Posts Tagged ‘concussions’

Balancing the Concussion Hype

Looking at both sides of the sensationalism

Over the past few years, the media has kept concussions, particularly with respect to football, in the headlines – some would argue ad nauseum. But the truth is, the press attention and research into causes, long-term effects and prevention is provoking both good and bad outcomes.

The best outcome is the awareness being brought to the general public about diagnosis, second-impact syndrome, removal, and return-to-play policies. Players who have been clocked are no longer being told to “just suck it up.” There are now concussion laws on the books in all 50 states and the District of Columbia and required concussion training for youth coaches and athletic trainers.

However, there is definitely a downside to the hysteria, according to Rance A. Boren, a Texas neurologist. “The notion that everyone who plays football going to be mentally unstable in 15 years is just not true,” he said.

Boren points out that the majority of sports concussion research has focused on professional and college level athletes, not high school athletes. This generally points to the number of hits a player sustains over a period of time, as opposed to the force of a few hits. A player with a decade-long professional career preceded by four years of college ball who likely also played youth football is an example of someone at risk for the long-term injuries frequently seen in the media. The kid who started playing football at 12 and stopped after three or four years of high school ball is hardly ever in that risk category.

It’s important to understand that CTE is not a risk associated with young football athletes –  only a small fraction of NFL and college players exhibit its effects.  CTE is not caused by a single or even multiple concussions that have been properly treated. The word chronic in CTE means the trauma resulted from multiple sub-concussive brain injuries sustained over a long period of time. CTE is usually something boxers or NFL linemen might experience after sustaining thousands of blows to the head over the course of their careers.

However, second-impact syndrome and unreported concussions resulting in subsequent injuries are more common at the high school level. Susceptibility to second-impact syndrome is biological. Boren explains that “metabolic buffering syntheses” haven’t been able to reset. So if you are hit again during that short period between an initial hit and recovery, then you are going to do more damage. If you are then hit again, then you do even more damage.”

It’s for this reason that the University Interscholastic League instituted a 10-day return-to-play rule. The 10-day period begins after all symptoms of concussion have subsided. Returning to play too soon can affect reaction time and vision, which leaves players vulnerable to other injuries.

We invite you to read our many articles on concussions and concussions relating to football

Source: Travis M. Smith, “Concussions: A headache of a problem,” 23 June, 2015.



Soccer-related concussions

Research looks at player collisions vs heading the ball

While the concussion hype focuses primarily around football, there’s also a lot of discussion about soccer-related head injuries. The soccer concussion debate centers around the question of whether or not a ban in youth soccer on heading the ball and other rule changes would impact the number of head injuries, particularly concussions.

A recent study published in the Journal of the American Medical Association’s JAMA Pediatrics shows that physical contact between players is the most common cause of soccer concussions. In that case, a change in soccer rules about using the head to hit the ball would likely have little effect on concussion rates.

This results of the study conducted by the Colorado School of Public Health were based on data collected from 100 high schools between 2005 and 2014. Researchers documented 627 concussions among girls and 442 among boys, which aligns with past findings that soccer is the second-leading cause of concussions for female high-school athletes and the fifth for boys.

Differing views

Better rule enforcement and continual re-emphasis on the technical skills of passing and dribbling make the game safer, according to the study’s author, Sarah Fields, an associate professor at the University of Colorado-Denver.  FIFA rules only allow for shoulder-to-shoulder contact among players, which Fields thinks should be more strictly enforced.

Not everyone thinks that minimizing rough play is the answer. One of those is Dr. Robert Cantu, a neurology professor at Boston University School of Medicine. Cantu says that most injuries to soccer players under his care that took place when heading the ball didn’t occur during intentionally rough plays. Instead, players were intent on heading the ball and collided with other players intent on the same thing or who got in the way.

While Cantu does not support eliminating heading the ball in soccer, he does recommend banning it for players under the age of 14, stating that’s the age level at most risk for concussion.

Another point in the ongoing debate is that even shoulder level contact can result in concussive forces, whether through direct contact or when a player subsequently hits the ground.

