Letter to the Editor: Discussion misses on key points about concussions
JUNE 19, 2015 LAST UPDATED: FRIDAY, JUNE 19, 2015, 9:20 AM
THE RIDGEWOOD NEWS
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Discussion misses on key points about concussions
To the Editor:
With four grandchildren in the Ridgewood school system and an epidemiologist’s interest in athletic health, I attended the June 1 session on “What You Should Know About Concussions in Youth Sports” at Benjamin Franklin Middle School.
The session was for the most part limited to concussion recognition and management, rather than the increasingly clear long-term risks, including premature dementia. There was no effective critique of the current “Return to Play after Concussion” protocols, which, for a variety of well-documented reasons, simply will not work. Essentially, these protocols allow us to feel good that something is being done while they enable denial of any serious short or long term risks.
There was no serious discussion of the inception of chronic traumatic encephalopathy and the accumulation of tau protein in the brain following some concussions, or multiple concussions. This cannot now be evaluated by scanning, but we know from autopsy studies the process can begin at a young age, especially in pee-wee leagues and high school football. In the settlement with the players union, the NFL has conceded the relationship of concussion to a variety of neurogentive conditions, including premature dementia.
The magnitude of the association is as yet unclear, although a study commissioned by the NFL suggests that premature dementia is five times more common by age 50 in NFL players who can remember their past concussions. The connection was easier when boxing was a much more prevalent amateur sport. “Dementia Pugilistica” is the main reason why boxing disappeared as an undergraduate sport by about 1950. The long “incubation” period between concussions in youth sports and dementia has given rise to much denial. If we drew an analogy to the devastating smoking and cancer story, long resisted as a “mere statistical association” by the tobacco interests, it seems we are at 1955, with about 10 years to go before the Surgeon General’s report, “Smoking and Cancer,” appeared in 1964.
There was talk of child athletes taking “big hits” to head and body, but no one asked why that was necessary to impart the values of team play, discipline, character, etc. The 15-year athletic injury surveillance project of the NCAA, 1988 to 2003, and published in 2007, establishes the rates and patterns of serious injury by gender in several commonly played sports. With young men, football causes about half the serious injuries, including concussion, for all the sports covered in the study. The public health impact of these relationships is even greater than they seem, since football teams are much larger than the others and thus more children are exposed to higher risk.
Finally, schools exist to nurture minds, not put them at risk – short and/or long term. It seems time for a prudent review of the objectives of sports activities sponsored by publically funded schools and the sports we choose to sponsor to achieve these goals.
Nicholas H. Wright, MD, MPH, FACPM, FACE
Williamstown, Mass.
