptoms and cognitive dysfunction, whether the rest is applied in the early or prolonged stages of recovery,” Moser notes.  The idea that cognitive and physical rest may help improve the condition of patients with post-concussion syndrome is [also] noteworthy,” she writes, because “there may be a perception among clinicians that once the 7- to 10-day time period in which the neurometabolic “cascade”4 has passed, and a patient continues to experience concussive symptoms, cognitive and physical rest is of limited use.”

Recent research5 suggests that blood flow to the brain was still reduced in more than a third of 11- to 15-year-olds even at 1 month or more post-concussion, which, Moser argues, not only “supports an even longer recovery period than typically thought but is consistent with the notion that a period of rest may be therapeutic” in treating post-concussion syndrome.

“Without evidence to support the case for rest, especially when weeks or months have passed since the injury, clinicians are met with resistance from athletes, parents, and school and athletic officials who do not see the therapeutic value of missing school or sports when many weeks have already passed,” the study notes. “Athletes, parents, and coaches may balk at the need for, or effectiveness of, rest and inactivity.  Without supportive empirical data, patient compliance is threatened and clinician judgments are often challenged and threatened,” says Moser.

“Our research now provides clinicians with solid evidence to show athletes, parents, schools and teams that rest really helps and should not be underestimated, no matter how long the time from injury,” says Moser. “I hope it helps us debunk the mistaken philosophy that it is better to push through the pain, than to take the time to heal.”


 Cognitive Rest
Time off from school
No homework
No reading
No visually stimulating activities, such as

  • computers
  • video games
  • texting or use of cell phones
  • limited or no television

  • Exercise
  • Athletics
  • Chores that result in perspiration/exertion
 No trips, social visits in or out of the home
 Increased rest and sleep

Study limitations

Dr. Moser was careful to note that her study comes with “significant limitations”:

  • It was retrospective in nature, and thus lacks blinding, randomization, and comparison with a control group, thus making it difficult to definitively show that observed improvement in neurocognitive test scores and decreased symptoms was actually the result of prescribed rest;
  • Prescribed rest, as a construct, needs to be more accurately defined for future studies to consider and control for such factors as:
    • type (physical versus cognitive)
    • length of rest period; and
    • degree or nature of prescribed rest (for example, no school versus partial school days or school attendance but no note-taking, homework, tests, computers, etc.);
  • Other variables need to be considered to help determine just how effective prescribed rest is as a concussion treatment, such as time since concussion (e.g. before the rest is prescribed) and severity of concussion symptoms at injury;
  • Compliance with prescribed rest was not specifically monitored or documented on a daily, prospective, systematic basis, and, given the age of the athletes in the study (14 to 23, mean age of 15), it is challenge to achieve 100% compliance;
  •  The study involved a small, selective,”convenience” sample of 49 high school to college age athletes seeking treatment from Dr. Moser’s Sports Concussion Center of New Jersey; as a result, more detailed consideration of and control for such variables as age, sex, ADD/LD, intellectual ability, and years in sports and type of sport was not possible;
  • No baseline cognitive testing was analyzed as few patients had such data available, so it was not known to what extent considering change from baseline would affect the interpretation of the study’s results; and
  • Data was not recorded or coded documenting on-field signs and/or symptoms at the actual time of injury.

Rest: deceivingly simple concussion treatment

“Although interpretation of the present study must be tempered by the fact that the group sizes are small, these data are compelling and the first to be presented that give credence to the importance of prescribed rest as a concussion treatment,” Dr. Moser says. “With so little currently known about rest from a research perspective, it is hoped that the present study will stir interest in this deceivingly simple, yet complex, construct and important treatment for concussion.”

1. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br. J. Sports Med. 2009:43:i76-i84

2. Halstead, M, Walter, K. Clinical Report – Sport-Related Concussion in Children and Adolescents. Pediatrics 2010;126(3):597-615.

3. Moser RS, Glatts C, Schatz P. Efficacy of Immediate and Delayed Cognitive and Physical Rest for Treatment of Sport-Related Concussion. J Pediatrics DOI: 10.1016/j.jpeds.2012.04.012 (in press).

4. Giza CC, Hovda DA, The Neurometabolic Cascade of Concussion. J. Ath Train 2001;36(3):228-235.

5.  Maugans TA, Farley C, Altay M, Leach J, Cecil KM. Pediatric sports-related concussion produces cerebral blood flow alterations. Pediatrics 2011;129:28-37.

Posted June 19, 2012

Read more:

Concussions are typically associated with grossly normal structural neuroimaging studies. In other words, unlike other injuries, concussions are usually injuries no one sees and, contrary to popular belief, don’t show up on most magnetic resonance imaging (MRI) exams or CT scans. As a result, conventional CT or MRI scans of the brain are usually not needed where post-concussion signs or symptoms are mild and clear within a week to ten days.

A CT or MRI is, however, recommended in some circumstances, including where there is or has been:

  • Loss of consciousness (LOC) for more than a minute (remember: a concussions may or may not involve LOC, with 90% of all concussions occurring without LOC);Doctor examing head CT scan results
  • Prolonged impairment of the conscious state, especially if there is any suggestion of a deteriorating level of consciousness;
  • Dramatic worsening of a headache;
  • Speech or language difficulties such as aphasia or dysarthria (impaired speech and language skills), poor enunciation, poor understanding of speech, impaired writing,impaired ability to read or to understand writing, inability to name objects (anomia)
  • Vision changes such as reduced vision, decreased visual field, sudden vision loss, double vision (diplopia)
  • Neglect or inattention to the surroundings on one side of the body
  • Loss of coordination, or loss of fine motor controll (ability to perform complex movements)
  • One-sided eyelid drooping, lack of sweating on one side of the face, and sinking of one eye into the socket
  • Poor gag reflex, swallowing difficulty, and frequent choking
  • Seizure activity; or
  • Worsening post-concussion signs or symptoms, or persistent symptom (longer than 7 to 10 days)(e.g. post-concussion syndrome)

CT or MRI?

A CT scan is the test of choice to evaluate for the four types of intracranial hemorrhage (subdural, epidural, intracerebral, or subarachnoid) bleeding in the brain, swelling of the brain during the first 24 to 48 hours after injury, or to detect a skull fracture because it is faster, more cost-effective, and easier to perform than an MRI.  No test, however, currently available is sensitive and specific enough to diagnose all intracranial  injuries.

