Heads Up

Local coaches and sports physicians up their game to prevent concussions and other injuries to young athletes

 

Manhattan Beach resident John Shapiro’s passion for football comes from deep roots as a player, coach and father. Yet recent circumstances have altered his view on the sport.

The Brown University graduate played wide receiver for the Oakland Raiders and Miami Dolphins in the late 1980s.

He coached extensively in the Redondo Beach Youth Football and Cheer program and continues to mentor local prep quarterbacks and wide receivers. Many of his players went on to become all-league players in high school and Shapiro said that he never had a serious injury to one of his players while coaching.

But when Shapiro’s second of three sons suffered head injuries, his concern regarding concussions grew.

CJ is a talented wide receiver on the gridiron and was ready to play varsity ball as a sophomore tlast fall. But an early-season concussion derailed his plans, keeping him out the entire season. He had suffered two during his freshman year.

“All three sons love football and fortunately they have another sport to fall back on,” John said. “We may let CJ play in his senior year. It wasn’t until CJ suffered the concussions that I realized I didn’t know as much about the injury as I thought I did.”

Shapiro’s oldest son Jake is a 2014 graduate of Mira Costa High School. The undersized linebacker was named to the all-Bay League team and was a league-champion wrestler in the 152-pound weight class.

Younger sons CJ and Adam are also two-sport athletes and played football in RBYF&C. In the spring season, CJ plays baseball and Adam plays lacrosse.

Shapiro said Mira Costa’s coaches and trainer Tim Cooper do a good job of keeping parents informed of injuries and are doing their utmost to reduce the risk of concussions. Athletes are given a baseline test at the beginning of the season and head football coach Don Morrow is using rugby-style tackling methods much like Pete Carroll has instilled with the Seattle Seahawks.

“Everyone’s trying to do the best they can,” said Shapiro, who is taking CJ to a concussion specialist in Seal Beach. “The truth of the matter is that kids are getting bigger, stronger and faster and once a person has a concussion, he or she is more susceptible to have another. My advice to parents is that if your child has a concussion, go see a specialist. Family doctors and many in the sports medicine field can easily misdiagnose or mistreat the injury, allowing the athlete to return to playing too soon.”

With childhood obesity a continuing problem in the United States, the decline of participation in organized youth sports is becoming a major concern not only among local leagues, but also in the medical profession.

Much of the decline is attributed to parent’s fears of their kids being injured – mainly from concussions. An ESPN poll stated “More than 87 percent of parents worry about the risk of injury, with concussion cited as the injury of most concern. A quarter of all parents have considered keeping their children from playing a sport because of fears about head injuries.”

In a Jan. 31 2014 article in the Wall Street Journal, William W. Dexter, a Maine physician who is president of the American College of Sports Medicine, noted that the decline in youths participating in sports could have long-lasting effects.

“It is much more likely,” Dexter said, “that someone who is active in their childhood is going to remain active into their adulthood.”

The article included statistics from data taken from 2008 to 2012. It showed participation in the four most-popular team sports (baseball, basketball, football and soccer) among boys and girls aged 6 through 17 dropped by about 4 percent while, according to the U.S. Census, the population in the age group fell only 0.6 percent.

A survey by the Sports and Fitness Industry Association and the Physical Activity Council, a nonprofit research agency funded by seven trade groups, found that the percentage of inactive 6- to 12-year-olds — youths involved in no physical activities over a 12-month period — rose to near 20 percent in 2012 from 16 percent in 2007, and inactive 13- to 17-year-olds rose from 17 to 19 percent.

Despite the highly-publicized issue of concussions, two contact sports showed an increase in participation with lacrosse growing by 158 percent and hockey up 64 percent among 6- to 18-year olds.

Dr. Glenn Huber, MD is a partner at Torrance Ortho and Sports Med Group and the sideline physician at Mira Costa. He said stated that out of 20 million children and adolescents taking part in recreational or competitive sports, 20 percent will sustain injury. One in four of these injuries will be considered serious.

“Basketball, followed by bicycling and football account for the highest numbers of injuries, Huber said. “The severity of injury increases with age. During puberty, boys suffer more injuries than girls. Increased body weight and overall strength and force involved in the sport are reasons for the severity in injuries. Girls are at higher risk of roller-skating and gymnastics injuries. Once they achieve puberty, girls are more likely to sustain knee injuries such as ACL tears. Of course we are seeing an increase in injuries, some severe, in the alternative X-game sports such as skateboarding and freestyle BMX. The more complicated tricks and general lack of safety gear besides helmets has led to this increase.”

Huber believes the rate of concussions is likely the same as in the past, but the identification and diagnosis of the injury has improved leading to apparently higher rates of detection.

