UPMC concussions study: Less contact in youth football practice doesn't help

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Last year, Pop Warner -- the country's largest youth football organization -- decided to limit the amount of contact in practices, trying to plug one of the many holes in the larger, leaky dam that is the bigger issue of concussions and brain-related injuries in football.

The move seemed to make sense. Less contact means fewer concussions, right? According to a recent study out of Pittsburgh, maybe not.

UPMC and the University of Pittsburgh today released a study that its researchers said refuted several concepts that have been presumed as correct in the medical field for years.

The researchers studied 468 male youth football players from 18 teams in Western Pennsylvania during the 2011 season and witnessed more than 11,000 athletic exposures, including practices and games. In the first-ever large-scale study completed specifically on youth concussions in football, the researchers recorded 20 medically diagnosed concussions throughout the season, a number close to the incidence rate of high school and collegiate athletes.

As with most research done in the relatively new area of concussion research, the findings didn't come without disagreements from the rest of the brain-related injury medical field.

Some of the findings weren't all that surprising -- for instance, the rate of concussions among 8- to 10-year-olds was almost three times less than it was with 11- and 12-year-olds, which makes sense considering the increased size and speed of the older kids -- but some of the other findings are causing the most backlash.

The big conclusion gleaned from the data was that limiting contact in practice, which Pop Warner did for the first time last season, is a mistake. Two of the main researchers, Michael Collins and Anthony Kontos, both Ph.D.s, think this limited practice time could actually have negative effects, because it gives kids less time to learn how to properly tackle.

"Limiting contact at practice in Pop Warner is short-sighted, because practice is an opportunity to teach proper technique, for kids to learn how to do this the right way," said Mr. Collins, who is also the executive and clinical director of the UPMC concussion program. "Eighteen thousand concussion patients visit the clinic every year, but the worst cases I see are kids who on Aug. 15, they decided to go out for football without ever learning the sport. They don't know how to tackle or play, and they get lit up. Like anything else, you need to learn your craft, and limiting practice time -- at least based upon this data -- is very shortsighted."

Julian Bailes, who is the co-director of the NorthShore University HealthSystem Neurological Institute in Chicago as well as the medical director and chairman of the Pop Warner medical advisory board, had no problem standing by the practice policies, even when presented with the new information from the study.

"Those who played and coached the game know that it's very possible to still teach technique without going head-to-head full contact," Dr. Bailes said. "If they're implying you need head-to-head full contact to learn proper technique, I disagree and think they're erroneous in that conclusion."

Bennet Omalu, one of the leading forensic pathologists of the field who is well known for his post-mortem research on head trauma, also expressed reservation with Mr. Collins' main conclusion of the study, which is that being able to fix concussions through treatment and rehab is more relevant than avoiding things like football altogether.

"The very basic medical principle, research or no research, is: Do no harm," Dr. Omalu said. "Anybody who tells me that willfully exposing the brains of children to repeated impact is something good, I would humbly disagree with that person. I am not an advocate for the idea that football should be banned or not played -- I am not that extreme. I stand with Pop Warner, and I stand with caution. Limit the exposure of children from repeated blows to the head in whatever activity they do."

This is coming off recent rule changes by the higher governing bodies of football, the National Collegiate Athletic Association and the National Football League, who have both made strides to try to reduce serious head contact in games. In February, the NFL owners voted that running backs are no longer allowed to lower their heads outside of the tackle box, while the NCAA decided that any play deemed to involve head-to-head contact in the open field will result in an immediate ejection, as opposed to a personal foul.

In youth football leagues, things become a little murkier.

From a research-based perspective, there is nothing concrete about the long-term effects of concussions on children. There are leads and theories, but the only way to truly track the effects of this brain damage would be to follow a large, controlled group of children from the beginning of their football careers until the age of 60. The money and manpower required for such a massive undertaking doesn't exist yet, Mr. Kontos said, meaning that until that 50-year project happens -- no matter the research, the researcher or the findings -- there will always be holes.

Many people in the field have concluded that it's not even concussions that cause serious brain issues later on in life. The issue is not necessarily the diagnosed concussions, but the smaller, repeated blows to the head that often go undiagnosed and unnoticed. It's a well-respected opinion, but as it goes with doctors studying brain trauma, it's not everybody's.

"When you focus on concussions and subconcussions, that means you still do not understand the fundamental concept of repeated traumatic brain injury," Dr. Omalu said. "Any paper, if their research was based on the occasions and malice of concussions and subconcussions, that paper is fundamentally flawed."

So, the conclusion on whether parents should allow or encourage children to play tackle football remains stuck in a place nobody wants it to be -- without a definite answer and with more research still needed.

Mr. Collins has four daughters. If he had a son, he would unequivocally let the boy play football. Dr. Omalu would not.

"My advice is caution -- first, do no harm," Dr. Omalu said. "I have a son who is 3 years old. I would never let him play football. Period. That's my son, and based on what I know, I should not be fooling around with my son's brain."

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Everett Cook: ecook@post-gazette.com and Twitter @everettcook.


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