Head Exposure In High School Football

May 11, 2015
David Markel, Head Coach
Ruston High School football
502 University Lane
Ruston LA 71270

Dear Mr. Markel
I have attached my technical report to this letter of transmittal. My technical report includes information about head exposure in youth football and how can it be prevented. I have researched and read many articles about this controversial topic. Head trauma will never be completely eliminated, but football can be made much safer and brain trauma can be drastically reduced. Many solutions have been proposed and I have made an easy to follow 3 step plan for safer football. The first step is educating coaches, athletes and parents about concussions, their symptoms and how they can affect the athlete. Then, practices need

to be modified and high impact drills, which do not replicate game situations need to be banned. Third, return to play guideline needs to be implemented and minimum standards to return to play need be required. To support my research and argument I used articles and sources form Prescott Memorial Library. The data was mostly collected from the researches in Journal of Biomedical Engineering, as well as Annals of Biomedical Engineering.
I hope this research will help you and your players become a healthier, stronger and better team. If you have any questions or suggestions, please do not hesitate to contact me. Thank you for your time.

Sincerely,

Anita Pecurcika
ForSaferKids Orginazation

Enclosure (1): Technical Report

Head Trauma and Concussion Prevention in High-School Football

Prepared for: David Markel, Head Coach
Ruston High School Football

Prepared by: Anita Pecurcika, Personal Trainer
ForSaferKids Organization

May 11, 2014

Abstract

Concussion Prevention in High-School Football
Prepared by: ForSaferKids Organization
May 11, 2015
The purpose of this technical report is to research one of the sports world’ s most challenging problems- head injuries in youth football. American football is one of the most popular sports in the United States and even though football was first played in colleges, nowadays football is children’s and youth’s game. Around 95% of players are younger than 18. Previously head impact exposure was not well documented and people were not informed how dangerous this game can actually be. With this topic getting more popular, many researches and studies have been done. I have read and researched many articles from peer-reviewed journals and books and found a lot of information about this problem. I have made a 3 step plan that would drastically reduce the brain trauma in youth athletes. First, coaches, athletes and parents need to be educated about concussion, its symptoms and how it can affect the athlete. Then, practices need to be modified and high impact drills need to be banned. Also, return to play checklist needs to be implemented and minimum standards to return to play should be required. Head trauma will never be completely eliminated, but fallowing these steps should significantly reduce the risks of head injuries.

Key words: Head injuries in youth football, youth football concussions, football head traumas, youth football, return to play checklist

Table of Contents

Executive Summary ………………………………………………………….. 1

Introduction…………………………………………………………………… 2
Methodology……………………………………………………………….…. 3
Problem Identification…………………………………………….….. 3
Data Collection…………………………………………………….…. 3
Finding Solution ………………………………………………….….. 4
Results and Discussion…………………………………………………….…. 5
Head Impact Data………………………………………………….…. 5
Recommendations/ 3 step Plan…………………………… ……………….… 9
Step 1……………………………………………………………….… 9
Overall Information………………………………………. 10
Dangers of Concussion……………………………...……. 11
Signs and Symptoms……………………………………… 11
Step 2……………………….……………………….……….…….… 12
Step 3……………………….……………………….……...………… 13
Phase 1……………………….…………….…………….… 13
Phase 2……………………….………….……………….… 13
Phase 3……………………….…………………….…….… 14
Phase 4……………………….…………………….………. 14
Phase 5……………………….…………………..………… 14
Conclusion ……………………….………………………..…………………. 15
Works Cited……………………….……………………….…………….…… 16

Executive Summary

Head injuries in youth football are one of the sports world’s most challenging problems. American football is one of the most popular sports in the United States and even though football was first played in colleges, nowadays football is children’s and youth’s game. Around 95% of players are younger than 18. There are almost 1.1 million high school football players, and even though the participation rate has decreased in the last decade, the concussion rate has doubled. Previously head impact exposure was not well documented and people were not informed how dangerous this game can actually be.

It has been found that. It has been found that high school players’ receive hits with much higher force then previously though and is very similar to college football and some of the professional football hits. With concussion rate growing, now every one in six players will withstand a concussion during their sports career. Concussion can be very dangerous and impact life many years in future. It has been found that there is correlation between concussion and dementia and Parkinson’s disease. Even one concussion can cause long-term brain damage.

