In the JournalsPerspective

Youth athletes experience head impacts in different scenarios, ages

Young children were more likely to experience high-impact head injuries during athletic practices while those performing at higher levels were more likely to sustain head injuries during competition, according to a study published in the Journal of Neurotrauma.

“Although concussion can be a significant injury, the majority of the head impacts that result from regular participation in football are termed subconcussive impacts,” Jillian E. Urban, PhD, from the department of biomedical engineering at Wake Forest School of Medicine, and colleagues wrote. “Recent case reports of chronic traumatic encephalopathy and associated memory loss, dementia and depression in former professional athletes participating in collision sports have brought attention to possible long-term consequences of head impacts in sports, both concussive and subconcussive.”

To assess youth athletes’ exposure to head injuries, the researchers evaluated three separate age and weight classes throughout four seasons in one youth football organization. They used the Head Impact Telemetry System to gather head impact data, and Wald tests to determine differences in accelerations and number of impacts in competition vs. practices.

Three groups comprised the study, with 39 children in level A (age = 10.8±0.7 years; weight = 97.5±11.8 lb), 48 in level B (age = 11.9±0.5 years; weight = 106±13.8 lb) and 32 in level C (age = 13±0.5 years; weight = 126.5±18.6 lb). In the three groups combined, the researchers assessed 40,538 head impacts.

Urban and colleagues observed a median acceleration of 19.8/49.4g in level A, 20.6/51.0g in level B, and 22.0/57.9g in level C. They observed a higher average acceleration in level C than in both level A (P = .005) and level B (P = .02). The researchers also noted a significant difference in the number of head injuries sustained during competition vs. practice (level A: P = .0005; level B: P = .0019; level C: P < .001). Further, youth athletes in lower levels obtained more impacts in practices, and higher-level athletes sustained more in competition.

“It is noteworthy that there are significant increases in head impact magnitudes from one level to the next within a single youth organization,” Urban and colleagues wrote. “This suggests that all youth athletes cannot be grouped together when studying [head impact exposure] and injury risk and more data are needed at all levels within youth football, especially at the youngest levels. … With increasing concern over the long-term neurological effects of repetitive head impacts, data from all levels are needed to understand athletes’ exposure to head impacts over a lifetime.” — by Katherine Bortz

Disclosure: The researchers report no relevant financial disclosures.

Young children were more likely to experience high-impact head injuries during athletic practices while those performing at higher levels were more likely to sustain head injuries during competition, according to a study published in the Journal of Neurotrauma.

“Although concussion can be a significant injury, the majority of the head impacts that result from regular participation in football are termed subconcussive impacts,” Jillian E. Urban, PhD, from the department of biomedical engineering at Wake Forest School of Medicine, and colleagues wrote. “Recent case reports of chronic traumatic encephalopathy and associated memory loss, dementia and depression in former professional athletes participating in collision sports have brought attention to possible long-term consequences of head impacts in sports, both concussive and subconcussive.”

To assess youth athletes’ exposure to head injuries, the researchers evaluated three separate age and weight classes throughout four seasons in one youth football organization. They used the Head Impact Telemetry System to gather head impact data, and Wald tests to determine differences in accelerations and number of impacts in competition vs. practices.

Three groups comprised the study, with 39 children in level A (age = 10.8±0.7 years; weight = 97.5±11.8 lb), 48 in level B (age = 11.9±0.5 years; weight = 106±13.8 lb) and 32 in level C (age = 13±0.5 years; weight = 126.5±18.6 lb). In the three groups combined, the researchers assessed 40,538 head impacts.

Urban and colleagues observed a median acceleration of 19.8/49.4g in level A, 20.6/51.0g in level B, and 22.0/57.9g in level C. They observed a higher average acceleration in level C than in both level A (P = .005) and level B (P = .02). The researchers also noted a significant difference in the number of head injuries sustained during competition vs. practice (level A: P = .0005; level B: P = .0019; level C: P < .001). Further, youth athletes in lower levels obtained more impacts in practices, and higher-level athletes sustained more in competition.

“It is noteworthy that there are significant increases in head impact magnitudes from one level to the next within a single youth organization,” Urban and colleagues wrote. “This suggests that all youth athletes cannot be grouped together when studying [head impact exposure] and injury risk and more data are needed at all levels within youth football, especially at the youngest levels. … With increasing concern over the long-term neurological effects of repetitive head impacts, data from all levels are needed to understand athletes’ exposure to head impacts over a lifetime.” — by Katherine Bortz

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Alicia Sufrinko

    Alicia Sufrinko

    One of the important aspects of this study is that many of these head impacts among players are happening in practice, which may provide an opportunity for instruction on how to limit those injuries in a more controlled environment since we cannot limit them during competitive games. Educating youth athletes on proper tackling technique can significantly minimize risk in the context of the sport, while also ensuring that players are adequately prepared for the impact they may experience during games.

    While some argue that starting earlier is worse because there are more head impact exposures, we also have to consider that learning the proper technique and safer play is best started when children are small and not applying as much force. I have seen many young boys at freshman high school football who haven’t played football before and who have a difficult time adjusting to the sport because they are simply not used to tackling, the contact and how to perform those techniques. 

    Although the AAP and other youth organizations have released policy statements enforcing proper techniques in youth football, there is significant variability within organizations, leagues, and even among coaches. There has been greater emphasis placed on reducing injuries in youth football, with more rules and policies put in place to limit the amount of contact exposure during practices — now, who abides by those rules is another question. While I am sure there are several organizations and teams that faithfully abide by those recommendations, there are others that interpret them more loosely.

    When pediatricians field questions from parents about whether it is safe for their child to play youth sports, I would recommend that pediatricians be cautious in how they respond. While we do not have evidence that playing youth football will to lead to dementia, we also have preliminary findings that there are changes in the brain that we don’t yet understand, which may or may not be meaningful.

    • Alicia Sufrinko, PhD
    • Neuropsychologist, UPMC Sports Medicine Concussion Program Clinical instructor, Department of orthopaedic surgery University of Pittsburgh

    Disclosures: Dr. Sufrinko reports no relevant financial disclosures.