Dr. Arlis-Mayor is a physician at the Center for Orthopaedics, and on staff at Yale-New Haven Hospital in Connecticut. She has experience working with young athletes, including those in New Haven Public Schools and area youth ice hockey teams. Dr. Arlis-Mayor told the story of a young lacrosse player who recently sustained a concussion, but didn’t tell her parents about the injury:

Arlis-Mayor explained that on a Monday, this lacrosse player sustained a concussion but kept playing her game and attending school. By Thursday, the student-athlete was running the wrong way on the field during a game . By then, said Arlis-Mayor, her injury was exacerbated and her recovery could take longer than if she had been given attention for her concussion immediately after the incident.

Said over and over again, Arlis-Mayor could not emphasize enough: “It’s better to miss one game than the whole season.”

According to the doctor, the best way to ensure a successful recovery from concussion is to follow the “Five Rs”:

1. Recognize. Athletes, parents, and coaches should learn to recognize the symptoms of concussion so that the athletes can be treated as quickly as possible. (To learn the symptoms of concussion, watch our YouTube video here: HensonFuerst video on “Symptoms of Concussion”)
2. Remove. The injured athlete should be removed from play immediately, and not allowed to return until approved by a physician.
3. Refer. Coaches and parents should be referred to a trained healthcare professional who is experienced in treating concussion.
4. Rest. Concussion victims should have as much rest as possible. Arlis-Mayor said three days in a dark room, no matter the severity of concussion, can make a world of a difference in recovery time.  Arlis-Mayor said exposure to bright screens like televisions and video games should be avoided. If computer time is necessary, recovering athletes should have very limited access to screen time, with 15 to 30 minutes “on” and one hour off.
5. Return. The overall goal is to get the athlete back to playing—but not before all symptoms have resolved.

Of course, treating concussion requires that the child actually report the injury. (Perhaps that should be the sixth R.) And another factor is lying by the athletes, parents, and coaches, all of whom want the athlete to return to play as soon as possible.

In order to ensure that athletes are ready to return to activity, Arlis-Mayor said baseline testing, like ImPACT, can help determine the cognitive ability of a concussion victim but is not the sole measure of recovery… Symptom observation through administering physical tests like balancing, help doctors and trainers determine if post-concussive athletes are ready to return to play. Returning too early, said Arlis-Mayor, places victims at a higher risk for a second concussion and at a higher risk of not recovering from the subsequent head injury.

Just about any sport can cause a concussion if the athlete’s head hits the ground in a fall, or if two players run head-first into each other. But some sports are more dangerous than others. Dr. Arlis-Mayor said it best:

“If you love your kids, don’t let them play football.”  [Dr. Arlis-Mayor, as quoted in the Branford Patch]

To read the full article, click here:  Heads Up! What You Should Know About Youth Sports Concussions

We have written extensively about the dangers of concussion–what doctors now refer to as “mild traumatic brain injury” or MTBI. So far, this has been a watershed year in how concussions are viewed. This year, we learned that a person who receives multiple concussions is at risk for developing Chronic Traumatic Encephalopathy (CTE), which leads to early dementia, depression, personality changes, and death.

We also learned this year that some cases of amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease) may be due to head trauma, not disease process.

This is also the year that we found out that the number of head injuries in children’s sports have doubled or even quadrupled in the past 10 years. MTBI awareness has even reached that most hard-headed group, the National Football League, which has mandated that an educational poster about concussion be hung in every pro locker room.

As Dr. Senelick states:

Although the population of NFL players is important, there are only 1,900 active NFL players each season. There are more than 3 million children playing football at the youth level and 1.2 million more playing high school football. This doesn’t even begin to count the number of kids playing soccer (heading the ball) and hockey (body checking). We have to ask whether we are taking adequate steps to protect our children – to change not just the equipment but the rules so that we reduce the chances of the players experiencing traumatic brain injuries.

What does he suggest? The same things experts and investigators have been suggesting for years:

1. Change the rules of the games to make head injury less likely.
2. Change the equipment, helmets and the equipment that makes dangerous projectiles of balls and pucks.
3. Mandate certified trainers in schools and for all organized sports activities.
4. Change the culture, so that we value health over winning a game…especially when our children are young, their brains are developing, and the games will be forgotten by morning.

None of that will be easy. Think how difficult it is just to get people to use a seat belt in a car, or to wear a helmet while cycling. Dr. Senelick notes that in Idaho…

We have an increasing number of bear attacks because people foolishly approach a bear, thinking it is safe to get that close-up picture. I recently read the following analogy:  If people are in the ocean and hear someone yell “shark” they race out of the water. If someone yells “bear” in Yellowstone, everyone races to get a close-up photograph. They have not been properly educated on the dangers of close encounters with a bear.

