Concussions up for basketball players - but why?

A just-released study points to a a major rise in the number of kids suffering serious head injuries while playing basketball.

According to the study published today in the Journal Pediatrics, kid players 5 to 19 treated in hospital emergency departments for basketball-related traumatic brain injuries rose 70 per cent from 1997 to 2007.

Assuming this is right, why would that be? I got a call from a reporter Friday (the study was embargoed until today) wanting to discuss that and hear any theories I might have.

My first thought - shared by many, probably - is that heightened awareness about concussions is a large factor. There's been so much publicity about the unseen harms of concussions, not just lately but going back to the mid 2000s. I highly recommend this piece from 2007 written by Alan Schwarz of the New York Times. It's remarkable in showing how little attention coaches, parents and players were paying to head injuries.

A second theory. Were substantially more kids playing basketball in 2007 than in 1997? I haven't been able to answer that, not directly. As close as I've been able to come is to establish that there were many more kids playing high school sports at the end of that 10-year span than the start. Total participation for all high school sports grew from 6.3 million in 1997-98 to 7.4 million in 2007-2008.

Here are things I believe are NOT responsible: Kids are getting bigger and faster (not that much bigger and faster); referees are allowing more physical play (zero evidence supporting that); sportsmanship is in steep decline so more elbows are flying (even more far-fetched).

This isn't the first study to point out how ignorant we all were about head injuries in youth sports. Doubtful it will be the last

Answering the ACL epidemic with training, coaching

Should parents invest in specialized sports fitness and skills training for their kid athletes? Usually, I'm a skeptic about such programs. The younger the kids, the more skeptical I am. (Batting lessons for 7-year-olds? Why?)

In Thursday's Washington Post, there's an article worth reading about a training regimen for kids that makes total sense. Its purpose: reducing ACL injuries in girls.

The article relates how Patricia Lake, a "determined Bethesda mom" is protecting her daughter.

The story explains:

"Lake's daughter, Corinne, ruptured her ACL the day before her 15th birthday, the day after she made the Whitman High School varsity soccer team as a freshman. Because she had not finished growing, doctors were reluctant to drill into her femur, a routine part of repairing the ligament. They held off her surgery for six months.

"The operation was followed by grueling physical therapy and personal training. As Corinne grew stronger, Lake began to wonder how she could keep her daughter's strength and flexibility regimen on track and help spare other girls the same fate. She spoke with Corinne's physical trainer, Graham King, owner of Balance Sport and Fitness, who was eager to start a program for teen girls.

"Now, once or twice a week, a dozen girls on Corinne's travel soccer team work on protecting their knees in Balance's Dupont Circle facility, a converted high school gymnasium, while their parents get in workouts of their own."

Recently, I spoke with Dr. Andrew Gregory, co-author of a just-published report on soccer injuries in kids. The conversation swung to ACL injuries. He recommends that parents choose teams and leagues that train coaches in injury prevention. He's helping to educate coaches of the soccer team his daughter, Sarah, 11, plays on. (Once again proving the axiom: When possible, get your kid on a team with the child of an orthopedic surgeon).

"There are [education] programs that teach girls how to land correctly, how to cut with their knees and hips in good position," Dr. Gregory told me. "Those can be very effective."

New - and recommended - youth sports Web sites

Two new kids' sports Web sites to point out and, if you're like me, to bookmark. Both provide excellent information about sports safety and injury prevention.

Just launched by the American Academy of Pediatrics, Healthychildren.org. Many topics covered, from Body Checking in Hockey - it causes 86 percent of all hockey injuries in kids nine and 15 - to Common Finger Injuries in Athletes to Exercise-Induced Asthma. The site also links to short AAP-produced audio pieces such as this one on how parents can avoid being lousy sports.

Next month, the American Orthopaedic Society for Sports Medicine launches its Stop Sports Injuries Web site. For now, the url is a static page with a few facts about AOSSM, headed this year by the surgeon for about every pro athlete you can think of, Dr. James Andrews. I'll be checking back soon for the official site unveiling.

New study on health risks to lacrosse players

In a study made public today, the American Academy of Pediatrics reports that sudden deaths due to chest trauma (getting hammered with a ball, stick, puck, opponent's forearm, and so on) are more common in lacrosse than any sport except hockey.

