by Sherry Posnick-Goodwin
The marching band hails the home team’s arrival on the field. Cheerleaders feverishly hurl themselves into the air. Excitement builds and the game begins. After a long wait, football season has finally arrived.
The roar of the crowd is deafening, and it drowns out the noise of two helmets colliding. A player falls and the crowd goes silent.
The injured player is removed and the game continues.
Coaches worry that the student may have sustained a possible concussion, but don’t know for sure. The symptoms — dizziness, nausea and headache — could happen instantly upon impact on a Friday night, or they might creep up on a student Monday morning while sitting in algebra class. There’s just no telling.
One thing is certain: Concussion rates in school sports are skyrocketing, having doubled in the last decade. Once considered a minor injury, repeat concussions are now linked to long-term brain damage. They happen more in football, but occur in other contact sports, too. Women’s soccer, for example, has the second-highest concussion rate. Then there’s lacrosse, volleyball, basketball and wrestling.
And that’s where our story begins — with Jake Forgy, a young man who got his “bell rung,” as they say, during a wrestling match last year while his mother, who’s a CTA member, watched in horror.
It started like any other wrestling match, before things took a bad turn. The coach didn’t see it, but Jake Forgy was severely head-butted by his opponent. Both boys were wearing helmets.
“I blacked out for a moment. I thought, ‘It’s no big deal,’ and kept on. Afterward, I felt weak. My head hurt. I felt dizzy and had to sit down. Then they took me to the ER,” recalls Jake.
After being diagnosed with a concussion, Jake was sent home to rest. His doctor advised him not to attend school, exercise, read, watch television or use a computer for a few days.
“It was hard. I wanted to stay in the competition. I wanted to go to school the next day. But I definitely knew I had the symptoms of a concussion.”
Now in his senior year at Montgomery High School in Santa Rosa, Jake feels fine. His goal is to play on the football and wrestling teams — and avoid more blows to the head, since research shows that multiple concussions affect how the brain functions.
A decade ago, Jake’s situation would have been handled differently.
“We’d say, ‘You just got your bell rung. Get back in the game when you feel better,’” recalls Dave Contreras, longtime football coach and the athletic director at Wheatland High School.
Today, concussions are taken seriously, says Contreras, a member of the executive committee of the California Interscholastic Federation (CIF), which governs high school sports. That’s because studies show repetitive head trauma can lead to permanent decrease in brain function, including memory loss, early Alzheimer’s disease and movement disorders. Getting back in the game is dangerous: A subsequent concussion before the brain recovers from the first one can slow recovery or increase the likelihood of an athlete having long-term problems.
There’s also a link to emotional disturbances. Some NFL players who committed suicide, including Junior Seau, suffered from chronic traumatic encephalopathy (CTE), a type of brain damage from multiple unhealed concussions.
Why the surge?
High school athletes sustain 300,000 concussions a year — and concussions doubled in the last decade, reports the Centers for Disease Control and Prevention (CDC). Football has the most, followed by girls’ soccer, where concussions mostly occur from colliding, not bumping the ball on one’s head. Hockey, basketball, wrestling, volleyball and lacrosse also pose risks.
“I think the increase is happening for a wide range of reasons,” says Contreras, Wheatland High Education Association. “Athletes are bigger, faster and stronger. They are more competitive, too.”
Frank Rodriguez, a school nurse and former high school football player, believes outdated, ill-fitting helmets, drills causing blindside “hits” to the head, not enough neck-strengthening exercises, and dehydration are factors, along with the public’s demand for extreme sports.
“Football is the ultimate warrior team sport, and it’s a collision sport,” says Rodriguez, Anaheim Elementary Education Association. “The athlete is mentored to think ‘Winning isn’t everything, it’s the only thing.’”
Students are starting sports at younger ages, and thanks to Title IX, many girls are participating in sports. Girls are more susceptible to concussions than boys.
Athletes are also to blame: Half of high school football players say they would continue playing, even if they thought they had a concussion. Nearly half say they wouldn’t report symptoms to their coach, despite knowing there are serious risks.
New rules protect athletes
“When in doubt, sit them out.”
This means athletes showing signs of concussion should be removed immediately from play and not allowed to return until they have written clearance from a licensed health care provider trained in the evaluation and management of concussions and brain injuries. After the CDC adopted that motto, the CIF passed Bylaw 313 in 2010 with that exact language.
The mandate is being taken seriously.
“You send kids to the doctor, that’s my bottom line,” says Tyrone Brown, athletic director at Silverado High School, where he has coached girls’ basketball and volleyball for years.
During a warm-up last year, one of his students was hit by “friendly fire” when a volleyball player spiked a ball at her head. When the girl remained lethargic, Brown urged her mother to take her to a doctor. The diagnosis: concussion.
