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Arlo Brodie loves being at the heart of the action on the football field, and while his dad cheers him on, his mother quotes head injury statistics and refuses to watch, but Arlo's winning plays, the cheering crowds, and the adrenaline rush are enough to convince him that everything is OK--in spite of the pain, the pounding, the dizziness, and the confusion.
Book
No Game for Boys to Play
From the untimely deaths of young athletes to chronic disease among retired players, roiling debates over tackle football have profound implications for more than one million American boys-some as young as five years old-who play the sport every year. In this book, Kathleen Bachynski offers the first history of youth tackle football and debates over its safety. In the postwar United States, high school football was celebrated as a \"moral\" sport for young boys, one that promised and celebrated the creation of the honorable male citizen. Even so, Bachynski shows that throughout the twentieth century, coaches, sports equipment manufacturers, and even doctors were more concerned with \"saving the game\" than young boys' safety-even though injuries ranged from concussions and broken bones to paralysis and death. By exploring sport, masculinity, and citizenship, Bachynski uncovers the cultural priorities other than child health that made a collision sport the most popular high school game for American boys. These deep-rooted beliefs continue to shape the safety debate and the possible future of youth tackle football.
eBook
Lone stars
When Coach Coop, a former star player for the Dallas Cowboys, starts exhibiting side effects from the many concussions he suffered while playing professionally, twelve-year-old wide receiver Clay Hollis becomes determined to help him get through the football season until Thanksgiving, when Coach plans to attend a ceremony honoring him and his former Super Bowl-winning teammates.
Book
Does reducing the height of the tackle through law change in elite men’s rugby union (The Championship, England) reduce the incidence of concussion? A controlled study in 126 games
ObjectivesMost concussions in rugby union occur during tackles. We investigated whether legislation to lower maximum tackle height would change tackle behaviour, and reduce concussion incidence rate.MethodsIn an observational evaluation using a prospective cohort design, 12 elite men’s teams played in two competitions during the 2018/2019 season. The Championship (90 games) retained standard Laws of Rugby for the tackle; the Championship Cup (36 games) used revised laws—the maximum tackle height was lowered from the line of the shoulders on the ball carrier to the line of the armpits. Videos of tackles were analysed for ball carrier and tackler behaviour. Injury data were collected using standardised methods.ResultsIn the lowered tackle height setting, there was a significantly lower proportion of tackles; (1) in which ball carriers (rate ratio (RR) 0.83, 95% CI 0.79 to 0.86) and tacklers (RR 0.80, 95% CI 0.76 to 0.84) were upright, (2) in which the tackler’s initial contact was to the ball carrier’s head or neck (RR 0.70, 95% CI 0.58 to 0.84) and (3) in which initial contact was above the line of the ball carrier’s armpit (RR 0.84, 95% CI 0.80 to 0.88). Concussion incidence rate did not differ between conditions (RR 1.31, 95% CI 0.85 to 2.01). Unexpectedly, compared with the standard tackle height setting, tacklers in the lowered tackle height setting were themselves concussed at a higher rate as measured by; (1) incidence (RR 1.90, 95% CI 1.05 to 3.45) and (2) concussions per 1000 tackles (2.09, 95% CI 1.15 to 3.80).ConclusionsLegislating to lower the height of the tackle meant that tacklers made contact with the ball carrier’s head and neck 30% less often. This did not influence concussion incidence rates. Tacklers in the lowered tackle height setting suffered more concussions than did tacklers in the standard tackle height setting.
Journal Article
Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial
BackgroundInjury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies.AimTo determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures.MethodsIn a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff.Results441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group.ConclusionA preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.
Journal Article
Tackle football and traumatic brain injuries : law, ethics, and public health
A timely look at the ethical, legal, and policy issues surrounding brain injury and collision sports.
American tackle football is an industry like any other. And like many industries, it sells a product that is dangerous to those who use it—or, in this case, those who play it. In Tackle Football and Traumatic Brain Injuries, Daniel S. Goldberg explores the connections among traumatic brain injury, collision sports, and the industry's continuing efforts to manufacture doubt. Focusing especially on youths and adolescents—the most vulnerable population that comprises over 99% of tackle football players in the US—Goldberg addresses the ethical and social implications of their participation in tackle football.