An MRI may be more appropriate if imaging is needed 48 hours or longer after an injury and is best coordinated through your child’s primary care physician or the specialist evaluating your child.  Because MRI is viewed as superior in detecting traumatic lesions of the brain, and does not expose patients to radiation, a 2011 study3recommends its use for assessing traumatic sport-related brain injuries, especially after the acute period.

Note of caution

The use of CT scans in diagnosing concussion is surprisingly common among neurologists (a 2011 study3 found the CT rate among neurologists at 72.2%), a rate the study’s author and MomsTEAM concussion expert, William P. Meehan, III, MD, said was “probably higher than it needs to be.”  Given the results of a a new study reported in the British medical journal, The Lancet4  that children and young adults scanned multiple times by CT have a small increased risk of leukemia and brain tumors in the decade following their first scan, parents should make sure a CT scan is really necessary in treatment of their child after head injury.

Source: Halstead, M, Walter, K. “Clinical Report – Sport-Related Concussion in Children and Adolescents”  Pediatrics. 2010;126(3): 597-615.

1. Concussion Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008, P. McCrory et. al, Br. J. Sports Med. 2009; 43; i76-i84.C

2. Sport Concussion Assessment Tool 2 (SCAT2)Br. J. Sports Med. 2009; 43; i85-i88.

3. Meehan WP, d’Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).

4. Pearce MS, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet. June 7, 2012 (published online ahead of print).

Revised and Updated June 20, 2012

Read more:


Equipment Group Issues Warning To Athletes and Parents about Concussion Claims

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) is warning athletes and their parents of the need to thoroughly understand the extent of protection provided by – or not provided by – athletic equipment worn while playing sports.Football helmet lying on grass

NOCSAE’s warning comes in the wake of claims by several companies that their products such as head bands, supplements or mouth guards reduce the incidence of concussion, and was made at the beginning of the group’s summer meeting in Kansas City.

“Parents, athletes and coaches are becoming more informed about concussions, and this increased awareness is vitally important to advancing athlete safety. But it also creates a demand for quick solutions. Unfortunately, there are quick solutions offered for sale which have neither scientific nor medical support that validate their claims to prevent or reduce concussions,” said Mike Oliver, NOCSAE executive director.

“Any device or supplement promoted as being able to prevent, diagnose or cure a concussion must be supported by scientific data and peer-reviewed research. Currently, there is no definitive scientific research linking mouth guards, head bands, supplements or other specialty products to a reduction in concussion risk or severity. For companies to suggest otherwise misleads athletes, parents and coaches into a dangerous false sense of protection against concussion. NOCSAE warns athletes and parents of athletes to get the facts about sports equipment and concussion protection and not rely solely on marketing and promotional materials when making equipment decisions.”

NOCSAE is an independent organization with the dual purpose of setting standards for the performance of athletic equipment and funding research necessary to advance the science of sports. Through NOCSAE’s independent process, physicians, academic researchers, coaches, trainers and manufacturers come together to establish standards based on accepted science and reliable data.

NOCSAE does no, however, maintain any standards for such products, and, therefore, no such products can be claimed as meeting the NOCSAE standards. While protective equipment certified to the NOCSAE standard play an incredibly important role in protecting athletes on the field of play, they should be not the primary approach to protecting against concussion. Learning to avoid unnecessary head impacts (e.g. proper tackling), honest self-reporting of concussion symptoms to a coach or parent, and following trained medical management decisions about when a concussed athlete can return to play are far more likely to prevent a concussion or reduce the chance of chronic problems that may be related to untreated concussions.

Source: NOCAE via PR Newswire

6/21/2012 @ 9:51AM |1,298 views

Since 1989, Riddell, Inc. (Riddell) has been the official helmet of the National Football League (NFL).  John T. Riddell established the company in 1927, but it was not until 1939 that its first soft plastic-shell football helmet was released to the public.  Advancements in technology and thinking have allowed members of Riddell to make improvements to its football helmets, which include web sling suspension, a chin strap, and the face mask.  By 1979, net sales for the company reached $15.1 million.

In 1991, the year that Riddell Sports became a public company, net revenues were up to $35.5 million.  Today, Riddell is a part of Easton-Bell Sports, Inc., and the companies find themselves caught in the line of fire with little protection to guard themselves from the hard hits that they may take in the pending NFL concussion litigation.

[Related: Easton-Bell Sports First Quarter 2012 – 10Q Filing]

The main allegation made by the roughly 2,500 plaintiffs seeking damages against Riddell is that the helmet manufacturer had a duty to protect NFL players against the long-term risk of concussions, yet defaulted on that obligation.  Further, the plaintiffs believe that Riddell falsely marketed their helmets as having the ability to reduce the risk of concussions by a substantial percentage and has failed to warn plaintiffs of the long-term health effects of concussions.

In conducting research for this article, I came across an article in the Pittsburgh Tribune-Review titled, “Now, concern turns to football helmet”.  It was written by Karen Roebuck and Joe Starkey and published on June 16, 2006, but for some reason the article was no longer accessible.  I happened to get my hands on the article and found at least one reason why Riddell would probably prefer to keep that article away from plaintiffs that have filed suit.

[Article: Now, concern turns to football helmet]

Roebuck and Starkey had focused their article on Pittsburgh Steelers quarterback Ben Roethlisberger’s anticipated use of Riddell’s Revolution helmet.  This is the helmet that plaintiffs refer to in their Master Complaint, pointing out that Riddell marketed the helmet as reducing concussions by 31%.  In their article, Roebuck and Starkey included comments from Marty Cothern, a Riddell key account manager.  According to the article, the following statement was purportedly made by Cothern:

The helmet was designed to protect players from concussions but also provides the best jaw protection available on a football helmet. (emphasis added).

That statement, alone, could potentially open the door to liability.  There should certainly be concern if Riddell was making public statements, through its employees, that its product could effectively protect players from concussions and players operated under the guise of such protection.  In the same article, quarterback Mark Brunell was quoted saying, ”I don’t care if some guys may think it looks silly…if it fits fine and gives me a lesser chance of getting a concussion, I’ll wear it — I’ll keep wearing it. Concussions are not a lot of fun. Once you have one, you never want to have one again.” (emphasis added).

But was the helmet actually reducing the risk of concussion, and were Brunell and other quarterbacks buying into Riddell’s marketing of the effectiveness of its helmet?

Mark Picot, Executive Vice President of Mahercor Laboratories, LLC, says that the helmet was widely panned and supported by fraudulent research.  Mahercor Laboratories, LLC produces the Maher Mouth Guard, and claims that since its development, no NFL Player wearing any products in their product line has ever succumbed to a concussion from a blow to the jaw.  It is fair to say that Picot is no fan Elliot Pellman, the former head of the NFL’s concussion committee.  ”Pellman and his crew decided to manipulated research in order to minimize the dangers of concussion and with the hope of selling helmets for Riddell,” said Picot in an email.  ”Who profited? Who paid the price?”

