Concussion rules miss the repeated head blows putting young athletes at risk of CTE

Research suggests that the cumulative force and frequency of head impacts, including those that cause no diagnosed concussion, may be central to the risk of chronic traumatic encephalopathy in young athletes.

Parents trying to weigh the promise of sport against the risk of brain injury are often told that youth athletics are safer than they once were. Better concussion awareness, sideline protocols and improved protective gear have all become part of the modern conversation. But Dr. Leana Wen’s reporting for The Washington Post argues that those changes may not address the central danger linked to chronic traumatic encephalopathy, or CTE: the accumulation of repeated blows to the head, including impacts that never trigger a diagnosed concussion.

That distinction matters because CTE is not limited to retired professionals. Research highlighted by the National Institutes of Health found the disease in more than 40% of 152 brain donations from young amateur athletes who died before the age of 30 and had a history of repetitive head impacts. The CDC says repeated head impacts may occur without obvious concussion symptoms, yet can still affect brain function over time. Together, those findings undermine the comforting idea that youth athletes are automatically protected simply because they are smaller, younger or subject to more safety rules.

Wen quotes Chris Nowinski, co-founder of the Concussion & CTE Foundation, saying that concussion protocols alone will not substantially cut overall exposure to repetitive head impacts. He argues that the public health stakes lie less in preventing the occasional diagnosed concussion than in reducing the countless smaller hits that add up across seasons. That view is supported by NIH-funded research suggesting that the force and lifetime accumulation of head impacts may be more predictive of CTE than the number of concussions a player has been diagnosed with.

The challenge, then, is not just to make existing sports slightly safer, but to change how some youth sports are played. The foundation Nowinski helped build, working with Boston University, has promoted protocols aimed at limiting both the number and force of head strikes. Those recommendations include reducing contact drills, tightening penalties for head hits and changing rules in sports such as football, soccer, baseball and ice hockey. The article notes that in some countries and federations, policymakers have already moved in that direction: England is phasing out deliberate heading for children under 11, Scotland has banned heading in training for children under 12, and Canada has prohibited bodychecking in hockey for players under 13.

For families, the practical message is stark: not every sport carries the same level of risk, and not every risk is worth taking. The American Medical Association has said young athletes and their parents should be given clear, balanced information so they can make informed choices. Wen’s conclusion is that parents should think less about whether their child’s sport has a new helmet or concussion rule, and more about whether it involves repeated head impacts at all. For many families, that may mean choosing sports with little or no CTE risk rather than assuming that familiarity, tradition or improved equipment makes contact sports safe.