It is very important to face this problem and find a best solution. After researching man peer-reviewed journals, books and articles, a 3 step plan for safe football was developed. First step is informing coaches, players and their parents about concussion, how to prevent it and how to spot it. The second step includes modifying practices and banning high impact drills that do not replicate game situations. The final step is a return to play guidelines, which consists of 5 phases. Each phase helps the player gradually ease into their normal schedule after a concussion.
Introduction
Concussion is traumatic brain injury with a brief loss in brain function. Concussions can occur with a hit, blow or bump to the head or the body causing the brain to move rapidly back and forth, shaking and twisting the brain within the skull. Concussions are considered functional injuries. Rather than damaging the brain cells and tissues, they affect the biochemical processes of the brain. Now, as these chemical changes have occurred, the brain is more vulnerable to other head traumas and is more sensitive to increased stress.

Football is one of the most popular sports in United States with almost 1.1 million high school participants. As it has been research by Dr. Faure in Journal of Physical Education, 16.67% of all USA high school football players will endure a concussion at least once in their sports career. With such high participation numbers and such high rate of concussions it is very important to face this problem and find a best solution.

Many peer-reviewed journals have been researched and numerous articles about this subject have been read. There are many proposed solutions; however, most of the time only one solution will not change the risks as much as plan of steps. This is the reason 3 step plan was created, which consists of informing coaches, players and parents about conclusions, their dangers and symptoms. The second step includes modifying practices and banning high impact drills that do not replicate game situations. The final step is a return to play guideline. If a player does withstand a concussion it is very important to return to play gradually and slowly. The risks of second concussion are 6 times more likely after the first one.
Methodology
This methodology division shows the steps that were taken to study head impact exposure in youth football, data collected and analyzed and how the best solution was found. I was fallowing these steps to gather the information needed for this final report:

1) Problem was identified.
First time encountering this topic was on Biomedical Engineering Society (BMES) official website. It showed up in several occasions as the most recently viewed and most recently talked about article. I was interested in learning more and researched many peer-reviewed journals in BMES as Annals of Biomedical Engineering. Many other peer-reviewed journals as Journal of Biomechanical Engineering, Sports Medicine and Journal of School Health were researched. Most of them found using Prescott Memorial Library database at Louisiana Tech University and searching with key-words as “head injury in youth football”, “concussions in youth football”, “high school football head injuries”.

2) Data was collected.
For the overall data of average hits in high school football I used a study found in BMES Annals of Biomedical engineering journal. This study “Head Impact Exposure in Youth Football: High school Ages 14 to 18 Years and Cumulative Impact Analysis” gives an overall information and raw data of linear hits 39 high school football players receive and give throughout a full season. The data is shown in results section of this lab report.

3) Best solution was found.
Researching these articles I found many proposed solutions. However, I found them not as affective because most of them only offer one solution. Modifying practices and education separately can help reduce the frequency and severity of head injuries and concussions; however, I believe that the biggest chance of reducing the risks are making a 3 step plan and joining all the best proposed solutions. This 3 step plan would include an education courses or classes for coaches, players and their parents, modifying practices and banning high impact drills, and also implying return to play guidelines.

Results and Discussion
The most common athletic head injury is sports-related concussion. According to Biomedical Engineering Society (BMES), as for now, football is noted for having the most concussions in high school athletes with highest head injury rates compared to other contact sports as hockey, basketball and soccer. It has been evaluated that there are almost 1.1 million students playing high school football and around 5.6 % (over 70,000) of high school football players withstand concussion each given year. With such a high participation and high concussion rate, it is essential to understand head injuries and research the cumulative risks over the course of athlete’s sports career and lifetime in general.

Head Impact Data

In research made by BMES, “Head Impact Exposure in Youth Football: High school Ages 14 to 18 Years and Cumulative Impact Analysis”, 39 high school players participated in study to find out the real data for head exposure in youth football during a normal season. There have been many studies in college and professional football, but this was the first serious study in high school level football. The average age of a player was 17.1 years, average height 181 cm and average weight of 89 kg. The total impacts measured were 16,502 with 412 impacts per player. The study lasted the whole season, counting 2 scrimmages, 12 games and 33 practices. According to the study, the data is very similar to the one detected at the collegiate level.
The liner data recorded for the season ranked from 10 g to 152 g. The median value for linear hits was established around 21 g and ranged from 15 to 27 g according to different players.

