The days of jarring hits in football being brushed off as “dings” or “cleaning out the cobwebs” are long gone.
With growing concerns over sports-related concussions, prep football players, coaches and parents are urged to take every high-impact collision seriously.
In terms of awareness, concussions have exploded onto the scene the last five years according to Dr. Alexander Powers, a neurosurgeon at Wake Forest Baptist Medical Center. A recent study authored by Powers revealed that even players who didn’t sustain concussions showed changes in the brain’s white matter over the course of a high school football season.
“After a season’s worth of football, kids that hit harder had more changes in white matter,” Powers said. “These are kids that did not have concussions. Obviously playing football exposes your head to risks, (such as) concussion and head injury. It also exposes the head to white matter injury, almost a bruising of the brain that occurs, that is proportional to the force of the hit.”
According to the Institute of Medicine and National Research Council, approximately 250,000 sports- and recreation-related concussions and other traumatic brain injuries among kids ages 19 and under were treated in U.S. emergency departments in 2009.
The report continued to say that those estimates are likely conservative, in part because many young athletes encounter a “culture of resistance” embedded in football when it comes to reporting when they might have a concussion or to following treatment plans.
Players worry about letting their team down, disappointing their coaches, or fear that reporting symptoms might affect playing time. Powers noted this mindset is widely prevalent in all levels of football — from Pop Warner and high school to college and the NFL.
“You look at the culture of the NFL and Major League Baseball,” Powers said. “You get hurt in the NFL, you are expected to play. If you get hurt in baseball, you are removed from the game, and rehab is a slow process. They don’t want you to play unless you are 100-percent healthy. It’s just the culture of football. It’s a tough guy’s sport where collisions occur on every single play of the game.
“It starts with the coach. You want kids to be tough, and play as hard as they can, but you are also protecting the kids the family has entrusted you with. I love the game of football. I have two sons that play the game. I want the game safer.”
Powers said his two sons (ages 10 and 12) have played youth football, but likely will not play at the high school level.
“It’s hard for me to do this research and let them go out and play,” Powers said.
North Carolina high schools are required to have a certified athletic trainer on the sideline, and many schools also have a physician on hand as well.
“Years ago, it was ‘You got your bell rung.’ That is no longer the position,” Mount Airy athletic director and offensive line coach Donald Price said. “We’ve got a physician on the sideline. You’ve got the Gfeller Concussion Act. We are constantly talking to and monitoring the kids. Once a kid says something or we see something that doesn’t look normal, we’ll have him talk to the doctor.”
Once a player is suspected of sustaining a head injury or confirmed concussion, he must be removed from the game and the school/athletic trainer/physician is required to follow the Gfeller-Waller Return to Play protocols. A form clearing the player to return must be signed by a licensed physician or D.O. before he attends a practice or game.
Having the protocol in place for handling a suspected concussion takes judgment calls completely out of the coaches’ hands and into medical personnel.
“There are some coaches that want to win at all costs. Some coaches lose perspective as the game progresses,” Price said.
A year ago, scientists at Wake Forest Baptist Medical Center came up with a way to measure the cumulative effect of impacts to the head incurred by football players. The Risk Weighted Cumulative Exposure metric captures players’ exposure to the risk of concussion over the course of a football season by measuring the frequency and magnitude of all impacts, stated Dr. Joel Stitzel, the senior author of the study.
According to the study report, concussions are the most common sports-related head injury, with football players having the highest rate among high school athletes.
Thousands of former professional players have filed lawsuits against the NFL, claiming the league was aware of the long-term health risks associated with head trauma.
“I think people have become more familiar with the signs and symptoms,” East Surry athletic director and defensive coordinator Randy Marion said. “With the education, it’s a buzz word now. A lot of people are talking about concussions.”
According to an ESPN report, Pop Warner saw participation drop 9.5 percent from 2010-12, “a sign that the concussion crisis that began in the NFL is having a dramatic impact at the lowest rungs of the sport.”
Football isn’t alone in the concussion conversation.
This year’s World Cup in Brazil and the numerous head injuries sustained in the tournament brought attention to the risks of concussion in soccer, a contact sport played at a high speeds and with little protective equipment.
“We definitely take (concussions) seriously,” North Surry head football coach Danny Lyons said. “It’s not just a football issue, it’s an athletic issue. There is a drop in participation in football. A lot of it has to do with the fear that’s out there about concussions and the brain.”
Many schools are taking steps promote concussion awareness, such as the Heads Up Football safety program which held a workshop in Forsyth County in June. The event was sponsored by the Matthew Gfeller Foundation. Gfeller was a student at RJ Reynolds High School in 2008 when a severe helmet-to-helmet collision during his first varsity football game caused a brain injury that led to his death two days later.
The N.C. High School Athletic Association is also being proactive. If coaches don’t comply with a state-mandated concussion management course requirement, they can expect to pay the price. At this spring’s NCHSAA board of directors meeting, the state approved a $500 fine per game for coaches who do not meet the mandate to take the National Federation of State High School Associations concussion course or equivalent course.
Coaches can also explore additional options, such as webinars, clinics, and health and safety classes.
New technology is also helping provide more data on concussions. Helmets can be fitted with sensors that send wireless alerts to coaches or trainers with hand-held devices on the sidelines, letting them know when a player has sustained a major hit, or series of hits, to the head.
The results of the preliminary study that revealed changes in the brain’s white matter were presented at the American Association of Neurological Surgeons annual meeting in San Francisco in April. Each player on a 45-member varsity football team wore a helmet fitted with an accelerometer device, which measures the impact of hits sustained in a game.
“I foresee a day when accelerometers are in every single players’s helmets,” Powers said. “They are used in terms of game management and player safety.”
In terms of players with a concussion history, Powers said he sees plenty of kids with repetitive injuries who were sent back to play too soon. If they are still experiencing symptoms such as headaches, dizziness, or neck pain, he encourages them to be honest with themselves and their physicians.
On Aug. 1, prep teams will be allowed to hold their first live practice, with the season openers set for Aug. 22.
While guiding their area football stars on the field this season, coaches will also be keeping an eye out after high-impact hits that might lead to players “seeing stars.”
“(Parents) have the expectation that the coach is going to coach their child in the safest manner possible and that the coach is going to take every effort and every caution to protect their child on the field,” Price said. “As a coach and an athletic director, if you are not going to do those things, you don’t need to be coaching.”