The dangers of life in the National Football League made headlines in 2009, when a study commissioned by the NFL found that retired players were 19 times more likely than other men of similar ages to develop severe memory problems. The obvious culprit: continued play after repeated head injuries. Indeed, head injury can imitate many types of neurodegenerative disease, including Parkinson’s disease and, as journalist Jeffrey Bartholet reports in “The Collision Syndrome,” on page 66, perhaps even amyotrophic lateral sclerosis, commonly referred to as Lou Gehrig’s disease.

The problem is not unique to professional sports. About 144,000 people aged 18 and younger are treated every year in U.S. hospital emergency rooms for concussions, according to a December 2010 analysis in the Journal of Pediatrics. Nearly a third of these injuries occur while kids are playing organized sports. Forty percent of pediatric concussions seen in emergency rooms involve high school students. The figure is slightly higher—42 percent—for younger children. Overall, concussions are most common in football and ice hockey, followed by soccer, wrestling and other sports, and slightly more boys than girls suffer concussions.

Despite the prevalence of brain injury from kindergarten to high school, relatively little research on the long-term health consequences of concussion has been conducted on child athletes, compared with those in college and in the pros. Scientists have an incomplete understanding of what happens when a child’s brain slams up against the inside of the skull during a blow to the head and how this affects neurological development. As participation in sports continues to grow (1.5 million youngsters now play on football teams in the U.S.), more head injuries are inevitable, making pediatric concussions an emerging public health crisis.

Doctors and public health experts are concerned about the effect of repeat concussions that occur before the brain has had a chance to heal from a prior impact. More research on how they affect younger brains is urgently needed. In addition, coaches, parents and school officials need to pay closer attention to what is already known about the hazards of concussions and how best to prevent permanent damage. (Visit www.cdc.gov/concussion for comprehensive information, including videos, on the topic.)

Most people assume, for instance, that loss of consciousness is the defining feature of all concussions. Yet “seeing stars,” headache, nausea, dizziness, confusion, irritability, and an inability to remember events before or after the injury are the most common symptoms. Because people don’t recognize these warning signs, however, youngsters may continue to play when they should not.

Similarly, because the most obvious symptoms usually disappear within a few minutes to hours, children often return to normal activities too quickly, which overtaxes their injured brain. Depending on age and symptoms, children should not take part in intense physical activity for several weeks to months after a concussion. Even the added neural exertion from mental activities like reading and video games can interfere with the cerebrum’s ability to heal—particularly in the first 24 hours after injury.

Some efforts to protect young brains may actually backfire. In football, hockey and other contact sports, protective headgear seems to have increased the risk of concussion by providing a false sense of security that encourages athletes to hit harder with their head. Helmets do, however, protect against skull fracture.

To address the concussion problem, more states could follow the example of Minnesota. Legislators there passed a law, which took effect in 2011, that requires coaches to undergo training to recognize concussions and mandates the immediate removal from a game of any player at the first sign of dizziness or confusion. He or she can return to sports only with a doctor’s authorization. The law could have the unintended effect of giving kids an incentive to hide their symptoms. The way around that problem, of course, is for schools, sports leagues and other organizations to join public health experts in raising ever greater awareness among coaches, parents and children to play it smart and take brain injury very seriously.

4 Comments

1. 1. Ray Haupt 01:30 AM 1/24/12

   Concussion is indeed a serious problem for young athletes as well as for professionals. Severe blows to the head causing unconciousness or disorientation are the most dramatic but lesser blows accumulated over a period of time may well be just as devastating although delayed.
   
   Not mentioned in Science Agenda is the matter of youngsters engaging in the sport of boxing. Young boxers are protected with headgear to avoid facial lacerations and broken bones and boxing gloves are well padded but a large number of sub-concussive blows to the head must surely be damaging over time just as in football.
   
   The National Football League has been studying this problem in the past few years and has revealed that retired professional football players have a much higher incidence of memory and other neurological problems then other men of similar age. The same sitution must surely exist in professional boxing and it is easy to project it as even more devastating than football. In a typical boxing match a contestant might well be hit over a hundred times but leading up to that fight might have been struck in the head many more times while practice sparring. The effects add up.
   
   Would serious long term brain injury be lessened if boxing rules were to forbid helmets and padded gloves? A return to bare knuckle boxing would result in more broken bones in faces and hands, and likely more lost eyes, but the number of sub-concussive blows must surely be reduced. Furthermore a fighter would be less likely to deliver full force punches to the head if he had a major risk of breaking a hand.
   

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2. 2. Torchlake 10:05 AM 2/1/12

   After reading this article...I have a question,actually an observation.
   When I was 10years old I fell 30ft head first out of a tree breaking both wrists and forearms. This incident did cause a sever concussion..This would be in 1960. After this accident, school work become a task. Spelling and math became a particular weaknesses. I wonder now, did I sustained a closed head injury? Guess I answered my own question.
   How could have been different had we knew then what we know now?
   Cognitive training/assistance!
   
   

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3. 3. buddhacosmos 10:10 PM 2/1/12

   On my 9th birthday i was struck forcefully in the center of my forehead with a croquet mallet. This knocked me unconscious. The next morning i was afraid of family, family activities and regular morning activities. This has persisted to the present. I am now ~50. After falling into a doors edge, and being knocked unconscious, in college, I also developed paranoid schizophrenia. This has persisted to present. I have often heard that blows of unconsciousness can contribute to para. schiz. -we should rethink what kind of sports and what situations we place our children. Schizophrenia is a devastating disorder without measure.

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4. 4. KSama 12:35 PM 2/5/12

   When one has a brain injury it is equivalent to a brain 'bruise'. This bruise contains spilled blood. The spilled blood contains the metal iron. The metal iron in the brain has been linked to neurodegenerative disease. In the disease Neurodegeneration with Brain Iron Accumulation (NBIA) they have shown recovery by targeting the iron for removal.
   "Her gait returned to normal"
   "CNS injury-induced hemorrhage and tissue damage leads to excess iron, which can cause secondary degeneration."
   "Iron chelator therapy may improve functional recovery after CNS trauma and hemorrhagic stroke."
   "Neurodegenerative disease and iron storage in the brain"
   

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