When it comes to concussions, the National Football League (NFL) seems to attract almost all the attention from the media. Remember the incident with Case Keenum, the St. Louis Rams’ quarterback? He returned to the field after being slammed to the ground in the same game. As a result, some questioned the NFL’s enforcement of its protocols, which was featured prominently in the media.

The reality is, however, that fewer than 2,000 people are playing in the NFL. But, there’s actually about 2,000 kids playing for every NFL player, which averages to 3.5 million kids playing youth football in the U.S. With a group so large, it’s clear we still have too little information when it comes to concussions in youth players.

“Shake it Off” Law

In 2006, the state of Washington created a new law in the name of 13-year-old Zackery Lystedt, also known as the “shake it off” law. In a life-changing game, Lystedt’s head hit the ground as he rolled through a routine tackle. While Lystedt didn’t lose consciousness, he did lie on the ground for a moment after the play, clutching his helmet. His coach determined, however, that he could play the rest of the game after sitting out for three plays.

By the closing whistle, Lystedt collapsed and was rushed to the hospital for emergency neurosurgery to relieve pressure inside his skull. Today, Lystedt is learning to walk again. The “shake it off” law requires players who show signs of concussion to be cleared by a medical practitioner prior to re-entering a game. While a good first step, what about the kids who play football and don’t display outward symptoms of injury? What about the damage that might be short of a concussion?

TBI and Youth Football Players

An imaging study in the journal Radiology, revealed that football players who had no concussion symptoms still showed changes associated with traumatic brain injury. In the study, the “head impact data” was recorded in male football players between ages 8 to 13 over the course of a season. The “head impact data” was recorded using a Head Impact Telemetry System to measure force, which was correlated with video games and practices. Christopher Whitlow, chief of neuroradiology at Wake Forest School of Medicine, headed the study with his team.

The players also underwent elaborate brain imaging before and after the season. To identify tiny changes in the structure of white matter, diffusion tensor imaging, which is a type of MRI, was used. The image measures fractional anisotropy (FA) of the movement of water molecules along axons. In healthy white matter, the direction of water movement tends to be uniform.

In head trauma, however, usually the FA values decrease as movement becomes less ordered. And in this case, the images of the boys’ brains showed a significant relationship between head impact and decreased FA in white-matter tracts by the end of the season. There were even more changes among the boys who experienced more head impact. Similar changes in FA have been reported in the setting of mild traumatic brain injury.

Altered Brain Development

In addition, it was found in a study published last year, that NFL players who begun playing football before the age of 12, had a higher risk of altered brain development, in comparison to players who started later. As Ann McKee, director of the Boston University Traumatic Encephalopathy Center, explained: “Kids’ heads are a larger part of their body. Their necks are not as strong as adults’ necks. So, kids may be at a greater risk of head and brain injuries than adults.”

Does this mean that kids should stop playing football? No, not necessarily. But, it’s clear that more rules need to be constantly updated as the latest research emerges. Protocols about what’s safe and what’s not should be implemented. Maybe, then perhaps youth football will be a reasonable idea. At this time, however, there’s still some work to be done!

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