This editorial appeared in the Summer 2015 issue of Colorado Tennis/by Kurt Desautels, Editor

I am a huge advocate for youth athletics.

Sport — ALL SPORTS— do great things for kids.

Organized sports not only keep kids healthier physically, but mentally as well. Regular physical activity benefits youth in many ways, including helping build and maintain healthy bones, muscles and joints; helping control weight and reduce fat; and preventing or delaying the development of high blood pressure. The list of benefits goes on:

• Childhood sports participation is a significant predictor of young adults' participation in sports and physical fitness activities. Adolescents who play sports are eight times as likely to be active at age 24 as adolescents who do not play sports.
   
• In addition to living physically healthier lives, physical activity is associated with improved academic achievement, including grades and standardized test scores. Further, such activity can affect cognitive skills, attitudes and academic behavior, including enhanced concentration, attention, and improved classroom behavior.

• High school athletes are more likely than non-athletes to attend college and get degrees; team captains, MVPs achieve in school at even higher rates.
   
• A number of studies provide support for the premise that physical activity, and sports in particular, can positively affect aspects of personal development among young people, such as self-esteem, goal-setting, and leadership. 

• Compared to non-athlete peers, female high school athletes are less likely to be sexually active, to use drugs, and to suffer from depression. The benefits extend to the workplace. A survey of 400 female corporate executives found 94 percent played a sport and that 61 percent say that has contributed to their career success.

But.... (there's always a "but"). 

Concussions: the elephant in the room 

There is a silent epidemic in youth sports, one that sportswriter Bill Simmons calls "the single most important issue in sports today.” Concussions.

Concussions are real, they are dangerous, and they are becoming more and more frequent in youth sports. CDC reports show that the amount of reported concussions has doubled in the last 10 years. The American Academy of Pediatrics has reported that emergency room visits for concussions in kids ages 8 to 13 years old has doubled, and concussions have risen 200% among teens ages 14-19 in the last decade.

Many parents understand the dangers, but avoid the issue by wishing the problem away or hoping and praying that their sons or daughters never face the issue.

The simple fact of the matter is, while science is learning more and more about the danger of concussions and sub-concussive impacts each and every day, as a society, we need to answer some tough questions as to the nature of youth sports and the danger of trauma on a developing young brain. The current research demonstrating the severity of trauma from a blow to the head while playing football — and even sports like hockey, lacrosse, soccer, baseball and basketball — is frightening to think about.

So, we don’t. We shake our heads, and then we continue on as we always have, and put our collective heads in the sand. If we don’t see it, or hear about it, or talk about it, maybe the whole thing will just go away.

But it's not going away. It's getting worse.

In 2012, there were 3,800,000 sports concussions reported. Breaking it down further, 1 in 5 high school athletes will sustain a sports concussion during the season, and 33% of those report two or more in the same year. Cumulative concussions have been shown to increase catastrophic head injury leading to permanent neurologic disability by nearly 40%.

Pulling our heads out

As a parent, you need to ask yourself the following question: Am I voluntarily putting my son/daughter at unnecessary risk by allowing him/her to play contact sports like football, hockey, lacrosse, or even soccer?

Before you consider the fairness of the question, consider the statistics (from the CDC):

Football players led all high school athletes in concussions, at 0.77 per 1,000 Athletic Exposures (defined as one athlete participating in one game or practice, in which he/she is exposed to the possibility of athletic injury). That may help explain why the number of boys playing Pop Warner football, the largest such program in the country, is down by nearly 10% since 2010.

The second most concussion-prone sport for boys is ice hockey (0.54), then lacrosse (0.46), followed by wrestling (0.24).

Girls have it even worse, especially when starting out. Soccer was considerably tougher on girls, who recorded a score of 0.67 per 1,000 AE compared to 0.19 for boys — concussions constitute fully 33.4% of all girls’ soccer injuries, equalling the next two most common types of soccer injuries, to knees and to hips/thighs/upper legs, combined. By comparison, concussion accounted for a more modest 25.8% of boys’ soccer injuries.

As with soccer, there’s a gender imbalance present in basketball, the number two concussion sport for girls, at 0.56 per 1,000, twice the rate for boys’ basketball (0.25).

The same gender disparity was present on the baseball diamond, where, as counterintuitive as it might seem, softball was more dangerous than hardball, with boys’ concussion rates at 0.05 compared to girls’ softball injury rates of 0.16.

And with the recent explosion in popularity of girls lacrosse and field hockey, it's also no surprise that concussion rates have climbed significantly in those sports as well, 0.35 and 0.25 per 1,000 AE respectively. Even cheerleading boasts an alarming concussion rate, at .014 per 1,000 AE. Remarkably, even non-contact girls' sports such as volleyball and gymnastics have concussion issues (0.09 and 0.07 per 1,000 AE respectively).

But concussions aren't the only problem when it comes to sports and young brains. 

Other brain injuries

Purdue researchers recently compared changes in the brains of high school football players who had suffered concussions with the brains of players who were concussion free. They found brain tissue damage in both. That's scary stuff. That means brain injuries are occurring without concussions and without players, coaches or parents being aware of it (remember that girls soccer is the most concussion-prone sport for youth and high school female athletes). It turns out that it’s not only helmet-to-helmet contact that can result in brain trauma.

A study conducted at Humboldt State University in California, revealed that both female and male soccer players who headed the ball the most during a game did worse on cognitive tests after the game than their peers who hadn't headed a ball. Moreover, the players that did the most heading also suffered more often from headaches and episodes of dizziness compared to players that headed the ball less often.

Another study by Harvard researchers looked at the brains of soccer players to those of swimmers, where they determined that there were changes in the white matter of the soccer players' brains that weren't there in the swimmers’ brains.

