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'Concussion Culture' in Youth Sports Must Continue Evolving, Report Says

Plenty of work remains to change the culture of youth sports when it comes to concussions, suggests a report released today by the Institute of Medicine and the National Research Council.

The 306-page report, authored by a specially-created IOM-NRC committee, sought to explore the existing research regarding youth-sports concussions to evaluate the next steps in concussion-management and -prevention.

Over the past decade or so, the committee discovered a significant rise in the number of youth-athletes treated for sports-related concussions (from 150,000 in 2001 to 250,000 in 2009). There was also a 57 percent jump in the rate of emergency department visits for sports-related concussions, according to the report, which echoes findings from previous research.

At the high school and collegiate levels, football, ice hockey, lacrosse, wrestling, and soccer were consistently associated with the highest rates of concussions for male athletes. For females, soccer, lacrosse, and basketball were the three sports with the highest rates of concussions at the high school level. Below, you can see the sport-specific concussion rates, per 10,000 athletic exposures (either practices or competition).

The IOM-NRC committee found that, while the base of research regarding youth-sports concussions has grown in recent years, much remains unknown about the causes and overall incidence of such injuries among youth athletes. Thus, the committee recommends that the Center for Disease Control and Prevention "establish and oversee a national surveillance system to accurately determine the incidence of sports-related concussions, including those in youth ages 5 to 21." Included in that surveillance system should be demographic information about each injured athlete, concussion history, use of protective equipment, and the qualifications of the personnel who evaluated the athlete, the committee suggests.

Additionally, work remains in terms of changing the "no pain, no gain" culture of youth sports when it comes to head injuries. "There is still a culture among athletes and military personnel that resists both the self-reporting of concussions and compliance with appropriate concussion management plans," the report says.

I wrote about this particular angle back in November of last year, regarding comments made by a head NBA coach. After one of his players caught an elbow from a teammate, the coach said, "He got touched up a little bit last night. That happens a lot in basketball. It's just that now they treat everybody like they have white gloves and pink drawers and it's getting old."

During a public briefing held for the IOM-NRC report's release today, committee chair Robert Graham suggested that sports-related concussions are often treated differently than other bodily injuries because they're not readily visible. Unlike a torn ACL or a broken arm, there's no clear way to visually assess the extent of a concussion, which can lead some coaches, parents, and youth athletes to underestimate the severity of said injuries.

But a youth-athlete who returns from a concussion before fully healing runs the risk of Second Impact Syndrome, which can be fatal depending on the severity of the second injury.

"Rest is key to recovery," Tamara C. Valovich McLeod, a reviewer of the report and a professor in the athletic training program at A.T. Still University, said in an email. "Staying out of physical activity, and modifying school if necessary is important." (The American Academy of Pediatrics issued a similar recommendation in a clinical report released on Oct. 27.)

Further Research Needed

One consistent theme throughout the IOM-NRC committee's report: There's plenty of room for additional research in the youth-sports-concussion realm.

Currently, there's no clear threshold to determine the amount of force that causes a concussion in youth-athletes. It's also unclear whether the threshold decreases for subsequent concussions after a student-athlete suffers his or her first head injury.

The committee identified defining those thresholds as a particular need, suggesting that the National Institutes of Health and the Department of Defense "should support research to establish objective, sensitive, and specific metrics and markers of concussion diagnosis, prognosis, and recovery in youth." It also recommends that the NIH and DOD conduct "controlled, longitudinal, large-scale studies to assess short- and long-term cognitive, emotional, behavioral, neurobiological, and neuropathological consequences of concussions and repetitive head impacts over the life span."

The NIH and DOD aren't the only two agencies that have their work cut out for them, though. The IOM-NRC report calls for the National Collegiate Athletic Association, National Federation of State High School Associations, and national governing bodies for youth sports to conduct a "rigorous scientific evaluation of the effectiveness of age-appropriate techniques, rules, and playing and practice standards in reducing sports-related concussion." Particular examples cited in the report include a placing limit on the amount of contact allowed in practice (something the Maryland education department hopes to do) or whether youth athletes should be on a "hit count" similar to what baseball pitchers face.

When it comes to sports equipment, the IOM-NRC committee found "limited evidence" that current helmets reduce the risk of concussion. (A study presented earlier this year during the American Orthopaedic Society for Sports Medicine's annual meeting found no association between the age and brand of a football helmet and a reduced risk of concussion.) Additionally, there's no evidence that additional equipment such as mouthguards and facemasks reduce the risk of concussion, but such equipment does serve other protective purposes.

"The findings of our report justify the concerns about sports concussions in young people," said Graham in a statement. "However, there are numerous areas in which we need more and better data.  Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."

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