“When I played high school football, getting ‘your bell rung’ wasn’t even considered a formal concussion,” Huber said. “Now our knowledge of the subject has led to the inclusion of the more mild forms of this neurological injury. Getting a head ‘ding’ or suffering dizziness are now considered Grade 1 concussions and are taken more seriously. Suffering acute loss of consciousness or a Grade 3 concussion is just on the end of the spectrum of severity.”

The Centers for Disease Control and Prevention offers a free online concussion training course available at cdc.gov/concussion/headsup.

Steve Nuccion, M.D. is an orthopaedic surgeon specializing in sports medicine and a staff member at South Bay Orthopaedic Specialist Medical Center, which recently opened a new office at 705 Pier Ave. in Hermosa Beach. He serves as the team physician for Peninsula High School.

“Concussions are certainly a hot topic,” Nuccion said. “Much research has gone into understanding the mechanisms that generate a concussion, the symptoms of a concussion and the treatment of concussions.  As a result of the heightened awareness of concussions among coaches, trainers, physicians and parents, concussions are being diagnosed much more frequently. Whether or not the true incidence has increased is hard to say, but it is unlikely they are occurring more frequently and more likely that we are detecting them better.”

The sporting goods industry is constantly improving equipment to improve the safety of athletes. Riddell is the leading manufacturer of football helmets, Rawlings’ batting helmets the tops in baseball and Cascade the leading choice for lacrosse head gear.

Yet Nuccion feels research and public knowledge is playing a larger role.

“Of all the advancements made related to concussions, it seems that the better recognition of a concussion has been the best improvement,” Nuccion said. “Once a player has one concussion, they are a risk for future concussions. Returning to their sport too soon increases that risk. Better detection methods and more stringent return to play standards hopefully will lessen the long term effects of concussions.”

Impact on the gridiron

The safety of young athletes has been a focus in football more than any other sport, fueled by numerous lawsuits filed against the National Football League.

In May 2014, Assemblyman Ken Cooley’s AB 2127 was introduced by the California State Assembly. AB 2127 seeks to reduce brain injuries and concussions among California’s middle and high school football players by limiting “full-contact” practice time and by ensuring student-athletes who have suffered a brain injury do not return to the playing field too soon.

AB 2127 prohibits full-contact football practices in the off-season and limits the amount of full-contact practice teams may hold during the pre-season and regular season to two per week, not exceeding 90 minutes in any single day. It also institutes a supervised return-to-play protocol for athletes who have suffered a concussion or brain injury.

If signed into law, the bill would make California one of several states to take preventative measures to limit concussions in middle school and high school football. Texas, long-known as a center of high school football, allows only 90 minutes of full-contact practice per week during the regular season.

The California Interscholastic Federation (CIF), which oversees high school athletics in California, supports AB 2127.

On July 1 2014 CIF Bylaw 506 (Practice Allowance Rule) went into effect.

CIF Southern Section Commisioner Rib Wigod released the following statement:

“The discussion on the health and safety of student-athletes is not only a topic we addressed this past year, but is also being examined by our legislators in Sacramento. We believe that our new bylaw regarding practice time limitations is a positive step forward in this situation, but there is more to examine in the time ahead.”

The new bylaw restricts football teams to no more than 18 hours of practice time per week and no more than four hours in any single day.

Double-day practices may not be held on consecutive days and they must include a minimum of three hours of rest between practices.

Any competition day would count as three hours toward the allowable weekly and daily hours, no matter the length of the contest(s).

On May 7, 2010 the State CIF Federated Council passed Bylaw 313. It requires a signed medical release before a student-athlete who is suspected of having sustained a concussion can return to play.

The Redondo Beach Youth Football & Cheer (RBYF&C) is a member of Pop Warner, which took the lead in youth sports by creating its own Medical Advisory Board.

The Board was created to ensure Pop Warner remains proactive on medical issues that affect youth sports, with the primary focus on prevention and proper identification and treatment of concussions, hydration awareness, proper nutrition guidelines and general health and safety.

Pop Warner is a partner with USA Football and its Heads Up Football program where coaches and league administrators are taught how to fit equipment, understand concussion awareness and teach tackling with players keeping their heads and eyes up.

In 2012, Pop Warner became the first youth football organization to officially limit contact during practices. The new rules eliminated full speed head-on blocking or tackling drills in which the players line up more than three yards apart.

The amount of contact at each practice was reduced to a maximum of 1/3 of practice time (either 40 minutes total of each practice or 1/3 of total weekly practice time). In this context, “contact” means any drill or scrimmage in which drills; down line vs. down line full-speed drills; and scrimmages.