The same is true for youth sports and brain injuries. There is a bear out there and people need to be educated and the rules need to be changed.

He ends his editorial with this sentence:  ”Our children are getting injured and dying — it is time to wake up.”  Given the traumatic head injuries we have seen, we agree.  The only thing more heartbreaking than seeing a child with a head injury is watching the agony of that child’s parents. No one gets over it…not the child, not the parents, not the grandparents, not the community. We owe it to…well, everyone to help protect our children from head injury.

If you want to learn more about concussion and other traumatic brain injuries, visit our website at www.lawmed.com. If you have questions, HensonFuerst has answers.

Our previous blogs on concussion:

Football Concussion Poster

Youth Concussion Rates Skyrocket

Metal Bat Controversy in Youth Baseball

Head Injury and Lou Gehrig’s Disease

To read Dr. Senelick’s full article, click here: Head Games and Youth Sports: Have We Gone Too Far?

To read a great Time magazine article, which has a link to a video of what football can do to the brain, click here:  The problem with football:  How to make it safer

The cause of this increase isn’t clear, but the researchers note that most of the concussions happened as a result of sports, even though fewer kids participate in organized team sports. So…if fewer kids play organized team sports, but there are more concussions due to sports, what exactly is going on?

According to the experts, there are a few potential explanations:

• while there are fewer organized team sports, there are more sports activities available;
• organized sports today are even more competitive today than they were in 1997, which puts kids at higher risk;
• practice and play times have become more intense.

There is also the possibility that parents and coaches are more aware of the symptoms of concussion, and are therefore more likely to take an injured child to the hospital.

No matter the reason(s) for the increase, everyone agrees that action needs to be taken to bring these rates down. For example, there need to be clear, comprehensive, and age-appropriate return-to-play guidelines for all young athletes. In the future, we may also see use of MRI scans, balance tests, and neuropsychological testing to take the guesswork out of concussion diagnoses. Helmet use should be required in sports that currently have no helmet rules (such as for skiing)…and other equipment could be modified to reduce injury risk (for example, padding goalposts, or decreasing mass and air pressure of soccer balls).

For more information, see this story posted by NPR: http://www.npr.org/templates/story/story.php?storyId=129519808

The original medical journal article is available online: Pediatrics

The reference is:

“Emergency Department Visits for Concussion in Young Child Athletes,” by Lisa L. Bakhos, Gregory R. Lockhart, Richard Myers, and James G. Linakis. Pediatrics, online publication August 30, 2010.

This week, a press release from C.S. Mott Children’s Hospital (part of the University of Michigan Health System) reports on a recent poll, and talks about the next step in recognizing concussions: parents.

According to the article, two-thirds of parents of young athletes worry that their children will get a concussion while playing school sports, but 50% don’t know if their children’s school has a concussion policy. One-third of parents are unaware of the dangers of repeated concussions, which can include permanent brain injury, early dementia, or even death.

Experts believe that a young athlete who suffers a concussion should not return to play for at least two weeks, and some brain injury specialists believe that injured players should sit on the sidelines for three full months to give the brain a chance to heal.

It can be difficult to diagnose a potential concussion on the field. Contrary to popular belief, most concussions do not result in a loss of consciousness…and symptoms may not occur for several hours after the injury. Young athletes may not recognize that they are hurt, or they may be afraid to mention symptoms for fear of losing playing time or of disappointing a coach or a parent.

What parents should know

Parent involvement in guarding against repeat concussions is critical.  Any time you suspect that your child has received a head injury, watch for these common signs and symptoms of concussion:

• confusion
• loss of memory (amnesia)
• headache
• dizziness
• a sensation of the world spinning (vertigo)
• imbalance
• lack of awareness of surroundings
• nausea and vomiting

If these symptoms appear after a head injury, consult a medical professional promptly for a full evaluation. Don’t allow a coach to pressure your child into playing before he or she has recovered. When in doubt, talk with a doctor.

For more information, click here:   “Concussion in Sports” from the Centers for Disease Control and Prevention (CDC)

To read the full C.S. Mott Children’s Hospital press release, click here: “Parents Ill-Prepared to Reduce Kids’ Concussions Risks”

If you have legal questions about concussion and brain injury, go to the HensonFuerst dedicated Brain Injury page. At HensonFuerst, if you have questions, we have answers.

The sport?  Cheerleading.  And compounding the tragedy of injury is the fact that only 20-25 states list high school cheerleading as a sport… the NCAA doesn’t recognize cheering as a championship sport… and unless the number has changed since December 2009, only 3 colleges consider cheering a sport–none in North Carolina. (Statistics from Journal of Athletic Training 2009)

Call a Sport a Sport.

