Here's an edited Q&A from the conversation.

Q: What's one of the biggest misconceptions parents have about sports injury prevention?

Bass: Many parents focus on game day. They focus on when the whistle blows or when the competition starts. What often gets overlooked is everything that happens before that. Preparation, practice habits, warmups, conditioning and recovery all play an important role in helping reduce injury risk and improve performance.

Q: What does a good injury prevention routine look like before practice or a game?

Bass: It starts with a proper warmup. We want to warm up before we stretch, not stretch before we warm up. The goal is to create blood flow, get muscles and joints ready to perform, and make warmups a consistent part of every practice routine.

Sports are all about routines, and creating healthy routines can help reduce injury frequency.

Q: Does playing one sport year-round increase injury risk?

Bass: Research suggests that sports specialization can contribute to higher injury rates and burnout. Younger athletes should be encouraged to participate in multiple sports.

As young athletes grow and mature, their interests usually become clearer. In many cases, specialization happens naturally over time rather than needing to happen at a very young age.

The goal should be helping kids enjoy sports while developing a variety of skills.

Q: What are some signs that an athlete may be pushing too hard?

Bass: Parents and coaches should pay attention to changes in performance, soreness, swelling, stiffness and limping.

Athletes are often pleasers. They don't want to disappoint coaches, teammates or parents, and sometimes they don't immediately report that something is hurting.

That's why communication is so important. The earlier we identify a problem, the more options we have to help the athlete recover and continue participating safely.

Q: Why is it important for athletes to be honest about injuries?

Bass: Many athletes worry that reporting an injury will immediately take them out of competition. What I want them to understand is that athletic trainers and sports medicine professionals are advocates for the athlete.

Our goal is not to keep them from participating. Our goal is to help them recover, perform at their best and stay healthy over the long term.

Building trust helps athletes feel more comfortable speaking up when something doesn't feel right.

Q: What should parents know about concussions?

Bass: Concussions are medically classified as traumatic brain injuries, and they deserve serious attention.

One of the most important things parents need to know is that no two concussions are exactly alike. A concussion may look very different from athlete to athlete. Some athletes may experience headaches. Others may become sensitive to light or sound. Some may struggle with sleep, concentration or mood changes.

If symptoms develop after a collision, fall or impact, it's important to have the athlete evaluated by a medical professional.

Q: Can athletes drink too much water?

Bass: Parents ask that question quite a bit.

While it is technically possible to overhydrate under certain circumstances, most young athletes are much more likely to be under-hydrated than over-hydrated.

Hydration should be consistent throughout the day. Athletes should not wait until they feel thirsty to start drinking fluids, especially during practices and competitions in hot weather.

Q: Is heat illness preventable?

Bass: Heat illness is one of the most preventable sports injuries we see.

Proper hydration, acclimatization to heat, regular breaks and recognizing warning signs early can make a tremendous difference.

Parents should pay attention to symptoms like headaches, cramping, fatigue, dizziness and unusual behavior changes during or after physical activity in the heat.

When athletes begin experiencing heat-related symptoms, it's important to cool them down, rehydrate and seek medical attention when necessary.

Q: What's one thing every athlete should do before practice?

Bass: Say thank you.

Thank the parents, caregivers, coaches, teammates and everyone else who helps make it possible for you to participate.

Playing sports is a privilege, and gratitude is something every athlete can carry with them onto the field, court or track.

The Bottom Line

Preventing sports injuries isn't about one single technique or piece of equipment. It starts with consistent habits: proper warmups, good nutrition, hydration, recovery and honest communication when something doesn't feel right.

By helping young athletes build healthy routines and recognize warning signs early, parents can play an important role in keeping kids healthy, safe and in the game.

With school back in session, many kids are once again suiting up for fall sports and hitting the field, track or court for competition. Doing so offers a child many benefits. Along with being an outlet for exercise and physical activity, playing sports gives kids an opportunity to develop meaningful friendships, practice resilience and learn the value of hard work and perseverance.

But, like with most activities, there are risks. Sustaining a concussion is one of them.

What is a concussion?

The Centers for Disease Control defines a concussion as “a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.” While sports, especially contact ones, carry an obvious risk of head injuries, a concussion can happen any time of year from any type of sport, recreational activity or play.

A 2018 report from the American Academy of Pediatrics evaluating three national injury databases estimated that 1.1 million to 1.9 million recreational and sports-related concussions occur every year in the United States in children 18 years of age or younger. When it comes to sports-related concussions for high schoolers, boys tackle football tops the incidence list with girls’ soccer coming in second, according to the report.

