The word “concussion” has become somewhat of a dirty word in the world of sports. For those not involved or invested in this world, it does not hold nearly the same weight. It is something you get during a car crash, miss a week of work and get back to normal. In the sports world however it carries a much greater connotation. There are athletes as young as twelve years old who are hiding their symptoms because they have already had two concussions and know their parents will pull them out of sports if they get a third. There are college football players who lay awake at night wondering not if, but how their sport is going to hurt them in the long run, both mentally and physically. The concussion protocol in the United States is something that must be improved. There is a large group of people who believe this change should begin with banning contact sports for children. Given the facts that show how detrimental concussions can be, one would think that banning sports would be a natural conclusion. However, sports are a huge part of the culture and economy in this country, making this a complicated issue. Banning youth sports would be a massive overcorrection to the concussion problem, but continued education and research will help the issue immensely. 

To truly understand how severe the issue of concussions is, it is crucial to understand exactly what the injury is. A concussion is described as a traumatic brain injury (Boston Children’s Hospital). Traumatic is truly the best word to describe the injury. The symptoms are wide, and vary between patients. Some of the most common include: headache, dizziness, sensitivity to light, memory and concentration issues, loss of consciousness, problems with balance, and many more (Boston Children’s Hospital). Concussions are caused by a variety of different mechanisms. Some include: a blow to the head, a hard fall, or a strong rotational force. Essentially, it is caused by the brain hitting the inside of the skull. A big issue with this specific injury is that there is rarely a designated time frame for return to play. The rehab must be taken day by day, a process that can be frustrating for athletes. Time frames are difficult to give, because each athlete is different and each athlete’s body varies in how they heal. 

A huge concern regarding concussions is something called post-concussion syndrome. It is crucial that the brain has completely healed following a concussion. If an athlete returns to play before their brain has completely healed, and receives another blow to the head, even at the fraction of the severity of the original injury, it can result in post-concussion syndrome (Mayo Clinic). This is an ailment where the patient experiences concussion symptoms for months, or even years following the injury. This can be incredibly debilitating and extremely detrimental to the patient’s daily life. It is a much bigger issue in terms of children, because post-concussion syndrome can affect brain development in unforeseen ways. In other words, if a young person experiences post-concussion syndrome, doctors cannot predict how this will impact their future in terms of their intellectual capabilities. Many people do not realize that this condition can be so debilitating, and thus do not treat concussions with the care they deserve, putting themselves or their children at risk (Mayo Clinic). 

The stigma about concussions in the United States has led to young athletes being afraid to report their symptoms to a parent or a health care provider. Part of the issue with this is that athletes know this will keep them out of competition, but they do not understand the severity of the injury. The issue with concussions is that unlike most other injuries they cannot always be seen with the naked eye. This means that the athlete experiencing symptoms is responsible for reporting it at their own will. A study of high school football players in Wisconsin found that almost 30% of high school football players had experienced a concussion, but less than 50% reported their symptoms. Many of them said that their reasoning was that the did not believe their symptoms were severe enough to warrant reporting. A large percentage said that they did not want to be kept out of competition. Many of the players surveyed did not even realize that their symptoms were those of a concussion (Guskiewicz et al) This stems from a lack of understanding about what concussions are and how serious they can be. It is clear that whether youth sports are banned or not, something must be done to improve concussion awareness in the United States. 

In most cases, provided the athlete has reported their symptoms to a health care professional, long-term damage is almost completely preventable. A more conservative approach to the return to play can greatly reduce the long-term damage caused by concussions. A major issue is that there is no standardized return to play protocol for health care providers to follow (Guskiewicz et al.). This can sometimes lead to athletes returning to play before their brain may be ready to do so, based on outside circumstances, such as competition schedule, or other factors important to the athlete. While there are certainly health care providers that follow a conservative approach, it is important that this approach be more widespread in order to protect the young athletes. A study found that 6.5% of college football players who sustained a concussion sustained a second one in the same season (Guskiewicz et al. ). It is crucial that this number be cut down by a more conservative rehab process, as the same study found that one concussion will make the athlete more susceptible to future concussions (Guskiewicz et al.).

The movement to ban youth contact sports, specifically football is led by Dr. Bennet Omalu. He is a leading expert on concussions in the United States, specifically on long term effects of these injuries. His work was featured in the recent movie, “Concussion.” He believes that allowing children to play youth football can be incredibly detrimental to their futures. His research states that even children who do not experience a full on concussion during the season, are still doing irreversible damage to their brains on a cellular level. He believes that contact sports pose an enormous risk to the health of children, and the decision to participate must be taken with great care. He believes that parents should not be able to make this decision for their children, because it will be the child that deals with the side effects, not them. He also acknowledges that children that age are too young to truly understand the gravity of the decision. With this in mind he proposes that contact sports should be banned for children under 18 years old, and only then will the athlete be able to make the decision to participate on their own. He likens contact sports to smoking, because while the implications are known, individuals still choose to partake (Omalu).  

Many argue that banning youth sports would lead to a snowball effect of attempting to ban anything that could potentially harm children. The nature of life is that sometimes people get hurt, and the same is true in sports. Participating in sports is inherently dangerous, and even the athletes are aware of this, but the benefits of participating in sports far outweigh the potential dangers. There is an enormous problem with child obesity in this country, and while that cannot be completely solved with sports, it will almost certainly be made worse if they are eliminated. Children learn such a wide variety of lessons through participation in sports, such as teamwork, leadership, confidence, and hard work.  and without this option millions of children would be left without an outlet to express themselves. It is important that children are still allowed to participate in sports, but that they are made as safe as possible for those that choose to participate. 

