Ban youth tackle football? That was nearly the case earlier this year in the state of Illinois as lawmakers introduced legislation (HB4341) to ban football for kids under the age of 12.1 The aim of the bill was to “delay the trauma…and protect childrens’ brains and the future of football.”2 However, Dr. Cynthia LaBella, Sports Medicine Director at the Ann and Robert H Lurie Children’s Hospital in Chicago provided written testimony arguing there is no evidence that eliminating tackle football would prevent CTE, a degenerative brain disease found in people with a history of repetitive brain trauma.2 The bill ended up dying in legislation, but the debate remains regarding the susceptibility of sports related concussions (SRC) in youth sports.  

Youth sports organizations have battled this issue directly through new rule implementation and better technique. For Instance, USA football developed an educational training program called the Heads Up program designed to “teach proper preventative blocking and tackling techniques, which has reduced the rate of concussions by 1.5 times.3 Likewise, US Soccer has issued new guidelines banning players 10 and under from heading the ball and limiting heading the ball in practice for those 11-13 years old.4
Not only has the implementation of new rules and training programs worked to lessen the risk of concussions, but athletes, parents, and healthcare professionals alike are getting better at recognizing concussion-like symptoms, reporting them properly, and following the best course of management and care. One way healthcare professionals have improved the management and care of concussions is through baseline testing. The National Athletic Trainers’ Association (NATA) and the American Medical Society for Sports Medicine (AMSSM) position statements have highlighted the importance of baseline testing for athletes.5,6
In the instance where a possible concussion does occur, baseline testing information provides critical information to healthcare professionals as to damage sustained, severity of concussion, progression of symptoms, and appropriate return to activity.5 One baseline test administered at Achieve Ortho Sports is the ImPACT® test (12 and older) and the ImPACT® Pediatric (5-11 years old). ImPACT® is a computer/tablet administered neurocognitive test consisting of a wide array of modules that measures level of symptoms, reaction time, verbal and visual memory, and processing speed. In the event of a suspected concussion an athlete can undergo a post-injury test which is then compared to their baseline test.
Though baseline testing can provide a detailed objective picture of an athlete’s cognitive state, concussion diagnosis still relies on the subjective information from the athlete. Therefore, it is extremely important for athletes to notify: coaches, athletic trainers, and/or parents if they are experiencing any concussion like symptoms.  

What is a concussion?
A traumatic brain injury induced by biomechanical forces with the following added features:7

• may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
• typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously though sometimes may evolve over a number of minutes to hours.
• may result in neuropathological changes
• results in a range of clinical signs and symptoms that may or may not involve loss of consciousness.

 
Common Signs & Symptoms:5

Amnesia	Headache	Dizziness	Nausea/vomiting	Visual Problems
Nervousness	Irritability	Balance problems	Sensitivity to light	Sensitivity to noise
Difficulty concentrating	Fatigue/feeling tired	Sadness	Ringing in the ears	Drowsiness

Urgent Signs & Symptoms:5

Severe worsening of headache	Seizures	Repeated Vomiting	Increasing confusion
Increasing neck pain	Numbness or tingling in arms/legs	Slurred Speech	Unusual behavior change
Very drowsy, can’t be awakened	Significant irritability	Less responsive than usual	Pupils becoming unequal in size

If any of the URGENT symptoms develop quickly and/or worsen in intensity, contact 911 and/or your family physician.

It is OK to:5	No Need to:	DO NOT
Apply ice as needed for comfort	Check eyes with flashlight	*Take ibuprofen, naproxen, or Advil
Eat a carbohydrate-rich diet	Wake up frequently (unless otherwise instructed)	Do not participate in activities that make symptoms worse
Rest	Stay in bed	Drink alcohol
Go to sleep		Elevate heart rate with strenuous exercise until approved to do so
Take minimal dose of acetaminophen (Tylenol) for minor headache*

 
References
1.         Sadin S. A youth tackle football state ban was sidelined, but debate over safety is “not going away.” chicagotribune.com. http://www.chicagotribune.com/suburbs/vernon-hills/sports/ct-vhr-tackle-football-ban-illinois-tl-0507-story.html. Accessed June 2, 2018.
2.         O’CONNOR J. Minimum age for tackle football will get Illinois House vote. chicagotribune.com. http://www.chicagotribune.com/news/sns-bc-il-xgr--youth-football-concussions-20180301-story.html. Accessed June 3, 2018.
3.         Tokish JM, Shanley E, Kissenberth MJ, et al. Heads Up Football Training Decreases Concussion Rates in High School Football Players. Orthop J Sports Med. 2017;5(3 suppl3). doi:10.1177/2325967117S00131
4.         Implementation guidelines for U.S. Soccer’s Player Safety Campaign: Concussion initiatives & heading for youth players - US Club Soccer. http://usclubsoccer.org/2016/03/14/implementation-guidelines-for-u-s-soccers-player-safety-campaign-concussion-initiatives-heading-for-youth-players/. Accessed June 3, 2018.
5.         1062-6050-49.1.pdf. http://natajournals.org/doi/pdf/10.4085/1062-6050-49.1.07?code=nata-site. Accessed June 3, 2018.
6.         Harmon KG, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine Position Statement: Concussion in Sport. Clin J Sport Med. 2013;23(1):1. doi:10.1097/JSM.0b013e31827f5f93
7.         McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017-097699