It's the season of hard knocks and hard-nosed tackling, stingers and dingers.
Except this fall, more than ever, the term "dinger" or "bell-ringer" is more likely to be called what it really is: a brain injury.
The thinking on brain trauma clearly is changing, not only in football but all youth sports. Increasingly, ankle-biter leagues are hiring athletic trainers, high school policies mandate medical clearance before a head-injured player can return to the field, and professional leagues are adopting tougher standards for helmets and the care of the heads inside them.
Still, it's not entirely clear how comprehensive the new policies are, or just which athletes most need protection.
The level of response has been uneven. According to the advocacy group Sportsconcussions.org., 28 states and the District of Columbia have adopted laws to protect youth athletes from concussions in the past several years, and 10 more have legislation pending, most requiring medical evaluation and clearance by a medical professional before returning to play. A dozen have nothing on the books.
Some experts worry that regulations do little good if athletic trainers or other qualified medical specialists aren't near the sidelines. Only about a third of high schools around the country have full coverage by certified athletic trainers. (See Scripps Howard News Service's report on athletic trainers at http://scrippsnews.com/projects/athletic-trainers/most-high-schools-spor... .)
Many of the laws address only scholastic sports, leaving the safety of younger and older athletes to their respective leagues or associations. In some states, legislatures have deliberately left setting treatment and return-to-play standards to leagues or high school associations.
The voluntary efforts mostly focus on more education and awareness of concussions and their short and long-term consequences. Some leagues have added baseline mental-capacity testing before each season, others have changed rules to reduce head knocks, or improved helmets and other equipment. Some youth football leagues have dropped tackling in favor of flags for kids younger than middle school or even high school age, but more than 3 million kids under age 14 still play tackle.
Estimates on the scale of the problem vary. The federal Agency for Healthcare Research and Quality reported that some 39,000 school-age children were treated for sports-related concussions at about 100 sentinel hospital emergency rooms during 2008 -- approximately 90 percent all ER visits for the condition.
Fifty-eight percent of those concussion visits came from kids 14 to 18 years old, 17 percent were ages 11 to 13, and 7 percent were ages 6 to 10.
Other experts calculate that the total number of concussions among young athletes under the age of 24 is about 300,000 a year, half occurring among high school competitors. The Brain Injury Association of America estimates there may be as many as 1.6 million to 3.8 million sports and recreation-related concussions among all Americans each year.
Researchers say it's become clear that the younger -- and less fully developed -- a brain is, the greater the risk that trauma can result in long-term learning or mental disabilities. And it almost always takes younger players longer to recover from head blows than an adult.
"Most adults will be completely clear of symptoms within a few weeks, unlike a young athlete," said Tom Martin, a clinical associate professor of neuropsychology at the University of Missouri. "So when you return a youth to play quickly, they are probably not fully recovered."
While most professional groups now agree that a baseline analysis of brain function is the best way to assess damage, there are disagreements about which tests to use and who should administer them. One recent study in Arizona high schools found girls scored higher than boys on a standard concussion assessment tool, but there were also many individual differences within each gender group.
Other researchers are studying specific concussion risks within sports. For instance, one recent study led by bone specialists at Brown University tracked head blows among football players at three colleges for three seasons using helmets fitted with sensors.
They found that running backs and quarterbacks tend to take the hardest hits, since they and opponents are often moving at top speed and from opposite directions, while linebackers and offensive and defensive linemen -- who make contact on every play -- took hits to the head more often, but with less force. The researchers said among the possible outcomes from their work is that helmet shape or padding might be revised to best protect players at various positions.
(Contact Lee Bowman at BowmanL@shns.com.)
(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)