The average 95th percentile linear hits for games and practices were very similar and reached around 56g with a range of 39 to 66g. The median and 95th percentile linear hits for each player recorded can be seen in Table 1. The least impacts occurred at the top (14.9%), the more at the back (21.8%) and the most to the front of the head (45.3%). Median linear acceleration (g) does not drastically vary in different locations but the highest values were recorded at the top of the head (25 g), then front (23 g), fallowing by back (22 g) and ending with side hits with median of 18 g (Figure 1 represents the column chart with median linear acceleration measured by impact location).

Figure 2 shows the injury risk as function of linear acceleration (the data shown in this technical report represents the green line).With highest probability as 1, which is 100% probability of injury. With average median linear hit of 21 g a player has 10% chance of injury and of 56 g in 95th percentile; a player has a 40% chance of injury after a hit in the game. It is important to note that a player has an average of 412 impacts per year; therefore, the chances of injury are very high. Player receiving a linear hit of 150 g is guaranteed a head injury.

As stated at HealthResearchFunding.org, even though overall football participation has declined over a last decade, concussion rates for children under 19 have doubled. According to Dr. Faure in Journal of Physical Education, one in six high school football players in USA will withstand a concussion at least once in their life during their playing career. The growth in concussion rate has been seen because of the overall growth in aggressive sports play. Younger players are treated as older ones and are pushed to exceed their limits. Since the frequency of concussions has been growing consequences of concussions can be very tragic it is very important not to treat this subject lightly.

Recommendations
Many of the football teams in USA are not modifying their practices and including high impact drills in everyday workouts.

They are not informed how big of an impact even a small player can make and how dangerous particular exercises can be. They are not as knowledgeable enough in concussion detection and diagnosis and do not know how to correctly manage a player if he would get one. Because of their lack of knowledge they can let their players get seriously injured and affect their lives even many years in the future.

Knowledge and education is the first step to safer football and it is very important to be aware of these statistics. Coaches, players and parents need to know and understand how frequently and how big of the hits players are getting. Many solutions have been proposed, but it is impossible to solve it only with one step, it has to be a process. A 3 step plan has been made that will greatly reduce the risks of head trauma, without drastically changing the fundamentals of football.

Step 1 - Concussion

Classes
Coaches, trainers, players and parents need take mandatory concussion and head trauma classes. One of the biggest problems is that players and coaches are not fully informed about head concussions and how they can affect the player. It is hard to diagnose a concussion if they are not taught how to identify one. Players also don’t know how head traumas can affect their short and long term health. These classes would provide information of what is concussions, how to spot it, diagnose and treat it. First of all, just the overall knowledge of concussions is needed. It is one thing just to say that concussions are bad and they hurt, but other is to understand the anatomy of concussion and seeing how the brain actually moves during an impact. A short example of these classes would include fallowing information:

1) Overall information about concussions.

Concussion is traumatic brain injury with a brief loss in brain function. Concussions can occur with a hit, blow or bump to the head or the body causing the brain to move rapidly back and forth, shaking and twisting the brain within the skull. Concussion can be compared to an egg. After a hard jerk, the yolk at first hits one side of the shell and then rebounds to the other. Same thing happens with brain in the skull.
Concussions are considered functional injuries. Rather than damaging the brain cells and tissues, they affect the biochemical processes of the brain. Now, as these chemical changes have occurred, the brain is more vulnerable to other head traumas and is more sensitive to increased stress.
In most cases concussions occur without the loss of consciousness. Even though it is a mild brain injury, every concussion needs to be looked upon seriously. It is very important to recognize and respond properly to a concussion. Early treatment can help prevent further traumas and even

