PREP FOOTBALL ’11: Players at risk for concussion on every snap
FLORENCE, S.C. –
Josh Davidson remembers taking a hit under the chin. Then he remembers sitting on the bench and being quizzed by West Florence’s athletic trainer, Dave Stoklosa.
As for what happened in between, well, ask someone else.
Davidson, the Knights’ quarterback, suffered a concussion on that hit last season near the end of a game at Myrtle Beach the third week of the season.
He looked left as he dropped back to throw and someone on his right missed a block when the Seahawks came with a weak-side blitz. One helmet under the chin later, and Davidson was out of action for more than a week.
“It happened so fast,” Davidson said. “One second you’re up and one second you’re on the ground. You kind of go black for a second. It’s definitely a different feeling.
“ … I don’t really remember exactly what happened on the field (after the hit).”
He started feeling better on Monday after the game, and in the old days, he might’ve been whisked back onto the field to start preparing for the next week’s opponent, in this case, Darlington.
But those days are long gone.
As more evidence emerges about the detrimental long-term effects of brain concussions, which can include a lifetime of headaches, memory loss, depression and unpleasant things in between, the more medical personnel all the way down to youth sports are paying attention.
“We’ve learned that a concussion is not only what happens on the field, but after that time,” said Dr. Patrick Denton, a certified sports medicine specialist with Pee Dee Orthopaedic Associates at McLeod. Denton oversees a Florence District 1 concussion education and treatment program for its athletes.
McLeod Sports Medicine offered a symposium on concussions this past spring for the district’s athletes, coaches and parents.
Researchers from the Sports Concussion Clinic and Children’s Hospital Boston and the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, estimated less than a year ago that 136,000 sports-related concussions occur among high school athletes in the U.S. each academic year. Some experts think that number might be grossly underestimated because of concussions that go unreported.
Just within the last few weeks, Illinois followed in the footsteps of other states and made it law requiring all student-athletes with concussions to get medical approval before resuming play. The law also requires education for coaches, parents, players and officials about concussion symptoms.
It wasn’t that many years ago when athletic trainers and coaches were still giving the old “how many fingers am I holding up?” test and sending players back onto the field after they “got their bell rung.” In those days, many players who might have felt hazy after a big hit — one of the common signs of a concussion — didn’t want to show any signs of weakness to their coach by sitting out.
But more and more high school sports organizations all over the nation are being more and more cautious.
“That’s a great thing,” West Florence football coach Trey Woodberry says. “It’s going to make our sport better. It’s going to make more kids want to participate. Parents won’t be second-guessing so much whether their kids should play football.
“We encourage (concussion education). I wouldn’t want my kid playing if we didn’t have this stuff. That’s what every coach needs to think of. Would you want your kid doing it?”
South Carolina doesn’t have a concussion law, but the state’s high school league began last year requiring coaches to take a free, online concussion course from the National Federation of High Schools. And, like some of the state laws in effect across the nation, the SCHSL mandates that athletes with concussions can’t return to play until they get proper medical clearance from a trainer or a doctor.
And that clearance does not come simply when a player’s symptoms disappear. When a player is removed from a game because of a possible concussion, Stoklosa is putting him through an on-field evaluation about every five minutes.
The evaluation includes simple memory exercises and orientation questions, like “Where are you?” and “What team are you playing against” and “What team do you play for?”
“Even if their symptoms are clear, they’re still my friend (on the sideline) for the entire contest,” Stoklosa said.
Woodberry said the good graces of a financial donor allowed West to purchase new helmets that meet concussion safety requirement for all the Knights’ football programs — ninth-grade, junior varsity and varsity. And, he said, West Florence spends up to about $8,000 each year reconditioning helmets to meet standards.
“We spend a lot of time and money making sure our kids are safe,” he said.
And Stoklosa, Woodberry and their peers at other schools in Florence District 1 and around the state are much more attuned to educating players about all aspects of concussions than they used to be.
The first day teams are allowed to put on pads, Woodberry said his staff line players up and teach them proper tackling techniques. They use catch phrases like “head up,” “lead with your chest” and “see what you hit.”
Even if a helmet-first hit doesn’t result in an injury, it’s likely these days to result in a penalty and possibly a disqualification for the offending player as officials are putting more emphasis on calling penalties on tackles where players put their head down and lead with their helmet.
But even with all the emphasis and education, Woodberry says that sometimes, he still has to battle that old mindset in some players who choose to remain mum when they’re injured — in the head or elsewhere — so they can stay on the field.
“They still try to get in. They want to play,” Woodberry said. “They’re not all thinking long term, not thinking of the consequences.”