Darren Heitner is an attorney at Wolfe Law Miami, P.A. in Miami, Florida, Founder of Sports Agent Blog, Professor of Sport Agency Management at Indiana University, and Co-Founder of Collegiate Sports Advisors.  Follow him at @DarrenHeitner.

By Leslie Reed \WORLD-HERALD BUREAU | Posted: Wednesday, June 20, 2012 9:47 am

LINCOLN — A University of Nebraska-Lincoln brain researcher is at the forefront of a newly announced partnership between the Big Ten and the Ivy League to study head injuries in sports.

Dennis Molfese, a developmental psychologist who heads UNL’s Center for Brain, Biology and Behavior, says the new partnership offers unprecedented opportunity to study how concussions and other head injuries affect the workings of the brain.

“For the first time,” he said, “we’ll be collecting large amounts of data from a large number of people — more than had ever been tested before.” The collaboration will enable scientists to examine athletes’ brains before and after they have suffered a concussion, to learn more about how concussions damage the brain and how the brain recovers from the injury.

“We should know more in a year or two about how to assess concussion and track its progress than we’ve learned in 100 years,” Molfese said.

Sports-related head injuries, particularly in football, have garnered increasing scrutiny in recent years, with studies showing that retired NFL players are more prone to dementia and depression if they had suffered multiple concussions during their careers. The suicide last month of former linebacker Junior Seau fueled speculation that his death, like that of several previous suicides by former NFL players, might have been linked to degenerative brain damage resulting from repeated head injuries. Multiple concussions can result in a degenerative disease called chronic traumatic encephalopathy.

Such findings have led to a congressional hearing, additional rules in the NFL and a class-action lawsuit against the NFL involving more than 1,000 former players. Nebraska is among a number of states in recent years to pass concussion safety laws to protect young athletes.

A typical major college football program experiences about 20 concussions per year among its athletes, Molfese said. With 12 Big Ten and eight Ivy League teams to draw from, scientists would have the ability to analyze about 400 injuries a year and to compare brains after injury with baseline MRIs taken of young athletes when they enter the program.

Big Ten and Ivy League officials officially announced the new partnership Tuesday. The effort has been in the works for more than two years.

An official with the Committee on Institutional Cooperation — the Big Ten’s academic arm — called the new partnership “the deepest and most significant research collaboration we’ve launched.”

“It draws perfectly on the intersection of great medicine, greath athletics and great academics that characterizes what is best in our universities,” said Barbara McFadden Allen, executive director of the CIC.

University of Iowa President Sally Mason and Princeton Univeristy President Shirley Tilghman, who serve, respectively, as chairwomen of the Big Ten’s Council of Presidents/Chancellors and the Ivy League’s Council of Presidents, also touted the new partnership.

“It will provide an incredible boost to our ongoing efforts while reinforcing the priorities of institutional research and reciprocity between some of the nation’s top academic organizations,” Mason said.

“The Ivy League is committed to fostering a safe and healthy environment for our student athletes,” Tilghman said. “By pooling our expertise and resources, our institutions aim to significantly expand upon the resarch needed to improve long-term, concussion-prevention measures.”

Molfese is an Oklahoma native whom UNL wooed away from the University of Louisville in 2010. New quarters for his laboratory are being built as part of the expansion and renovation of the east side of Memorial Stadium. The lab is scheduled to open in July or August 2013.

Nebraska Athletic Director Tom Osborne agreed that the Athletic Department will contribute $1.5 million toward the cost of outfitting Molfese’s laboratory, which will include a sophisticated MRI machine that studies brain activity.

Molfese also serves as coordinator of the Big Ten’s research into athletic brain injuries. As such, he helps organize the work of some 44 scientists, team physicians and athletic trainers, tackling issues such as common research standards among participating universities’ institutional review boards; establishing a central repository for collecting and maintaining data; and developing standard formats for data.

Although the research will focus on athletes, it has implications far beyond sports, Molfese said. It also could help the person who suffered a brain injury in a car accident, the child who was hurt in a shaken-baby incident and the newborn who was deprived of oxygen during birth.

“We should definitely be able to make (football) much safer, and if injuries do occur, students will have a better prospect of recovery,” he said. “But there are 1.5 million new head injuries each year in the U.S. and sports injuries are a relatively small part of that.”

Author: Katherine Snedaker

Baseline testing your players is very important for all youth sports teams for players over the age of 11. Even the impartial CDC is now on board and has printed an education flyer for teams to use to support of baseline testing for all youth athletes. But at the same time, there is also new emphasis on training all coaches with concussion awareness and sideline management of possible head injuries. While teams who fall under their state concussion laws must follow certain requirements, most non-school, volunteer-run teams have choice and most cannot accomplish both in one season. As the Concussion Advisor for our State Lacrosse League for the last few years, I have often asked which one should a team focus on first. After working in this field for several years, testing kids as a coach and as part of a concussion clinic, I have a clear answer based on my experience.

Always spend your time, money and effort on Coaches Training first.  Baseline testing is important; however, it is a second step after coach, player and parent education. Here is why…

While baseline testing is valuable, I have seen teams use testing to address concussions in their sport in place of educating coaches, parents and players. Ideally both testing and education should be put in place at the same time. As a concussion social worker and a former youth coach, I started out of my personal frustration when I keep receiving the same type of phone calls from upset parents who had ImPACT tested their kids. The following is a true story and is not unique at all. I can pick really any sport – boys or girls’ teams – and recount a similar story.

A hockey team signed up for ImPACT testing instead of both testing and concussion education for their coaches. Like most leagues, this team did not think they had the time for their coaches to be trained and so they only offered ImPACT testing to their players. A fraction of the players who signed up for testing were kids who already had already had a concussion.  Their parents already knew about value of ImPACT testing with their experience with ImPACT in the past. Despite growing awareness in sports about concussion, I have found that parents who have not had any previous concussion education tend to not sign up their kids for testing if testing is offered as optional by the team.

So the hockey season started and a few games into the season, a boy took a hard hit to his head as he was slammed into the boards. Coming off the ice, the hockey player told his coach that he had no headache, but his vision was so blurry so he could not read the numbers on the back of the other players’ jerseys. The coach who had no concussion training thought the kid was joking and so sent this player back into the game. The coach did not know blurry vision was a sign of a concussion and that any player with a hard hit to the head should sit out for 24 hours, even with no immediate sign of a headache. The player also did not know this was a sign of a possible concussion.