The number of football-related deaths and serious head injuries among high school players in recent years resulted in the concussion laws for all sports being enacted in all 50 states and the District of Columbia.

We encourage further reading of our articles on concussions.

Source: Amrith  Ramkumar, “Injury study spurs debate on soccer-related concussions.” 31 July 2015.

Study: Physical Causes of Concussions in Youth Football

And potential for lowering the numbers

A new study by Sadler Sports Insurance and American Youth Football (AYF), the world’s largest youth football organization, reveals the actual physical cause of concussions in youth tackle football ages 5 to 15. The study included 2,231 Accident insurance claims filed over the years 2004 to 2013. During this time period, 5.58 percent of total claims reported were due to concussions. Below are trends for the physical cause of concussion claims:

Contact with the ground

Tackled by player

Collision with opponent/other

Tackling player

Blocked by player

Collision with teammate

Blocking payer












Another way to consolidate the claim information is as follows:

Collision with player

Contact with ground







One of the primary risk management controls to reduce concussions in youth tackle football is the emphasis on the safe tackling techniques demonstrated in the Seattle Seahawks’ tackle training video. These methods would likely impact those concussion claims resulting from tackling players and tackled by player for a total potential 37% reduction of all concussion claims. In addition, they would also reduce sub-concussive impacts and reinforce the more effective tackling technique.

Our earlier studies on concussions in AYF indicated that the vast majority of concussions occur during games – only 28 percent of concussion claims occur during practice. For more information on claims occurring in youth tackle football, see AYF Releases Data on Injuries in Youth Tackle Football.


Concussions among girl soccer players

Why are girls more vulnerable?

Middle school girl soccer players suffer more concussions than girls in high school and college. Researchers say incorrect heading techniques and the young girls’ less developed brains and neck muscles are likely contributors to the rate of concussions.

What’s adding to the problem

A recent study found 59 concussions among 351 girls aged 11 to 14. Participants in the study complained of dizziness, headaches, inability to concentrate and being drowsy. Exacerbating the problem is that many continue to play despite their symptoms, risking a second injury.

Despite the experts advising that players not return to practice or games until symptoms disappear, 58 percent of the players in the study continued to play even with symptoms persisting,  according to the study’s co-author Melissa Schiff, professor of epidemiology.

The same study found that heading the ball was the cause of 30 percent of the players’ concussions and more than 50 percent were the result of Girls heading ballplayer collisions.

Looking to lower the numbers

The rate head injuries among young girls linked to heading the ball doesn’t surprise John Kuluz of Miami Children’s Hospital.

“I see it all the time,” he said. Kuluz’s advice: athletes who have suffered a concussion should avoid heading the ball.

Oddly enough, concussions resulted 23 times more frequently in games than during practice. Should heading the ball be banned to reduce the number of head injuries?  Some suggest that middle school athletes should be taught proper heading technique in practice but prohibit its use in play until high school.

The study was published in the Jan 2014 online issue of JAMA Pediatrics.

More information on concussions and risk management are available on the Sadler Sports Insurance website.

Source: Kathleen Doheny, “Concussions Common in Middle School.”  Healthday. 20 Jan 2014.

MLB Catcher Concussion Rates Rising

Trend in 2013 season unknown

On any given day, there are between 60 and 75 catchers on major league rosters and about Baseball concussions15 percent of them have been on the disabled list specifically designed for concussions within the last 30 days.

Major League Baseball catchers are experiencing concussions at an alarming rate this season. At least one was caused by the accumulation of foul tips. I’m sure that MLB will be studying this trend carefully and develop suggestions to better protect catchers.

Our injury statistics for youth baseball Accident claims don’t indicate a frequency problem in this area. Since we started tracking injuries in 1994, about three tenths of one percent of total injuries involved catchers suffering concussions, and none were due to being hit in the mask by a foul tip.

Source: Aaron Gleeman, “Catchers are Suffering Concussions at an Alarming Rate,” 21 Aug. 2013.

