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For Your Patients-Concussion: Would You Let Your Kid Play Contact Sports?

Susman, Ed

doi: 10.1097/01.NT.0000534163.36662.28
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ARTICLE IN BRIEF

Nearly 66 percent of neurologists attending a debate at the AAN Annual Meeting voted “no” to the question: Would I let my child play contact sports? Two experts in traumatic brain injury argued pro and con perspectives on the question.

LOS ANGELES—Despite pleas to ‘let kids play,’ most neurologists attending the AAN Annual Meeting here last month voted “no” to the question posed in the controversies plenary: “Would you let your child play contact sports?”

Before Jack W. Tsao, MD, DPhil, FAAN, professor of neurology at the University of Tennessee in Memphis, attempted to sway the audience toward the concept of free-range kids when it comes to sports, he knew he faced an uphill task. Using the AAN app, participants voted either for or against the proposal, and the results were daunting: 34 percent said they would let their kids play contact sports, 66 percent said they would not.

Taking the floor first, Dr. Tsao argued that American football and ice hockey are not the only sports where injuries, including concussion can occur — in fact, he cited a case in which a ballroom dancer — not exactly considered a contact sport — ended up with a concussion when her partner dropped the dancer on her head.

He said that a Department of Defense-National Collegiate Athletic Association study of 39,612 college athletes found concussion occurred more than 3,000 times — and in sports that included football and ice hockey as well as volleyball, swimming, tennis, fencing, and cheerleading.

Importantly, Dr. Tsao argued, letting kids play sports has many health benefits. “Playing sports improves cardiovascular health and endurance,” he said. “It helps in maintaining physical fitness by improving motor skills. It improves cognitive performance by requiring sustained attention and playing sports decreases childhood obesity and diabetes.” He noted that a sedentary lifestyle and a high body mass index are associated with lower cognitive function across the lifespan.

He also argued that playing sports and exercise had psychological benefits, too. “Playing sports reduces stress, depression, and anxiety; it contributes to development of life skills such as teamwork and collaboration, leadership skills, responsibility, discipline, and a work ethic,” he said.

Dr. Tsao said that multiple studies have suggested that individuals who play sports during childhood develop a sense of community, have improved academic achievement, develop a positive social attitude and relationships, are less likely to skip school or use illicit substances, and are more likely to be gainfully employed after college graduation, especially young women.

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Noting that concussions occur across the spectrum of sports, Dr. Tsao said that the risk of these head injuries can be reduced through education and knowledge, use of protective gear, the teaching of proper techniques — such as heads-up tackling techniques in youth football, and implementing and enforcing safety rules.

Citing a 2012 study in Mayo Clinical Proceedings, Dr. Tsao said there is evidence the late risk of dementia among high school football players when compared to those who played in the band was not statistically different. Nor were the rates of Parkinson's disease or the rate of amyotrophic lateral sclerosis.

But Dr. Tsao's arguments did not sit well with Christopher Giza, MD, professor of pediatric neurology at the University of California, Los Angeles, who argued the opposing viewpoint.

Dr. Giza said contact sports should be avoided because the young brain is more vulnerable to the danger of a catastrophic acute injury and chronic sequelae, and the risk-benefit ratio is not in favor of contact sports for youth since an infinitely small number of youth will ever reach a level of playing sports in college or professionally

The practices of various sports need to change to improve safety, Dr. Giza said. He was particularly concerned about the risk of playing sports aside from traumatic brain or spinal injury. He said kids may suffer from overuse injury, from musculoskeletal injuries, from burnout, and from the risk of using performance enhancing drugs.

“The risk-benefit is too high,” he said. “There are plenty of other things that kids can do that don't involve this kind of risk.”

He said in addition to the acute injuries that occur in contact sports some problems that occur with playing sports in youth such as late musculoskeletal problems or late neurodegeneration or dementia has been seen recently with studies of the brains of National Football League players that show signs of chronic traumatic encephalopathy. And for most of the youth who experience these injuries there is no monetary gain.

Dr. Giza said sports have to change dramatically before he thinks he would endorse contact sports by youth. There has to be use of proper equipment; players have to be taught to practice good techniques, such as unnecessary contact in practice; rules have to be enforced; the athletes and teams have to be educated; and concussions have to be identified and treated.

Until then, he said: “Don't let kids play contact sports.”

After both debate participants had added their rebuttal statements, the electronic polling was again put to use – and the arguments of the presenters did not appear to move the needle: The final vote: 35 percent in favor of letting kids play; 65 percent of the neurologists would keep them off the field.

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Both presenters offered a post vote caveat – that people should not take their position as being what they truly believe, because as Dr. Tsao noted, “We were assigned what side of the argument to make.”

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LINK UP FOR MORE INFORMATION:

•. Savica R, Parisi JE, Wold LE, et al High school football and risk of neurodegeneration: A community-based study https://linkinghub.elsevier.com/retrieve/pii/S0025619612002649. Mayo Clin Proc 2012; 87(4): 335–340.
    © 2018 American Academy of Neurology