Using our heads to protect young brains

Underlying these statistics is an important fact: the brains of youth and high school athletes are still developing, making them more vulnerable to brain injuries. As such, Dr. Robert Cantu, a neurosurgeon and leading expert on sports concussions, recommends that kids don't play tackle football before age 14. He also recommends banning heading in soccer and body checking in ice hockey before 14. In a New York Times editorial, Dr. Cantu even suggested that kids could be held out from these activities longer, as late as 16 or 18.

"In light of what we now know about concussions and the brains of children, though, many sports should be fine-tuned. But many parents and coaches are satisfied with the rules as they are. They like seeing youngsters in helmets and pads, and watching them slide headfirst into second base. The closer the peewee games resemble those of the professionals, the happier we are. It’s natural for a parent or a coach. Even a neurosurgeon.

But children are not adults. Their bodies are still maturing. Their vulnerabilities to head trauma are far greater. A child’s brain and head are disproportionately large for the rest of the body, especially through the first five to eight years of life. And a child’s weak neck cannot brace for a hit the way an adult’s can (think of a bobblehead doll.)

A child’s cranium at 4 is about 90 percent the size an adult’s. That’s important to a discussion of concussions and concussion risk."

Now that we know what’s going on, Cantu says we cannot continue to look the other way and pretend concussions will go away on their own. It's time to have an open discussion. His comments beg the question, do we really want to place a kid in any sport in which they are hitting their head on a regular basis?

So as parents, we need to embrace the benefits of youth sports and balance that with what we now know is dangerous and scary about them. It boils down to this... How much contact is acceptable?

Now that you know....

So by now if you've read this far, you're virtually an expert on concussion frequency in youth sports. As an expert, what will you do with this new information?

Like you, I've kept my head in the sand on this issue when it comes to my own kids. But after a particularly alarming story told to me by an acquaintance, it made me realize that we, as a culture, as coaches and as parents, need to bring concussions out of the shadows. Better diagnosis, better after care, better awareness...all of these are crucial as we move forward. Since concussions happen even in non-contact sports like gymnastics and cheerleading, and since progressive brain injuries can occur even when there is no person-to-person contact, we need to rely on science and medicine and their ability to better prepare our players, and to better educate our parents and coaches. The danger is too high, given that the vast majority of concussions aren't even diagnosed properly, putting kids at risk for a secondary concussive event, which both prolongs and intensifies the dangerous effects to the brain.

Of course, there are always alternatives. You could yank your child out of sports altogether, but then all those positive attributes go by the wayside. Or you can enroll your child in a safer activity, one that offers all the tremendous benefits of sports but protects your child's most important asset....

Life lessons...minus the risk of concussion

As this is a tennis publication, you might not be overly surprised to learn that among the top 10 most popular high school sports, tennis ranks with golf and swimming as the activities with the fewest concussions/head injuries.

In fact, according to Dr. Neeru Jayanthi, the Medical Director of Primary Care Sports Medicine at Loyola University Chicago, concussions in tennis are incredibly rare (although they do occur). In his data set (comprised of more than 150 junior players competing in thousands of athletic exposures), they have recorded zero concussions.

Dr. Jayanthi and other neuroscientists have come to label tennis and swimming as a nonconcussion sports, which may be a big relief to those parents who are anxious to introduce their kids to tennis.

Something else parents might not know is that compared to other sports, tennis players get better grades (48% have an "A" average), are better behaved (73% have never been sent to the principal's office), are more community-minded and well-rounded (82% volunteer in their community), and are less prone to risky behaviors, such as binge drinking, cigarette smoking and marijuana use (More Than a Sport: Tennis, Education and Health, Don Sabo, PHD).

You see, tennis isn't just a game. It's a great teacher.

It teaches you many of the important things in life, like perseverance, the value of sportsmanship, how to win or lose with dignity, good judgment, integrity and a sense of honesty. Introducing tennis to kids isn't just about teaching them the game, it's about teaching them a set of values that will last a lifetime.

All the teamwork, none of the padding

Tennis isn't unique in producing youngsters with positive characteristics. And tennis isn't unique in providing a safe environment for competitors. But other than tennis, how many sports can you name that have all of the positive benefits of physical exertion, balance, coordination, strength, stamina, problem-solving, competition....with virtually zero risk of head injury?

For those of you who have your children participating in any of the sports mentioned in this article, please understand that there is no finger-pointing or sideways glances directed toward you. My own children participate in contact sports, and thankfully, neither has experienced any collisions that would cause me to be concerned about their brains.

But...

It is estimated that at least one player sustains a mild concussion in nearly every American football game, and that the likelihood of an athlete in a contact sport experiencing a concussion is as high as 20% per season.

And once an athlete has suffered an initial concussion, his or her chances of a second one are 3 to 6 times greater than an athlete who has never sustained a concussion. In fact, more than a third of high school players in one recent survey reported two or more concussions within the same school year.

Yikes! These are odds that simply cannot be ignored. It's time that we, as parents, openly acknowledge and address the risks associated with youth contact sports.

As a parent of young athletes, both of whom are competing in contact sports, these statistics are sobering. And while I won't forbid my children from playing lacrosse or soccer or basketball, the reality is that we are now exploring new athletic opportunities, including tennis — which my son has previously sworn off (another story for another time).

The purpose of this article is not to scare anyone away from other sports, or to capitalize on fear in such a way to lead parents to tennis. We must educate ourselves and assess for our kids their best interests. As tennis players, you already know the value that this sport adds to your lives.

Tennis has been called the "ideal sport for a healthy heart." But as we learn more and more about the dangers associated with physical contact in athletics, it is also time to recognize tennis as the "ideal sport for a healthy brain."
 

Back