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Want Conclusive Answers on Concussions? There Aren't Any

11 Dec, 2019

By: Michael Popke
This and More Headlines on Head Injuries in the Concussion Report

If you’re looking for definitive guidance on concussions in young athletes, you’re out of luck, according to pediatric experts in sports medicine, neurology and related fields who evaluated three decades of sports concussion-related research. Such questions as how many concussions are too many, when should kids call it quits and what are the long-term effects of repeat concussions still have no universal answers — and perhaps never will, according to the Associated Press, reporting on the expert panel’s consensus statement published in the journal JAMA Pediatrics.

Among the conclusions:

  • Kids should be taught collision techniques before beginning to play contact sports.
  • There is no conclusive evidence that younger children face a higher risk of sufferings sports-related concussions.
  • Evidence remains inconclusive on whether multiple childhood concussions are linked with long-term neurological changes.
  • Technology that measures head-impact exposure and advanced brain-imaging techniques are both experimental and not ready for use.
  • Although helmets should be worn in high-impact sports, there is little or no evidence that headgear prevents concussions in rugby and soccer.

Experts on the panel emphasized that parents should not keep their children out of sports. “The last thing we want to tell kids is not to be active,” the statement’s lead author, Frederick Rivara, a pediatrician and injury prevention researcher at the University of Washington’s medical school, told the AP.

In other concussion-related news…

• Many female athletes encounter higher concussion rates than their male counterparts, according to two studies conducted by researchers at Hospital for Special Surgery (HSS) in New York City.  

Researchers concluded their findings demonstrate a need for further interventions to reduce concussion rates, such as the required use of protective head equipment in women’s sports, the adoption of neck-strengthening exercises and other prevention training, and greater enforcement of rules to decrease levels of contact in men’s sports. 

The first study, “Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis,”was publishedin the journal Sports Health. Researchers conducted a meta-analysis of sex-based differences in concussion incidence in lacrosse, soccer, baseball/softball, basketball, track and field and swimming/diving. They found that the concussion incidence rates for females were statistically significantly higher compared to males in both soccer and basketball.

“While the causes are unknown, we suspect this … might be attributed to females having decreased head and neck strength, greater peak angular acceleration and increased angular displacement compared to males,” Daphne Ling, lead researcher anda sports medicine epidemiologist at HSS, said in a statement. “Female athletes are also more likely to disclose their symptoms to coaches and parents. This is important for physicians to consider when treating patients who participate in these sports.”

The second study, titled “Women Are at Higher Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse,”was published in the journal Clinical Orthopaedics and Related Research (CORR).Researchers conducted a meta-analysis of 10 studies published from January 2000 to December 2018. These studies reported concussion incidence for both male and female athletes who participated in ice hockey, soccer, basketball, baseball/softball and lacrosse. The objective was to identify in which sports female athletes were less likely to experience concussions from player contact versus ball or equipment contact.

In female athletes, the main cause of concussions was contact with the ball or equipment in lacrosse, and heading the ball in soccer. Additionally, female hockey players were more likely than male players to experience concussions after contact with the ice surface. Researchers found no differences between male baseball and female softball players for ball- and equipment-induced concussions. Similarly, there was no difference observed between male and female basketball players for surface or ball contact. 

A separate new study, “Concussion Incidence and Trends in 20 High School Sports,”published in the journal Pediatrics, “found that girls who play high school soccer are at nearly the same risk for traumatic brain injuries as boys who play high school football. In fact, concussion rates were higher among girls than boys in every high school sport,” according to Forbes.com.

“If we truly want to reduce the impact of sports concussions, more research is needed on what causes concussions so that prevention measures can be put in place, as well as better reporting of sex and gender differences across sports,” Ellen Casey, author of the ball and equipment study and a sports medicine physician at HSS, said in a statement.

• Researchers at the University of Colorado Boulder claim that adolescents who play football and other contact sports are no more likely to experience cognitive impairment, depression or suicidal thoughts in early adulthood than their peers. As AthleticBusiness.comreports, “the extensive studypublished in the Orthopaedic Journal of Sports Medicine, followed nearly 11,000 [participants] for 14 years and concluded that those who play sports are actually less likely to suffer from mental health issues by their late 20s to early 30s.” The study analyzed data from 10,951 participants in the National Longitudinal Study of Adolescent to Adult Health, a representative sample of youth in seventh through 12th grades who have been interviewed and tested repeatedly since 1994. They were divided into groups of individuals who participated in contact sports, those who intended to play non-contact sports and those who did not intend to play sports. “There is a common perception that there’s a direct causal link between youth contact sports, head injuries and downstream adverse effects like impaired cognitive ability and mental health. We did not find that” said lead author Adam Bohr, PhD, a postdoctoral researcher in the Department of Integrative Physiology. “We [also] were unable to find any meaningful difference between individuals who participated in contact sports and those who participated in non-contact sports. Across the board, across all measures, they looked more or less the same later in life.”

• Konnor Finn, a former high school player who suffered a traumatic brain injury that caused blackouts and personality changes after a helmet-to-helmet collision in 2017, is suing the Cache County (Utah) School District and the Utah High School Activities Association. Finn alleges his coach told him to “man up,” “get back out there” and keep playing with the head injury, and he is seeking at least $300,000 in damages, according to local media. Since 2011, all high school coaches, including those in Cache County, have been trained to recognize concussion symptoms and are required to follow concussion protocol that includes clearing a student-athlete by medical personnel before he or she returns to practices or competitions, reports KSL.com.

• A new study published in Acta Neuropathologica Communicationsreveals that DNA may affect concussion symptoms. Canadian neuropathologists Lili-Naz Hazrati and Nicole Schwabanalyzed 38 donated human brains with a chronic history of mild traumatic brain injury (mTBI) associated with contact sports. “We found evidence of inefficient DNA damage repair and the acquisition of cellular senescence (the irreversible ceasing of normal cell division), which may be a pathophysiological mechanism [that] causes brain dysfunction after mTBI,” Hazrati and Schwab wrote. “Compared to healthy participants of the same age, mTBI brains presented with significantly elevated levels of DNA damage.… While we do not yet fully understand how the pathways of DNA damage and cellular senescence impact mTBI outcomes, we believe these outcomes are likely specific to each individual. The pathophysiology of concussion is therefore a complex issue to tackle, as it is possible that each person has different molecular repercussions in response to the same injury. In the context of sports, this means that we may not be able to implement ‘one size fits all’ policies, and may need to cater to individual needs for both prevention and treatment of traumatic brain injury.”

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