Recent studies have shown that fear and awareness of concussions has led to decreased participation in youth sports leagues around the nation.
While participation numbers in the Baltimore area are inconclusive, concussions are definitely on the minds of local parents, coaches and sports and medical professionals.
"It's become the disease du jour," Dr. Kevin Crutchfield, director of the sports concussion program with LifeBridge Health, said of concussions. "It's become the cocktail party phraseology."
Crutchfield said a documented decline in one of the nation's oldest and largest youth football organizations, Pop Warner, demonstrates how far concussion awareness has come.
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It started when the NFL was called to testify before Congress on the issue in 2009.
"That's why they started this big concussion awareness thing," Crutchfield said. "This is when they admitted they had a problem, and if they had a problem, everyone had a problem."
In May 2011, Gov. Martin O'Malley signed a bill into law that, among other things, requires concussion awareness programs at schools and in recreation leagues. The legislation also requires that a child who is suspected of having sustained a concussion be removed from practice or play and only return after a licensed healthcare professional approves it.
"There are protocols that coaches are required to follow," Arden McClune, director of parks and recreation in Harford County, said.
McClune said since 2009 there has been a slight decrease in participation in youth football leagues in the county, but the reason isn't clear.
"We have seen a slight decrease over that time period, although it is hard to determine if that is due to economic conditions as opposed to parents having concerns about concussions," McClune said.
In Baltimore County, registration for the 2011 rec football season was 5,882. Enrollment has only varied slightly since, rising to 6,003 in 2012 and dropping to 5,776 in 2013. Like in Harford County, there's no documented explanation for the variation.
"With that heightened awareness has come parents saying ‘well my kid's not playing that sport,'" Crutchfield said.
That increased concern from parents has also been witnessed by Derek Steele, manager of the Play it Again Sports in Baltimore.
"I definitely see a difference in the parents that come in and are aware of it," Steele said of concussions.
Steele said each season his store typically sells about a half a dozen football helmets to individual parents in addition to the group orders the business fills for different leagues around the area.
During the 2013 season, however, that number jumped to 30 or 40 individual helmets.
"It was people coming in and specifically the first question they were asking was do you have football helmets that will protect against concussion," Steele said. "They were coming in specifically to get the best thing to protect their kids' noggins."
Steele, a coach himself, said he recommends a helmet by Xenith that has a high safety rating.
Crutchfield explained what's most important is that the helmet fits properly.
"Nothing is certified to reduce concussions," Crutchfield said.
Crutchfield said the best way to protect against concussions is to change rules of the games, the way they are played and teach the proper techniques.
While awareness of concussions is more prevalent now than a decade ago, there is still a lot medical professionals don't know about them.
"We don't really know what the long-term effect on a young developing brain is," Crutchfield said. "We do know from animals that when you get a concussion, brain cells die."
A lot of concussion treatment is based on consensus in the medical community.
"We're really sort of just learning this stuff," Crutchfield said.
As medical professionals continue to learn about concussions, Crutchfield says caution is probably the best course of action especially when it comes to youth athletes.
"I think it's good to shift that far until we know," Crutchfield said.