Davidson, though, does not fall into that category. He’s seen and heard the horror stories from some athletes, including former NFL players, who end up with all sorts of brain health issues later in life because of repeated, undiagnosed concussions.
“I want to enjoy my later life just as much as I’m enjoying it right now,” he said. “If I’m getting concussions left and right and I start having brain problems, if I’m not working right up here (pointing to his head), I’m not working anywhere else.”
Through a grant from the McLeod Foundation, District 1 athletes who participate in any contact sport are given a baseline computer test before they can participate in their sport. That way, if the athlete does suffer a concussion, they take the test again and results can be compared to see just how severe the concussion is.
But unlike just a few years ago, there’s no longer such a thing as a mild concussion, at least in terms of an athlete getting back on the field.
“We’re told now that a concussion is a concussion,” Davidson said. “They used to rate them as mild or severe or whatever. And obviously, some are worse than others, but the attitude is you either have a concussion or you don’t.”
If a high school player suffers a concussion in a game, there’s a good chance he’s going to miss the next game after undergoing cognitive and physical tests.
Stoklosa said players have to pass a computerized test that measures memory and brain speed, called the ImPACT Test, and physical exertion tests before they can resume play. Even if a player’s symptoms have cleared, even light jogging can make them reappear, he said.
It took Davidson three tries after his concussion to pass the ImPACT test. He missed the Darlington game the week following the injury and returned the next game against Wilson.
Making sure a player’s brain is healthy later on in life isn’t the only concern. There’s always the extreme case, like Matt Colby of Costa Mesa High School in California. He died in September of 2001 after collapsing on the sideline during a game, never again becoming responsive.
In the days leading up to his death, Colby, according to reports in the Los Angeles Times and other publications, complained to some friends of headaches after taking a hit to the head in a previous game. His coaches held him out of practice that week, but he was cleared by a doctor to play in the next game.
An examination of Colby’s brain revealed evidence of brain trauma he’d suffered up to two weeks before his death. The Orange County coroner’s office found that Colby died of repeated blunt force trauma to his head, according to a report on ESPN’s “Outside the Lines.”
No time is more crucial to correctly deal with concussions than before a player reaches adulthood, Stoklosa said. Once a player suffers a concussion, he’s more likely to have another one, he said. And a teenager’s brain is still maturing, which makes a second brain trauma potentially much more dangerous.
That’s why Stoklosa said he considers his primary role to be just as much of an educator as a caregiver.
“A lot of these kids might not have a clue why they might have a headache,” he said. “If we can get the word out about why I need to know if they’re having any of those symptoms, it helps.
“It’s a really conservative approach. Some parents might not understand, some coaches might not understand, but it’s really for the good of the kids.”
Concussion signs and symptoms
(observed by medical staff)
Appears dazed or stunned
Is confused about assignment
Forgets plays
Is unsure of game, score, opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows behavior or personality changes
Can’t recall events prior to hit or fall
Can’t recall events after event or fall
(reported by athlete)
Headache or pressure in head
Nausea
Balance problems or dizziness
Double fuzzy vision
Sensitivity to light
Sensitivity to noise
Feeling sluggish or slowed down
Feeling foggy or groggy
Does not “feel right”
TREATMENT OF CONCUSSIONS
According to West Florence High School athletic trainer Dave Stoklosa, only two things can heal a concussion: rest and time. Trainers in Florence District 1 have a specific protocol to follow from the moment a concussion is suspected up to the time a player is cleared to return to play.
Concussion protocol
1. Remove the athlete from activity
2. Perform serial evaluations (orientation questions, memory exercises, concentration exercises, etc.) every five minutes.
3. No same-day return to play
4. See physician within 48 hours for computerized concussion testing
Return to play
There are 24 hours between each of these steps. If the athlete fails any step (if symptoms return during any step) return to previous step for at least 24 hours:
1. No activity, assessment at rest; proceed to step two once symptoms are gone
2. Light aerobic exercise
3. Sport-specific training
4. Non-contact training drills
5. Full-contact training with medical clearance
6. Game play
Home instructions
1. Complete physical and mental rest until symptoms are gone. No reading, text messaging, TV or video games, since all those activities can make symptoms worse.
2. Unlike older treatment protocols that called for the athlete to be awakened about every hour, let the athlete sleep. No need to check for athlete’s mental status changes. Seek immediate medical care if there is a worsening of the athlete’s condition.
3. Headache from concussion will not usually respond to pain medicines. Only time and rest help the headache.
4. See a doctor within 48 hours of injury for ImPACT Test.