“A lot of concussions go unreported or undetected,” said Nicole Pitts, D.O., a sports medicine physician at Cook Children’s Pediatric Specialties in Prosper. “Usually 2 in 10 high school athletes who play contact sports, including soccer and lacrosse, get a concussion.”

Signs and symptoms

A concussion can sometimes be hard to spot. After all, it’s an internal injury. There are no visible cuts, bruises or breaks. Parents and coaches must rely on how a child feels and behaves to spot the signs and symptoms, which could have a delayed onset and last for days, weeks, months or more.

If your child takes a blow to the head, here are the signs and symptoms that they may have a concussion:

• Persistent headache or increasing head pressure
• Drowsiness or difficulty waking, characterized by grogginess, haziness, sluggishness or foggy feeling
• Dizziness and balance issues
• Blurry or double vision
• Weakness, numbness or reduced coordination
• Persistent vomiting, including nausea
• Slurred speech or slowed responses
• Convulsions or seizures
• Confusion, forgetfulness or difficulty recalling events before or after the injury
• Restlessness, agitation or heightened sensitivity to light and noise
• Behavioral or personality changes
• Loss of consciousness
• Asymmetrical pupil size (one pupil larger than the other)

What to do if you suspect your child has suffered a concussion

If you suspect your child has suffered a concussion, first and foremost, pull them from the game or activity.

“If they're in a game and you suspect they’ve had a concussion or had a blow to the head, or they're having any of those symptoms, even if you’re not sure, but suspect it, they need to be removed from the game immediately,” Dr. Pitts said. “That's the most important thing, and they should not be put back into play in that game or any activity on the same day at all.”

Have them evaluated by a professional, like a physician or athletic trainer, right away, especially if they lose consciousness, are confused and disoriented, are vomiting continuously and have trouble talking.

What's next

The clinical protocol for concussion treatment and rehab includes two strategies for evaluating an athlete’s recovery and readiness to get back in the game. The first 24 to 48 hours after a concussion should be a time of rest for the athlete, followed by a gradual and staged reentry to school and sports using the return-to-learn and the return-to-sports strategies. Athletes should remain in each stage for a minimum of 24 hours and should be able to complete the activities each stage allows with little to no exacerbation of concussion symptoms before moving to the next.

“We'll get them back into school first and once they're back in school and able to do all of their school activities and they're not having any symptoms, then we’ll start them on a return-to sports protocol,” said Carolyn Snow, MS, LAT, ATC, OTC, sports medicine coordinator at Cook Children’s Orthopedics and Sports Medicine. “We don't want to do any sports activities until they’re symptom-free.”

Dr. Pitts utilizes these clinical strategies with her concussion patients in Prosper. Cook Children’s Orthopedics and Sports Medicine concussion clinics at Walsh Ranch, Hurst and Mansfield also follow the return-to-learn and return-to-sports clinical protocols, in addition to utilization of a concussion testing tool called ImPACT to help determine a child’s readiness to return to activity. This computerized test measures memory, attention span, and visual and verbal problem-solving. Dr. Pitts is also certified to administer the ImPACT test.

Recognizing the signs and symptoms of concussion early on, and taking immediate action can help protect your young athlete’s mind from further or more serious injury. Getting the proper treatment and rehabilitation can minimize the long-term consequences from concussion and get them safely back in the game when the time is right. 

"Should my child play football?"

"Should my child play football?"

You may be asking yourself this question with all the recent news about the dangers of chronic traumatic encephalopathy or CTE. A study in the most recent Journal of the American Medical Association (JAMA) found that 110 of 111 NFL players whose brains were studied after their deaths showed they had CTE. CTE is a disease that gets worse over time, affects the brain and is linked to frequent head trauma. CTE is not related to just concussive hits, but repetitive sub-concussive trauma as well. Symptoms of CTE can present as trouble with mental tasks, changes in mood and or behavior.

CTE findings were mainly present in the athletes from the professional level however they were present in both high school and college athletes as well. The study had some limits in that there were some potential biases in choosing the participants from the professional level. As the families of these professional athletes may have notice symptoms while the athlete was still alive, motivating them to donate the athlete’s brain to the study. The study also does not represent the whole group of athletes exposed to football at the college or professional levels.

Now you ask yourself, does this carry over to our middle school and high school football players? Well sadly at this time we still don’t have all the answers and more studies need to be done, but this helpful information going forward.

