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District has pro-active policy on sport concussions

After the hit, a particularly powerful pop from a defensive back that appeared from the blind side at full speed, the receiver took a while to rise to his feet.

Visibly shaken, he was dizzy, somewhat nauseous, his head throbbing with a dull ache. Confused (he was a little frightened, not knowing how he’d suddenly seemed to appear at that place on the field), he could not figure out if he needed to run back to the huddle, line up or head to the sidelines. Fortunately, the ref who rushed to check him over as he rose on unsteady legs, led him over to his team. There, after a quick examination by the athletic trainer, he was told that he would be sitting out the rest of the game.

It was a good call, by the ref and the team’s athletic trainer.

Although the receiver told the trainer, “I guess I really got my bell rang out there,” the situation was much more serious than that. Like hundreds of thousands of other student athletes every year, the receiver had received a concussion. Sitting out the rest of the game not only potentially saved the athlete from future cognitive disorders or behavioral issues, but could well have saved the kid’s life.

Contrary to popular belief, a concussion is not a bruise to the brain caused by hitting a hard surface (in fact, swelling or bleeding is generally not seen on radiological scans), but occurs when the head either accelerates rapidly and then is stopped, or is spun rapidly. That disturbance of the brain causes neurons to become depolarized and fire all their neurotransmitters at once in an unhealthy cascade, flooding the brain with chemicals and deadening certain receptors linked to learning and memory. The results often include confusion, blurred vision, memory loss, nausea and, sometimes, unconsciousness.

In recent years, the issue of concussions has gained prominence as an area of concern in the media. First entering the national dialog after numerous retired NFL players reported cognitive, behavioral and physical problems, the issue of the effects of concussions on younger players began to take form. Although the NFL addressed concussions in late 2009 with the league’s most stringent rules to date, the NCAA and high school sports associations lagged in setting similar policy for student athletes. However, as the issue of sports-related concussions garnered more and more media attention, student athlete organizations quickly moved to regulate head injuries in sports.

Last year, the Colorado High School Activities Association (CHSAA) handed down policies, procedures and protocols to coaches, trainers and athletic directors regarding how the organization would regulate concussions in high school sports (that policy can be found at http://www.chsaa.org/sports/medicine/ along with other information on concussions).

Fortunately, the Archuleta School District 50 Joint was ahead of the curve on addressing sports-related concussions, not waiting for CHSAA action by instituting strict protocols for handling athletes that had sustained head injuries on the field of play. According to the district’s trainer, Steve Urban, “It’s a policy we’ve already upheld, anyway.”

Athletes suspected by Urban of having sustained a concussion are immediately sidelined and put through a series of tests to determine the extent of the concussion (if any) and what steps are necessary to insure the health and safety of the athlete.

Urban said that there are several grades of concussions that he typically sees: A Grade 1 concussion is one in which symptoms are resolved in 15 minutes while a Grade 2 concussion has those symptoms continuing for more than 15 minutes; a Grade 3 concussion involves any loss of consciousness.

The danger, Urban said, is Second-impact syndrome?(SIS), a condition in which the brain swells rapidly after a person suffers a second?concussion?before symptoms from an earlier one have subsided. The result of SIS is often fatal, and almost everyone who is not killed is severely disabled. Young athletes are particularly at risk and the reason Urban will not allow athletes to return to play before symptoms of the initial head injury have been resolved.

“Kids die, they go into comas,” Urban said regarding the catastrophic consequences of SIS.

It is not an easy call to make, but it is a necessary one. Compounded by the pressure of parents to see their child getting more playing time is the desire of coaches to field a winning team, Urban said he feels confident that, once the diagnosis of a concussion is made, all parties involved agree that erring on the side of caution is what’s best for an injured athlete. Indeed, an extensive body of research shows that once a person suffers a concussion, the athlete is four times more likely to sustain a second one. Worse, after sustaining several concussions, it takes less of a blow to cause the injury and requires more time to recover, making the risk of SIS a much larger concern.