While on the surface, banning youth sports seems like the most sensible option. If the concussion problem is that serious, why not simply shut down the source? However, most people believe that this would be a massive overcorrection to a problem that while serious, would not warrant the entire youth sports system to be shut down. There is evidence that states that as long as a concussion is managed properly, the athlete is not at risk for brain damage more than any other person, and that most children completely recover without adverse side effects (Glatter). This was demonstrated by a follow up study 50 years later of high school football players in Minnesota who were found to have no greater evidence of neurological damage than the average person (Janssen et al.). This would point to the real problem with the concussion debate being not the exposure of children to concussions, but the improper handling of the recovery process. With this in mind, the focus on youth sports reform in the United States should focus largely on stricter return to play protocol, as well as continued education of coaches, children, and parents on what concussions are and how to prevent them (Glatter).

The American Academy of Pediatrics put out a position statement that affirms their belief that tackle football and other youth contact sports do not need to be banned. They suggest that the rate of occurrence of catastrophic head injuries for young athletes is between .19 and 1.78 for every 100,000 athletes (American Academy of Pediatrics). They feel that as long as children are taught the proper way to tackle, and are playing in the appropriate age level that they believe that there is no reason to eliminate tackling from the sport. They affirm the fact that there should be a certified athletic trainer at all practices and competitions, in order to recognize and treat all injuries, but specifically concussions. Despite all of this the American Academy of Pediatrics acknowledges the concern some parents may have about allowing their children to participate in tackle football, and recommends that non-tackle alternatives are made available to them (American Academy of Pediatrics). 

There is a somewhat obscure and outrageous notion, but one that exists nonetheless, that there are some sports medicine practitioners that are not doing all they can to prevent concussions. This is brought up almost exclusively at the professional level, but with concerns that it could trickle down to the lower tiers of the sports medicine field. These accusations were raised by Ian Munchnick in his book Concussions Inc. The accusations were mainly directed towards the medical staff of the Pittsburgh Steelers. He outlines his reasons in further detail in his book, but his main concern was that sports medicine has become such a big and for some, profitable industry, that some doctors were benefitting from the continued occurrence of concussions in the NFL (Munchnick). These accusations are outlandish and are little more than a scare tactic used to distract from the actual science beyond concussions. Doctors take an oath where they promise to do all they can to help their patients, regardless of the financial gain that may come from it. This is not a concern that parents need to have at all. These accusations were brought up regarding people at the highest level of sports. The local physician or athletic trainer that is treating their child has nothing to gain by mismanaging concussions, and it would be incredibly detrimental to their career to do so.   

One important obstacle in the prevention of concussions is the fact that the current helmets are not actually designed to prevent concussions. The current helmets are designed to prevent skull fractures, which is why there is a relatively low incidence of this particular injury in football. A major issue with the current helmets is that they do little to prevent injuries caused by rotational forces, which is one of the main mechanisms that cause concussions (Camarillo). There is a modification to these helmets where there is a soft outer shell placed around the helmet, called the ProCap. This soft shell has been found to reduce the speed of the collisions that cause concussions. They have been found to be somewhat effective in protecting athletes, but they are almost never used during games. It would be expensive to purchase this equipment for entire teams, but they can be a beneficial tool to help athletes who may be more at risk than others, as it would offer some extra protection (Wilson).

A great resource that is doing a lot of work in the field of preventing concussions, especially in youth and high school sports is Heads Up by the CDC. They provide information to parents, coaches, officials, and even the young athletes themselves. They also provide resources for health care providers to better communicate this information to their patients. They do not advocate for banning contact sports, just for making them as safe as they possibly can. For coaches, it provides a foundation to teach them what concussions are and how serious the injury is, as well as proper technique to prevent head injuries. It also discusses how they would know how an athlete is ready to return to play. It provides parents with information about what a concussion is and how to help their child deal with one. It gives officials information on how to keep the game safe, helping them to prevent head injuries from their position. Additionally, it provides information to children so they can better understand what is going on in their brain (CDC). 

There are many proposed ways to manage the concussion epidemic in this country. The utmost priority to help this problem must be continued concussion research. The reason the concussion problem got so bad in the first place is because for so long so little was known so little about the injury. The more that is known about concussions, the better the treatment will be for the athletes who sustain them. Few parents pull their children out of sports when they sprain their ankle because it is well understood, easily treatable, and poses no long-term danger. The key to bridging this gap is more research. Additionally, continued education will prove to be incredibly important. 

Sports can be an inherently dangerous undertaking. One of the biggest concerns for parents of young athletes has become concussions. There has been extensive discussion in the media of this issue, largely due to the movie Concussion, which focuses on the work or Dr. Bennett Omalu. He has done extensive research on the long-term effects of concussions, and believes children should not be allowed to play contact sports until they turn 18. He believes that allowing children to play contact sports is putting them in immeasurable danger that they cannot fully consent to. Most medical professionals believe that this would be a massive overcorrection to the problem. This stance is supported by both the American Academy of Pediatrics and the CDC, who believe that sports are a healthy undertaking for children.  Concussions become a much bigger concern when they are not managed properly. It is imperative that a conservative, standardized concussion protocol is established in order to prevent the serious consequences of a concussion that is mishandled. Continued education and research on the topic are they key to keeping children safe for as long as they choose to participate in sports. 
