Concussions are traumatic brain injuries, that’s the bottom line. The Center for Disease Control and Prevention (CDC) has defined concussion as a brain injury that is induced by traumatic biomechanical forces secondary to direct or indirect forces to the head.(1) These forces can be a bump, blow, or jolt to the head and/or body. The external forces in turn cause the head to move back and forth. The brain, which is suspended in a fluid called cerebral spinal fluid (CSF), then essentially bounces off the walls of the skull. The internal pin ball game that ensues inside the skull brings on chemical and structural damage to the brain. In a recent study, the CDC found that nearly 20% of the estimated 1.7 million concussions that occur each year are sports related (2). The highest incidence of youth sports related concussion occurs in rugby, hockey, and American Football; while the lowest incidence of concussion have been found to occur in volleyball, baseball, and cheerleading.(2)
Prevention Since there is no cure for a mild traumatic brain injury, prevention is the best solution. Unfortunately, there isn’t a solution available that completely prevents a concussion from happening. However, there are many preventative measures that can be taken to help decrease the risk of a youth athlete sustaining a concussion. The Brain Injury Alliance of New Jersey, as well as the CDC, have gathered information put forth by leading experts in the field of youth sports concussions: (3, 4)
follow the rules of your respective sport
display good sportsmanship: play clean and safe
inspect playing surfaces and surrounding areas; ensure that goal posts or poles that are exposed are padded
learn and use proper technique for your respective sport
follow sport organization policies and procedures: some organizations have implemented policies in football, soccer, and lacrosse that limits the amount of contact hours during practice(5)
ensure that the athlete is using proper fitting, maintained and appropriate equipment during their sport
Wearing an appropriate fitting piece of personal protective equipment such as a helmet in a contact sport is an absolute must to aid in reducing the risk of concussions. In fact, the American Orthopedic Society for Sports Medicine suggests that ensuring helmets fit properly may be one of the simplest but most effective ways to minimize the risk of concussion(6). In another recent study, it was concluded that an improperly fitted football helmet is a risk factor for sustaining a concussion with increased duration and heightened symptoms (7). While ensuring proper fit of basic equipment can help reduce the possibility of concussions, adding specialty equipment has not been found to effect the possibility of sustaining a concussion. There have been recent studies concluding that in sports like football, rugby, soccer, field hockey, and ice hockey adding extra pieces of preventative equipment such as a custom made mouth-guard, headgear, or a face-shield has not been found to be effective in preventing concussions.(8,9) In addition, some studies have actually found that wearing protective head gear can give the athlete a false sense of confidence. These athletes believe that they are not subject to concussions because they have protective gear and therefore may play more recklessly (10).
Neck Strength Although adding extra protective equipment has not been found to be significant in helping prevent concussions, there is hope in another area. Several recent studies have compiled great evidence that suggests that increasing neck strength has been found to reduce the risk of concussion during a collision. These same studies have also found that activating neck muscles and facial muscles in preparation for an incoming collision (“bracing for impact”), can significantly reduce the possibility of sustaining a concussion (11,12). Simply adding neck strengthening accompanied with impact anticipation may reduce the risk of sustaining a concussion (9). Most neck strengthening programs include a combination of shoulder and neck strengthening. Before engaging in any program labeled as “neck strengthening”, please consult with your medical professional to ensure said program is appropriate.
Additional Information: Education can be the absolute key to concussion prevention. The CDC is an excellent resource for information on prevention of concussions and signs and symptoms of concussions for athletes, parents, and coaches. Be sure to consult a medical professional if a concussion is suspected. Remember there is no cure for a concussion, yet steps can be taken to prevent the likelihood of them occurring during sport.
Read More Articles by EXOS Regarding Youth Athletes:
1. Gioia GCollins M. Concussion Defintion And Pathophysiology. 1st ed. Center for Disease Control and Prevention; 2006:1-5.
2. Pfister T, Pfister K, Hagel B, Ghali W, Ronksley P. The incidence of concussion in youth sports: a systematic review and meta-analysis. British Journal of Sports Medicine. 2015;50(5):292-297. doi:10.1136/bjsports-2015-094978.
3. Concussion Prevention - Sportsconcussion. Sportsconcussion. 2016. Available at: http://sportsconcussion.bianj.org/concussion-prevention/. Accessed June 25, 2016.
4. Concussion Fact Sheet For Coaches. 1st ed. Center for Disease Control and Prevention; 2016:1-4. Available at: http://www.cdc.gov/headsup/youthsports/coach.html. Accessed June 25, 2016.
5. Trahan K. Ivy League football coaches agree to end tackling in practices during season. SBNationcom. 2016. Available at: http://www.sbnation.com/college-football/2016/3/1/11140628/ivy-league-full-contact-tackling-football-practices-ncaa. Accessed June 25, 2016.
6. Torg J, Boden B, Hirsch H et al. Athletic Induced mTBI and Catastrophic Intracranial Injuries: Determining Helmet Efficacy and Predisposing Injury Profiles. 2012.
7. Greenhill D, Navo P, Zhao H, Torg J, Comstock R, Boden B. Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players. Sports Health: A Multidisciplinary Approach. 2016;8(3):238-243. doi:10.1177/1941738116639027.
8. Navarro R. Protective Equipment and the Prevention of Concussion - What Is the Evidence?. Current Sports Medicine Reports. 2011;10(1):27-31. doi:10.1249/jsr.0b013e318205e072.
9. Eckner J, Oh Y, Joshi M, Richardson J, Ashton-Miller J. Effect of Neck Muscle Strength and Anticipatory Cervical Muscle Activation on the Kinematic Response of the Head to Impulsive Loads. The American Journal of Sports Medicine. 2014;42(3):566-576. doi:10.1177/0363546513517869.
10. Clay, Michael B., Kari L. Glover, and Duane T. Lowe. "Epidemiology Of Concussion In Sport: A Literature Review". Journal of Chiropractic Medicine 12.4 (2013): 230-251. Web.
11. Collins C, Fletcher E, Fields S et al. Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports. The Journal of Primary Prevention. 2014;35(5):309-319. doi:10.1007/s10935-014-0355-2.
12. Caswell S, York M, Ambegaonkar J, Caswell A, Cortes N. Neck Strengthening Recommendations for Concussion Risk Reduction in Youth Sport. International Journal of Athletic Therapy and Training. 2014;19(6):22-27. doi:10.1123/ijatt.2014-0043.
Brittani Cookinham, PT, DPT, ATC, LAT
Physical Therapy Manager, EXOS‐TX