Banging Heads

C oncussion, or mild traumatic brain injury (MTBI), continues to occupy the center stage in sports medicine. The relationship between contact sports and degenerative central nervous system diseases—such as dementia, amyotrophic lateral sclerosis, depression, and chronic traumatic encephalopathy (CTE)—remains unclear and thus deserves focused investigation as researchers probe for clinical answers. Contact sports are an integral part of American life due to their popularity at all levels of play, from the school yard to the professional ranks. America's interest in sports that can cause high-velocity trauma continues to grow and is evident on most weekends in the fall and winter. Drastic measures to change the games have been and, understandably, will continue to be resisted by most participants, coaches, and viewers for fear of altering the nature of the competition. However, for parents, many of the recent findings are alarming. Former players cautiously review the recent reports as they ponder their own fates. Some of the more recent findings are worth review. When all causes are considered, children have the highest incidence of MTBI. 1 Recent reports estimate that MTBI occurs in 692 of 100 000 children younger than 15 years. 5 Up to 16% of children require medical attention for a head injury by age 10. 3 One of the difficulties in isolating the lasting effects of head injury in children and teenagers is that preinjury factors, One of the consequences of MTBI is postconcussion syndrome (PCS), which is a collection of cognitive, physical, emotional, and behavioral symptoms lasting from weeks to years. Studies have estimated that between 6% and 35% of children suffer PCS after MTBI. 3 A recent prospective study of children 1 questioned a consecutive cohort of families of emergency room admissions with MTBI (n, 670) or extracranial injury (n, 197). Three months after injury, 11% of the children with MTBI were still symptomatic, compared with less than 1% with extracranial injury. The impact of PCS on school performance and social functioning in children and adolescents is unknown but may be an important factor in their neurological development. Current estimates indicate that 1.2 million high schoolers play football in the United States and sustain up to 68 000 concussions per year. 11 Players experience approximately 3000 hits per season, with some hits generating forces in excess of 100 g's. 12 The participation numbers dramatically decrease from the high school level to the college level, but the …