Under AB 1451, passed in 2012, high school coaches receive online training every two years on how to recognize signs of concussions and respond appropriately. The training is important, says Brown, but doesn’t diminish the importance of health care professionals, since educators are not medical experts.
“The online training is helpful and makes you more aware of what’s going on, but we are not trained to diagnose concussions, and if we misdiagnose the situation, we could be blamed for acting as a doctor,” adds Brown, Victor Valley Teachers Association.
Targeting a defenseless opposing player and making contact above the shoulders are grounds for ejection under an NFL ruling two years ago, and the ruling has filtered down to the collegiate and high school levels. So has the rule stating if a player’s helmet comes off during play, the player must leave the field of play for one down, which reduces the threat of intentional bumping.
NFL players recently bargained to eliminate “live contact” during off-season practice to reduce the risk of brain damage from cumulative hits, and NFL players are not allowed to wear pads during off-season workouts. The National Collegiate Athletic Association (NCAA) has been urged to follow suit. Rules limiting preseason contact have not filtered down to high schools, but CIF officials say they may eventually. The policy has been adopted at Fresno Unified School District and a few others.
“We’re all trying to be proactive with sports, and it’s an ongoing process,” says Contreras.
Reducing hits during practice is a priority for Shane Wood, a football coach at Tulelake High School for 22 years.
“On occasion there needs to be some full impact, but that doesn’t need to happen frequently in practice.”
Wood’s players perform daily exercises to strengthen the neck, and they wear state-of-the-art helmets purchased two years ago with grant money. He also makes sure they drink plenty of water. None of these things guarantee a concussion won’t happen, but they can reduce the odds.
“We take a different approach now,” says Wood, Tulelake Basin Teachers Association. “We put more attention on taking care of the kids, and winning at all costs is secondary to athletes’ health.”
Setting a baseline
The best way to determine whether a concussion has occurred is having athletes take a “baseline” test, a preseason exam to assess balance, reaction time and brain function. Comparing post-injury reactions to baseline test results helps determine when a player can return to school and participate in sports.
Sometimes baseline tests are administered by a doctor or athletic trainer during an exam that clears students for eligibility. A player may be asked to count backwards, stand on one foot or perform other skills to assess cognitive and reaction levels.
A baseline test administered by Jake’s physician determined that he had a concussion, says his mother, Trista Forgy, a teacher at Strawberry Elementary School in Santa Rosa and president of the Bennett Valley Teachers Association.
“He had a perfect score during his physical, but after the concussion he couldn’t recite the months of the year backward or balance on one foot. It was shocking. We were blown away that he couldn’t do these things.”
Baseline tests are not yet mandated by the CIF for high school athletes, although some districts require them. Santa Rosa City School District, where Jake attends school, required athletes to undergo baseline testing this year. However, the Press Democrat reported that the testing hasn’t happened due to snags in hiring trainers to administer the tests and monitor students.
Online baseline tests are now required by the NCAA for college sports teams.
“They are very helpful,” says Kim Sutton, head coach for women’s soccer at CSU Chico and a California Faculty Association member. “The tests give feedback on reaction time, and when students retake them, we know how severe a concussion is. We make students retake the test repeatedly until it shows they are able to play. You can’t base your decision on what an athlete tells you, because they are not honest.”
Baseline testing can’t determine if students have had concussions in different schools. Sutton recalls a freshman who did not share information that she had one or more concussions before arriving at Chico.
“She displayed signs and symptoms of a concussion after a morning training session. On some days she couldn’t focus. She had severe headaches most of the time. She was nauseous, had physical discomfort, memory issues, and on some days was extremely depressed. Once we learned she had had multiple concussions, she saw a specialist. The doctor said she could not play contact sports ever again, because of the risk of injury. The student finished her freshman year and then returned home to seek medical care. She was only 18. It was heartbreaking.”
Changing the concussion discussion
In addition to following the CDC guidelines, use common sense. Don’t let athletes persuade you that they are “just fine” after a bump or blow to the head. Remind them that it’s better to miss one game than an entire season. Talk to parents so they recognize the signs and symptoms, suggests “Heads Up,” a free online course and resource toolkit offered by the CDC at www.cdc.gov/concussion.
Jake’s mother is glad to see a new focus on safety. While sports are a great way for youths to stay active, learn leadership and be part of a team, they can also be dangerous.
“It rocked my world; there’s nothing worse than seeing my incredibly active son hooked up to an IV and having a CAT scan,” says Forgy. “It won’t be easy watching him play football this year. He’s a big boy, and I want him to live his life. I prefer that he not do things that risk his well-being. But I’m glad to see the sports community is learning how to prevent, recognize and respond to concussions.”
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