After two minutes of skating without any additional hits, this player collapsed on to the ice and hit his head again. At this point, his worried parents rushed down the stands to their son now unconscious on the ice. The parents had doubts after their son’s first hit, but trusted the coach to make the “right call.”

While having an baseline ImPACT test helped this player’s doctors after the injury, training for this coach could have prevented the second blow to this player’s head and may have reduced the long recovery this player might suffer to heal from this concussion. But everyone thought they had done the best they could – The youth hockey player took his ImPACT test, his parents felt reassured they had protected their son, and the team felt confident they had taken steps towards a safer season, but the key piece education for coaches, parents and players was missing. What if the coach had known the signs? Or the player himself said, “Coach, I think I have the signs of a concussion?” Or the parents had insisted on speaking to their son after such a hard hit and knew to pull him when he complained of blurry vision?

I receive several calls a month from families with very similar stories. I hear regret from parents over and over when they wish they had checked on their child after a blow to the head, but they trusted the coach to make a call.  Being a coach for a number of years, I do appreciate when parents let me do my job; however, when it comes to head injuries, I use my cellphone and call the parents to the bench to see their child, and make them an active part of the process. If I believe a child should not return play, I do not let a parent talk me out of my decision. But a parent has doubts about a child who I think could return to the game, I go with the parents’ gut and remove the child from play.

A player with a second blow to the head in a game or practice risks longer recovery times and in very rare cases, even death. I am afraid that in “only offering ImPACT testing,” sports teams are feeling secure that they have addressed the safe issues around concussions. Coaches’ training is put off until next year. Since the management in these sports teams haven’t been educated why the coaches and parents and players all need concussion education, they are missed the point of protecting the kids before a second injury. With simple, quick educational programs, coaches can remove players from play as soon as there is a suspected head injury, players can raise their hands and say, “take me out,” and parents can feel confident when to say, “you are done for the day.”

With education for coaches, parents and youth athletes, it is easy to live by CDC’s motto is ”When in doubt, sit it out. Better to miss one game than a whole season.”

Westport PAL and are hosting a free event with football specific concussion information presented by local concussion experts plus exhibits showcasing new technology to help identify possible head injuries on the field.


  • Concussion info specific to football practice and play
  • Specific training techniques for coaches to reduce and prevent concussions
  • Local medical concussion specialists will answer questions from parents and coaches
  • An athletic trainer will also be available to answer questions on how AT scan help manage the sidelines for concussions and other sports injuries.
  • Opportunity for hands-on exploration of new technologies to address possible concussions right on the sidelines of practice or a game
  • Refreshments

7 pm  Concussion education for coaches & how to best to manage players from the sidelines when an injury occurs by Katherine Snedaker, MSW, of

7:45 pm Q & A with cookie refreshments with Dr. Mike Lee of Concussion Specialists of CT and Kristina Eilbacher, LATC, CSCS, the Westport PAL’s football Athletic Trainer from Performance Physical Therapy

8 pm Football Session: Carmen Roda, Westport PAL, will present his new research outlining the dramatic reduction of concussions with specific steps, drills, and techniques

Cheer Session: Katherine will present new research on girls’ concussions and hold a brainstorm session to develop safer training for girls’ cheer


Sponsors and Exhibiters

Medical Field

New Technology to aid with concussion recognition

  • PAR’s Concussion Recognition and Response Phone App that a coach or parent can use if an athlete suffers a blow, bump or other injury during a game or practice. The app guides the coach through a series of questions and makes a recommendation about whether to remove the athlete from play and get medical attention. The app is available for Apple and Android mobile devices and costs $3.99.
  • The Battle Sports Science’s IMPACT INDICATOR, embedded in chin strap which attaches to any helmet, measures the force and duration of a hit to a player’s helmet. Instantly, players and coaches can know when or if a possible head injury is detected. Once alerted, a coach can get the player to the sideline for evaluation maximizing treatment, recovery and preventing further injury.

Refreshments provided by Galaxy Cookies from Darien


We want to thank all these sponsors and SoNo Field House for their continued support of Concussion Awareness in youth sports.


Written by  National Cancer Institute

Children and young adults scanned multiple times by computed tomography (CT), a commonly used diagnostic tool, have a small increased risk of leukemia and brain tumors in the decade following their first scan. These findings are from a study of more than 175,000 children and young adults that was led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and at the Institute of Health and Society, Newcastle University, England.

Researchers from the National Cancer Institute and Institute of Health and Society at Newcastle University in England reviewed 175,000 cases and found that in children ages ten and younger, two to three scans can triple the risk of brain cancer and five to ten scans can triple the risk of leukemia.

The researchers emphasize that when a child suffers a major head injury or develops a life-threatening illness, the benefits of clinically appropriate CT scans should outweigh future cancer risks. The results of the study were published online in The Lancet on June 7, 2012.

“This cohort study provides the first direct evidence of a link between exposure to radiation from CT and cancer risk in children,” said senior investigator Amy Berrington de González, Ph.D., Division of Cancer Epidemiology and Genetics, NCI. “Ours is the first population-based study to capture data on every CT scan to an individual during childhood or young adulthood and then measure the subsequent cancer risk.”

Risk is small

Despite the elevation in cancer risk, these two malignancies are relatively rare and the actual number of additional cases caused by radiation exposure from CT scans is small. The most recent (2009) U.S. annual cancer incidence rates for children from birth through age 21 for leukemia and brain cancers are 4.3 per 100,000 and 2.9 per 100,000, respectively. The investigators estimate that for every 10,000 head CT scans performed on children 10 years of age or younger, one case of leukemia and one brain tumor would occur in the decade following the first CT beyond what would have been expected had no CT scans been performed.

CT scans deliver a dose of ionizing radiation to the body part being scanned and to nearby tissues. Even at relatively low doses, ionizing radiation can break the chemical bonds in DNA, causing damage to genes that may increase a person’s risk of developing cancer. Children typically face a higher risk of cancer from ionizing radiation exposure than do adults exposed to similar doses.

The investigators obtained CT examination records from radiology departments in hospitals across Britain and linked them to data on cancer diagnoses and deaths. The study included people who underwent CT scans at British National Health Service hospitals from birth to 22 years of age between 1985 and 2002. Information on cancer incidence and mortality from 1985 through 2008 was obtained from the National Health Service Central Registry, a national database of cancer registrations, deaths and emigrations.

