The University of Pittsburgh Medical Center (UPMC) estimates that between 1.7 and 3 million sports- and recreation-related concussions will occur this year. One recent study found that the rates of sport-related concussions were highest in football, boys’ lacrosse and girls’ soccer. However, according to UPMC, half of those concussions will go undetected or unreported.
Here's what the experts say:
A problem lies within detection and understanding of the seriousness of concussions. Often, young athletes are hesitant to tell teammates, coaches, trainers and doctors if they have suffered a possible brain injury.
“When you talk to the kids, what they feel is the internal peer pressure. It’s not like their peers pressuring them to lie, it’s the ‘Hey, we need you, hurry up and get well because we want you to play.’ When you really talk to the kids and try to understand, they are afraid of letting people down and that’s what we’re running into.”– Dr. Gregory Stewart, Co-Director of the Tulane Sports Medicine Program and Director of the Louisiana Sports Medicine Society
Certified athletic trainers play a key role in the education of young athletes about concussions as well as in the detection and treatment of these injuries.
"Compared with high school athletes who had access to an athletic trainer, those without such access were less knowledgeable about concussion."– "Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer"
Parents can help schools to address this issue. If their child plays sports – especially sports with high concussion rates – they should learn how to recognize these injuries.
"Researchers have documented athletes' lack of willingness to report concussions to medical personnel, so parents of youth athletes should also be educated to recognize signs and symptoms of concussion. Parents (or guardians) typically have the most contact with young athletes and so are well positioned to report atypical behavior, but many parents are not properly educated on the topic of concussion."– National Athletic Trainers' Association Position Statement: Management of Sport Concussion
Concerns surround whether schools always follow best practices (and whether they do enough to address the risk of other catastrophic injuries both during the season and in off-season conditioning).
“The best practices are not being followed. … I’m kind of mystified, but people are just not implementing evidence-based medicine and policies at the high school level. I’m not saying they’re not interested in it, but they’re just not doing it.”– Dr. Douglas Casa, Chief Executive Officer of the University of Connecticut’s Korey Stringer Institute
Fortunately, 49 states (and the District of Columbia) have passed laws that specifically address the issue of concussions in youth sports.
"Most forbid a return to play on the day of the suspected concussion, require clearance to resume play from a qualified medical professional, and mandate education on the issue for parents and athletes. About half of the laws require training for coaches."– "Tackling Concussions"
"The Texas law includes a first-in-the-nation provision for the creation of concussion oversight teams by each school district or charter school participating in interscholastic sports."– MomsTeam.com, youth sports information website
However, laws alone won't solve the problem. Many officials hope the laws spur more research and increase data collection, which can help researchers.
“The big overarching question is how often are these injuries occurring in youth athletes, male and female. … Until we know just how many injuries are going on out there it’s going to be really difficult for us to study and learn what are best practices, what works best.”– Dr. Munro Cullum, a neuropsychologist overseeing ConTex, a study by the University Interscholastic League (UIL) and researchers at UT Southwestern that tracks concussions among Texas high school students
Our understanding of concussions and the management of these injuries in young athletes is ever-evolving and, in turn, will benefit from data and research.
“There’s emerging evidence that strict or prolonged rest is not good, and there’s emerging consensus that we need to start looking at concussion subtypes … We’re at the cusp of dramatic changes [in management].”– Dr. Brian Hainline, Clinical Professor of Neurology at New York University, and Indiana University, Indianapolis, and Chief Medical Officer of the National Collegiate Athletic Association
Some believe that a fundamental shift in teaching sports before kids even enter high school is necessary.
In 2015, the U.S. Soccer Federation issued concussion guidelines that prohibited "heading" by soccer players ages 10 and younger and restricted heading by players ages 11-13 to only practices, never in games.
Pointing to the effect of brain injury concerns on declining participation numbers in high school football, a 2018 white paper by the Aspen Institute's Sports and Society Program suggested teaching flag rather than tackle football before athletes reach the high school level.
"I think that this has the opportunity to really save the game of football, honestly."– Drew Brees, New Orleans Saints quarterback, who founded a mixed-gender flag football league for youth players from kindergarten through 10th grade