The Centers for Disease Control and Prevention (CDC) estimates 1.6 million to 3.8 million concussions each year.

So should your child be playing football or any contact sport for that matter?

While the war on concussions is alive and well, the scariest part is that our youth are the ones most susceptible. But what do we do with our youth in the meantime? As parents, you are the ones that ultimately decide what activity your child plays.

I am not recommending that you pull your children out of football or that football shouldn’t exist. As someone that helps treat children with post-concussive symptoms, I urge you to at least educate yourself on the sport your child is asking to play or you are asking your child to play. Here are five questions you should be asking…

1. What is a concussion and how do they happen?

A concussion is an injury to the brain that comes from a hit, a fall or an injury that shakes/ jars the head. Concussions are not only football injuries. They can happen in any sport or in daily life.

2. What can I do to be proactive?!

• Put the safety of your child ahead of winning.
• Make sure the coach is teaching the correct fundamentals.
• Proper tackling form can diminish the likelihood your child will hit their head.
• Helmets are not weapons.
• Despite claims, no helmet has been proven to prevent concussions.

3. What does a concussion look like?

Concussions are injuries to the brain and they are not injuries that you should play through.

Concussions can present in many different ways. The most important thing to watch for is if your child is not acting like his or her normal self. Children may also present or complain of:

• Vision changes - such as sensitivity to light and intolerance to reading.
• Dizziness/ Vertigo.
• Memory loss.
• Loss of consciousness (Fainting).
• Vomiting.
• Changes in mood.
• Lowered attention span.
• Changes in hearing and balance.

4. When should we seek help?

• If there is any sign of concussion you should seek immediate medical attention.
• Any suspicion of a concussion should be treated as a concussion until proven otherwise.
• Find a sports medicine physician that specializes in concussion management to ensure that signs and symptoms are not missed.

5. Who else can help treat the symptoms of concussions?

Concussions may require an overall specialized, team approach:

• Physician to make sure there's nothing more serious going on and to manage the care of the patient.
• Speech and Language pathologist – can help with memory, organization skills and higher level language skills.
• Audiologist - to help with hearing and balance.
• Occupational Therapist- can help if patients have trouble using their hands, writing in school or visual/ spacial management.
• Physical Therapist- can help balance, dizziness and safely return to sport.
• Ophthalmologist- can help with visual problems.

Click to learn more about Cook Children’s ImPACT program.

Other Resources:

• Impact Concussion Management
• What every parent needs to know about concussions
• Helmets Don't Prevent Concussions
• SPORTS resources
• Cheerleader injuries

Our Experts:

Ryan Blankenship, PT, MPT, SCS, is a SPORTS physical therapist at Cook Children’s. Cook Children’s SPORTS Rehab is a leader in the community in sports injury. Additional information and helpful tips can be found on the Cook Children’s SPORTS Rehab website. Cook Children’s SPORTS Rehab is a leader in the community in sports injury prevention.

Ricardo Guirola, M.D., specializes in Rheumatology and Sports Medicine. Dr. Guirola takes care of athletes and being part of their active and directed therapy. As part of his education, Dr. Guirola obtained a Master's of Education. He uses those skills to teach families, students, residents, nurses and other physicians. Outside of his medical practice, Dr. Guirola spends times with family, runs and plays soccer and tennis.

Contributing Author

Alan Littenberg, PT, DPT, is a sports physical therapist at Cook Children’s SPORTS Rehab. At Cook Children’s, our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete’s bones, muscles, body and mind to get your child back on the field as safely and fast as possible

If you have paid attention to football over the last several years you know that there have been many rule changes geared toward preventing concussions.

Most of these rule changes have been spurred on by a huge law suit that was brought against the NFL by a large group of former players, in which the NFL will wind up having to pay out more than 1 billion dollars. The bottom line and what is portrayed in the movie is that there was research that brought into question the harmful effects of repetitive head trauma related to football. The NFL rather than looking into this and aiding this research in an effort to find out more, put its efforts into discrediting the research and trying to cover their own interests.

The research they were trying to discredit dealt with the autopsies done on the brains of former NFL players that displayed a condition called Chronic Traumatic Encephalopathy or CTE. CTE is a progressive degenerative disease found in people who have suffered repetitive brain trauma, including sub-concussive hits to the head that do not cause immediate symptoms.

Individuals with CTE may show early symptoms of dementia, such as memory loss, aggression, confusion, and depression. Just this past week Ken Stabler former Super Bowl winning quarter back for the Oakland Raiders who played 15 years in the NFL and who died in July was found to have stage 3 CTE.

