OHSAA adopts new recommendations to minimize concussion risks

2015-07-16 16:06:23 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

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The Ohio High School Athletic Association announced this week it's adopting recent recommendations from the National Federation of State High School Associations Concussion Summit Task Force to reduce the risk of concussion and head impact exposure.

Recent studies have shown the cumulative effect of taking multiple hits to the head increases a player's risk for a concussion.

The guidelines limit full contact practices, such as restricting hitting practices to 60 minutes a week with no back-to-back sessions.

This week, I visited in studio and spoke with 1590 WAKR morning show host Ray Horner about these recommendations and the impact on teams. Also, as athletes gear up for their fall sports, we discussed proper hydration tactics to keep kids safe and healthy this season.

Below is an audio file and transcript of our discussion.



HORNER: Dr. Joe Congeni from Sports Medicine Center at Akron Children's Hospital joining us.

It was about 60 minutes ago we hooked up with Tim Stried from the OHSAA (Ohio High School Athletic Association) pertaining to national recommendations that Ohio is jumping in on pertaining to concussions and football practices, and specifically summer practices and beyond.

Joe, I know we were gonna go down this road this morning, so talk about what you've heard and these recommendations and how you see this all shaking out.

DR. CONGENI: Yeah, you're right, Ray. It's summer and beyond. It's all season long.

HORNER: Yeah.

DR. CONGENI: And ... you've probably mentioned the limit on the full contact practice? No back-to-back days; no 2 days in a row of contact practices. No more than 30 minutes of contact practice twice a week. So, 60 minutes a week at most with hitting practices and, uh, only 2 practices in the course of a week.

So, those are really the big ones. Uh, they come from the national federation. Ohio adopted 'em, sent 'em out yesterday.

Dr. Joe Congeni Dr. Joe Congeni

I spoke with several of the trainers and really what we wanted to know was how big of a change is this gonna be? First of all, hopefully everybody will abide by these rules. It's a little bit hard to, uh, keep an eye on 'em and enforce them, but hopefully everybody will abide by them.

Many of the trainers said that their coaches had already been reducing a lot anyway. They had not been doing as much hitting as in the old days. Some said it would be a big change. Some said it would be a smaller change.

But, what it all revolves around, the ultimate question here is, is there a cumulative effect to this injury of concussion? In other words ... the hit count, taking several hits in a row, puts you at risk for the one hit that leads to a concussion or is it that no, there's no difference at all and it's just one significant hit to the head, you know, the blow to the brain that causes a concussion?

And, I think what this is showing us is the research is looking like there is a cumulative effect and so it does add up over time.

... Of course it's not gonna do anything during the game, but the question is if it reduces the cumulative effect, will it reduce concussions? And, we think it will.

HORNER: Yeah, I guess that's the aspect that I was looking at. I wanted to ask you is this bang, bang, bang, bang leading to the big bang of the concussion? You're saying research says that.

DR. CONGENI: Right, right. And so, as you and I have spoken about for a lot of years, pitch counts lead to .

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Okay, so you throw, uh, 90 pitches and then you throw again 2 days later 80 pitches and then all of a sudden the arm gives out with a tear, uh, avulsion fracture of that growth plate known as Little League elbow or injury, so is it a similar kind of thing? And, the answer is yeah, we believe it is.

It's a big enough deal to make sure to protect these kids, and so most people are adopting this cumulative effect. This will really reduce the amount of hits that kids take during the week and, therefore, make them safer during the game on the weekend.

HORNER: And Joe, Tim also went on to talk about . ... He was real careful. He didn't want a lot of backlash pertaining to football coaches and athletic directors, and he said they can alternate.

You know, for example, offense contact Monday, defense contact Tuesday, which you have to be careful -- and you know this -- that a lot of these high school kids play offense and defense, so that's where it kinda gets muddy.

DR. CONGENI: They do. It does. The deal is that it depends on, like, the level that you're at. As you know as we're down in the level 5 and 6 and 7, kids have to be going both ways. We just don't have enough players. And when you're up in the big D-1s and stuff, there's a lot more specialization.

But, yeah, I don't want to get away from the spirit of what the recommendations are. ... That would make it really hard to know when you have people going both ways. We really have to try to limit these contact practices.

I think coaches can get creative with this. I think a lot have already been doing this, like I said. I've seen a change in the last 5 years, and now the rules just go along with the changes the coaches have made.

They can get creative during the week. They can do a lot more speed of the game kind of thing, but reducing the amount of contact practices is an important step.

HORNER: I hear what you're saying, too, about the lead-in into the concussion. What does research say pertaining to summer drills when these guys are 2 times a day, offense, defense, constantly hitting, compared to game activity? Because from my end, I often hear about the concussions on game night.

DR. CONGENI: Yeah.

HORNER: Uh, Joey or Sammy or Charlie all got the concussion on Friday night. We don't hear a whole lot about the concussions during practice.