Urban said that the district has taken a very proactive approach in setting protocols for injured athletes. Prior to even taking the field, district athletes are administered a series of cognitive tests that establish a baseline of responses that, after a concussion is sustained, are used in comparison to measure the effect of and (hopefully) recovery from the injury. Those tests are administered on a computer (the program was donated to the district by Mark Zeigler at Rocky Mountain Physical Therapy) and are a requirement for all athletes who desire to play high school sports.

Both the district and now CHSAA mandate that, following the identification of a concussion, the athlete is immediately pulled from the rest of the game and is subjected to numerous tests (including an examination by an independent physician) before being cleared to return to the field of play.

Urban added that while, “The vast majority of concussions we see are football injuries, we see them in every sport.”

“After a concussion, we assign a number score, on a scale of zero-to-six, on a symptom assessment checklist,” Urban said. “The goal is to get back to zero. Once at zero, and after seven days rest, the athlete can return to practice, but cannot participate. During that time, we put them through various physical tests to see if the symptoms return after blood is pumped through the brain from physical activity.”

If the athlete no longer presents with concussion symptoms, and is cleared by Urban, they are sent to a physician for yet another examination and assessment. After that, Urban then makes a final examination before allowing the student to return to play.

Ultimately, Urban said that there is no cookie cutter approach to dealing with student concussions and the district handles each case uniquely. “Nothing is set in stone,” Urban said.”“Every concussion is different. A lot of it depends on the maturity of the brain.”

Urban added that his job entails much more than just examining athletes on the sidelines and charting the progress of recovery from an injury. “I’m as much as a counselor as I am a trainer,” he said, “and a lot of times I have to talk to kids about the frustration they’re experiencing after a concussion. The memory loss, the inability to concentrate, the inappropriate emotions, it can be really confusing and devastating for a kid who can’t understand what’s going on with their brains.”

In fact, emotional disorders are often a symptom of concussions and a 2007 study found that retired N.F.L. players who sustained three or more concussions during their careers, 20.2 percent reported suffering from depression — three times the rate of players who never had concussions.

Likewise, significant cognitive impairments have been associated with numerous concussions including the inability to process short-term memories (making it difficult to retain new information), disturbed pattern recognition, decreased verbal ability and concentration.

Unfortunately, concussions can often go undiagnosed despite the attention given by even the most astute and conscientious trainer or medical professional. Indeed, recent research suggests that repetitive blows to the head that do not lead to obvious “punch drunk” symptoms can have no less devastating effects on cognition and behavior. Again, that research showed that younger athletes were most at risk for the deleterious effects of repetitive blows to the head on neurological functions.

That research has put pressure on helmet manufacturers to develop equipment technology that can prevent concussions. Although helmet companies have standards that are meant to ameliorate the effects of large-scale blows to the head, those are industry-enforced regulations and are not monitored by state or federal agencies, much less school athletic associations. As such, while helmets can be very good at preventing skull fractures, they do next to nothing in the prevention of concussions.

That could be changing soon: Earlier this week, the New York state legislature introduced a law designed to ensure that football helmets meet new safety standards to protect younger players, the first state to do so. Part of those standards is a challenge to manufacturers to develop technologies that minimize any and all impacts to the head.

Although research continues to grow in showing the negative effects of sports-related head injuries, it appears doubtful that the research will put an end to high school football any time soon. In Pagosa Springs, athletics in general (and football, specifically) are a long-standing tradition and the glue that binds a small community together. In order to insure the strength of that bond, the district has taken steps to look out for the future of its athletes. Unfortunately, although those steps go above and beyond CHSAA regulations, recent research suggests that those procedures and protocols are not enough to prevent the effects of repetitive blows to the head.

The future will tell if helmet technology is the magic bullet or, if no such technology is developed, if the future of football and other high-impact sports are worth the risk of lifelong impairments suffered by student athletes.

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