C+ means more work is needed

On January 12, 2010, the National Athletic Trainers’ Association (NATA), along with 29 other healthcare and sports organizations met and held a summit to address the youth sports safety crisis that is currently affecting youth sport. But… with heightened attention paid to the effects of concussions on athletes… with the new bills passed in many states regarding the treatment of concussion and Traumatic Brain Injury (TBI) in youth athletes… with rule changes and increased disciplinary action for rule violators… with the amount of media exposure paid to the need for preventing preventable sport injuries… we still are not where we should be. The National Athletic Trainers’ Association still knows more can and should be done. Thus on 12/7/2010, the National Athletic Trainers’ Association and the Youth Sports Safety Alliance have given all of these efforts a “C+” for 2010 noting that 48 youth athletes have died in the past year. This injury epidemic can not be stopped by organizations like the National Athletic Trainers’ Association and STOP Sports Injuries alone. It is going to take a complete paradigm shift (a change in the culture of youth sports, if you will) in how youth sports are governed, played and taught. The Sports Legacy Institute has brought research into practice resulting in rule changes in collision sports, increased awareness and a change in the NFL culture and attitude regarding TBI. The culture is changing in college and professional sport, but not at the youth level yet. In a December 8, 2010 New York Times article (Parents Embrace Documentary on Pressures of School), a child psychologist is quoted saying: “When success is defined by high grades, test scores, trophies we know that we end up with unprepared, disengaged, exhausted and ultimately unhealthy kids”. Since sport related injuries are caused by a mistake (intrinsic or extrinsic), having a disengaged, exhausted and unhealthy kid participating in youth sports is just the type of mistake that will give us an injured athlete (contributing to this epidemic).

Timing is everything

Timing is everything. A simple hit to the chest at the right time can be deadly. This is illustrated in the CNN.com article from 12/8/10 where a 16 year old catcher was hit in the chest and collapsed. This is a classic example of commotio cordis. Commotio cordis is a condition where sudden cardiac death occurs when there is a forceful blow to the chest over the left ventricle 10-30 m sec before the peak of the T-wave of the heart contraction cycle. While this is a very rare problem, it is estimated that there is a 90% mortality rate and illustrates the need for an AED to be accessible where ever athletic practices are held.

Important not to cloud the discussion over depression

There has been much deserved attention placed upon concussions and the effects of repetitive sub-concussive hits to the head in sport. While these discussions bring much necessary light to the health and protection of the brain in all levels of sport, it is wrong to attribute all depression and mental illness in athletes to brain trauma. Mental illness affects athletes just like it affects the non-athletic population. Teen and young adult suicide is often a result of untreated depression. Traumatic brain injury (TBI) has been shown to be a factor in depression, but focus (especially media focus) on this being the cause may result in the neglect (or misdiagnosis) of depression, especially in non-athletes or those who are not subjected to head trauma. For the same reason that many possible concussions are not reported, signs or symptoms of depression are also not reported. In their desire to compete, athletes often do not report anything that they feel might keep them out of their game. Athletes have always been told to be tough and to fight through adversity, so they may not want face any perceived acknowledgment of weakness for admitting depression. While it is important recognize that depression may present itself after a concussion or as a side effect of multiple sub-concussive hits to the head, it is also important to not allow the attention paid to concussions cloud the attention that needs to be given to the recognition and treatment for depression. If too much attention is paid to the potential cause of depression and not to the recognition and treatment, it may be too late.