What Every Youth Sports Parent Should Know About Concussions

more informed parent = better protected athlete.

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Keith Titmuss was an Australian rugby star with all the promise in the world. Then in 2020 tragedy struck the National Rugby League rookie when he had a stroke and died from exertional heat stroke during a two-hour training that was later deemed “more likely than not inappropriate.” He was just 20.

Titmuss’s tragic death recently reentered the new when it was discovered that he was suffering from stage 2 CTE (chronic traumatic encephalopathy), the degenerative brain disease disorder that causes the death of nerve cells in the brain from repeated blows to the head. Titmuss, who had played competitive rugby since age 5, is the youngest known athlete to be diagnosed with the CTE. Dr. Michael Buckland, the neuropathologist who discovered the CTE after Titmuss’s brain was donated for research, is sounding the alarm.

“He had early exposure and he had a lot of exposure and I think every parent should sit up and consider their child's long-term brain health and ask the question of the [organizations]: are they doing enough?” Dr Buckland said.

Last week was Concussion Awareness Week. Yeah yeah, not the most uplifting of “holidays”. But an important one for any youth sports parent, coach, athlete and concerned citizen. There’s a reason it’s called Concussion Awareness Week and not Concussion Prevention Week. There is no way to 100% prevent a concussion but there are smarter ways to approach sports.

We are already aware of concussions. We’re aware that concussions appear to be commonplace in the NFL, particularly if your name is Tua Tagovailoa. We’re aware that concussions are part of the risk/reward calculus when playing sports. You might be less aware that there have been seven known deaths of young football players since August, three of them linked to head trauma. This sentiment is by no means meant to scare anyone; it’s an opportunity to gain more understanding about a significant injury invisible to the naked eye.

There is a LOT of concussion information out, much of which is ever-changing. So, for fear of bogging you down, I’ve picked out concussion-related information that I hope is both useful and accessible.

What exactly is a concussion? What happens to the brain?

Concussions typically, but not always, come with symptoms. A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. (CDC). A sudden blow to the head can cause the brain to come into contact with the inner skull. There is potential of bruising the brain, pulling nerve fibers, and tearing blood vessels. (American Association of Neurological Surgeons)

What is a subconcussive hit? Is that just like a minor concussion?

There are no symptoms in subconcussive hits.

A subconcussive impact is a bump, blow, or jolt to the head that
does not cause symptoms. This differs from concussions, which do cause symptoms. A collision while playing sports is one way a person can
get a subconcussive head impact. Studies are ongoing to learn about subconcussive head impacts and how these impacts may or may not affect the brain of young athletes. (CDC)

CTE has been diagnosed in athletes who had no reported concussions but suffered thousands of subconcussive hits.

What are the main symptoms of a concussion?

Lack of balance, dizziness, confusion, sensitivity to light, nausea, and headache. Like Covid and many illnesses, the athlete may experience just one or numerous symptoms.

What questions should you ask an athlete with a possible concussion?

You can start with basics like their name, address or birthday. (UC Davis Health) If amid a competition, ask the athlete the score or even the name of the opponent.

Football has to have the highest frequency of concussions, right?

Wrong. At least when it comes to the games themselves.

Per 10,000 athlete exposures:

• Girls’ soccer, with 8.19 concussions

• Boys’ football, with 10.4 head injuries

• Boys’ ice hockey, with 7.69 concussions

Interestingly, concussion rates during practice were different than during competitions. Football still claims the highest rates of concussion in this category, at 5.01 per 10,000 exposures. However, cheerleading is the only sport with a higher practice concussion rate than competition concussion rate, with 63.7% of cheerleading concussions occurring at practice.  (Journal of Pediatrics)

Why are concussions so dangerous?

The initial issue facing an athlete suffering a concussion is the feeling that it’s nothing, that it can be shaken off. Or even worse, they recognize something is awry but doin’t want to lose minutes or let their team down. Unlike contusions, bone breaks or bloody noses, concussions are invisible.

Only 10% of concussions involve a loss of consciousness (US Soccer Training Center)

Do boys and girls experience concussions in a similar fashion? Are the concussion resources similar?

Of course there’s an imbalance. This great infograph from the CDC highlights the differences:

Graphic via CDC

How prevalent are concussions?

An estimated 1.6 to 3.8 million athletes annually suffer concussions, according to the Brain Injury Research Institute. Often, cases are underreported and undiagnosed. A study by the American Academy of Pediatrics shows the number of sports-related concussions is highest in high school athletes, but they are significant and on the rise in younger athletes. (National Safety Council)

Most concussions occur during games, not practices. Few result in loss of consciousness. Protect The Brain breaks down sports concussion facts for all age groups:

● 10% of all contact-sport athletes sustain concussions yearly

● Football injuries associated with the brain occur at a rate of one in every 5.5 games

● 5% of soccer players sustain brain injuries

● The head is involved in more baseball injuries than any other body part; almost half of injuries involve a child's head, face, mouth or eyes

● An athlete who sustains concussion is 4-6 times more likely to sustain a second concussion

What’s the deal with Guardian Caps for football players?

Guardian Caps are large, soft-shelled pads that are worn over hard-shelled helmets and said to reduce impact of force by 10% (NFL Research). NFL players were mandated to wear Guardian Caps during training camps and for the first time have the option of wearing them during the regular season.

There’s a significant push to mandate Guardian Caps usage in collegiate, high school, and youth sports. Per Guardian Sports, their caps are being utilized by 5000+ high school programs and 1000+ youth sports organizations. The company claims that given the slower nature of high school vs. the higher levels that Guardian Caps can reduce impact in those players by 33%.

What about measures in other youth sports?

USA Hockey raised the minimum age for body checking (a defensive player crashes into the opponent who's handling the puck) to 13-14. It was previously 11-12. One study claims that disallowing body checks can result in a 58% reduction in concussion risk.

Florida requires standardized protective headgear for high school girls' lacrosse, and there is a swelling movement in other states to follow suit.

Finally, what can you do as a parent?

The good news is at the high school level all 50 states have concussion laws, most of which require coach education. But whether your kid is 4 or 14, it’s crucial to find out the concussion education and protocols employed by your athlete’s organization. Does the organization’s website have concussion information? Ask the coach about concussion protocol. Be proactive.

Of course this is just scratching the surface but hope it’s helpful nonetheless. If any of you have a cautionary tale or story of excellence involving a coach or organization’s handling of a concussion, please share it with us.