The Role of Sports Rules and Training in the Prevention of Sports-Related Concussions in Youth Kevin Guskiewicz, PhD, ATC Kenan Distinguished Professor Chair, Department of Exercise and Sport Science UNIVERSITY of NORTH CAROLINA at CHAPEL HILL Institute of Medicine & National Research Council Washington, D.C., February 25, 2013
Cumulative risks for youth athletes Should kids be playing contact or collision sports?
Developing Character Through Sport Character development is the practice of getting it right. Sport teaches the value of practice and personal development besides providing a pseudo-environment, allowing for correction and modification within the bounds of real life. Choices are easier through proper concentration and practice. - Kent M. Farley; US Sports Academy -The Sport Digest (2007; ISSN:1558-6448)
How to increase physical activity without increasing injury risks? Sports Management of injury risk is key to successfully promoting physical activity Injury
Rules Table 1. HS RIO, Original Sample Competition Football Injuries by Punt, Kickoff and General Play, 2005/06-2011/12 School Years. % of Competition Injuries that were Concussions Punt Kickoff General Play Year 2005/06 23.9% 21.1% 10.8% 2006/07 19.6% 43.0% 11.2% 2007/08 19.0% 31.5% 12.3% 2008/09 18.1% 34.4% 14.0% 2009/10 14.6% 39.8% 18.9% 2010/11 37.0% 61.4% 24.3% 2011/12 35.0% 48.3% 20.8% Overall 24.0% 42.4% 16.0% Courtesy of Dr. Dawn Comstock
Rules Table 2. HS RIO, Original Sample Competition Football Injuries by Punt, Kickoff and General Play, 2005/06-2011/12 School Years. % of all Concussions Punt Kickoff General Play Year* 2005/06 4.5% 7.7% 87.8% 2006/07 2.8% 21.0% 76.3% 2007/08 3.7% 12.1% 84.2% 2008/09 4.1% 15.4% 80.5% 2009/10 2.7% 11.9% 85.4% 2010/11 4.6% 19.0% 76.4% 2011/12 4.7% 17.7% 77.6% Overall 3.9% 15.6% 80.5% *Rows sum to 100% Courtesy of Dr. Dawn Comstock
Impact magnitude by play type position Play Type Closing Distance Ave Linea r Acc. lower_cl upper_cl DF Prob.t Defense >10 yards 25.36 23.14 27.79 9 <.0001 Defense <10 yards 23.47 21.99 25.05 9 <.0001 Offense >10 yards 24.66 22.48 27.04 9 <.0001 Offense <10 yards 23.94 22.59 25.36 9 <.0001 Special teams >10 yards 26.82 24.93 28.84 9 <.0001 Special teams <10 yards 20.93 18.13 24.15 9 <.0001 Ocwieja, Mihalik, Guskiewicz; ABME 2011
NFL s 2011 Kick-off Rule Change Table 2. Regular Season Game Kickoff Statistics in 2011; 3-year Comparison Result of Kickoff Total Fair Kick Out of Short Free or Opponent Total Year Touchbacks Returns Catches Bounds Onside Kicks Received Kickoffs 2008 2114 371 7 36 47 1 2576 2009 2004 401 12 30 36 1 2484 2010 2034 416 7 39 43 0 2539 2011 1375 1120 1 26 50 0 2572 Average 2008-2010 2050.7 396 8.7 35 42 0.7 2533
NFL s 2011 Kick-off Rule Change Table 3. Significant Injuries As a Function of Kickoff Plays 2011 Regular Season; 3-year Comparison Regular Season Games Year Concussions Neck/Spine Fractures ACL Sprain All Injuries 2008 (N=2576) 26 (1.0%) 12 (0.5%) 10 (0.4%) 3 (0.1%) 152 (5.9%) 2009 (N=2484) 25 (1.0%) 7 (0.3%) 6 (0.2%) 2 (0.1%) 147 (5.9%) 2010 (N=2539) 28 (1.1%) 7 (0.3%) 11 (0.4%) 8 (0.3%) 135 (5.3%) 2011 (N=2572) 15 (0.6%) 8 (0.3%) 8 (0.3%) 7 (0.3%) 136 (5.3%) Average 2008-2010 (N=2533) 26.3 (1.0%) 8.7 (0.3%) 9.0 (0.4%) 4.3 (0.2%) 144.7 (5.7%)
Injury prevention: Infractions Checking from behind Funded by: NOCSAE & USA Hockey Elbowing/head contact
MSSE, 2010 Illegal collisions (elbowing, intentional head contact, or high sticking to the head) made up 17% of all body collisions. Illegal collisions resulted in higher linear and rotational acceleration (23g; 1530 rad/s 2 ) versus legal collisions (21g; 1417 rad/s 2 ). Conclusions: Athletes and coaches should conform to rules; officials should more stringently enforce rules & assess more severe penalties to players who purposefully foul an opponent.