Soft Cover Football Helmet Add-ons

Liability issues result in add-ons being banned

The Colorado High School Activities Association ruled that the helmet shell called the  Guardian Cap can’t be worn in games and that schools may void protection from helmet manufacturers’ warranties if they allow the use of such helmet shells during practices. Approximately 15 high school and youth teams in Colorado were using the Guardian Cap.

The National Operating Committee on Standards for Athletic Equipment issued a statement that read in part: “The addition of after-market items by anyone that changes or alters the protective system by adding or deleting protective padding to the inside or outside of the helmet, or which changes or alters the geometry of the shell or adds mass to the helmet, whether temporary or permanent, voids the certification of compliance with the NOCSAE standard.”

In my opinion

Add-on helmet productsWhen a youth football client asked my opinion on whether or not to experiment with the use of such helmet shell products in the face of concussion concerns, I provided the following response:

It is true that the attorney of a football player who has suffered a serious brain or spinal injury will sue all parties that could be remotely responsible, including the helmet manufacturer, helmet distributor, helmet cover manufacturer, helmet cover distributor,  conference administrators, coaches, sanctioning body, etc. The helmet manufacturer would certainly argue that that it was not responsible for the injury due to the use of the helmet cover product which voided the manufacturer’s warranty. I’m not sure whether the helmet manufacturer could completely escape liability with such an argument. If they were successful, that leaves the General Liability insurance policies of the helmet cover manufacturer including any distributors and the conference on the hook. It’s likely that the helmet manufacturer carries a much higher liability limit than the other parties.

From a common sense point of view, it would seem that the additional padding and shock absorption would lessen the impact. On the other hand, the larger diameter and weight could increase rotational torque which could also impact concussions. But common sense is not always reality. For example, commotio cordis (sudden cardiac arrest due to arrhythmia) is an infrequent but usually fatal occurrence in youth baseball when a ball strikes the heart at the precise millisecond of the heart rhythm. It made common sense that youth players should use padding or a shield to protect against this risk and a number of products were introduced to provide such protection. But, one lab study using pigs being shot in the heart by baseball pitching machines showed that this type of protective device actually made a commotio cordis event more likely. It is best to leave the safety decisions up to the scientists. Of course, scientific progress can be slow and it can be difficult to determine if they have an agenda. Also, scientists can be wrong even if most are in agreement.

So what’s the answer?

The safest play from a liability perspective is to go with the recommendations of 1) your manufacturer, 2) NOCSAE, and 3) the sanctioning/governing body if they have an opinion on the issue. There is always safety in siding with the recognized authorities, though, this does not mean that they are correct.

The manufacturers of soft helmet shell covers and other similar add-on devices claim that the big helmet manufacturers are shutting them out of the process with their influence over the various sanctioning bodies and NOCSAE.  They point out that smaller companies have historically played an important role with scientific research, creativity, and problem solving.

I would like to hear your thoughts on this issue.

Source: Guardian Cap: Controversial Ruling May Mean End To Use In Colorado; Adrian Dater; Denver Post; 8-1-13

NFL Strikes Back in Concussion Media War

Consultants’ research and motives questioned

Dr. Mitchell Berger of the NFL’s Head, Neck, and Spine Committee was interviewed by ESPN’s “Outside the Lines” and spoke out against Boston University researchers Robert Cantu and Chris Nowinski. Berger accused the the two self interest by trying to profit from the hype they created with studies linking football and brain damage.

“The BU Group, their whole existence — their funding — relies on perpetuating that it’s a fact if you play football you’re going to have some form of cognitive impairment….So it’s very, very difficult to accept it because it is so biased,” said Berger.

Dr. Cantu aptly responded by saying, “Mitch Berger, with all due respect, is full of s—. No, not with respect.”

It should be interesting as the former players’ lawsuit against the NFL progresses to get a more balanced perspective on the issue because, so far, the media has only covered the plaintiffs’ allegations.

Please see our previous articles for more information on the ongoing debate about concussions in the NFL.

Source: Steve Fainaru and Mark Fainaru-Wada. “Between the Lines.” 06 April, 2013.