Pop Warner’s age-weight schematic also helps protect younger, lighter players..

“As the sideline physician for Mira Costa, I cannot see every hit on all parts of the field for the whole game,” Huber said. “Now the global approach has included recognition by referees, coaches and trainers alike to identify the symptomatic player and pull him or her from the game before a repetitive injury can occur.”

Mira Costa is using pre-season questionnaires and computer software programs to create a baseline database for each player. After a head injury, findings on these tests are compared to the player’s baseline profile. This info, combined with physical exam findings, determines when the player is ready for return to play.

“We have improved the approach to treating the concussions by acknowledging that this is a brain bruise or contusion,” Huber explained. “Just as a severe muscle contusion requires rest and avoidance of strenuous activities, a player with post-concussive symptoms is instructed to rest the brain and allow it to heal. No bright lights, no video games, no TV, no reading and avoidance of strenuous exercise are paramount to allow a young brain to recover.”

Preventive measures

In 1929, John Tate Riddell founded a company that developed the first removable football cleat to improve footing in wet weather football games. Today, engineers and designers help Riddell remain on the cutting edge of safety-oriented equipment.

It’s helmets receive a 5-STAR rating from Virginia Tech’s Helmet Ratings study and its impact sensor technology monitors and records impacts during play. Its shoulder pads give responders easier access to players in emergencies.

In August, Riddell introduced the SpeedFlex, a helmet that reduces impact force by adding flexibility to key helmet components and boasts improved sightlines and a new ratchet-style chinstrap.

As team physician at Peninsula High School, Steven Nuccion has seen more than his share of injuries.

“All youth sports place developing athletes at risk for injuries,” Nuccion said. “Most injuries are minor, such as sprains or strains. Many are associated with year round participation and are more overuse in nature. In general, the more significant injuries, such as ACL tears, are seen in soccer for girls and football for boys.

“The best way to prevent serious injury related to youth sports is pre-participation conditioning. Younger players have developing bodies that often have muscloskeletal imbalances that predispose them to injury. For sports that rely on running, a program of stretching and strengthening the core muscles and the leg muscles has been shown to decrease injuries such as ACL tears. For throwing sports, exercises that strengthening the shoulder girdle help to stabilize the shoulder and minimize shoulder injury. Many young athletes are now playing their chosen sport year round. It is important to build up activity gradually and make sure a period of recovery is built into the season to avoid overuse injuries.”

Huber said that there is a growing concern in sports medicine circles about overuse injuries due to single sport concentration year round.

“There is an alarming rise in ‘Tommy John’ ligament tears in young baseball pitchers who are frequently ‘showcased’ at tournaments on their travel teams,” Huber said. “I tell parents that even the pros take at least a three-month hiatus from their sport during the off-season. The more repetitive strain you place on the elbow, or any other body part for that matter, the more likely injury may occur.

“For the young athlete, recommendations for successful, injury free participation involve plyometrics, core strengthening, multi-sport participation and supervised strength training. A general rule of thumb for younger athletes is to have them only exercise with weights they can lift six times or more. Do not have them train with maximal or near-maximal loads. This may reduce the risk of repetitive use injuries and growth plate injuries.”

The popularity of lacrosse on the west coast has made it arguably the fastest growing sport in the United States. In a few short years, Mira Costa and Redondo have built strong programs that are getting closer to competing on the same level as the longer-existing programs in Orange County.

With the increase of participants comes a higher percentage of injuries, which local coaches are well aware of.

“The past two years specifically there has been a lot of attention directed at concussions,” Mira Costa boys lacrosse coach Aaron Karsh said. “This is very important because it’s not that more are occurring, it’s that we as coaches, parents, and players are now more aware of the injury and its long term effects.

“Overall injuries are on the rise, players are playing more and more, and thus with more time on the field they are prone to more contact, their bodies go through more stress, etc. We encourage players to play multiple sports, which allows for some variety in their exercises and competition  and produces a more well-rounded athlete.”

Karsh noted that new rules have been adopted to deter players from “game changer” hits such as blind side hits that often lead to injury. He also stressed the importance of proper equipment.

“Lacrosse helmets have come a long way in the past three years,” Karsh said. “One big factor that many people overlook is the mouth guard. This can often be the best way to improve protection for a player. Investing in a better mouth guard can often be a difference maker when a player suffers a big hit, and when they deliver one too.”

Tom Borgia was named the 2014 Bay League girls lacrosse Coach of the Year after leading Redondo’s girls lacrosse team to its sixth straight league title.

“I should be an expert after all of the injuries we had this year,” Borgia said. “I know all coaches in every sport go through a concussion training class. The week after I did the training, two of my girls got concussions.”

