Dr. Kevin Walter wouldn't forbid his own kids from playing football. In a way, that's an encouraging sign for the sport.
Few have seen as many concussions as the program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin. He's also seen up close the way coaches and parents mismanage injuries, motivated by bad information or a desire to maintain the status quo. In other words, he knows very well how a sport like football can hurt.
"I wouldn't want my kid to quit if they loved (the sport)," Walter said. "There are values in that it's physical activity and exercise; I would support that all the time. (Concussions) are going to happen in these contact sports, but if you have the proper education, training and culture of reporting — if you can prevent concurrent concussions and back-to-back concussions —you can eliminate 90 percent of what's wrong."
But from Walter's perspective, that's not happening yet. Though awareness and proper concern for concussion has elevated in past years, he still believes there's room to grow. The increased demands of youth sports have made overuse injuries that once belonged to adults common in children, as well, and the head injury is at the center of the maelstrom. That's particularly true with the National Football League's efforts to increase awareness and decrease cases of players whose concussion-related symptoms linger long past their playing days.
"If we don't start changing culture of sport at the youth level and let it percolate up to high school, college and beyond, then concussion continues to get minimized and ignored," Walter said. "Kids see these pro athletes who want to hide it. That's garbage. When role models and heroes aren't paying attention, and kids have a coach who jokes about it or says, 'You're losing your spot (if you can't play)' ... coaches who don't create this positive environment about being able to report your concussion and deal with it are part of the problem. It starts with reporting it and not minimizing it or making fun of the injury and calling you a wimp."
Concussions are sneaky on two fronts. The vast majority of those inflicted heal within a couple weeks with proper diagnosis, which may lull parents and coaches into disregard. For another, the wide range of symptoms and reactions to a concussion make it difficult to pin down.
"There are more-severe and more-mild concussions, but there's no predictive value," Walter said. "I can't tell you on Day 1 when I see the two-week (to recover) kid and the two-month kid, who's going to be who. Nothing can predict the symptoms, which is why you want to get rid of the grading (at the time of the injury). Later you can say if it was mild or severe, but a concussion is a concussion."
An article by Robert Lee Hotz in the The Wall Street Journal on Aug. 19 cited an analysis from the U.S. Consumer Product Safety Commission that deduced one athlete between the ages of 7 and 19 is taken to an emergency room for a concussion every three minutes. Based on a study by Safe Kids Worldwide, a nonprofit child-safety group, students between ages 12 and 15 accounted for almost half of the concussion-related ER visits.
Moreover, Walter said adolescents take longer to recover than adults. Eighty percent will recover in two weeks, but 14 percent won't recover for three months or more. The problems can snowball from there as patients put pressure on themselves to get better.
"Do they rest, do they have AP classes, is the kid sleeping well, does he play video games, does he have something emotional going on, are the parents getting a divorce? Anything that stresses your brain (can cause symptoms to linger)," Walter said. "It's just life stuff. Maybe it takes a month to recover and you hear teammates whispering in the hallway that you're not a team player. Now they're thinking, 'something's wrong with me,' and spiraling off to this woe-is-me place which will stress your brain and recovery."
Up to speed
Of course, many youth organizations are well aware of the concussion dangers. Changes in football practice plans have been implemented to reduce live tackling over the years. In Mukwonago, the Braves youth football program waters fields regularly to soften falls, and youth sports leaders such as Dan Snell of Sussex have attended summits on the issue.
"The thing that surprises me the most is that people think of concussions as a football-related injury only," said Snell, who represented the Wisconsin All-American Youth Football League at the 2013 NFL Foundation/USA Football Youth Football Summit in Canton, Ohio. "It's widespread through all of sports and life. Concussions can happen sliding down a slope and you hit your head. It's not something just tied with youth sports; it's tied with everyday life."
The AAYFL follows the WIAA guidelines for concussion, with forms parents need to sign and tackling techniques that align with the idea of maximizing player safety.
"We're trying to get away from the mentality that you only have a ding," Snell said. "The other (growing option) is a pretest of a child's cognitive awareness, so when you go in and think you have a concussion, they can go back to where you were before the hit (and compare). The overall awareness has improved."
WIAA director of communications Todd Clark said participation numbers have been dropping across the state in football, but that can't be attributed to any one factor such as the growing concern over concussions.
"You can see by the numbers over the past five years that there has been a decline even before any new information about concussions was brought to the forefront by the NFL," Clark said. "Other factors could have impacted last year, too, such as an eight-game season (instead of the typical nine) or an early start the year before."
Snell also said he hadn't seen any decline in participation in the AAYFL.
"Have there been people who left because of it? Yes, but our numbers have been steady," he said. "We lose more kids to our soccer program than concussion (worries)."
Walter pointed out that Wisconsin state law requires all youth sports to have some measure of concussion education.
"Families have to sign off and say they know the signs and symptoms," he said. "If you think they have a concussion, they need to be immediately removed, and nobody gets back without written medical clearance.
"In theory, all sports across the state have that obligation, but there's not a great deal of enforcement going on with that law."
Until it hurts
Concussion isn't the only injury-related worry in the youth sports realm.
"A lot more injuries that used to be for adults, stress fractures and stuff … now we see that in kids," Walter said. "There are a lot more Little League shoulder and Little League elbow, and it's because of overuse, because of early sports specialization.
"I tell baseball players there's a reason Yovani Gallardo goes to the dugout when he's done pitching and doesn't go play third base and doesn't pitch again for several days. He's resting and takes care of his arm. If we expect the highest-level athlete, who is skeletally, physically and mentally mature and has trainers all over him, to do that, why are we asking our skeletally, emotionally and physically immature athletes to play even more?
"The answer we use is, 'They're young and they'll bounce back,' and that's wrong. We're asking our young athletes to take on schedules that our professional athletes wouldn't dream of. You go to the soccer park where kids are playing five to six games in a weekend. In the World Cup, soccer players complain about three games a week."
Walter said advanced training techniques have gradually filtered down from the upper levels to the high-school level, where the subset of athletes features a wide variety of physical and mental maturity. Without the same skill set and drive, those techniques can do as much harm as good.
Walter said there's another factor in play, which he's observed in young athletes who never can quite get over their ailments.
"They're getting stronger but their pain isn't improving, and I realize it's their way out of sport," he said. "You see parents dump tons of money (into sports). If you've been doing gymnastics since you were 7 and you get to be 15 and you're done with it, it's hard to step up and tell your parents because they've been so invested monetarily and socially. They might even have a great relationship with their parents. I've had families tell me point blank, 'We've put $100,000 in; this is not stopping now.'"
Walter pointed out that some parents, who become accustomed to the social lifestyle and friendship circle of other parents on a well-traveled youth team, also lose something when a child gets injured.
"Even if you have great youth athletes, there are some injuries you can reasonably play through and some you can't without jeopardizing your future," Walter said. "As a coach, an athlete or a parent, I don't think you're objective enough."
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