IMPACT STUDIES: Research places focus on head injuriesPublished 7:00am Thursday, June 27, 2013
“Concussions are a fact of the game,” said Hunter Adams, Holtville High football coach.
Concussions have existed since before the first “slobberknocker” was delivered. In the past five years, they have come to the forefront.
“It’s a different time,” said Stanhope Elmore coach Jeff Foshee.
A concussion, as defined by the Mayo Clinic is: “A traumatic brain injury that alters the way your brain functions. The effects are usually temporary, but can include problems with headache, concentration, memory, judgement, balance and coordination.”
“It’s a brain bruise,” said Brent Vinson, facility director at Wetumpka’s Rehab Associates. “The brain gets bruised (suffers a contusion) when it bangs against the skull.”
The brain floats inside the skull. Think about putting a peeled grapefruit inside a jello mold.
“It’s part of the body, so it’s resilient and can take a little, but the tissue is very sensitive,” said Vinson.
Concussions are common in contact sports. Football, in its design and function is a contact sport. According to the American Journal of Sports Medicine, high school athletes sustain an estimated 300,000 concussions per year.
“They were not nearly as scrutinizing when I was playing ball as they are now,” said Foshee. “I guarantee you I had three or four that got diagnosed.”
A study by a former professional wrestler, Chris Nowinski, actually started the concussion discussion.
“I fought to bring this issue to the forefront because after investigating my concussion history and post-concussion syndrome under the guidance of Dr. Robert Cantu, I was shocked that athletes were not informed of the serious consequences of concussions,” said Nowinski, via email Wednesday morning. “In the beginning, it was simply about raising awareness.”
A former Harvard football player and WWE professional wrestler, Nowinsky was forced to retire following a series of concussions in 2003. He since moved on to serve as co-founder of the Sports Legacy Institute and the co-director for the Center for the Study of Traumatic Encephalopathy.
“I am very excited about how far we’ve come in six short years,” said Nowinski. “Very few issues in public health have ever changed this quickly. However, we still have a long way to go before we can look ourselves in the mirror and say that we are handling the concussion crisis the right way.”
The work of the Sports Legacy Institute has triggered studies across the country.
“There are a lot of neurological centers throughout the country doing concussion and post-concussive studies,” said Vinson “A player who ‘got his bell rung’ getting up and going back in the game isn’t the case any more. They need medical clearance.”
While football has been the most prominent in the news, studies have also shown that soccer and cycling are also concussion-laden events. Cheerleading too is on the horizon as a sport where concussions and head injuries are prominent.
“Concussions can occur in any sport,” said Wetumpka football coach Tim Perry. “(Cheerleaders) don’t wear any headgear, any protection really. They are being thrown and tossed around and sometimes hit the floor or the ground.”
According to the Mayo Institute: “Concussions usually are caused by a blow to the head, but they can also occur when the head and upper body are violently shaken.
“As coaches, protecting the athletes is our No. 1 priority,” said Perry. “It’s nice to see all the research and that allows us to coach them in a safer way. You don’t ever want to see a decline in participation due to injuries.”
Some injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don’t realize it.
Vinson can speak to that, having suffered a concussion during a high school football game.
“I was at JD and we were playing Prattville. I took a lick to the head and don’t remember that game,” said Vinson. “I was watching the film and doing things that I didn’t remember doing. But that was a different time, we didn’t have trainers or people on the sidelines like we do now.”
The American Journal of Sports Medicine in 2011 reported that U.S. high schools with at least one certified athletic trainer on staff found that concussions accounted for nearly 15 percent of all sports-related injuries reported to ATs and resulting in at a loss of at least one day of play.
Based on video games and highlight films, the view of the concussion, or any head injury for that matter, stems from an “ooh-inspiring” collision that usually leaves one player standing and celebrating while the other is left clearing out the cobwebs.
“We’ve got to protect the player,” said Foshee. “When you put that gear on and that helmet, there’s an inherent risk. It’s a collision sport and your best players are going to stick their nose in there.”
As a result, concussions and head injuries are also the hardest to treat.