Clear radiation/cancer relationship

Approximately sixty percent of the CT scans were of the head, with similar proportions in males and females.  The investigators estimated cumulative doses from the CT scans received by each patient, and assessed the subsequent cancer risk for an average of 10 years after the first CT. The researchers found a clear relationship between the increase in cancer risk and increasing cumulative dose of radiation. A three-fold increase in the risk of brain tumors appeared following a cumulative absorbed dose to the head of 50 to 60 milligray (abbreviated mGy, which is a unit of estimated absorbed dose of ionizing radiation). Similarly, a three-fold increase in the risk of leukemia appeared after the same dose to bone marrow (the part of the body responsible for generating blood cells). The comparison group consisted of individuals who had cumulative doses of less than 5 mGy to the relevant regions of the body.

The absorbed dose from a CT scan depends on factors including age at exposure, sex, examination type, and year of scan. Broadly speaking,  two or three CT scans of the head using current scanner settings would be required to yield a dose of 50 to 60 mGy to the brain. The same dose to bone marrow would be produced by five to 10 head CT scans, using current scanner settings for children under age 15.

Lower dosages called for

In countries like the United States and Britain, the use of CT scans in children and adults has increased rapidly since their introduction 30 years ago. Due to efforts by medical societies, government regulators, and CT manufacturers, scans performed on young children in 2012 can have 50 percent lower radiation doses, compared to  scans carried out in the 1980s and 1990s, say the investigators. However, the amount of radiation delivered during a single CT scan can still vary greatly and is often up to 10 times higher than that delivered in a conventional X-ray procedure.

The lead author of the study was Mark S. Pearce, Ph.D., Institute of Health and Society, Newcastle University. “CT can be highly beneficial for early diagnosis, for clinical decision-making, and for saving lives. However, greater efforts should be made to ensure clinical justification and to keep doses as low as reasonably achievable,” said Pearce.

This study was supported by contract NO2-CP-75501 from the U.S. National Cancer Institute.

# # #

Reference: Pearce M S, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet. June 7, 2012.

Source: By Tom Farrey via ESPN

In a move that challenges the longtime culture of America’s most popular game, Pop Warner will introduce new rules to limit contact drills to one-third of practice time, and ban full-speed, head-on blocking and tackling drills in which players line up more than 3 yards apart.
The rules will go into effect starting with the 2012 season, when Pop Warner will become the first nationwide league at any level of football to restrict the amount of contact players experience.
Pop Warner is expected to announce the rules Wednesday, after a meeting of its medical committee.

“At our level, we try to limit exposure to contact as much as possible because we want our players healthy for the game. We’ve got to get young people to play the game in a safe way. You’ve got to start somewhere, right?” — Alabama coach Nick Saban

“There are times when people and organizations have to evolve, and this is that time,” said Dr. Julian Bailes, a neurosurgeon and chair of the Pop Warner Medical Advisory Board. “For the future of the sport, we need to morph it now and take the unnecessary head contact out of the game. If parents were considering allowing their child to play football, this (move) should assure them.”
The oldest and largest national youth football organization, Pop Warner adds the rules on the heels of several studies highlighting the health risks in youth football. A Virginia Tech study published this year showed that some hits among second graders pack as much force as those seen at the college level. Last year, researchers also discovered a deceased teenage player suffered from Chronic Traumatic Encephalopathy, a degenerative disease of the brain generally associated with athletes who experience repetitive hits to the head.
Bailes said his committee was particularly swayed by research suggesting that brains can be damaged not only from the big hits seen more commonly at the high school and adult levels but from smaller, more repetitive, sub-concussive blows experienced by players at all levels. Also, he said, most head injuries happen in practice.
Pop Warner executives anticipate pushback from youth coaches who may not want to change their ways, Bailes said. But the 83-year-old organization has support from at least one well-known coach, who in turn contends that most coaches at the college and NFL levels share his opinion.
“I’m very supportive,” Alabama coach Nick Saban told ESPN. “At our level, we try to limit exposure to contact as much as possible because we want our players healthy for the game. It’s even more important for a youth coach to do that. We’ve got to get young people to play the game in a safe way. You’ve got to start somewhere, right?”
Coaches will be allowed no more than 40 minutes of contact during a practice, or one-third of total practice time each week. The term “contact” means any drill or scrimmage in which players go all-out with contact, such as one-on-one blocking or tackling drills.
The second rule change prohibits full-speed, head-on blocking or tackling drills in which players line up more than 3 yards apart. Having two linemen in stances immediately across from the line of scrimmage from each other is allowed, according to Pop Warner rules. Coaches may conduct full-speed drills in which the players approach each other at an angle, but not straight ahead into each other. And there should be no head-to-head contact.
Saban said the new rules are “important to future participation” in football, a game whose safety has come under question even by those closest to it. Last year, ESPN’s “Outside the Lines” spoke with several NFL veterans and their families who were steering their sons away from the game, and since then other players such as former quarterbacks Troy Aikman and Kurt Warner have added their voices to the concerned. Saban said that quality players can be developed without exposing them to high doses of collisions when young.
“I’m at our camp right now,” Saban said by phone. “We have 1,100 kids here, ages 8 to 13, and it is all non-contact. These kids are improving tremendously. It’s not just contact that a player needs. It’s a matter of knowing how to come out of a block, how to use your hands, all kinds of things you can learn without contact. In fact, if you learn to use your hands better, you don’t need to use your head as much.”
Last year, the Ivy League announced that its teams will be limited to only two full-contact practices a week during the season, compared with a maximum of five under NCAA rules. By contrast, Pop Warner is a national organization, with 400,000 children between the ages of 5 and 15 participating in 43 states, plus Germany, Russia, Japan and elsewhere. It is a major feeder system not just for high schools and colleges but the NFL, where an estimated 70 percent of all current players got their start in Pop Warner programs.
Bailes said the aggressive culture and traditions of football may make it difficult to get some youth coaches on board. But he insists, “We’re not trying to fundamentally change the game. We’re trying to ensure its survival by reducing the potential for injury in practice.”
Saban suspects that over time, the new rules will become as accepted as the practice of not putting players through two-a-days in the sweltering summer sun — once a standard in football.
“Anytime you change something, people will say no, they’ve done it this way for a long time,” Saban said. “But there’s always a better way.