Along with the two concussions, his players suffered a broken finger, a dislocated finger, shoulder separation, shin splints and a slight fracture of a leg.

“I have had three players get ACL surgery in my last three years and none because of contact with a player,” Borgia said. “I love turf fields but I am not sure how safe they really are.”

Prior to the 2014 lacrosse season, which is held in the spring, a new, softer ball that featured the same weight and bounce was introduced for both boys and girls competition.

Borgia noted that the ball is more of an issue with boys lacrosse, where a shot can travel 90 mph into a crowd of players. In the girls game, a player can not shoot if any player is in the lane of the shot to the goal.

“We had a few rule changes this year that, in my opinion, make it safer in girls lacrosse,” Borgia said. “The major change was number of players spread around the circle during a draw. While two center midfielders are doing the draw, the number of players from each team around the circle has been reduced from four to two. The old rule would result in 10 players swinging in the air or maybe scooping on the ground for the bouncing ball. Now the new rule means that only six total players are entering that scrum for possession so it is much safer.

“Another new rule involved illegal contact with your stick in the horizontal position. Even if you are not pushing the stick into a player, and even though a player runs into your stick that is in a horizontal position, the foul is on you. It is a way to free up space for cutting. There is a lot less holding of girls cutting to the goal now so the players should move freely and safely with less contact.”

In soccer there is talk about eliminating headers – particularly among kids below the high school level – where players direct the ball using their heads.

Mira Costa boys soccer coach Gary Smith disagrees.

“The thought of soccer being played without heading the ball is ridiculous,” Smith said. “Players who use the forehead, which is the proper technique, rarely suffer from a concussion. A concussion in soccer is usually from accidental head to head contact or hitting one’s head on the ground.

“At Mira Costa, the trainer and the coaches have been educated on the protocol when a possible concussion is an issue. The athletes are given a diagnostic test, which can be used as a baseline to compare to that same test given after a concussion is suspected.

“I’ve seen many soccer injuries over the years, but it is usually an ankle or knee injury. The soccer ball is rarely the cause. Playing on artificial turf is my concern when it comes to injuries. The players take much more of a pounding than they do on natural grass.”

Even though they are not considered contact sports, baseball and softball deal with their own issues of safety. Redondo softball coach Jennifer Dessert said the decision to have cages put on batting helmets approximately 10 years ago was the last major change in safety for softball players.

“The CIF and our Umpire Association are very good at updating bats for the girls each year,” Desser said. “In addition, RUHS along with the CIF have increased initial coaching training to include concussion training certification. This alone has created an elevated awareness of the harsh effects of concussions – something all parents and coaches should be trained to recognize and properly care for in their athletes.

“However, I feel some things should still be a personal issue, but I recommend them. For example, I feel that in some instances corner athletes and pitchers should wear face masks. The speed of the ball off the bat is a whole lot faster than it used to be with the high tech bats that are made these days. Improvements in the comfort and visibility of those masks are much better than when they were when first becoming popular.”

Dessert also stressed the importance of wearing basic knee pads. The repetitive action of sliding, diving on defense and collisions can produce scar tissue that can build up over the years from continued trauma and bruises, which increases the chances of serious injury.

“We have steadily increased our strength training each year to reduce injury,” Dessert added. “Our off-season and in-season sport specific strength training and conditioning have definitely reduced the number of throwing arm injuries. The results have proven to be very beneficial — not just in preventing injury but in all aspects of their performance as well.”

Redondo’s baseball team had an improbable run late in the 2014 season, propelling the Sea Hawks to a second-place finish in the Bay League. Coach Jeff Baumback led his squad on an eight-game winning streak before losing to eventual champion Bishop Amat 3 – 1 in the CIF-SS Division 3 semifinals.

Baumback believes his training methods played a key role in Redondo’s success.

“I feel many coaches grind the players all season and often times practice longer and more frequently towards the end of the season,” Baumback said. “As Bay League play wound down and the playoffs approached, we took several Mondays off. Making sure the boys had that extra day of rest was important. I believe it played a factor in our late season success. We had little to no injuries this year, players weren’t fatigued and we looked our strongest at the end of the season. Overuse and fatigue are huge factors in the cause of injuries, so I take advantage of resting players throughout the year when the schedule permits.”

Baumback noted the importance of maintaining the facilities, including keeping the playing surface well groomed, the use of top quality equipment such as protective screens, and issuing new personal batting helmets each season.

“The batting helmets are much better that they used to be. They fit better and are much stronger,” Baumback added. “Also, the catcher’s gear is much better, it’s lighter but the coverage is better. The hockey style masks also now have small shock absorbers built into the mask, which helps prevent concussion-like symptoms from taking fouls tips off the mask.”

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