Goldberg discusses the true scope of the danger and the costs to society and individuals of caring for injured participants. If these risks were to become widespread public knowledge, the profitability and perhaps even the viability of American football would be at risk. As the tackle football industry has consistently worked to mask the health hazards involved in playing football, it has used a particular tool that has proved highly effective in achieving this subterfuge: the manufacture of doubt. Goldberg advocates for using public health laws as a tool for countering these efforts at obfuscation, and he outlines specific policy proposals intended to address the population health and ethical problems presented by tackle football.
The book draws on public health ethics, public health law, and the histories of occupational and public health to assess the limits of parental choice to expose their children to risks of injury. Should kids play tackle football at all—and who decides if they should? Goldberg offers practical answers to these critical legal, ethical, and social questions. Chris Nowinski, former Harvard football player and WWE wrestler, provides a timely and insider's perspective on these critical issues in the foreword.
eBook
Sub-concussive head impacts from heading footballs do not acutely alter brain excitability as compared to a control group
Repeated sub-concussive head impacts are a growing brain health concern, but their possible biomarkers remain elusive. One impediment is the lack of a randomised controlled human experimental model to study their effects on the human brain.
This work had two objectives. The first one was to provide a randomised controlled human experimental model to study the acute effects of head impacts on brain functions. To achieve this, this work's second objective was to investigate if head impacts from heading footballs acutely alter brain excitability by increasing corticospinal inhibition as compared to a control group.
In practised and unpractised young healthy adults, transcranial magnetic stimulation was used to assess corticospinal silent period (CSP) duration and corticospinal excitability (CSE) before and immediately after performing headings by returning 20 hand-thrown balls directed to the head (Headings; n = 30) or the dominant foot (Control; n = 30). Moreover, the Rivermead Post-Concussion Questionnaire (RPQ) was used to assess the symptoms of head impacts. Head acceleration was also assessed in subgroups of participants.
The intervention lengthened CSP duration in both the Headings (6.4 ± 7.5%) and Control groups (4.6 ± 2.6%), with no difference in lengthening between the two groups. Moreover, CSE was not altered by the intervention and did not differ between groups. However, performing headings increased headaches and dizziness symptoms and resulted in greater head acceleration upon each football throw (12.5 ± 1.9g) as compared to the control intervention (5.5 ± 1.3g).
The results suggest that head impacts from football headings do not acutely alter brain excitability as compared to a control intervention. However, the results also suggest that the present protocol can be used as an experimental model to investigate the acute effects of head impacts on the human brain.
Journal Article
Symptom Exacerbation and Adverse Events During a Randomized Trial of Early-Stage Rehabilitation After Sport-Related Concussion: Safety Outcomes From the Active Rehab Study
Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels.
Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions.
Cluster RCT (NCT02988596).
Sports medicine clinic and field settings.
The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US/Canadian colleges (n = 128) and US high schools (n = 40).
Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132).
Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group.
The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9/819 MDR + EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported.
Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.
Journal Article
Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football
BackgroundHistorical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season.MethodsA prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67 years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome.ResultsWith similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05).DiscussionReduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts.Trial registration numberNCT02696200.
Journal Article
Sports Injuries of a Portuguese Professional Football Team during Three Consecutive Seasons
Professional football players are exposed to high injury risk due to the physical demands of this sport. The purpose of this study was to characterize the injuries of a professional football team in the First Portuguese League over three consecutive sports seasons. Seventy-one male professional football players in the First Portuguese Football League were followed throughout the sports seasons of 2019/2020, 2020/2021, and 2021/2022. In total, 84 injuries were recorded. Each player missed an average of 16.6 days per injury. Lower limbs were massively affected by injuries across all three seasons, mainly with muscular injuries in the quadriceps and hamstrings and sprains in the tibiotarsal structure. Overall, the injury incidence was considerably higher in matches than in training. The two times of the season that proved most conducive to injuries were the months of July and January. Our results emphasize the importance of monitoring sports performance, including injury occurrence, and assisting in identifying risk factors in professional football. Designing individualized training programs and optimizing prevention and recovery protocols are crucial for maximizing this global process.
Journal Article