More common as opposed to common. Over 28 years, the study revealed just 23 deaths or cardiac arrests in male athletes in high school and college lacrosse programs. Not an epidemic. Still, this will doubtless get the attention of lacrosse parents, scholastic sports associations, U.S. Lacrosse.

Researchers analyzed data about stricken lacrosse players from 1980-2008 and learned the following:

-Ten died after receiving blunt chest blows, including four goalies wearing chest protectors.

-Twelve other students collapsed because of pre-existing cardiovascular disease.

The authors recommend - sensibly - that better chest protectors be developed to protect players from freak accidents.

Gym class more dangerous than it used to be

Not sure what to make of this but, as a public service, am passing it along: Gym class apparently is becoming more dangerous.

A study released today by the American Academy of Pediatrics reports that the number of kids injured during gym has leaped 150 per cent in 11 years. (That is, the annual number of cases increased 150 percent during the study period).

During the years of the study (1997 to 2007) researchers analyzed the cases of 405,305 children and adolescents treated in emergency departments for PE-related injuries. Here are some highlights pulled from the data.

-Nearly 70 percent of the injuries occurred during six activities: running, basketball, football, volleyball, soccer and gymnastics.

-Researchers noted differences in the types of injuries suffered by boys and girls. Boys, for example, were more likely to be injured on the head, during collisions with other people, and during group activities. Girls tended to suffer strains and sprains to the lower extremities, and to be injured during individual activities.

-Middle school-aged children accounted for the majority (52 percent) of injuries.

Mouthguards, helmets and Tommy John surgery

As followers of this blog know (due to my railing on the subject) all youth sports injuries are not created equally. There are two major types: acute injuries that are incidental to the sport being played, i.e., turning an ankle on second base or catching an elbow in the face during a fight for a rebound; and overuse injuries caused pretty much by one thing: playing sports so intensely that a kid's body breaks.

Some recent info on both types:

According to a new study, the number of acute baseball injuries is falling, at least those that are showing up in hospital emergency rooms. The annual number of those injuries fell 24.9 per cent from 1994 to 2006, according to the research, just published in Pediatrics.

From the report: "The most commonly injured body parts were the face (33.5%) and the upper extremity (32.4%). The most common injury diagnoses were soft tissue injury (34.3%) and fracture (18.4%). The most common mechanism of injury was being hit by the baseball (46.0%). Children in the 9- to 12-year age group had the highest injury rate (2.4 per 1000 population). When injury rates were calculated by using baseball-participation data (2003), children in the 12- to 17-year age group had a higher injury rate (19.8 per 1000 participants) than those in the 6- to 11-year age group (12.1 per 1000 participants)."

More from the study: "Youth baseball is a relatively safe sport for children. Although injury rates and the total number of injuries declined during the study period, our findings indicate that there are opportunities for making baseball an even safer sport for children. We recommend that all youth baseball players wear properly fitted mouth guards, that all leagues, schools, and parks install safety bases, that all batters use helmets with face shields, and that all players use safety baseballs."

Meanwhile, there's less (i.e., nothing) to indicate a dip in overuse injuries among youth baseball players. In fact, the anecdotal reports point to just the opposite. Here's the latest alarm bell, a good piece on youth pitchers undergoing Tommy John surgery in last week's Oregonian. If you question whether we're really putting kids at risk, consider this paragraph from the article:

"Dr. James Andrews of Birmingham, Ala., has become a household name in the baseball world. He has seen a steadily rising percentage of young pitchers coming in for his elbow ligament replacement surgery. More than one-quarter of his 853 patients in the past six years were at the high school level or younger. One was 7."

Sports training for babies may be overrated

Discouraging news for parents who have invested heavily in sports DVDs for toddlers and even infants. (I just bought one as a gift for a cousin whose new baby will be under heavy pressure to start at linebacker for Penn State in 2027).

These training tools probably accomplish nothing.

I admit I had my suspicions. Now they've been confirmed by the American Academy of Pediatrics, which recently published a study concluding that TV and videos for kids under 2 may not influence skill development.

