Coaches, programs adjust as concussion diagnoses spike

CONCUSSION SYMPTOMS

The NFL uses seven observable symptoms used to identify players with concussions:

SOURCE: National Football League

At a time when athletes are bigger, stronger and faster than decades ago, precautions are being implemented to reduce the risks of concussions.

Concussion diagnoses in children and young adults under age 22 rose 500 percent from 2010 to 2014, according to a new study published by FAIR Health, a national, independent, nonprofit organization who says its "mission is to bring transparency to healthcare costs and health insurance information."

This study, the organization said in a release, was conducted based on healthcare insurance claims filed from 2007 to 2015 for people ages 0-22 years old.

An initiative by the National Football League intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries, is being felt all the way down to youth football, local coaches said.

“We’re all accountable,” said Lance Engleka, Middletown High School football coach.

The Ohio High School Athletic Association has joined dozens of states in adopting recommendations from the National Federation of State High School Associations’ Concussion Summit Task Force to address the diagnosis and management of concussions.

Since last year, the OHSAA has banned student-athletes from returning to play after a suspected concussion without a release from a doctor or athletic trainer. That permission must be written and submitted to the official before a player can return to a game after leaving with a potential concussion, said Dan Ross, OHSAA commissioner.

The state also instructed schools to limit full contact on consecutive days; a student-athlete is limited to 30 minutes of full contact in practice per day; a student-athlete is limited to 60 minutes of full contact in practice per week; and a student-athlete can be involved in full contact in a maximum of two practices in a seven-day span.

All coaches must review and know the signs and symptoms of concussion and to prohibit any athlete who displays these signs or symptoms from participating in a practice or a contest, the OHSAA said. Officials also are required to know the signs and symptoms of concussion and to direct immediate removal of any athlete who displays these signs or symptoms.

The state rule regarding return-to-play after concussions applies to about 350,000 high school athletes, Ross said.

A different perspective

Engleka has experienced concussions on two levels: as a parent and a coach.

His son, Cam, a junior football player at Springboro High School, was brought up to the varsity team toward the end of the season his freshman year, to run the scout team as the Panthers prepared to face Lakota East in the state playoffs. It was cold and rainy that day, so Engleka watched practice from his car.

He remembers his son getting sandwiched between two defenders.

“That’s a pretty good hit right there,” Engleka remembers thinking.

When his son got in the car after practice, he fell asleep, and his father had to wake him up when they got home. He took a shower, then fell asleep again, his father said. Then he was diagnosed with a concussion. The football coach faced what parents fear.

“As a coach you’re always concerned for your kids and their well being,” said Engleka, in his 23rd year of coaching. “But you’re looking at it from a football perspective. This was a different perspective for me. It was pretty unique. It made me more cognitive when players are complaining of head injuries.”

A standout athlete at Miamisburg High School, Engleka, 46, said when he played football, there weren’t the precautions like today.

“I don’t think the word concussion was ever uttered in a football setting,” said Engleka, a 1988 Miamisburg graduate who played baseball at Miami University. “They always used the words, ‘Did you get dinged?’ or ‘Do you see stars?’ There was a mindset that you didn’t want to show weakness, you didn’t want to come out, you wanted to keep playing.”

Then he added: “That has changed a great deal. The safety of the players is always first and foremost.”

Paul Young, a 1985 Badin High School graduate who played football at the University of Indianapolis, agreed.

“We were told to ‘suck it up and get back in there,’” Young said. “Going out of a game was considered a sissy thing.”

Young, now a coach and director of the Junior Rams football program, said his organization participates in Heads Up Football, a safety program that teaches football players the proper, and safer way, to tackle. The players are taught to lead with their shoulders, not their helmets.

Engleka said parents who have children interested in playing sports should educate themselves on the dangers associated with concussions, ask if medical professionals are available and what is the concussion protocol.

“Be as informed as possible,” he said.

Also, he said, players need to understand that if they suffer a concussion, there’s a possibility they may miss at least one game until they’re cleared to return. It’s a hard lesson for some players to understand, he said. They want to play. They aren’t thinking about the possible longtime effects of brain damage.

Engleka’s message: “You have the rest of your life to think about.”

Research still in its infancy

Engleka is not surprised by the increased number of concussions, especially considering the size and speed of today’s athletes.

“Bigger bodies in motion at a higher rate of speed, colliding, there is going to be some kind of residual affect to that,” he said. “It looks like the brain is taking the majority of those impacts.”

Dr. Scott Albright, of Orthopedic & Sports Medicine Consultants and Associates in Middletown, called concussion studies “the new frontier” because research is in its infancy. He said it may take years to better understand the potential damage done by brain injuries.

“Every kid is different,” he said. “Their brains are still developing. We don’t know the ramifications.”

He said baseline tests are used to assess an athlete’s balance and brain function as well as the presence of any concussion symptoms, he said. Results from baseline tests can be used and compared to a similar exam conducted by a health care professional during the season if an athlete has a suspected concussion, Albright said.

The NFL and its 32 club owners will provide $100 million in support of engineering advancements and medical research in addition to the $100 million previously pledged by the league to medical and neuroscience research, Commissioner Roger Goodell has announced.

Since 2002, the NFL has made 42 rule changes to protect players, in addition to staffing each game with 29 medical professionals, he said.

Player safety made national headlines since forensic pathologist Dr. Bennet Omalu’s 2002 identification of chronic traumatic encephalopathy, or CTE, in the brain of former Pittsburgh Steelers center Mike Webster, 50, who committed suicide. CTE is a progressive, degenerative disease set off by repeated head trauma, Omalu said.

Nearly a decade later, former Chicago Bears defensive back Dave Duerson, 50, committed suicide, aiming a gun at his chest rather than his head so his brain could be preserved and studied. Boston University researchers made a postmortem diagnosis of CTE.

In 2012, 80 concussion-related lawsuits on behalf of more than 2,000 NFL players were combined and filed as a single class-action lawsuit in federal court. The players accused the NFL of negligence and failing to notify them of the link between concussions and brain injuries.

Three years later, a federal judge gave final approval to a settlement in the lawsuit. This agreement provided up to $5 million per retired player for serious medical conditions associated with repeated head trauma and reportedly could cost the league $1 billion over 65 years. The deal also called for baseline medical exams for retired NFL players and monetary awards for those who are diagnosed with Alzheimer’s, Parkinson’s disease, dementia, amyotrophic lateral sclerosis and certain cases of CTE.

An estimated 3.8 million sports concussions occur in the U.S. each year, said Dr. Stanley Herring, of the University of Washington, a concussion expert and the team doctor for the NFL’s Seattle Seahawks and Major League Baseball’s Seattle Mariners.