Safety in Ice Hockey. Second Volume, ASTM STP 1212, 1993-30% fewer penalties and 25% fewer game suspensions in Bantamlevel Fair Play teams compared to their non-program counterparts. - At the Peewee level, Fair Play teams averaged 1.3 major penalties per season compared to 6.3 major penalties for non-program teams. - 71% of Fair Play teams did not receive a single game suspension. - Interventions that reward proper behavior can minimize illegal conduct, and severe misconduct more likely to cause injury.
Training and Skill Development: Proper Contact Technique Proper Coaching Self-organization & optimization ensues in skill development as a result of interaction between: Individual Environment Skill/task Sport Culture Skill Practice On-the- Field Exposure Thelen, 2005
Why Start Young? Earlier motor skill exposure promotes future expertise (Baker, 2003) High capacity for skill acquisition ( LeGear, 2012; Gallahue, 1995) Skill exposure at a younger age promotes neuroanatomy supportive for skill expertise and injury prevention (Tenant, 2012; Amunts, 1997) Thus there is a physiological basis, not just theory for early skill exposure
Motor Skill Development & Age Neuroanatomy reorganizes over time Skill exposure at a young age improves neural plasticity or hard-wiring of a motor skill Pre-adolescence presents the optimal window for skill development and acquisition (Lubans, 2010; Gallahue, 2006) Maximal development of motor skills: exposure to both the skill and its context (environment) is necessary (Thelen, 2005) reinforced through repetition & instruction to ensure maintenance
Neuromuscular Performance Training Mature Neuromuscular Performance Potential Optimal performance is achieved when training is initiated in pre-adolescence Pre-Adolescent Training Initiated Adolescent Training Initiated No Training Initiated We see greater improvement in performance when skill exposure & training is initiated earlier in development Myer, 2011
CMAJ 2011. DOI:10.1503 /cmaj.101540
Why might some athletes be at greater risk?
Cervical Muscle Strength & Conditioning Cervical strength training programs change muscle structure and strength (Alricsson, 2004; A. F. Burnett, 2005; Seng, 2003) May not be a matter of pure strength, but cervical power (Almosino 2010; Mansell 2005) Low cervical strength is associated with increased risk of sustaining moderate to severe head impacts (Schmidt & Guskiewicz, 2013)
Injury prevention: Anticipation Funded by: NOCSAE & USA Hockey
Pediatrics, 2010 Open-ice collisions resulted in higher linear & rotational acceleration (22g; 1565 rad/s 2 ) versus collisions along the boards (21g; 1368 rad/s 2 ). Unanticipated collisions resulted in higher linear & rotational acceleration (23g; 1550 rad/s 2 ) versus anticipated collisions (21g; 1414 rad/s 2 ). Conclusions: Teach youth players technical skills to heighten awareness of imminent collisions & mitigate the severity of head impacts in hockey.
Am J Sports Med February 14, 2013
Athletes must be able to accurately: Identify static and dynamic features scan and interpret visual information alternate between looking between varying distances perform efficient eye movements respond quickly to visual stimuli Sensory Input Anticipation Cervical Muscle Activation Head Impact Severity
Level of Anticipation
Safer Football, Taught From Inside the Helmet UNC athletic trainer Scott Trulock and Dr. Kevin Guskiewicz talking with Offensive Linemen Alan Pelc. By ALAN SCHWARZ Published: November 5, 2010 New York Times CHAPEL HILL, N.C. Alan Pelc has been taught how to block since his Houston boyhood, how to push and pulverize and punish oncoming defenders on the football field. This was different. He was learning how not to punish himself.
What We Think We Know: Youth athletes are safer when taught the proper techniques and fundamentals of their respective sports at the appropriate age; When coaches, parents and youth athletes are taught effective concussion recognition and response, youth players are safer; Unnecessary contact in youth sports needs to be limited for safer play;
What We Think We Know (con t): Rule enforcement of unsafe player behavior that puts the head at risk for injury must be put into action; There is no consensus by medical experts for a specific age at which kids are safer to begin playing contact sports.
What We Don t Know: Concussion thresholds and why they vary from person to person. If playing contact sports for any number of years makes someone more susceptible to CTE. If certain playing standards for youth sports are safer, but we re gaining evidence.
Where Do We Go From Here?: Increased emphasis on: Coaching education; teaching the fundamentals the right way Concussion recognition and response (parents, coaches, players) Reducing contact, but not eliminating it when it s part of the game
Where Do We Go From Here? (con t): Utilize instructional tools such as USA Football s Heads Up Tackling Identify predispositions to concussion - Track head impacts to identify high risk behaviors, enforce rules, and modify behavior to protect the head Follow the science so that recommendations can be evidence-based
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