While there is much more research that needs to be done to fully understand the potential long term effect of concussions and repetitive head trauma the current evidence can’t be ignored. One of the scariest things about concussions is how much we don’t know.

While the NFL is portrayed in a pretty bad light in the movie, in their defense I don’t think they reacted much differently to concussions than the majority of the population does. For the longest time I think a lot of people (myself included) had the attitude of “Oh it’s just a concussion.”

Working with concussion patients in clinic I have heard parents say, “I played football and got a few concussions I didn’t realize that it was a big deal.”

There are many athletes who might get a concussion, recover well and never have any other problems, but there are also patients who have an extremely difficult time recovering. We see patients take months to recover and report constant headaches, dizziness, blurred vision, difficulty concentrating in school, and mood swings.

We have seen patients whose parents report a complete change in their personality where they are much more angry and aggressive than they were before the injury. The scary thing is we don’t know how a person is going to react after a concussion, or how many concussions are too many, or if the repetitive sub-concussive trauma that they sustain is enough to cause problems later in life.

I played football when I was younger. I’m not coming out against playing football, but when I played you couldn’t start playing tackle until your eighth grade year which means 13-14 years old. We have to remember that elementary age through high school kids still have brains that are developing and we need to protect them.

The longer they play full contact football the more hits and more traumas they are exposed to, so I think we need to pay close attention to when we let our kids start playing tackle football. We also need to keep a close eye on how our kids recover if they do sustain a concussion. The longer and more difficult a patient’s recovery is the first time they have an injury, the more likely they will have a long, difficult recovery if they sustained another concussion.

Finally, how many concussions are too many? The answer is we don’t know for sure. What we do know is that concussions are mild traumatic brain injuries. We also know that CTE is a condition found in people who have suffered repetitive brain trauma. So how many concussions constitute “repetitive trauma?” That is a question we cannot answer for sure, but one that I think parents should think long and hard about before letting their kids back on the field.

SPORTS resources:

• The Cook Children's SPORTS program
• Football injury prevention
• What every parent should know about concussions
• There's no such thing as 'just' having your bell rung
• Top 10 questions parents have about sports injuries
• Injury Prevention Guide
• Strength training in children/adolescents
• Young athlete's injury prevention guide
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• Preventing children's sports injuries
• Pain that won't go away

Researchers in Pediatrics found that only track and field and swimming were safer as far as the number of injuries to athletes, but because of the high risks of cheerleading stunts the injuries were often times dangerous.

The study found:

• The most common injuries are concussions at 31 percent, but lower than all other girl sports.
• About one third of those injured, were participating again in a week.
• Forty-one percent of cheerleaders were out for one to two weeks.
• Eleven percent were out more than three weeks.
• Five percent were out for either the season or were career ending injuries.
• Most of the injuries were to girls, but boys also were injured because they were usually at the base of the formation.

The Cook Children’s Emergency Department admitted six cheerleading injuries from Oct. 9, 2014 to July 28, 2015, a low number compared to a sport like football. But four of those six required surgery at Cook Children’s.

Amanda Vick, PT, DPT, a Cook Children’s SPORTS physical therapist, was a cheerleader in high school. She points to the focus of cheerleading become a year-round sport, including athletic competitions, summer camps and competitions, leading to the increase in the number of injuries.

Plus, cheerleading has changed over the years to include high level gymnastic tumbling runs and stunts. Most common injuries seen at Cook Children’s are fractures, strains, sprains and concussions. She says more regulations could help lower the amount of injuries in cheerleading.

“Cheerleading has not historically been recognized as a sport, at many levels,” Vick said. “This means cheer may not be under the control of an athletic department. Cheerleading does not have to follow certain rules and regulations that other sports monitor and improve for safety. Therefore, increasing safety awareness is key for protecting cheerleaders.”

Due to this change in the demands of cheerleading, it is important for coaches and cheerleaders to understand proper techniques during stunts and tumbling, strengthening, leg and arm alignment, core activation and different risks related to floor surface and practice time.

Read more on Vick’s advice to protect cheerleaders here.

About the source

Amanda Vick, PT, DPT, is a Cook Children's SPORTS physical therapist.The SPORTS Program at Cook Children’s offers educational material for parents, coaches, trainers and nurses for sports-specific injuries. Our team of experts have specialized training in pediatrics and collaborate together to share their knowledge in growing bodies and dynamic training principles.