“If you’re going to compare concussion rates at practices versus games, you have to have the same degree of scrutiny at practices as at games,” Cantu says. “There’s nobody at practice other than the coaches, and we don’t know if they know what a concussion is or not, and they can’t make the diagnosis.” Nowinski points to one past study’s finding that a trainer’s presence increases the incidence of concussions four to eight times and another that found doctors can identify up to seven times as many concussions as athletic trainers.
In fact, noting that the concussion rate in Kontos’s study for young players during games is two to three times higher than it is for older players during games, Nowinski said the study shows that football for eight- to 12-year-olds “is dramatically more dangerous than for high school and college players. Due to the lack of medical infrastructure at all levels of football below high school, this study shows there is more reason than ever to restrict full-contact practice.”
Together, the two studies offer a couple of takeaways. The potential biases in the first study and the low practice numbers in the second support prior findings that many concussions go unreported while also pointing to high incidence rates among youth. The Eisenberg study also reveals the challenges in assessing the severity of concussions, suggesting “that there cannot be an absolute set standard on how a concussion should be treated,” Clearfield says. And the “dose-response effect” in Eisenberg’s study—where more time is required to recover when more concussions have occurred in a patient’s history—offers more evidence of the potentially lifelong symptoms of multiple concussions. Athletes with multiple concussions at a young age, Nowinski says, should seriously consider switching to a sport in which concussions are less likely.