If you could prevent shoulder and elbow injuries in baseball pitchers by making one simple change, would you? Hopefully, if you’re the parent or coach of a young pitcher, your answer is yes.
Through years of research, we generally know the risk of shoulder and elbow injuries increases dramatically when kids pitch too much — too many pitches and innings without enough rest. That research led to the adoption of pitch counts.
Could a similar injury prevention strategy work in youth football? Instead of pitch counts to protect young arms, consider hit counts to protect kids’ brains.
While tremendous attention has focused on the consequences of concussions in football, there’s growing concern about the long-term effects of repetitive subconcussive blows. These are not the tackles that cause loss of consciousness and memory loss. These are the smaller impacts the brain absorbs over and over during practices and games.
Hit counts, or limits to the number of blows above a certain threshold that a football player could absorb during a week or a season, would be adopted to decrease the potential risk from those blows. A study recently published in the American Journal of Sports Medicine shows just how common those repetitive blows are in high school football.
Researchers at the University of Michigan used sensors to record impacts above a certain acceleration threshold. They found that the average high school football player suffers an average of 774 head impacts over the course of the season, or about 50 significant hits per week. Linemen took the most hits, followed by tight ends, running backs and linebackers.
Assuming that we wanted to move forward implementing hit counts, what would the threshold number of these hits then need to be? We don’t know a baseline number above which we can confidently say that the risk of brain damage increases. If we did, would we need to adjust that hit limit for different ages or different positions? Just as experts disagree on the best way to protect throwing arms — pitch counts by game, week or season or innings limits per year — similar issues mount with football hits.
Logistically, monitoring a player’s hit counts would seem to be challenging. Any parent or coach can easily count the number of pitches a kid throws. On the other hand, recognizing the impact of every block and tackle is not possible through casual observation.
Installing sensors into helmets could capture this impact data. The time spent by coaches or athletic trainers compiling the data and determining which players must sit or avoid contact could be overly burdensome, though. Plus the cost of sensors for all players could be prohibitive for most high school and youth teams.
Another solution could be to make one or more practices each week completely noncontact sessions. The authors of the repetitive impact study estimate that limiting contact to just one football practice per week would decrease the number of head impacts by 17.8 percent. Completely eliminating contact in practices would reduce head impacts among all players by 38.9 percent.
It is difficult to predict the actual health effects of hit count limits. Critics might suggest that noncontact practices could cause players to use poor tackling techniques in games. Theoretically, the number of catastrophic head and neck injuries could actually increase. Plus the neurocognitive changes from repetitive subconcussive blows would not become evident for years, making it almost impossible to prove that hit counts do work.
The Institute of Medicine and National Research Council recently published a report on sports-related concussions in youth athletes. This NFL-funded study received attention mainly for showing that high school football players are almost twice as likely to suffer concussions as college players. However the committee did review the evidence concerning repetitive subconcussive blows among young football players.
The report cited some imaging studies that do show changes in brain tissue with repetitive impact. The study concluded that while some research does show functional neurologic impairment with repetitive blows, other studies do not.
The committee also addressed the concept of hit counts and labeled it “fundamentally sound.” Without more scientific data, though, it could not advocate a limit to the number of hits above a particular threshold in a given week or season.
Without question, we need much more data on these repetitive head impacts in order to prevent their potential damage. We need to learn more about their cumulative toll on behavior, emotional and cognitive function. We need more studies examining the brain tissue of former football players. And we need to actually see football leagues adopt hit counts to monitor their results.
The need for more research into repetitive hits does not mean that we should dismiss the idea outright. As more parents question whether their kids should play football at all, expect much more research — and consideration — of hit counts in youth football in the coming months and years.
Dr. David Geier is an orthopaedic surgeon and sports medicine specialist in Charleston. For more information about concussions and other sports medicine topics, go to his blog at drdavidgeier.com.
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