BY Katherine Snedaker of on June 20, 2012 

Concussions are a part of youth sports at every level from elementary school years to college. Playing at the local playground, riding bikes or just being a kid can put a child at risk for a concussion. If every parent and coach were trained and prepared to respond to concussions, there would definitely be a drop in multiple impact concussions which seem to be the majority of the serious cases at the clinic where I work. It only takes one adult to stepped forward and pulled the child from the field at the first signs of trouble, and give a quick sideline assessment. Avoiding additional blows can make all the difference in a child’s recovery.

But I used the word “adult” not “coach”… yes, I meant adult.

Coaches need help with concussion recognition if we are going to try to identify kids sooner who have been concussed.  Any adult, any parent can being prepared with some simple steps:

1. Educate yourself on the signs and symptoms of a concussion along with the other members of your family so that an educated adult is always available during a practice or a game or by phone for your child to call.  Always check in with your child on the car ride home from any sporting activity or play date, and ask their day, and how they are feeling. If your child complains that he/she hit their head, you should  know the correct questions to ask to see if there could be an issue with a head injury. With the 20 minute CDC course and PAR CRR App ($3.99) on your phone, you can be ahead of most youth coaches and truly make a difference when a child is injured in a practice or a game.

2. Educate your child about concussions. There are simple, painless videos for the media savvy teenager of today. Studies show that kids are more likely to report concussions when they know what a concussion is. Teach your child to report to an adult if they notice signs of a teammate with a possible head injury.  The earlier the diagnosis, the sooner a child can begin the rest needed to heal a concussion.

3. Check your child’s sports equipment at the beginning, middle and end of each season. While there is no sport equipment, including helmets, that can prevent concussions, ill fitting or worn equipment can make many injuries worse. After a hard hit, recheck all equipment for damage again. Bike helmets need to replaced after every fall, while other sports helmets are more durable.

4. Make sure all your child’s coaches and camp counselors have concussion awareness training. If they don’t, politely email them a link to a training video and ask them to let you know what they thought of it after they view it.

5. Make sure your coach has your cell number with him/her at the field if you are dropping off your child for sports. If you aren’t available, substitute another adult’s cell phone number and have the proper paperwork so that adult can make medical decisions for your child. While it is rare, never leave a coach alone in a 911 situation to make medical decisions for your child.

6. Attend as many games as you can and watch your child play for the sheer love of the sport. But also be aware if your child is hurt in a game, you have the right to see your child no matter what the policy of the team. Coaches cannot see every player in every moment of a game and coaches are not doctors. Parents must be responsible for their children’s well-being and that includes deciding when a child should be pulled from a game. You are the final authority over your child and be prepared to make that call if you do not agree with a coach who wants your child to play when you have concerns about a possible injury. So many parents have shared with me that they wanted to pull their injured child from a game, but instead deferred to the coach and their child was hit again and only then too late was pulled from a game. Multiple blows tend to complicate and length recovery time for a concussion.  As the CDC motto says, “When in doubt, sit it out. Better to lose a game than the whole season!”

7. If you suspect your child may have a concussion, know when to call 911, when to drive to the ER, and when to just call your child’s regular doctor. The ER is not always the best place for a concussion, but there are certain signs that 911 call is absolutely the only response. Do you know the difference?

8. If your child has a concussion, follow your doctor’s instructions. If you don’t understand or your child will not comply, call the doctor back and ask for another way to deal with the issue at hand.  You can read how best to care for your child after a concussion. Your pediatrician can refer your child to local concussion specialists after your doctor has diagnosed the concussion.

9. Enjoy sports. Have your child play a variety of organized (a mix of competitive and club) sports year around as sports promote fitness and strong bodies.  One 2004 study showed that only 20% of all youth concussions occur in organized sports.  It is my personal experience that unsupervised children who are bored and looking for something fun to do, can end up in trouble faster than a child on a field with adults playing a game with rules and a referee.

10. And make your child wear a bike helmet! The greatest concussion risk for your child happens when he or she is riding a bike according to this CDC study.  While a helmet cannot prevent a concussion, biking without a helmet can make any accident worse.  Many parents say they would never let their children play football, yet these same parents let their children ride their bikes without helmets.

There are ways to prevent concussions, reduced their risks, respond quickly and appropriately when a concussion occurs.  Sports and physical exercise are key to living a healthy life… Concussions are a risk, but the rewards of an active life are tenfold when concussion awareness and prevention is in place for all involved.

Katherine “Price” Snedaker

Katherine is the founder of Sports  which provides free resources, educational program and speakers for recreational sports teams, town leagues and private schools to build concussion awareness into their programs for players, coaches and parents.  She designed her website and program around her concern with middle school aged athletes who are not covered by CT Concussion Law since they play in private or town leagues rather than in public middle schools where they would be protect the law.  She has been work with CT and NY lacrosse leagues for several years and hopes to bring concussion awareness to teams from other sports across the state.  Katherine is also the founder of Team Concussion, a social media/web based support group for teenagers with concussions.

Katherine has her Masters in Social Work and has worked as a school social worker.   In addition to being a lifelong athlete, she has over ten years experience coaching boys lacrosse and co-ed soccer with children aged 5 to 15.  She has vast experience with concussions as an athlete, a professional, a coach,CONNy league advisor and a parent of three active sons.  One of her sons has suffered through a number of concussions, mostly from non-sport activities.

To help with research, Katherine has agreed to donate her brain to the study of CTE after she dies and encourages all adult athletes with concussion histories to consider this option (click here for more info).

 Call 911 if the person or child:

  • Is vomiting repeatedly
  • Has unequal pupils
  • Is confused
  • Has weakness on one side of the body
  • Passes out or Is unconscious
  • Is unable to wake up
  • Has a seizure


Source: CDC

Thursday, 10 May 2012 14:02

Written by  Michigan State University

EAST LANSING, Mich. — New research out of Michigan State University reveals female athletes and younger athletes take longer to recover from concussions, findings that call for physicians and athletic trainers to take sex and age into account when dealing with the injury.

The study, led by Tracey Covassin of MSU’s Department of Kinesiology, found females performed worse than males on visual memory tests and reported more symptoms postconcussion.

Additionally, high school athletes performed worse than college athletes on verbal and visual memory tests, and some of the younger athletes still were impaired up to two weeks after their injuries.

“While previous research suggests younger athletes and females may take longer to recover from a concussion, little was known about the interactive effects of age and sex on symptoms, cognitive testing and postural stability,” said Covassin, a certified athletic trainer at MSU.

“This study confirms that age and sex have an impact on recovery, and future research should focus on developing treatments tailored to those differences.”

The research funded by a two-year grant from the National Operating Committee on Standards for Athletic Equipment, appears in the current edition of the American Journal of Sports Medicine.