DR. CONGENI: Well, 2 parts of the research, and you know, 5 or 10 years ago we couldn't say this before the research.

* No. 1: That's what you hear about, but the fact is there are still a lot of concussions that take place during practice.

* And, No. 2 is with the helmets, uh, that came out a few years ago where you can actually look at the blows to the head -- the hit count, so to speak. I think we have been able to, uh, track a pattern that shows there is a cumulative effect. And, the kid that's taking a lot of hits during the week is more prone to having that one hit that leads to a concussion.

I think those 2 parts of the research are really what led to these recommendations.

HORNER: One thing that I'm already seeing as these kids are getting ready for practices, whether it be college or high school or pro, I'm seeing a lot more of the enlarged helmets; those concussion-fighting helmets that almost seem like they have the additional cap on top, especially for the lineman.

I was reading just last week, more and more of these lineman are going to those type of helmets.

DR. CONGENI: Yeah, you know how it is.

HORNER: Have they been effective?

DR. CONGENI: You know how it is. We don't have enough research to say yet ... but every new helmet that we bring out there, there's maybe a slight amount of an improvement to no amount. There were a couple of studies in the last year that showed helmet wear really doesn't have a big affect at all on concussions.

HORNER: Wow.

DR. CONGENI: It has a big affect on, uh, skull fractures and brain bleeds, and that's a big deal. Those numbers though are very, very small, but the helmet-to-concussion reduction in previous iterations of new helmets that we've brought out have not shown a significant decrease.

HORNER: Wow. Dr. Joe Congeni with us, Sports Medicine Center at Akron Children's Hospital. Anything else on the concussion side and the guidelines you wanted to bring up?

DR. CONGENI: No, I mean that is big news ...

HORNER: Yeah.

DR. CONGENI: and it comes very soon. I mean, we are heading into most teams' camps in the next week or 2, right into, uh, the beginning of practice here in 2 weeks.

HORNER: Well, when we get into these "dog days of summer" the other thing I wanted to bring up to you was hydration.



You know, a lot of these kids are doing the cross-country training, not only football. And, you've got soccer and they're working hard out there, as well. Real important to stay hydrated and I thought you could go over some guidelines there, Joe.

DR. CONGENI: Yeah, they sure are. ... We've hit this pretty hard, and I think the coaches and the athletes even are a lot better educated than they were a decade ago. And, they know the kinda things to look at.

... Here we keep using that term, cumulative effect. If you're getting dehydrated a little bit each day by the end of the week you're gonna be in real trouble.

And so, making sure that you're looking at things , uh, you know, your urine's not too concentrated and yellow. Making sure that you're drinking before, during and after running. Those types of recommendations are being pretty well, and these athletes and coaches are pretty up to date on those.

HORNER: You know, the sports drinks are good. Water might be the best. I don't know, but the energy drinks are not. And, I wanted to hit that drum because seeing more and more of these young athletes .

... Rocco was just talking to me about it. He said, "Dad, what do you think about these energy drinks I see a lot of these kids drinking?"

I said, "No. A good friend of mine, Dr. Joe Congeni, said stay away from them." They're just solid caffeine. Talk about that.

DR. CONGENI: They're high in caffeine. Caffeine will dehydrate you. It's a diuretic actually. ... Um, definitely stay away from the energy drinks.

The controversy of water versus the, uh, solutions with electrolytes in them, that is a different debate.

If you're exercising for more than an hour, hour and a half, it may not be unreasonable to use the rehydrating solutions that have electrolytes in them: the Powerades and Gatorades and things like that. But, you said it before, water is still the best rehydrating solution there is.

HORNER: Okay, and I think these coaches have gotten pretty good. I know in interviewing a lot of the coaches, most of them are trying to stay out of that heat between 10 and 2. You know, either early morning practices, or I see a lot of the coaches are starting practice at 3, 4 in the afternoon.

DR. CONGENI: That's right. Yeah, stay away from the heat of the day. Making sure that you're, you know, lighter uniforms, the permeable uniforms, uh, all those types of things. I think that our coaches do a good job.

The real good news for me is the trainers start to be around on the landscape here coming up. The trainers are really the key. In the June practices and early July, the trainers aren't there yet. As we get into late July and August, the trainers come.

They really are a wealth of information. They're very good on the catastrophic injuries. They're very good on the nagging-type injuries. And so, having those athletic trainers around are a really big deal and we need to do a real good job supporting those athletic trainers that are out there.

So, I feel a lot more comfortable as we get into the later part of summer that the trainers are gonna be there for, uh, education purposes and they're gonna be there for those catastrophic events that we do not want to hear about in the month of August.

HORNER: Alright, Joe. Thanks for coming on in this morning. Good stuff on the concussions.

DR. CONGENI: Thanks, Ray.

HORNER: There you go. Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital.

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