The Concussion Risk in High School Football

The science behind the statistics published an insightful blog post,  “The Fragile Teenage Brain: An In-depth Look at Concussions in High School Football.” The post explains why teenage brains are so susceptible to injury and provides a glimpse into exactly what happens inside the brain during a concussion. It also provides an excellent explanation of how the head injury problem in football in the 1960s and early 1970s was addressed by the National Operating Committee on Standards for Athletic Equipment (NOCSAE) standard, which established guidelines for sports equipment including football helmets.

The following excerpts from the article are especially revealing:

The compromises of helmet design help explain why there will be no quick technological fix for football concussions. Last October, Jeffrey Kutcher, chairman of the American Academy of Neurology’s sports section, told a committee of United States senators that all the current concussion prevention products being sold were largely useless. “I wish there was such a product (that could prevent concussions) on the market,” he said. “The simple truth is that no current helmet, mouth guard, headband, or other piece of equipment can significantly prevent concussions from occurring… Is extremely unlikely that helmets can prevent concussions the way they prevent skull fractures.” He went on to criticize numerous claims by helmet manufacturers suggesting otherwise, noting that even Riddell’s specialized anti-concussion helmet has only been shown to reduce the rate of concussions by 2.6%.

Coach Rollinson echoes the skeHigh school athletespticism. “Every year, we get more and more parents showing up with some fancy helmet and telling us that this is the one their kid has to use,” he says. “I’m sure they spent a lot of money on that helmet. I know it makes them feel better. So we always say, sure, your kid can use that helmet, but we have to do the fitting. And you know what happens? The helmet doesn’t fit. They spend $1000 on it because the manufacturer makes some crazy claim, but it’s way too big. And then when you fit it properly, the kid says it’s too tight, that it’s not comfortable anymore. But that’s the way it needs to be.

This is a recurring theme among the coaches and trainers at Mater Dei. According to the football staff, the most important helmet factor has little to do with the helmet itself. Instead, it has to do with the way the helmet fits the head. In theory, this is an easy problem to solve: Every NOCSAE approved helmet is fully adjustable. Teenagers, however make the fitting process surprisingly difficult. “Most of the time, the problem is forgetfulness,” says Fernandez. “That’s why we are always reminding the players to check air levels. We tell them that before every single game. But sometimes they leave it loose on purpose, just because he can get hot and sticky in there.”

John Sadler Quoted in Rough Notes Magazine

 When Rough Notes magazine wants to inform the insurance agent subscribers on the current state of sports insurance industry, they interview leading voices in the sports insurance niches. John Sadler is is one of those voices. You can read the  recent article in which Sadler comments on the following issues impacting the market:

  • Impact of economic downturn on sports registrations
  • Increase in volunteer theft and embezzlement
  • Sandusky impact on coverage for sex abuse and molestation
  • Impact of repeat concussions and less than concussion events
  • Need for efficiency in processing sports insurance transactions
  • Need for simple risk management tools to reduce injuries and lawsuits

Source: Rough Notes Magazine, April 2012

New Concussion Research Project

Lab dummies, martial artists and boxers used in the study

Concussion testingTwo new studies are being conducted by the Cleveland Clinic and Case Western Reserve University under the name of the Cleveland Traumatic Neuromechanics Consortium. The purpose of the studies is to prevent head and neck injuries and to develop better treatments.

“There are many more questions than answers about brain injuries,” said Adam Bartsch of the clinic’s Head, Neck, and Spine Research Laboratory. What researchers want to know is what level of force or number of repeated impacts causes temporary or permanent brain damage.

The first part of the study will focus on the testing of football helmets using dummies that are rammed by an air powered device under under various conditions that mimic real life impacts. Researchers hope to learn what can be done to helmets to improve impact absorption and protect the skull. The second part of the study involves studying up to 600 mixed martial arts fighters and boxers over a four-year period.

Source: Research Hopes To Curb Head, Neck Injuries In Athletes; Insurance Journal, April 2, 2012