The Lancet, Volume 382, Issue 9904, Page 1536, 9 November 2013

Concussion in sport: fair play for young people

The Lancet
“Some people believe football is a matter of life and death…it is much, much more important than that.” Millions of sports fans and players worldwide would agree with Liverpool Football Club manager Bill Shankly.
Sport can open doors: to health and self-respect, to a college scholarship, even to wealth and fame.
But there is increasing public concern about the risks of concussions—commonly defined as “a complex pathophysiological process affecting the brain, induced by biomechanical forces”.

Sports-related concussions in youth: improving the science, changing the culture—released on Oct 30 by the US Institute of Medicine and National Research Council—focuses on concussions in young people between 5 and 21 years of age.

Incidence data are far from definitive, but the report cites estimates of between 1·6 million and 3·8 million traumatic brain injuries related to sports and leisure in the USA per year, and National Collegiate Athletic Association data suggest that sports-related concussions have increased in recent decades.
Information on the long-term health sequelae of concussions in young people is also patchy. However, the report authors highlight that the ongoing development of the brain might affect susceptibility to, and recovery from, concussion.

Concussion can result in physical, cognitive, emotional, and sleep problems: typically recovery takes 2 weeks, although persistence of symptoms for periods of up to years has been reported. Worryingly, previous concussions are associated with an increased risk of further concussions, and there is evidence that repeated concussions increase the number and severity of symptoms.

Proposed solutions include a US national surveillance system, the establishment of objective markers of diagnosis, better longitudinal data, a national review of techniques to reduce concussions, research into the biomechanical determinants of concussion risk, and large-scale efforts to change attitudes so that concussions are taken seriously, and players are given the time and treatment necessary to recover
A multidisciplinary effort on a grand scale is needed. Young athletes give generously of their time, energy, and enthusiasm to their school and college teams: safety and good health are the least they can expect in return.

G Mohan.