death.
To protect the child from concussions, it is very important to make sure the athlete is wearing appropriate equipment. Chinstrap needs to be used properly. Parents needs to reassure the child that football is just a game and no win or championship is worth risking their health for. It is OK to sit the game out if injured. It is important to reassure the young athlete that it is in his best interests to detect and treat the head trauma as fast as possible and that he is not being a hero if he is suffering and pushing through games.
2) The dangers of concussions.
There can be no dangers of concussions; however, they also can be very serious. As stated in HealthDay news, just one concussion may cause serious long-term brain damage. Athlete’s brain may continue to show signs of injury even months after the symptoms have gone. Researchers have found that people with concussions had lost notable amount of white and gray matter showing brain atrophy. Since brain cells do not regenerate, this damage is permanent. Repeated concussions may increase the risk for Parkinson’s disease, dementia and/or depression later in life. Also, it has been researched that repeated knocks to the head, can cause chronic traumatic encephalopathy (CTE), which is a degenerative brain disease that can cause dementia. CTE has shown symptoms as memory loss, confusion, aggression and depression. Mostly these symptoms only appear later in life. This trauma is not only seen in professional football players, but also in young athletes. They are very vulnerable to this disease, since their brain is only maturing.
3) Signs and symptoms of concussions.
It is very important to spot a concussion in time, therefore very important that coaches, players and parents know the signs and symptoms of concussion. Faster the concussion is spotted and treated, the less time it takes to heal and the player will be able to return to the game.

Some of the symptoms may include:
•

When concussion has been spotted, it needs to be treated properly. Dr. Drisccoll from Mayo clinic states that concussions need time to heal. It may take up to several weeks for a complete recovery. For the first few days children should rest from physical and thinking activities. Return to the activities should be slow and gradual. If children return to their usual activities too soon, they risk developing complications. Another concussion while still recovering can result in more permanent damage and longer lasting symptoms.
Step 2 – Modifying Practices
Completely eliminating tackling would be most efficient way to reduce the risks of head trauma. However, it would harshly change the fundamentals of football. A more possible option would be modifying practices and banning high impact drills. As we can see in head impact data in the beginning of the lab report, almost half of the hits have been observed during the practice. Therefore modifying the practice and eliminating high impact drills that do not imitate game situations would let the team cut the overall risks of injury. Proper tackling skills need to be taught and implied in games. For example, tackling with a head up and not using a helmet as a weapon in attacking the player of the opposite team. As we saw in head impact data, even though the top of the head hits were only 3rd most used hits, they were the ones receiving the most force. Since there are other ways to tackle, head-first tackles should be banned from the practices and encouraged not to be used in games.
Step 3 – Return to play guideline
Returning to play shortly after a head trauma can result in more serious and extensive brain damage and in some cases has actually ended in death. Before returning to the game players should see a medical professional and get their approval. Minimum standards to return to play should be required. This return to play guideline would consist of 5 phases over a course of weeks and even months, the player and the health care professional would go through before the player completely returns back to the game.
• Phase 1
Whenever a player has rested after a concussion, he first needs to begin with light aerobic exercise only to increase the heart rate. An example of this kind of exercise would be light jogging, walking or bike. No heavy weight lifting or sprinting is allowed.
• Phase 2
Athlete need to continue with light exercise and jogging to increase his heart rate, however he now id allowed to go longer and push himself little harder. A light weight lifting is allowed, but the trainers need to be careful not to forget to reduce the usually used weights.
• Phase 3
Now, athlete is allowed to participate in heavy, but non-contact physical activity. An example would be regular weight lifting, sprinting, high-intensity stationary biking and non-contact specific drills.
• Phase 4
Athlete now is allowed to return to regular, but controlled practice.
• Phase 5
Player is allowed to participate in football competitions.
These phases may take weeks and even months to complete, Player needs to be honest with his professional health care expert and know his own limits.

Conclusion
American football is one of the most popular sports in the United States and even though football was first played in colleges, nowadays football is children’s and youth’s game. Around 95% of players are younger than 18. With so many players in the United States and around the world we need to be careful how we approach this problem. ForSaferKids has developed a 3 step plan that would drastically reduce the frequency and the severity of concussions.

One of the biggest problems is that players and coaches are not fully informed about head concussions and how they can affect the player. It is hard to diagnose a concussion if they are not taught how to identify one. Players also don’t know how head traumas can affect their short and long term health. Steps 1would inform coaches, players and parents about head traumas, the dangers of concussion and how to spot them. Step 2 is more hands-on activity. The practices needs be modified and the impact drills that don’t replicate the game situation need be banned. Since the hits to the head receive the most force, head first tackle needs to be banned as well. Step 3 consists of return to play guidelines. Returning to play shortly after a head trauma can result in more serious and extensive brain damage and in some cases has actually ended in death. Before returning to the game players should see a medical professional and get their approval. This guideline consists of 5 phases that would help the player and health care professional to ease in normal practice and game schedule.