“It’s not like a knee or an ankle where you can look and see that there’s obviously something wrong,” said Vinson. “If it’s a grazing or a glancing blow, I will assess the athlete and let them play under my supervision. But if they are showing the slightest symptom of a mild concussion, then they have to have medical clearance by a physician.”
That medical clearance usually involves a CT scan of the head or an MRI.
“There are no outside symptoms they are healing,” said Vinson. “They will initially present with symptoms: Blurred vision, just not being themselves. After a couple of days they may be healing, but they aren’t quite ready to get back out there, especially if its a contact sport or cheerleading. But you’re dealing with youth and they may not take the best care of their bodies. A knee you can brace or immobilize – you can’t do that to a head.”
Vinson said one of the easiest way to tell if something is off with a player, is to get to know them and know their personalities.
“The more I know them, the more I’m able to notice subtle changes. If the kid is usually a sharp kid and if after a tackle or a collision, he’s suddenly not, that’s something to check on,” said Vinson. “The same thing for the kid who’s jovial and joking and having a good time. If all of a sudden he’s emotional or has a blank stare – there’s a problem there.”
Vinson said there’s always a plan of action when dealing with any type injury, especially a head injury.
“To the brain, a violent tackle can feel the same as a car wreck, especially if the body goes one way and the head goes another,” said Vinson. “It’s whiplash. Anything beyond a kid just having his bell rung, I’m not going to send them home with the parent. I’m going to send them to the hospital to get checked out. And a lot of it is being proactive.”
“It’s a tremendous load off our minds as coaches,” said Perry. “Having a guy like Brent on the sidelines, that’s a relief. When you are in the heat of the moment, trying to coach a game, having someone like that with the expertise is a great asset. He’s more familiar with the symptoms and what to look for.”
A 2012 paper presented to the Amercican Academy of Pediatrics pointed out that high schools with ATs have concussion rates much higher than those that don’t (eight times higher in girls soccer and 4.5 times higher in girls’ basketball). The reasoning in the higher numbers could be due to athletic trainers’ having the ability to spot the subtle signs of a concussion. A stat that goes back to Vinson being able to be around and know the players.
Having a player suffer a concussion, mild or worse, can also alter a the course of a season. In 2013, Holtville High kicked things off against W.S. Neal. Fourteen Bulldogs returned to Slapout after four quarters of football suffering some sort of injury.
Hayden Lott, the first-year quarterback suffered a concussion that kept him sidelined off and on throughout the season.
“Hayden was a different type of athlete than what we’d seen at Holtville,” said Adams. “It didn’t change the way we prepared or worked with the players and got them ready for the week. It did limit us to what we could do in some aspects though.”
All three high school coaches agree advances in technology as a result of all the studies are helping to reduce the number of injuries.
“There are more preventative measures now,” said Adams. “I can look at my dad’s old suspension helmet. It was like going out there and wearing a Tupperware bowl on your head. Even when I played, the MaxPro shell with either an air halo or a bunch of cushy padding, didn’t do much. Now, helmets are designed to fit the curvature of the players’ head. The face mask is designed to distribute the shock. All that goes to making the athletes safer.”
Perry, who coached in Arkansas before coming to Wetumpka, can see a lot of similarities between that state’s Activities Association and the AHSAA.
“Coaches are required to take seminars like here and there’s the rule that an athletic trainer be present, if not at practices at games,” said Perry. “If there’s an athlete that sustains an injury, we are always going to err on the side of caution and get them evaluated.”
Concussions and head injuries unfortunately, aren’t only limited to the upper ranks. Middle schoolers and youth athletes are also at risk.
“The biggest thing for the middle school parents and youth sports coaches and parents is to be educated,” said Vinson. “I, as the sports med provider for the community, if I’m at a game whether it be youth football or a softball tournament at the park and I see something that looks bad I’m going to check it out. Especially if the kid’s out of it and mom or dad starts freaking out. I’ll tell them this is what you should look for and educate them, especially if the symptoms don’t show up for seven or eight hours later. I’ll give them my number and tell them to call me. It’s tough because you can’t see it.”