From the AAP: "Researchers looked at the amount of time 872 children spent watching television or videos from birth to 2 years of age, then assessed their language and visual motor skills at age 3. When researchers adjusted for other factors that could influence these skills, such as maternal education and breastfeeding, the effect of television appeared neutral. Contrary to many parents’ perception that television viewing is beneficial to their children’s brain development, the researchers found no evidence of such a benefit."

Ok, next time I buy the infant tackling dummies.

New research on injuries to disabled players

Interesting new research on a seldom-discussed topic: sports injuries among high school kids with disabilities. Among the findings: players at greatest risk for injury were athletes with autism and athletes with histories of seizures. "Athletes with autism had about five times the injury rate of athletes with mental disabilities. Athletes with seizures had more than 2.5 times the rate of injury reported among those with no seizure history," according to the study published this month in the journal Pediatrics.

Sensible sports advice from our pediatricians

The American Academy of Pediatrics is one of the best sources around for commentary and information on youth sports injuries. I've found the AAP's advice unfailingly sensible and accessible.

Case in point: "A Minute for Kids," a series of 60-second audio files - 18 in all - that take on important topics. I particularly liked reports on eye protection (42,000 eye injuries occur during sports play each year; half of those hurt are under 15) and adult conduct at youth sports events (Stop yelling, you're embarrassing your children).


Nothing revolutionary here. Still, because these words come from our kids' doctors they carry extra weight.

Can youth hockey be safer?

The Toledo Blade reported last week on devastating injuries to two youth hockey players - ages 14 and 18 - that occurred in high school games on the same day. Both players were checked by opposing players. Both fell to the ice. Both suffered serious paralysis.

The older player, Dustin Wells, initially had no feeling in his right leg. The injuries of the younger player, Kyle Cannon, were even more serious. He's hospitalized with a broken neck. A few days after the incident, he'd regained some feeling in his abdomen and arms, The Blade reported on December 6.

The injured players weren't the only lives affected. The player who skated into Kyle Cannon, causing him to fall hard on the ice, is being investigated by police after Kyle's father filed a complaint with the local police department. And Kyle's teammates met with counselors to help them deal with their grief - and to help get them back on the ice for a game four days later.

Whether these injuries were accidents or could have been avoided is for Toledo school officials to look into. However, this is a time when youth hockey officials nationally should be evaluating how to make the sport safer. The American Academy of Pediatrics offers the following data:

-Two hundred thousand children play youth hockey in the U.S.

-Among youth players, 9 to 15 years old, head and neck injuries accounted for 23 per cent of all hockey injuries, according to a study.

-Body checking made up 86 per cent of injuries that occur during games.

AAP's recommendations:

-Body checking should not be allowed in youth hockey for children age 15 years or younger.

-Youth hockey programs need to educate players, coaches, and parents about the importance of knowing and following the rules as well as the dangers of body checking another player from behind.

Incredible, growing youth football players

People Magazine, November 10 issue, has an interesting piece on the problem of high school football and obesity.

As reporter Amy Elisa Keith explains, some kids see football as their ticket to college scholarships. And they see rapid, execessive weight gain as a necessary step in the process. So with the tacit approval, and sometimes the encouragement, of coaches and parents, they pack on the pounds.

She writes, "Today the average NFL lineman is nearly 30 pounds heavier than 20 years ago. And as the bigger-is-better mentality has trickled down to youth leagues, the average lineman in a top high school program now weighs in at a hefty 232 pounds with coaches and parents encouraging teenage boys to engage in extreme eating so they can adapt to this new body standard."

There have been several recent studies on this subject, all raising the question: why aren't adults pushing children away from the table?

In 2007, a study of more 3,600 high school linemen in Iowa discovered that 45 per cent were too heavy and nine per cent of those obese. That compares with 18 per cent of male children and adolescents judged overweight in the general population. In Michigan, another study of 653 youth players (ages 9 to 14) found that 45 per cent were overweight or obese.

"Being big is encouraged, because you need that weight on the field," one high school coach tells People. "But we as coaches don't look at the ramifications of gaining 70 pounds in four years on the health of a teenager."

Much is made of how youth sports are safer with adults around to supervise, inspect and protect. Here is an example of just the opposite.

