Football players as young as 7 sustain hits to the head comparable in magnitude to those absorbed by high school and adult players, and most of the hits are sustained in practices, not games, according to research to be released Wednesday.
The findings, which may influence how youth football organizations handle training methods and rules, were included in four studies published by researchers at the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences. The research, though limited, is considered by experts to be a step in the effort to address the relatively shallow understanding of the potential long-term effects of head trauma on young players.
More than 25,000 football players from 8 to 19 years old are taken to emergency rooms seeking treatment for concussions every year, but most of the research on head injuries in football has focused on professional and college players.
The new research, which was presented at the annual Biomedical Engineering Society conference this week, tracked about 120 players in Virginia and North Carolina from 7 to 18 over two seasons. Each young athlete wore six devices, known as accelerometers, in their helmets to measure the force, position and direction of the hits, and every practice and game was videotaped to determine how they occurred.
To help determine any changes in brain structure and function, many of the players received magnetic resonance imaging brain scans before and after the season, and after they sustained a concussion. Some players also received magnetoencephalography scans, or MEG scans, to map their brain activity.
"This is a basic study on how many times kids get hit in the head," said Professor Stefan Duma, who runs the School of Biomedical Engineering and Sciences and oversaw the youth football studies. "The number of hits and magnitude was a lot higher than people would have estimated. When we present it to the parents, everyone is surprised."
In the first of the four studies, 19 boys ages 7 and 8 were found to have absorbed 3,061 hits to the head during the 2011 and 2012 seasons, with 60 percent of those hits coming in practice. The players sustained an average of 9 hits per practice and 11 in games, which are less frequent. Although none of the boys received a diagnosed concussion, they absorbed 11 hits of 80g of force, or greater, a level that represents a higher risk of concussion.
"This study demonstrated that some head impacts at this level are similar in magnitude to high-severity impacts at the high school and collegiate level," the authors wrote.
A second study tracked three teams of players from 9 to 12 for one season. Nearly 12,000 hits were recorded, or an average of 240 per player. Again, players absorbed more hits during practice, and at higher acceleration rates than younger players. As a result, "these data suggest that rules designed to restrict player contact in practice are capable of reducing head impact exposure in youth football," the authors wrote.
Under increased scrutiny from parents, lawmakers and others, youth leagues have tightened rules to reduce the amount of hits children absorb. Pop Warner, the national organization made up of volunteer coaches and hundreds of thousands of children, some as young as 5, has reduced the amount of contact players can have in practice, and increased training for coaches, steps based partly on the medical belief that the brains of young players are particularly vulnerable because they have not fully developed.
"The professionals have a players union to protect them, but in many ways, the athletes that need the most protection have the least formal protection," said Dr. Vernon Williams, a neurologist at the Sports Concussion Institute, which advises high school, college and pro teams on baseline testing and when to return to play after concussions. "As you get earlier in age, the contrast is more striking."
Jon Butler, the executive director of Pop Warner, had not seen the results of the Virginia Tech-Wake Forest studies. But he applauded any work that accurately reflects the exposure of young players.
"There is a crying need for more research," Butler said. "There has been a lot of misinformation handed out. We're doing what we can with limited resources, but we don't have the funding to pay for major research studies."
The authors of the study note that their research has several limiting factors, most notably its size and length. Only a dozen or two athletes were tracked in each age category, and only for one or two seasons. More young athletes need to be studied to create a fuller set of data to determine the long-term effect of the hits they absorbed.
"While we have immediate data and finding, we're looking at 5- and 10-year students to help us answer the big questions about how much is too much," Duma said. "We are just at the beginning."
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