On a Monday evening in July, the Elk River Youth Football Association is scrimmaging on a field in Elk River, Minn. The players are all in second through eighth grades; the smallest ones can't weigh more than 60 pounds. They run up and down the field, bouncing off foam pads and water coolers and each other.
Coach Mike Miller stands on the sidelines. He played football when he was younger, and remembers getting knocked around pretty badly.
“I don't have enough fingers and toes to know how many stars I used to see sometimes. That's the god's honest truth,” he says. “There were times when you would get knocked down and you literally think you saw stars, and the next play you're in. Shake the cobwebs off and you go.”
What Miller describes was probably a concussion, though people didn’t used to think about it in those terms. You 'saw stars' or ‘got your bell rung’ – it wasn’t anything to worry about.
Things are different now, at Elk River and across the nation. In the past couple of years, as new information has emerged about the links between recurring concussions and dementia, depression and Alzheimer’s-like symptoms, many states have passed some form of concussion-related legislation to protect youth athletes. Laws usually require that kids suspected of having a concussion be taken out of a game immediately. Most also require some form of concussion education for coaches and trainers.
But there’s been scant research done on the intensity and frequency of hits young athletes regularly take in practice and play.
In February, the Center for Injury Biomechanics, a collaboration between Virginia Tech and Wake Forest universities, released the very first study of head impact exposure in elementary and middle school football players. Researchers attached sensors to the helmets of 7- and 8-year-olds to determine how often they were getting hit, and how hard. The sensors picked up G-force, which measures acceleration relative to the earth's gravitational pull. One G is the acceleration caused by gravity that occurs at the Earth’s surface, which we experience most of the time.
"Actually, when we first started, we didn't expect to find anything," says Stefan Duma, the lead researcher on the study. "We didn't think a bunch of 7- and 8-year-olds were actually moving fast enough to have high enough acceleration to trigger our sensors."
Instead, Duma's sensors picked up an average of more than 100 head hits per child over the course of a football season's 10 practices and five games. Most of those hits were small; Duma compared them to an aggressive pillow fight (15 Gs). But Duma found some of the impacts worrisome. "What surprised us was that there were quite a few hits above 40 Gs," which can be compared to a minor car accident, he says. "And if you look at the very highest, we had six impacts that were above 80 Gs. That's very high. And that's when you start to worry about a risk of concussion."
The concussion risk is a real one – not just in football, but also for a whole host of sports, including hockey, lacrosse, basketball, soccer – even cycling. Emergency room data collected between 2001 and 2009 and available from the Centers for Disease Control and Prevention, recorded almost 250,000 sports-related concussions in children and teens in 2009, the most recent year available. That number is almost certainly low. Studies show that more than half of concussions go unreported and some researchers suggest the real totals for young people are between 500,000 and 1 million per year.
Such frightening figures raise real questions for parents trying to weigh the risks and rewards of youth sports participation. The numbers of children participating in contact sports seems to be holding relatively steady, despite the increased awareness of concussion risk. The Pop Warner football league says that its enrollment this year is on par with that of previous years.
But some parents are having second thoughts.
Kate Janson is the mother of an “extraordinarily large and coordinated” 3-year-old boy who loves football so much he sometimes sleeps with a ball.
Kate, who lives in Scottsdale, Ariz., is a huge football fan herself. She spends every Sunday she can in front of NFL games and she's a longtime fantasy football player. She's spent years managing virtual rosters made up of real athletes. And it was while tracking her players' statistics in the real world that she began to notice something disturbing: She was always having to shift her rosters around because her players were always getting injured.
Kate started reading up on concussions and following the news reports about traumatic brain injuries in former NFL players. And she decided that no matter how much she loved the game of football, she couldn’t let her son play.
“I feel like a hypocrite,” she says. “Here I am totally into football as a fan, but would I want [it for] my kid? No way."
Tim McCarty, of North Canton, Ohio, used to love watching his son Shawn, a rising high school junior, play lacrosse. “It’s an amazing sport,” he says, full of strategy and tactical skill. Shawn has played the sport since he was in eighth grade -- and though he would come home from practice with bruises running up and down his arms, Tim never worried too much about it.
“It was just so a part of the game; we never thought about it at all,” he says. “We never felt like there was any reason to be afraid.”
Shawn got his first concussion in eighth grade. His second came just three months ago, in the middle of the lacrosse season, and was more severe. He sat out for the rest of the season on his doctors' and parents' orders. He is still in physical therapy.
To a certain degree, concussions are cumulative, which means that once a kid gets his or her first concussion, he's more likely to get a second and a third. And more concussions might mean more permanent damage. But doctors can't tell Tim what the breaking point is, when damage becomes catastrophic and irreparable. In general, experts give parents mixed advice. There are no set rules about how young is too young to play contact sports, what kind of game play is too dangerous, or how many concussions are too many.
And that leaves Tim McCarty struggling with a dilemma many parents face: On one hand is his son, who desperately wants to get back on the field. And on the other is Shawn's future.
“What happens if this happens again?” Tim says. “I can see it in the doctor's eyes, I can see it in the therapists' eyes, I can see it in all the adults' eyes. That someone who is 16 years old that has had multiple concussions needs to stop playing. And there are probably parents who would say, 'Are you out of your mind? Why is this even a question?' But all I'm saying is, it's not that easy.”
For now, Tim says he is planning to let his son play lacrosse next spring. The joy Shawn gets from the game along with the discipline and the physical exercise all just barely outweigh Tim's fear of head injuries. But the pleasure Tim used to get from watching his son run down the field is tempered. From the sidelines, everything looks a lot more fragile now.