Between 2001 and 2005, federal statistics reveal more than 150,000 sport-related concussions occurred among youth ages 14 to 19. However, the actual number is likely much higher, as current statistics reflects only concussions that involved visits to the emergency departments.

The study led by Covassin looked at nearly 300 concussed athletes from multiple states over two years. All of the athletes had previously completed a baseline test before taking three different postconcussion tests, the same ones used in professional sports, after being injured.

When it comes to sex differences, Covassin – who has worked with thousands of young athletes across mid-Michigan since coming to MSU in 2005 – said what often is needed most is simple education.

“We need to raise awareness that yes, female athletes do get concussions,” she said. “Too often, when we speak with parents and coaches, they overlook the fact that in comparable sports, females are concussed more than males.”

Coupled with the fact that high school athletes take longer to recover than collegiate athletes, Covassin said the study reveals a real potential danger to younger athletes by not fully recovering after a concussion.

“Younger athletes appear more at risk for second-impact syndrome, where a second concussion can come with more severe symptoms,” she said. “While it is rare, there is a serious risk for brain damage, and the risk is heightened when athletes are coming back before they heal.”

The next steps, Covassin said, are to investigate sex and age differences at the youth sport level and whether treatment options needed to be tailored for an athlete’s age.

“If we can develop treatments that speak directly to sex and age, I think we can better protect athletes from the long-term side effects of concussions,” she said.

The full article appears at

The 2-year study included three elements; computerized neurocognitive testing using the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), balance testing utilizing the Balance Error Scoring System (BESS), and a Post-Concussions Symptom Scale (PCSS).

The 296 athletes enrolled in the study completed the ImPACT and BESS baseline testing and if a concussion was sustained they were tested again at 2,7, and 14 days after the injury occurred.  They completed the balance test 1,2 and 3 days post-injury.

The results of the study were:

– female athletes scored worse than male athletes on visual memory; females also reported more symptoms

– high school athletes scored worse than college athletes on verbal and visual memory

– high school athletes were still impaired on verbal memory 7 days post-concussion compared to college athletes

– high school male athletes scored worse on the BESS than college male athletes

– college female athletes scored worse on the BESS than high school female athletes

Researchers state further studies should develop and assess interventions tailored to age and sex differences and include younger participants.

Source:  Michigan State University — May 9, 2012

Am J Sports Med. 2012 Apr 26. [Epub ahead of print]; The Role of Age and Sex in Symptoms, Neurocognitive Performance, and Postural Stability in Athletes After Concussion;

Law Summary


  • Connecticut law requires the Board of Education to develop a concussion and head injury training course and refresher course.
  • Intramural and interscholastic coaches who hold coaching permits from the state Board of Education would be required to complete an initial concussion and head injury training course and then a refresher course every five years.
  • Intramural and interscholastic coaches must immediately remove a student athlete diagnosed with a concussion or observed exhibiting signs, symptoms or behaviors consistent with a concussion.
  • A student athlete removed from play may not participate in supervised team activities without a written clearance from a licensed health care professional trained in the evaluation and management of concussions.


Here is the full language of the law

There are many ways to reduce the chances of a concussion or other form of TBI, including:

  1. Wearing a seat belt every time you drive or ride in a motor vehicle.
  2. Buckling your child in the car using a child safety seat, booster seat, or seat belt (according to the child’s height, weight, and age).
  3. Children should start using a booster seat when they outgrow their child safety seats (usually when they weigh about 40 pounds). They should continue to ride in a booster seat until the lap/shoulder belts in the car fit properly, typically when they are 4’9” tall.1
  4. Never driving while under the influence of alcohol or drugs.
  5. Wearing a helmet and making sure your children wear helmets can help reduce risks of other head injures, but helmets do not prevent concussions. To lower risks of other serious head injures, wear a helmet when:
    • Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
    • Playing a contact sport, such as football, ice hockey, or boxing;
    • Using in-line skates or riding a skateboard;
    • Batting and running bases in baseball or softball;
    • Riding a horse; or
    • Skiing or snowboarding.
  6. Making living areas safer for seniors, by:
    • Removing tripping hazards such as throw rugs and clutter in walkways;
    • Using nonslip mats in the bathtub and on shower floors; Installing grab bars next to the toilet and in the tub or shower;
    • Installing handrails on both sides of stairways;
    • Improving lighting throughout the home; and
    • Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.2,3,4
  7. Making living areas safer for children, by:
    • Installing window guards to keep young children from falling out of open windows; and
    • Using safety gates at the top and bottom of stairs when young children are around.
    • Making sure the surface on your child’s playground is made of shock-absorbing material, such as hardwood mulch or sand.5


  1. Centers for Disease Control and Prevention. Warning on interaction between air bags and rear-facing child restraints. Morbidity and Mortality Weekly Report MMWR 1993;42(No.14):20–22.
  2. Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: effects of exercise training. Physical Therapy 1993;73(4):254–265.
  3. Lord SR, Caplan GA, Ward JA. Balance, reaction time, and muscle strength in exercising older women: a pilot study. Archives of Physical and Medical Rehabilitation 1993;74(8):837–839.
  4. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age and Aging 1999;28:513–518.
  5. Mack MG, Sacks JJ, Thompson D. Testing the impact attenuation of loose fill playground surfaces.Injury Prevention 2000;6:141–144.

What Can I Do to Help Feel Better After a Concussion?

Although most people recover fully after a concussion, how quickly they improve depends on many factors. These factors include how severe their concussion was, their age, how healthy they were before the concussion, and how they take care of themselves after the injury.

Some people who have had a concussion find that at first it is hard to do their daily activities, their job, to get along with everyone at home, or to relax.

Rest is very important after a concussion because it helps the brain to heal. Ignoring your symptoms and trying to “tough it out” often makes symptoms worse. Be patient because healing takes time. Only when your symptoms have reduced significantly, in consultation with your health care professional, should you slowly and gradually return to your daily activities, such as work or school. If your symptoms come back or you get new symptoms as you become more active, this is a sign that you are pushing yourself too hard. Stop these activities and take more time to rest and recover. As the days go by, you can expect to gradually feel better.

