Guest Column - April 2012
Find a printable version here

Youth Sports

Play Smart, Play Safe
Treating & Preventing Concussions in Youth Athletes

By Dr. William Spangler

The times are changing—and for the better. Today, there is a growing awareness of the potential long-term cognitive and physical impact of concussions at every level of sports. A 2011 a survey on behalf of Safe Kids USA found that 42 percent of parents worry to some degree about their children suffering a concussion while playing a team sport. Parents also said that they and the coaches both need to be trained in sports injury prevention and sports safety, the survey showed. While they still feel they and the coaches have more to learn, they feel they are more knowledgeable than they were a decade ago and take more precautions to keep their kids safe.

Due to advances in medicine, greater knowledge of the seriousness of concussions and other head injuries, and a concerted effort by professional athletes to educate youth athletes, there is now much more awareness of the long-term health implications of getting even just one concussion—let alone multiple concussions.

At the professional level, a number of well-publicized athletes have suffered the long-term consequences of multiple concussions. Professional athletes have had their careers cut short due to multiple concussions. These kinds of tragedies emphasize today's need for better concussion care for athletes—especially our youngest competitors.

The Basics: What Is a Concussion?

Contrary to popular belief, a concussion is not a bruise to the brain caused by hitting a hard surface. In most cases, no physical swelling or bleeding is usually seen on radiological scans. The injury generally occurs when the head either accelerates rapidly and then is stopped, or is spun rapidly due to a bump, blow or jolt to the head or body that causes the head and brain to move quickly back and forth.

The numbers are frightening and tell their own story. A total of 135,000 children between the ages of 5 and 18 are treated in emergency rooms each year for sports- or recreation-related concussions and other head injuries, according to the Centers for Disease Control And, with 30 to 40 million kids playing youth sports every year, the chance of suffering a concussion is more common than most people imagine. Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury.

A concussion can result in a change in a child's behavior, thinking or physical functioning. Coaches report that their youth athletes may appear dazed or stunned, are confused about their assigned position, forget an instruction or play, and may be unsure of the score or opponent. Other signs that they notice of a possible concussion include moving clumsily or with poor balance, answering questions slowly, briefly losing consciousness, showing mood or personality changes, and being unable to recall events prior to the hit or fall, or after the hit or fall.

Trickle-Down Effect

We often hear news stories about the forced retirements of amazing star quarterbacks or renowned boxers because of the numerous concussions they have suffered. But, the awareness goes beyond that, and that awareness thankfully trickles down to the college-level athletes and eventually, although to a lesser degree, to the high school and middle school youth athletes.

For example, the NFL in 2010 released new rules to prevent head injuries. In fact, 2010 became the "Year of Concussion Awareness" in the NFL. These rules prohibited a player from launching himself off the ground and using his helmet to strike a player in a defenseless posture in the head or neck area. Play was stopped when a player lost his helmet. The NFL also instituted more stringent return-to-play guidelines for players who suffered concussions. Teams also had to consult with an independent neurologist whenever a head injury occurred.

Further measures announced in February 2011 required that new test rules be used by all teams before sending a player back to the field. A focused exam was incorporated so that the injury was immediately identified and athletes with head or spine injuries could be removed at once from play.

Baseline Testing

One of the most important changes in the diagnosis and treatment of concussions over the past few years has been the increased use of baseline cognitive testing for athletes. This allows tests to be done at the beginning of the particular sport season under the supervision of a parent, coach or trained clinician. The time to take such tests is generally under half an hour. The results of these tests can then be compared to the same test that is repeated post-injury. The two results are compared to determine if there has been a concussion.

The Best Care

Coaches and parents need to enforce safety rules and the rules of each sport. If a parent sees a coach not following the rules, that person needs to speak up and not be worried about "butting in" or being pushy. Their child's safety is at risk, and no athletic scholarship or glory on the field is more important than that. They also need to explain to their children the importance of practicing good sportsmanship during each game and each practice.

If an injury is suspected, that child needs need to sit out the game and be examined neurologically for a possible concussion. The child should cease doing any kind of activity that could cause the symptoms of a concussion to worsen. The child should return to the sport only after he or she is symptom-free.

Parents and coaches should be reminded that nothing, and I mean nothing, is more important than the health, welfare and safety of their children—regardless of what sport they are playing.

Dr. William Spangler is the worldwide medical director for Travel Guard, a Chartis Company that is a global leader in travel medical, security and travel assistance. He is the spokesperson and physician for Chartis' aHead of the Game campaign, which seeks to inform the public about the dangers of concussions in youth sports. He serves as the team emergency physician for the NFL's Houston Texans. For more information, visit