Connecting on Concussion: Why Agency Advocacy Is Important

September 1, 2016, Department, by Lisa Paradis

By providing a steady diet of concussion information, education and advocacy, park and recreation agencies can help create healthier, smarter youth sports generations for years to come.Telling people about the importance of concussion education is like telling people about the benefits of eating kale. No matter how passionately you outline the value, sometimes it’s just not something they’re willing to swallow. Just like with kale, mainstream media consistently reports compelling stories and new research about sports concussion so that the information continues to have a frontline presence in news channels, providing hope that after enough exposure, people will eventually come around.

Although once regarded as simply “getting your bell rung,” the perception of the potential seriousness of concussion has changed to reflect the research. During the past several years there has been an abundance of information pointing to evidence that not only should youth sports concussions be taken seriously, but that exposing parents, coaches and athletes to information about concussion symptoms greatly diminishes the potential for long-term side effects post-concussion.

Having a Return-to-Play Protocol

One of the most critical elements of good concussion management practices is educating the parent, coach and athlete about when to be removed from play. “When in doubt, sit them out” is the basic rule of thumb every agency’s program leadership should be communicating to the general public. A responsible adult in charge should be making the often-contentious decision to remove an athlete from play if concussion is suspected, regardless of the athlete’s (or oftentimes, parent’s) protests.  

However, it can be difficult to manage an injury that is invisible. The National Institute of Health reports that, when properly managed, a “majority of people who sustain a sport-related concussion recover within a 7-10-day period.” But, since every individual has a different recovery time, it can be hard to know when a young athlete is ready to get back to play. In the past, parents, coaches and the concussed athlete would make an arbitrary decision about return to play, sometimes actually prolonging the athlete’s recovery time or increasing the chances of side effects from the injury. Having a return-to-play protocol in place puts the clearance for back to play squarely on the shoulders of a healthcare professional, reducing agency liability and providing the parent, coach and the athlete with a navigational tool for safely returning to play.  

Many agencies have taken on the challenge and developed comprehensive return-to-play protocols and concussion management policies in their communities, and some have even leveraged “the power of the permit” to mandate training as a requirement for facility use. But, even though parks and recreation has made strides in its role in educating the public, more can be done to ensure players are safe. 

Reducing Contact

A January 2015 study by the Boston University School of Medicine pointed to possible increased risk of cognitive impairment from playing youth football. “Sports offer huge benefits to kids, as far as work ethic, leadership and fitness, and we think kids should participate,” says study lead author Julie Stamm, a Ph.D. candidate in anatomy and neurobiology. “But, there’s increasing evidence that children respond differently to head trauma than adults. Kids who are hitting their heads over and over during this important time of brain development may have consequences later in life.” 

Reducing contact for younger players and modification of game rules are among the many things that can be championed at the recreational level. As recently as May 4, 2016, the Democratic leaders of the House Energy and Commerce Committee sent letters  to the leaders of collegiate and youth football organizations asking how they plan to prevent and mitigate the risks of degenerative brain disorders for student-athletes: “While changes at the professional level are important, football organizations across all levels, as appropriate, should consider rules changes and educational outreach to ensure the safety of all athletes and their developing brains. Additionally, we need to ensure that parents have accurate, up-to-date information necessary to make informed decisions about their children’s participation in football and other contact sports.”

Making sure that recreational programs implement U.S. Soccer’s 2015 decision to eliminate U-10 heading and limit heading in U-11/U-13, as well as Pop Warner Football’s rule to limit contact in games and practices are simple, but meaningful modifications to youth sports. Starting kids in contact football at a later age is a controversial but poignant example of agencies setting the tone for player safety. Reports show that 70 percent of the football players in the United States are under the age of 14, and every child player ages 9-12 can be exposed to 240 head impacts during a single football season.  

Flag football, a four-letter word in many communities, promotes the game of football in a fun and safe environment, where players touch the ball many more times in one game than they generally do in a typical tackle football game. USA Football has partnered with NFL Football to promote “NFL Youth Flag Football,” and now has thousands of leagues all over the country. Played in a five-on-five format, teams of eight to 10 kids learn the fundamentals of the sport and compete with other players, all in an atmosphere of fun and little contact. And, the fears of the young flag football player never reaching NFL status seem to be little more than parental grumblings. Reports show that many current NFL players, including Eli and Peyton Manning and Tom Brady, didn’t start playing contact football until seventh and ninth grade, respectively. Both families encouraged their kids to play flag football. Retired NFL Hall of Famer Archie Manning said of watching his son Eli play flag football for many years “God that’s a great game. I wish I’d played my whole career in flag football.”

Making Education a Requirement

Chris Nowinski, co-founder and president of the Concussion Legacy Foundation, whose work has been groundbreaking in the field of concussion research, says, “Parks and recreation agencies play a critical role in providing concussion awareness and education at the grassroots level. They have an opportunity not only to provide a safe place to play, but also to expand their reach to create a safer community.”

Dr. Neal McGrath, a nationally recognized neuropsychologist and the Clinical Director and founder of Sports Concussion New England says, “Making concussion education a routine requirement for youth sports players, parents and coaches in the park and recreation setting can accomplish a great deal. Park and recreation programs have the opportunity to begin the concussion education process for younger athletes as a routine part of their sports participation. That education therefore begins at an earlier point for their parents as well.”

Millions of children play sports that are sponsored by park and recreation agencies, and while it may not be simple, educating the public is an important element of service delivery in any department. For at least the near future, youth sports will continue to have its share of people who either don’t believe concussion management is their problem or who don’t agree with the research. But, by providing a steady diet of concussion information, education and advocacy, agencies have the ability help create healthier, smarter youth sports generations for years to come.  

Note: I created and implemented a policy that mandates concussion education training for all organized youth sports groups who use Brookline facilities. My father, a former football player, donated his brain to Boston University’s Center for Traumatic Encephalopathy through the Concussion Legacy Institute after his death in 2008. Click here for a list of resources on this topic.


Lisa Paradis  is the Director of Brookline Recreation.