By Julie Potyraj
In 2006, 13-year-old Zackery Lystedt (1) was a gifted athlete playing middle school football. While tackling an opponent during a game, his head hit the ground. Despite the fact that Zackery suffered a concussion, he was only sidelined briefly before returning to the game. Shortly after his return, he collapsed on the field and, after being rushed to a nearby hospital, where he underwent emergency surgery to relieve the pressure on his skull from his swelling, injured brain. Several strokes and months in a coma followed. Zackery was unable to speak for nine months following his accident and did not stand again for nearly three years.
While Zackery's story is a sad one, it's made even more tragic by one simple fact: had he not returned to play after his initial injury, he likely would have experienced a full recovery.
Birth of Return-to-Play Laws
Head injuries in young people are common. Between 2001 to 2009, an estimated 173,285 kids and adolescents 19 years and younger were treated in U.S. emergency departments annually for nonfatal traumatic brain injuries (TBIs) related to sports and recreation. (2) The primary activities in which these injuries occurred included football, basketball, and soccer. Since many concussions are not reported, or are treated on an outpatient basis, the true number of sports-related TBIs is probably much higher.
Zackery's saga served as a cautionary tale on the dangers of returning to play too soon (3) - and was a wake-up call for schools and youth sports leagues across Washington State. In May 2009, the state implemented the Zackery Lystedt Law, a comprehensive law focused on concussion safety in contact sports. The legislation (4) has four core components:
- Providing education and training to coaches on recognizing concussion symptoms and responding appropriately.
- Requiring that any young athlete suspected of having a concussion during a game or practice be removed from play.
- Allowing a young athlete to return to play only after being evaluated and cleared by a health provider.
- Requiring an annual, updated concussion information and consent form (5) signed by parents and players as a condition for participation.
Between 2009 and 2014, legislatures in all 50 states and the District of Columbia enacted robust concussion safety laws (referred to collectively as "return-to-play" laws), many modeled on Washington State's Lystedt Law. The laws vary widely, but most contain provisions about raising awareness among students, parents, coaches, and volunteers through concussion education programs. Twenty-one states mandate that coaches be trained in youth sports concussion recognition. Texas and Arizona allow an athlete's parent to pull them from a game immediately if they suspect a concussion. (6) In 2010, Massachusetts enacted a law preventing coaches, athletic trainers, and volunteers from allowing students to engage in athletic techniques that endanger the health of other students. (4)
There Are Gaps, But Laws Are Working
In most states, return-to-play laws have loopholes. A 2014 Associated Press analysis (7) found that only 21 states were as stringent as Washington's Lystedt Law, reporting that:
- One-third of the laws do not specify which ages or grades are covered.
- Few laws apply to recreational leagues such as Pop Warner.
- Few laws clearly state whether they cover public or private schools (or both).
- Nearly all laws lack penalties for schools or leagues that fail to comply.
Yet despite such gaps, studies show that the laws are having a positive impact. A recent University of Michigan study (8) reported a 92 percent increase in 12-18 year olds seeking medical treatment for head injuries in states with concussion laws. Even in the absence of legislation, the Michigan study showed that simply promoting awareness of an injury can have a positive and widespread effect. After the implementation of the first concussion safety laws in 2009, treatment rates in states without laws rose 20 percent annually (this figure was 13 percent in states with safety laws in place). Additionally, in states without return-to-play laws, concussion-related office visits jumped 78 percent compared to pre-legislation.
Closing the Gaps
In the meantime, we need to keep moving forward to close all the gaps in return-to-play laws. According to public health experts like Debra Gordon (3), concussion education for parents, athletes, and coaches should be mandated and not just recommended. Other improvements that should be considered by state legislatures include:
- Penalties for non-compliant coaches
- Banning specific sports movements or strategies known to cause concussions.
- A mandated minimum waiting period after a diagnosed concussion before return to play.
- Required completion of a symptom-specific, graduated exercise program before return to play.
In the absence of state laws that cover non-scholastic sports programs and pre-high school ages, municipalities should establish their own return-to-play guidelines.
The responsibility of protecting our children does not fall on one set of shoulders; it requires a collective approach that involves parents, coaches, teachers, administrators, and medical professionals. Zackery and his family proved that people at the community level have the power to bring about change. Let's continue to work together to create a safer environment for young athletes.
Julie Potyraj is the community manager for MHA@GW and MPH@GW at the Milken Institute School of Public Health at The George Washington University. For several years, she served as a community development specialist in Zambia coordinating youth empowerment programs and reproductive health education and is currently an MPH@GW student focusing on global health and health communications.
1. Centers for Disease Control and Prevention. "The Lystedt Law: A Concussion Survivor's Journey." Available at: http://www.cdc.gov/media/subtopic/matte/pdf/031210-Zack-story.pdf.
2. Gilchrist J, Thomas KE, Xu L, McGuire LC, Coronado VG. "Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged Less Than or Equal to 19 - United States, 2001-2009." Morbidity and Mortality Weekly Report. CDC, 2011; 60 (39): 1337-1342.
3. MPH@GW Blog. "From the Legislature to the Field: "Return-to-Play" Laws and Youth Concussions." 2016. Available at: https://publichealthonline.gwu.edu/blog/return-to-play-laws-youth-concus....
4. National Conference of State Legislatures. "Traumatic Brain Injuries Among Youth Athletes." 2015. Available at: http://www.ncsl.org/research/health/traumatic-brain-injuries-among-youth....
5. Northwest Ultimate Association. "Zackery Lystedt Law and Head Injury Resources." Available at: https://www.discnw.org/youth/lystedt.html.
6. Moms Team. "Youth Sports Concussion Safety Laws: Texas." June 24, 2011. Available at: http://www.momsteam.com/health-safety/youth-sport-concussion-safety-law-....
7. Fendrich H, Pells E. "AP Analysis: Youth Concussion Laws Pushed by NFL Lack Bite." The Associated Press. January 28, 2015. Available at: http://pro32.ap.org/article/ap-analysis-youth-concussion-laws-pushed-nfl....
8. Michigan News. "New concussion laws result in big jump in concussion treatment." December 22, 2014. Available at: http://ns.umich.edu/new/releases/22586-new-concussion-laws-result-in-big....
Posted May 11, 2016