While “recognition” might seem like a minor point, it has major ramifications for safety.  A “sport,” performed competitively and for entertainment, requires strict guidelines to ensure the safety of athletes. In 1980, when cheering was still primarily about leading the crowd in cheers, there were fewer than 5,000 emergency room visits. Today, cheering involves highly skilled gymnastics (as well as being tossed in the air and trusting that someone will be there to catch you).

Without the sanction of being a sport, cheerleaders often have to practice in areas that make injuries more likely, such as an asphalt parking lot or a team member’s backyard.  A “sport” requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches.

Gimme an A-C-T-I-O-N.

One of cheering biggest and most vocal supporters is Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). The group’s 26th annual report devotes a special section to cheerleading injuries, which describes the current state of cheering as a sport, details specific catastrophic injuries and how they occurred, and suggests sample guidelines that could help prevent cheerleading injuries. As quoted from the report (available here):

“Is cheerleading an activity that leads the spectators in cheers or is it a sport? If the answer is to entertain the crowd and to be in competition with other cheerleading squads, then there must be safety guidelines initiated. The authors of this research question why it is called cheerleading, when competitive cheer has nothing to do with leading the crowds at athletic events in cheering for the athletic teams on the playing field. Following are a list of sample guidelines that may help prevent cheerleading injuries:

1. Cheerleaders should have medical examinations before they are allowed to participate. Included would be a complete medical history.
2. Cheerleaders should be trained by a qualified coach with training in gymnastics and partner stunting. This person should also be trained in the proper methods for spotting and other safety factors.
3. Cheerleaders should be exposed to proper conditioning programs and trained in proper spotting techniques.
4. Cheerleaders should receive proper training before attempting gymnastic and partner type stunts and should not attempt stunts they are not capable of completing. A qualification system demonstrating mastery of stunts is recommended.
5. Coaches should supervise all practice sessions in a safe facility.
6. Mini-trampolines and flips or falls off of pyramids and shoulders should be prohibited.
7. Pyramids over two high should not be performed. Two high pyramids should not be performed without mats and other safety precautions.
8. If it is not possible to have a physician or certified athletic trainer at games and practice sessions, emergency procedures must be provided. The emergency procedure should be in writing and available to all staff and athletes.
9. There should be continued research concerning safety in cheerleading.
10. When a cheerleader has experienced or shown signs of head trauma (loss of consciousness, visual disturbances, headache, inability to walk correctly, obvious disorientation, memory loss) she/he should receive immediate medical attention and should not be allowed to practice or cheer without permission from a physician.
11. Cheerleading coaches should have some type of safety certification. The American Association of Cheerleading Coaches and Advisors offers this certification.
12. The NFHS should make cheerleading a sport, which will place cheerleading under the same restrictions and safety rules as all other high school sports. The NCAA should follow this same recommendation.”

HensonFuerst commends the research and activist efforts of Dr. Mueller and his team. We represent the interests of far too many children and young adults whose lives have been shattered due to head trauma or other catastrophic injury. There are few things in life as heartbreaking as broken potential. We agree that it is time to let recognition and regulations catch up to this fast-moving, physically demanding sport. Yes, sport. Let’s at least make an effort to stop the hemorrhage of young, enthusiastic lives.

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page. If you have questions, HensonFuerst has answers.

(Related and interesting articles can be found here: Flying without a net: Cheer injuries on rise. MSNBC and Cheerleading is leading cause of catastrophic injury in young women, ScienceDaily.)

The primary federal program directed specifically at preventing concussion in high school sports is Heads Up: Concussion in Youth Sports, a program of the Center for Disease Control and Prevention (CDC). This program provides information for coaches, trainers, athletes, and parents, including information about how long a child should sit on the sidelines after concussion. For example:

“Several factors may affect decisions about when it is safe for an athlete to participate in sports again, which are referred to as return-to-play decisions. For example, research has shown that athletes who have sustained one concussion are at increased risk of sustaining another concussion. An athlete who sustains a repeat concussion before the brain recovers from the first—within hours, days, or weeks—may recover more slowly or may have increased likelihood of long-term consequences. Research has also shown that children and adolescents are more likely than adults to sustain a concussion and take longer to recover from one, although the reasons for this difference remain unclear.” (from the GAO report)

What is clear is that concussion–more precisely known as mild traumatic brain injury (MTBI)–is more common than estimated, more damaging to young brains than most people think, and not as respected as it should be. What we’ve learned from studying adult athletes is that repeated mild head trauma can lead to permanent and debilitating brain injury, including early dementia and death.  No one encourages young people to get injured, but there is a strong culture encouraging kids to get back in the game, and to play through the pain. The government’s report is the first step in making sure everyone is aware of the potential severity of every head injury.

(For more information about brain injury, visit HensonFuerst dedicated web page:  HensonFuerst TBI page.)