White Coat, Black Art·Blog

Kids risk head injury even if no concussion

How much does your child risk brain injury playing team sports like football, even when there are no symptoms of a concussion? More than you think, says @NightshiftMD
High School football players run sprints during a practice/ (Kevin Wolf/Associated Press)

The 'invisible epidemic' is how some in the medical community refer to head injuries in children who play contact sports.  But the assumption has been that the kids at risk were those who had experienced concussions. A new study published online in the journal Radiology questions that premise.   

The study by U.S. researchers at Wake Forest School of Medicine concluded that kids who play football have measurable changes in the brain following a single season even if they don't have symptoms of a concussion. They studied 25 boys between ages 8 and 13 who play youth football.  During games and practices, the kids' helmets were equipped with sensors that record and transmit head impacts.  All practices and games were video recorded to confirm the accuracy of each head impact report. Each child had an MRI of the brain before and at the end of the season. None of these kids had a documented concussion.  Still, their MRI scans at the end of the season had subtle but definite abnormalities.

A study of just 25 kids may seem insignificant, but statistically speaking, there were enough kids enrolled to draw conclusions. The findings are the latest to show that you don't need to have a concussion to have problems stemming from repetitive hits to the head.  A 2010 study of high school football players from Purdue University found that the kids who had a large number of hits had measurable changes in their visual working memory as well as changes on functional MRI brain scans. 

USA Football, that country's national governing body, says roughly 3 million young athletes participate in organized tackle football.  So, it made sense that researchers would study kids who play football. If they did a study in Canada, they'd look at kids who play hockey. You can add soccer to the team sports most likely to result in head injuries in kids. Public health officials in Canada say that when compared to other types of injuries, head injuries from hockey, football and soccer in kids increased by 40 per cent between 2004 and 2014, making them the most common type of injury bringing kids between ages 10 and 19 to the emergency room. 

Critics point out that the MRI scans did not detect brain damage per se.  What they found are abnormalities in the movement of water molecules in the wiring of the brain. That's a crude measure of the brain function. The researchers didn't check to see if the findings correlate to subtle learning problems in school.  As for the abnormalities found on MRI scans, no one knows if the changes found after a season of tackle football revert to normal a few months later.  Still, the authors say it's plausible that they've identified kids at risk of long-term brain damage. The fact that the greater the number of head impacts, the bigger the effect on brain function suggests that something bad is happening. 

Autopsy studies of athletes and others with a history of repetitive head injuries but no concussion have shown the early states of Chronic Traumatic Encephalopathy or CTE.

Given concerns regarding head injuries in youth, what are doctors recommending? In the U.S., several states put limits on full-contact football practices.  In 2013, Hockey Canada's Board of Directors voted to ban body checking in peewee hockey.  Last month, the American Academy of Pediatrics recommended that doctors encourage parents to keep their kids from specializing in a single sport until age 15 or 16 at the earliest.  The main point is to keep kids from training so intensively for one sport because doing so puts them at risk of overuse injuries as well as anxiety, depression and burnout.  But that sort of recommendation would also result in fewer kids participating in sports associated with repetitive head injuries.

In my opinion, kids playing at-risk sports like hockey and tackle football can't wait for definitive evidence. Their parents need to consider pulling them out now - before it's too late to avoid permanent damage.


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