Despite good intentions, laws aimed at preventing concussions and promoting concussion awareness in youth sports are not making young athletes any safer.
Two new studies published in the American Journal of Sports Medicine paint a grim picture of the impact of concussion prevent laws.
The first study surveyed 270 coaches from a random sample of public high school football, girls’ soccer, and boys’ soccer in Washington State. Nearly all answered concussion knowledge questions correctly and the majority said they felt very comfortable deciding whether an athlete needed further concussion evaluation.
However, among the 778 athletes surveyed in a second study, 40 percent reported that their coach was not aware of their concussion, and 69 percent of the athletes reported they played with concussion symptoms. Even worse, only 33 percent of athletes who had experienced symptoms consistent with concussions reported receiving a concussion diagnosis.
Washington’s law is named for Zackery Lystedt who suffered a brain injury in 2006 following his return to a middle school football game after sustaining a concussion. He and his family, along with medical personnel, lobbied the state extensively for a law to protect young athletes in all sports from returning to play too soon.
Now that Mississippi passed a youth concussion law in January, all 50 U.S. states have a law aimed at preventing youth brain injuries in sports. But are they working?
The Lystedt law, which is essentially the law followed in every other state, outlines three core elements to prevent secondary concussions: (1) annual education for athletes and parents; (2) mandatory removal from play for athletes suspected of having concussions; and (3) clearance by a designated health professional before a concussed athlete can return to play.
Washington passed the Lystedt Law in 2009 to honor Zackery Lystedt (above). The law prohibits athletes under the age of 18 who are suspected of having a concussion from returning to a practice or a game until cleared by a medical professional.
The law’s efficacy, however, is falling short of projections.
“Six years after the passage of the nation’s first concussion law, educating coaches about concussions does not appear to be strongly associated with the coaches’ awareness of concussions. Too many athletes are still playing with concussion symptoms,” explained the studies’ principal investigator Frederick Rivara, MD, MPH, professor and vice chair of the Department of Pediatrics, and division chief for General Pediatrics at the University of Washington.
The studies also identify a crucial gap in knowledge for parents and athletes. Under the law, parents and athletes are required to sign a form alerting them to the dangers of concussions. The majority of coaches reported that they provided athletes with at least some instruction on concussions, including reading materials, videos or websites, but nearly one-third reported not providing athletes with any additional information.
For parents, the education they received from coaches was even less: Nearly 60 percent of coaches reported not providing parents with any additional concussion education, other than asking them to sign the legally required form.
“The Lystedt law was designed to improve identification of athletes with concussion and thus prevent athletes from continuing to play with concussive symptoms, risking further injury. Perhaps someday we can design laws that prevent concussion, but this would likely require different methodology, such as rule changes,” explained study author Sara P. Chrisman, MD, MPH, acting assistant professor in the Department of Anesthesiology and Pain Medicine Department of Adolescent Medicine Seattle Children’s Hospital.
Although concussion prevention laws are a step in the right direction, it appears that there is a long way to go for the law to catch up with the realities that athletes and coaches deal with on the sidelines.
To stay up to date on the latest concussion prevention laws, check out the Law Atlas Youth Sports Traumatic Brain Injury map analyzing each state’s laws.