Baseball helmets in high school, continued

More on high school baseball players and face protection.

The issue generates more discussion in the November edition of Pediatrics. Ronald W. Coen, of St. Luke's Regional Medicial Center, Boise, Idaho, writes that to advocate for helmet-wearing infielders is "highly quixotic." (Translation: What were you thinking?) Dr. Coen then raises an issue that I did not in Sunday's post. "Helmets would restrict peripheral vision and restrict the ability of the defensive ball player to dive for balls and also look upward for high fly balls. It is not difficult to imagine a third baseman diving to his right for a line drive only to have his helmet move into his line of vision and batter his face when he hits the ground."

Also in the November edition, Comstock and Collins, researchers and helmet advocates, respond: "Sports have strong traditions and cultures, and historically, introduction of protective equipment has been resisted." (Translation: Get over it). "When helmets were introduced to football, ice hockey, and men's lacrosse, some were concerned that injury rates would increase. Athletes in these sports also use their peripheral vision to field fast-moving hard objects during play; however, few clinicians today would argue that these sports would be safer if helmets were not required."

An interesting debate, well argued on both sides. I maintain that the most formidable obstacle to required face protection is the pro-sports model. If sport goggles were mandatory in the big leagues, attitudes in the amateur/youth ranks would soften quickly.

High school baseball and facemasks

Safety is first in youth sports - or should be. But what happens when safety collides with our notion of what looks and feels like sports?

Recent example: Two researchers from The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, Christy L. Collins and R. Dawn Comstock, collected data from 100 high schools about baseball injuries during the school years of 2005-2006 and 2006-2007. In all, they found 431 injuries. Of those, 60 (11.6 per cent) were attributed to being hit by a batted ball. (Warning: More statistics ahead.)

Blows to the head/face (48 per cent) and mouth/teeth (16 per cent) accounted for the highest percentages of batted-ball trauma. Of kids who were smashed with a batted ball, 18 per cent required surgery. All this, and a lot more, is published in a scholarly article that appeared recently in the journal Pediatrics.

Collins and Comstock conclude their paper with a recommendation, one that, while perfectly sensible, I bet my vintage Mickey Mantle bobblehead will never catch on. "[W]e strongly recommend that helmets with face shields or at least mouth guards and eye protection be used by pitchers, infielders, and batters at the high school level," the authors note.

The recommendations have several things going against them: the added expense of the safety equipment, which most high schools would be hard-pressed to absorb; and the thorny issue of enforcement. Imagine an umpire checking each inning for mouthguard compliance. (I don't want to). Though adults might be loathe to admit it, our most vigorous objection might be on aesthetic grounds. We tend to like kids sports best when they are indistinguishable from the real thing. And who ever saw Alex Rodriguez wearing a facemask?

Kids and marathons

With the Marine Corps Marathon behind us and the New York City Marathon just ahead, I wondered: What do sports docs say about children and distance running? (Yes, we think about these things so you don't have to).

I imagined plenty of research on the subject and guidelines spelling out who is too young and who isn't. Not right. Instead, there's this advice from the American Academy of Pediatrics.

"There is, at present, no scientific evidence that supports or refutes the safety of children who participate in marathons. There are no recorded data on injuries sustained by children who run marathons. Marathon training requires a gradual increase in total weekly mileage, which may be less than or equal to the total weekly distance that is generally logged by high school cross-country teams (35–40 miles). Regardless, a clearly devised weekly plan, ensuring that safe running conditions are in place, and the provision of proper education on endurance activities (including environmental conditions and appropriate hydration) should all be part of the training process. A critical environmental safety concern is the ambient temperature and relative humidity, because a child is less able than an adult to handle heat stress. Weather-related guidelines have been set for all marathons, and these guidelines should be strictly enforced by the medical director for all youth endurance events. Ultimately, there is no reason to disallow participation of a young athlete in a properly run marathon as long as the athlete enjoys the activity and is asymptomatic."

I have run in 12 marathons to date, New York and Marine Corps among them. I've seen - and been passed by - many high school athletes. I can't recall a younger child in my races. But then, by mile 20, I'm barely conscious.