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When Bob Cantu Says No Collision Sports Before Age 14, Parents Need to Listen

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The blockbuster announcement came across my desk two days ago, but it took me a while to process its full significance.  In fact, it may take me a while longer to fully appreciate all of its implications for youth sports.

Dr. Bob Cantu, MomsTeam's first concussion expert from 2000-2008, and someone I have known and respected for more than a decade, is recommending that kids under the age of 14 not participate in collision sports as currently played.  Youth football players stretching

That's right: Dr. Cantu, one of the nation's pre-eminent concussion experts, co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine, co-director of the Neurologic Sports Injury Center at Brigham & Women's Hospital, and co-founder, with Chris Nowinski, of the Concussion Legacy Institute (formerly Sports Legacy Institute), will detail in his forthcoming book a recommendation that kids should delay playing collision sports such as football, hockey and lacrosse (or that the rules be changed to reduce or eliminate head contact, such as flag, not tackle, football and no body-checking in hockey), to reduce the risk of developing chronic traumatic encephalopathy  (CTE), a degenerative neurological disease which leads over time to personality changes, memory loss, even dementia.  Early signs of CTE in the brains of 17- and 18-year olds, says Dr. Cantu, have been detected in the brains of kids who showed no symptoms when they were alive.

"The young brains are more vulnerable, they're less myelinated (the protective sheath - myelin - that develops around neurons), the necks are weaker, the heads are bigger proportionately so the forces that accelerate the brain need not be as high to produce higher acceleration," Cantu told Boston's WCVB-TV.

It's not just concussions that worries Dr. Cantu, its the accumulation of sub-concussive blows: "In fact, we've had a number [of brains] in our center who have had no recognized concussions at all, so its total brain trauma."

"We have millions of youngsters putting their heads into collision sports right now and we don't really know how safe this is for them," Cantu said.

Hopefully, the recommendation from Dr. Cantu will carry the necessary weight to have some real impact (pardon the pun) on the youth sports community.  MomsTeam and I have long advocated in favor of a delayed start to playing collision sports.  As early as 2006, when my book, Home Team Advantage, was published, I was trumpeting the recommendation of the American Academy of Pediatrics that children wait until middle school to play collision sports like football, and was writing about studies that, even then, showed that a "history of concussions and probably sub-concussive contacts to the head may also be risk factors for late-life memory impairment and mild cognitive impairment."

Tough choice for parents

So what is a parent of a young athlete who has been playing football since he was seven, or who is considering signing up their child for Pee Wee hockey for their child to do? 

Take Dr. Cantu's advice seriously. Seriously consider whether allowing your child to play collision sports at an early age is hazardous to their long-term health. Weigh the rewards and benefits of participation in collision sports against the now undeniable risks.

One thing that Dr. Cantu's recommendation makes clear is the need for better training of youth athletes, a view shared by  Rosemarie Scolaro Moser, Ph.D., sports neuropsychologist, founder of the Sports Concussion Center of New Jersey, and a MomsTeam expert. 

"A big consideration in all high risk sports is that at whatever age the youth transitions to contact or collision, whether 12, 14, 16, or 18 years of age, youth athletes will need to be trained to engage in safe, proper contact," Moser says . "Otherwise, lack of a proper program of training safe contact skill development will essentially defeat the purpose of setting an age designation.

That means we will need educated coaches to teach safe and proper skill contact development in practices, so that when the youth athlete transitions to game contact, he or she will be ready, at any age. We know that kids' brains are vulnerable, that youth concussion is a public health problem, and that the effects of concussion can be devastating. We also know that sports can play an important role in a child's overall development as a person. The question is, Can we provide the resources and support necessary to make all youth sports safer, whether the sport is considered a collision, contact, or noncontact sport?" 

The need for better training of youth and high school football players in proper tackling is a subject I also have been writing about for years. A recent NATA study shows that high school players are at greater risk for concussive events in part because they haven't learned proper tackling techniques. MomsTeam has consistently promoted the efforts of coaches like Bobby Hosea to teach players to use what he calls "Dip n' Rip" (a tackling technique in which a football defender stops the ball carrier with an upward thrust across the chest and shoulders, not by leading with his helmet).

Proper tackling technique needs to be taught at every level, from Pop Warner to high school. At least one concussion expert thinks it might eliminate up to half of football concussions at the youth and high school levels.  Because the risk of concussion triples among younger hockey players in leagues where body checking is allowed, USA Hockey recently banned the practice at the Pee Wee level.  Teaching how to absorb body contact in hockey is also something that expert groups, like the American Academy of Pediatrics, recommend as a way to reduce the risk of brain injury.

What I wrote in that same blog post almost two years ago is worth repeating today:  "Recent news stories have recounted how parents of football players have been torn about whether they should let their kids continue playing and describe the prospect of long-term injury if they keep playing as 'kind of scary.' Some report having decided not to let their kids play football based on the new evidence."

Again, this is something I faced ten years ago. As I  wrote in my book Home Team Advantage and have recounted often on this site, "I ultimately decided to end my son Spencer's football career after his sophomore year in high school because to continue playing, given his history of concussions and learning disabilities, posed, in my view, an unacceptable risk of long-term injury. And this was long before studies began coming out showing just how potentially dangerous football was to a player's long-term mental health."

But as I said then, and say again now, "I am not now and have never suggested that parents simply refuse to let their children play football. But parents do need to make the decision based on complete information; information which they still do not have." (but is rapidly becoming available, as researchers in Boston, at Purdue University, the University of North Carolina and Virginia Tech, find out more and more about the link between sub-concussive blows and short- and long-term brain injury)