Getting Better: Tips for Adults

  • Get plenty of sleep at night, and rest during the day.
  • Avoid activities that are physically demanding (e.g., heavy housecleaning, weightlifting/working-out) or require a lot of concentration (e.g., balancing your checkbook). They can make your symptoms worse and slow your recovery.
  • Avoid activities, such as contact or recreational sports, that could lead to another concussion. (It is best to avoid roller coasters or other high speed rides that can make your symptoms worse or even cause a concussion.)
  • When your health care professional says you are well enough, return to your normal activities gradually, not all at once.
  • Because your ability to react may be slower after a concussion, ask your health care professional when you can safely drive a car, ride a bike, or operate heavy equipment.
  • Talk with your health care professional about when you can return to work. Ask about how you can help your employer understand what has happened to you.
  • Consider talking with your employer about returning to work gradually and about changing your work activities or schedule until you recover (e.g., work half-days).
  • Take only those drugs that your health care professional has approved.
  • Do not drink alcoholic beverages until your health care professional says you are well enough. Alcohol and other drugs may slow your recovery and put you at risk of further injury.
  • Write down the things that may be harder than usual for you to remember.
  • If you’re easily distracted, try to do one thing at a time. For example, don’t try to watch TV while fixing dinner.
  • Consult with family members or close friends when making important decisions.
  • Do not neglect your basic needs, such as eating well and getting enough rest.
  • Avoid sustained computer use, including computer/video games early in the recovery process.
  • Some people report that flying in airplanes makes their symptoms worse shortly after a concussion.

Getting Better: Tips for Children

Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:

  • Having the child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
  • Making sure the child avoids high-risk/ high-speed activities such as riding a bicycle, playing sports, or climbing playground equipment, roller coasters or rides that could result in another bump, blow, or jolt to the head or body. Children should not return to these types of activities until their health care professional says they are well enough.
  • Giving the child only those drugs that are approved by the pediatrician or family physician.
  • Talking with their health care professional about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
  • Sharing information about concussion with parents, siblings, teachers, counselors, babysitters, coaches, and others who interact with the child helps them understand what has happened and how to meet the child’s needs.

Help Prevent Long-Term Problems

If you already had a medical condition at the time of your concussion (such as chronic headaches), it may take longer for you to recover from the concussion. Anxiety and depression may also make it harder to adjust to the symptoms of a concussion. While you are healing, you should be very careful to avoid doing anything that could cause a bump, blow, or jolt to the head or body. On rare occasions, receiving another concussion before the brain has healed can result in brain swelling, permanent brain damage, and even death, particularly among children and teens.

After you have recovered from your concussion, you should protect yourself from having another one. People who have had repeated concussions may have serious long-term problems, including chronic difficulty with concentration, memory, headache, and occasionally, physical skills, such as keeping one’s balance.

Learn more about potential long-term outcomes of concussion and other forms of TBI.

Could heading the ball in soccer lead to degenerative brain disease, like that seen in athletes in other sports? That’s the question addressed by a review in the January issue of Neurosurgery,official journal of the Congress of Neurological Surgeons.

As yet there’s not clear evidence to link heading to short- or long-term brain injury, according to Dr Alejandro M. Spiotta of the Cleveland Clinic and colleagues. However, while research is ongoing, they stress the need for proper heading technique at all levels of organized soccer.

New Review of Evidence on Heading and Brain Injury Risk in Soccer

Soccer (called football outside the United States) is the only sport in which players use their unprotected heads to intentionally deflect, stop, or redirect the ball. Headed balls travel at high velocity both before and after impact, raising concerns about possible traumatic injury.

In 2002, English footballer Jeffrey Astle, known as a “formidable header,” died with degenerative brain disease. The damage was consistent with chronic traumatic encephalopathy (CTE): a progressive neurodegenerative disease caused by repeated brain injury, seen in American football players and other athletes. Those reports have prompted concerns about similar risks in soccer players.

Although concussions are common in soccer, they more often result from the head striking another player or the goalpost, rather than heading the ball. But there’s still concern about long-term injury related to repetitive trauma from heading.

Detailed biomechanical studies have been performed, showing that heading is a complex task in which significant energy is absorbed by the head. Emphasizing the importance of proper heading technique, studies have shown that anticipation and “pre-tensing” of the neck muscles play a key role in absorbing and redirecting the impact of a headed ball.

Pending Further Research, Emphasis on Proper Heading Technique

Older studies reported symptoms related to heading (“footballers’ migraine”), but more recent research has not confirmed those effects. One factor may be the introduction of newer soccer balls that don’t absorb moisture—unlike the leather balls used in Jeffrey Astle’s day.

Soft headgear has been suggested to protect against soccer-related head injuries, although studies have questioned the protective benefits. There are even concerns that wearing headgear might even lead to increased injury risk, if players develop a false sense of security.

For now, the data on heading and brain injury “leave us somewhat in the grey zone,” according to Dr Spiotta and colleagues. While it’s reassuring that there’s no clear link to CTE, the potential for long-term brain injury remains. “Even if the cognitive impairment were to be mild, it would still present a major medical and public health concern because of the massive volume of soccer players worldwide,” the researchers write. “Any possible detrimental effect…may only become clinically evident decades in the future.”

Dr Spiotta and coauthors emphasize the need for further research—including autopsy studies of players in the “light ball” era—to see if there is any similarity to the patterns of brain injury seen in CTE. Meanwhile, “Proper heading technique should continue to be stressed at all levels of play.” The authors also highlight the importance of using an age-appropriate ball size for younger soccer players, as they develop the neck strength and posture control needed for proper heading technique.

Source:  Newswise reprint; Neurosurgery is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Journal Reference:

  1. Alejandro M. Spiotta, Adam J. Bartsch, Edward C. Benzel. Heading in SoccerNeurosurgery, 2012; 70 (1): 1 DOI: 10.1227/NEU.0b013e31823021b2

The First Study of Head Impacts in Youth Football

In a groundbreaking study, researchers at Virginia Tech placed instrumented helmets on 7 and 8-year-old football players and collected data on more than 750 hits to the head over the course of a season.  See Video.

The findings provide the first quantitative assessment of the acceleration and risk that young brains are exposed to in youth football.

Lead researcher, Stefan Duma, a professor of Biomedical Engineering, has been gathering data on head impacts among college players at Virginia Tech for nine seasons.  In his new study, he reports some head impacts in youth football equal in force to some of the bigger hits he sees at the college level. “Nobody expected to see hits of this magnitude,” says Duma.

The study was conducted through the Center for Injury Biomechanics at Virginia Tech, the world’s largest laboratory for impact and injury research, with ongoing projects for the U.S. Department of Defense, the U.S. Department of Transportation and NASA.

“Hard Hits, Hard Numbers” features interviews with Professor Duma, Dr. Gunnar Brolinson, who is head of Virginia Tech Sports Medicine, the coach of the participating youth football team, players and parents.