“Concussions now seem to be the injury that is in front of us, particularly from a soccer standpoint right now,” Norton said. The consequences for those injuries are just now becoming clearer.
Georgia is poised to become the 44th state to pass a law requiring greater attention to youth sports players who get a concussion after the Georgia General Assembly overwhelmingly approved a bill earlier this month. The Return to Play Act of 2013 would require schools and recreation departments to provide information to coaches and parents about concussions and to set rules that prohibit a player with a concussion from returning until cleared by a health care provider. How schools and programs implement those requirements will be up to them, giving them flexibility on the cost, said lead sponsor Rep. Jimmy Pruett, R-Eastman.
“It just says you’ve got to do it,” he said. “It doesn’t say how to do it.”
As a running back in high school, Pruett said he had his own brushes with concussions.
“I remember getting knocked out and they come out there with the smelling salts and just woke you back up,” he said. “I remember a quarterback we had going back into the game. He didn’t have a clue where he was on the field.”
The developing brain, in particular, is a concern because it doesn’t heal as quickly as once thought and the legislation hopes to prevent additional damage during that especially vulnerable period, Pruett said.
“So that second blow or third blow could be catastrophic,” he said, particularly later in life. “With that type of concussion, a second blow or second injury in the same game could certainly do permanent damage, from the research that has been done.”
It is the studies of damaged brains, particularly those at the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, that has shown the extent of those repeated blows.
In a study published last year in the journal Brain, the center and its affiliates looked at 85 brains with a history of repeated mild brain trauma, 64 of whom were athletes. Of those, 68 had evidence of that chronic damage ranging from small spots to widespread damage across whole brain regions.
The symptoms for CTE as it is called ranged from headache and attention problems in the milder cases and dementia and aggression in the most severe, with at least seven suicides among those with the damage and others talking about suicide before their deaths.
An example of what can happen is a 21-year-old college football player who committed suicide. When they looked at his brain, there were “20 areas of the brain that were separately, you could say, rotting away,” said Chris Nowinski, co-director of the center and of the Sports Legacy Institute.
This likely is beginning early, he said. Baseball teams restrict kids from throwing a curveball too early, he said, but youth football often does not have the same restrictions on hitting.
“At 6 years old, you’re welcome to start hitting them in the head as much as you want,” Nowinski told a recent meeting of the Association of Health Care Journalists. And it is more destructive at that level than many people realize.
“We found out that 7-year-olds hit each other as hard, in terms of brain trauma, as college football players,” said Nowinski, a former college football player and professional wrestler whose career was cut short by concussions. “And yet we still encourage this sort of behavior.”
Those hits add up during a season, he said. One study of high school football found a player could get more than 2,200 blows to the head during a season. The Sports Legacy Institute and others are calling for leagues to implement Hit Counts, of no more than 1,000 per season or 2,000 per year.
Some of the damage may already be accumulating as evidence of the progressive CTE damage has been found as young as 17 years old, Nowinski said.
“We’re going to find this in younger and younger kids,” he said.
And not just in football but soccer is becoming a concern with heading the ball, Nowinski said.
“Soccer headers are the next big thing,” he said.
Pruett said other Georgia legislators tried to talk him into limiting the bill to specific sports but he refused.
“I said look, a concussion can happen anywhere,” he said.
Nowinski would like to see limits on teaching kids soccer headers before age 10, for instance, and to limit their practice overall. While younger kids may learn to head the ball, it doesn’t really happen in games, said Norton of Augusta Arsenal Soccer Club.
“Younger kids can’t get the ball in the air with their feet,” he said, and it doesn’t really become part of game strategy until they are 12-13 years old. Even then, it is not the header that is the problem, Norton said.
“I think it’s more collisions that cause concussions, particularly head-to-head collisions, obviously,” he said. The issue has become more prominent in the last year and the club has been trying to get information out about it, Norton said.
“Unfortunately, we’ve had a few players recently that have had concussions,” he said. “It is an issue that seems to be more in the forefront now than it has been in the past.”
Those trying to raise awareness about how damaging concussions can be are looking for that awareness to stem what could be a lot of damage down the road.
“Hopefully, we will eventually get to a place where we have some sense and people recognize that both these concussions and these subconcussive hits can lead to some terrible things,” Nowinski said. “The kids pay the price.”