Just 10 years ago, it wasn’t unusual for a young athlete to be told “shake it off” after a head injury and then be back on the field, court or mat within 15 minutes. In 2007, The New York Times chronicled the deaths or serious injuries of 50 high school players in more than 20 states from 1997 to 2007. Two years later, the Washington State Legislature passed the Lystedt Law after 13-year-old Zackery Lystedt collapsed on a football field with a severe brain injury. He had just returned to play after suffering a mild concussion earlier in the game. The law was the first in the country mandating specific protocol for managing a youth athlete after a concussion. Since then, more than 30 states have passed similar sports-related concussion laws, and several more have legislation pending. See a state-by-state overview here.
Meanwhile, the concussions continue. According to the Centers for Disease Control and Prevention (CDC), emergency room visits by young athletes with traumatic brain injuries (TBIs) rose 60 percent during the past decade. Another study from the American Journal of Sports Medicine found that concussions in high school sports rose at an annual average rate of 15 percent from 1997 to 2008.
Awareness Key to Preventing Long-term Injury
As a result of legislation like the Lystedt Law, the National Federation of State High School Associations and the National Collegiate Athletic Associations have teamed up with the CDC to develop protocols for treating concussions, as well as a program to educate athletes, parents, coaches and trainers on the symptoms and management of a sports concussion. At the core of these laws and protocols are “The Four Rs”: 1) recognize, 2) remove, 3) refer and 4) return to play only when cleared by by a licensed health care professional.
The American Journal of Sports
Medicine tracked the concussion
rate for athletes in 25 high schools
from 1997 to 2008 per 1,000
exposures (games or practices).
1) Recognize the Signs
A concussion is a brain injury caused by a direct or indirect blow to the head, and thus rapid movement of the brain inside the skull. Despite a higher prevalence in boy’s football, concussions can occur in any sport, and to girls as well as boys (see chart). Signs can include immediate memory disturbance, dizziness and vomiting (download full list). Note that an athlete does not have to lose consciousness to suffer a concussion. And keep in mind that a competitive young athlete might be less than forthcoming about his or her condition (hear why from this athlete).
2) Remove the Athlete
If you have any doubt about young athletes after a head injury, sit them out. And under no circumstance let them return to a game the same day of the concussion.
3) Refer to a Professional
Don’t try and judge the severity of the injury by yourself. Have the athlete evaluated as soon as possible by a health care professional.
4) Return Only When Cleared
Treating young athletes with a concussion is uniquely challenging because their brains are
still developing. Returning to action too early can result in second-impact syndrome, which can cause severe brain injury or death. Concussed athletes should not practice or play until they've been cleared by a licensed health care professional, and only then after showing no signs of a concussion during the six-step graduated rehabilitation program as shown here. Graduated rehabilitation will require a minimum of five days, and probably longer for young athletes.
- Heads Up: Concussion in Youth Sports — CDC clearinghouse for fact sheets, posters and clipboard reminders for coaching staff, athletes and parents
- STOP Sports Injuries — Tip sheets, articles and videos on youth sports injuries and concussions
- Sport-Related Concussions in Children and Adolescents, Pediatrics, the Journal of the American Academy of Pediatrics View abstract. Download article.
- The Fragile Teenage Brain, Jonah Lehrer, Grantland — An insider’s look from one of ESPN.com’s most popular writers.