Posted by: mdegeorge | November 20, 2010

Weekly Diagnosis 11-19: Pop Warner uses its head on concussion debate

It’s been a while since the Weekly Diagnosis made its last appearance. For the duration of that hiatus though, the buzzword on the sports injury front has been concussions.

That’s true again this week, headlined by the announcement Thursday that Pop Warner football will begin requiring doctor’s notes for all suspected concussion victims before they are eligible to return to play.

The nationwide organization that overseas the participation of some 280,000 youth players has also created a national advisory board for medical issues. They’ve enlisted some prominent names in the field, including NFL Players’ Association adviser Dr. Julian Bailes and Dr. Stan Herring. The latter helped sculpt the Lystedt Law, which requires physician approval before a player sustaining a head injury returns to action.

PHILADELPHIA - OCTOBER 17: DeSean Jackson  of the Philadelphia Eagles is laid out by Dunta Robinson  of the Atlanta Falcons during their game at Lincoln Financial Field on October 17, 2010 in Philadelphia, Pennsylvania. Both players were injured on the play and had to be helped off the field. (Photo by Al Bello/Getty Images)

Though the concern over head injuries among younger players is more marginal because of the less dangerous forces at play, the sheer magnitude of collisions overseen on the Pop Warner gridiron makes them accountable for a sizeable part of the estimated 300,000 sports-related concussion occurring every year, as estimated by the American College of Sports Medicine. Of those, close to 85 percent go undiagnosed, undetected, and untreated.

The news comes just before an Outside The Lines report on Nathan Stiles, a Kansas high school football player who had a history of concussions and died after an on-field hit triggered severe brain hemorrhaging. The site of the massive blood loss was like what doctors described as an “old bleed”, a location that hemorrhaged previously but was undetected in the battery of CT scans Stiles underwent for his previous injuries.

The Associated Press this week also did an extensive report on the business side of concussions, detailing the various tests on the market commonly used to assess neurological health.

The case of Stiles, despite its undeniable heart-wrenching quality, is ultimately an anomaly—of the 1.8 million football players in the country across all levels, Stiles holds the tragic title of the only football-related fatality this season.

What are commonplace, however, are all manner of injuries impacted the overall neurological health of young athletes, many of whom are still at vital junctures in their cognitive development and unable to fully understand or recognize the signs of potential damage inflicted upon them.

Pop Warner’s new mandate is a progressive step that should be replicated by youth organizations the nation over. They even have provisions to circumvent what is often the most harmful influence in youth sports: parents. One stipulation requires that in the case of coach’s children, a non-related coach must stand-in to provide necessary clearance. The desire of parents to obsessively live vicariously through their children’s on-field exploits in succeeding where they themselves failed will never be completely mitigated—in this or any youth sport. But the acknowledgement of the uncomfortable notion that some less-than-scrupulous parents may (wittingly or otherwise) put their children’s best interests second to the pursuit of victory is a noble admission.

There are certainly problematic areas the new rules will have to navigate. One is the scarcity of medical care for the many inner-city participants of Pop Warner, who use the league as both an escape from potentially troublesome situations and as a showcase for talent in an attempt to permanently leave the challenges of their youth behind. Statistical analysis in other areas has shown a marked decrease in accessibility to and utilization of health care across certain socioeconomic and cultural boundaries.

It could be that the compulsion to get a child back on the field means the doctor or clinic will be more regularly dialed. It’s more likely that this impediment could add deprivation of football as another disadvantage for many.

Ultimately, Pop Warner’s approach is a proactive one that should be emulated by other youth organizations. Oversight committees for Canadian hockey have been taken to task of late with a rash of high-profile head injuries in the NHL and a “groundbreaking” study released earlier this month that reveled “a disturbing lack of compliance by the athletes to undergo requested neuropsychological evaluations and multiple physician visits, as well as a lack of understanding about the seriousness of concussion,” according to one of the study’s authors.

Precautionary measures must be adopted by all organizations overseeing sports in which head injuries are prevalent, not just those like hockey and football which garner a disproportionate share of attention. Immediately, sports like lacrosse and rugby come to mind.

Pop Warner’s efforts should be a standard for the rest of the youth sports establishment to follow. But with close to a quarter of a million untreated concussions and head injuries in this country every year, it’s not time to celebrate yet.a


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