Concussions changing contact sports and not just football

By: Andrew L. John, The Desert Sun | September 2, 2016

Indio football coach Marty White, talks to players during a game. (Photo: Zoe Meyers/The Desert Sun)

A brutal collision left Marty White dazed and disoriented after he clutched a football to his chest and accelerated through a seam in the defense under the bright lights on a random Friday night in late 1982.

White, then a high school junior in Buffalo, N.Y., slowly picked himself up off the field and unwittingly shuffled to the opposing sideline with his mind in a fog. His team’s coaching staff retrieved him, returned him to the correct side of the field and two plays later he was inserted back into the action.

White played the remainder of the game, he was later told, though even then he couldn’t recollect much of it. On the bus ride home, he curiously looked down and noticed the dirt and grass stains that camouflaged his jersey.

“I looked down at my uniform and asked my friend, ‘How did we get so dirty on the way to the game?’ ” recalls White, now the head football coach at Indio High School. “I didn’t realize that we had already played.”

White later played college football at Penn and estimates he suffered four or five noticeable concussions during his playing career. In some cases he blacked out. Other times, he slurred his speech and experienced memory loss immediately following the violent encounter that caused the trauma.

Now as a coach, during a time when concussion research and awareness is surging throughout the country, White sees the contrast in how such trauma is managed from when he played the violent game.

“When we played and you got your bell rung, it was, “Are you OK? How many fingers am I holding up? OK, go back in,” White said.

“Night and day.”

As White has witnessed, concussion management and discussion are slowly changing in the Coachella Valley, despite being secluded in a corner of a state that lags behind a nationwide emphasis in new concussion-related education and protocol.

California is one of the few states that does not require high schools to have a full-time certified athletic trainer on campus to monitor concussions and other forms of trauma. As a result, just 19 percent of the roughly 1,500 schools in the state have a certified individual monitoring concussions and ensuring proper procedure is carried out.

“A state that is very behind in their understanding and awareness of especially concussion management, but I’d say sports medicine in general,” said Patty Curtiss, a certified trainer and concussion consultant who works with Eisenhower Medical Center and College of the Desert.

Patty Curtiss, COD Athletic Training Program Lead. (Photo: Zoe Meyers/The Desert Sun)

Six of the 14 valley high schools (43 percent) have a certified trainer on campus, alluding to the progress that is being made. Still, the number leaves much to be desired at a time when rapid concussion education has moved to the forefront of sports-related athletic training.

“The No. 1 thing that schools and school districts in California can do to help reduce risk and minimize injuries is having a certified athletic trainer at their schools with their student-athletes and their athletic teams,” said Roger Blake, the executive director of the California Interscholastic Federation.

“On concussions, it’s the return to play protocol, and that certified athletic trainer is the one who can really make a difference on that high school campus.”

In some instances, having a certified trainer on campus is the difference between a concussion that is misdiagnosed and mistreated versus one that leads to full rehabilitation.

Baseline testing has been used for years by professional teams and colleges, yet has only recently been a fundamental part of concussion prevention and rehabilitation at the high school and youth level.

The testing, performed by a trainer or physician, provides a baseline assessment for an athlete, and further testing after head trauma can help properly diagnose the severity.

One time a year, Andre De Leon, a physician at Eisenhower Medical Center, and other physicians organize a free lecture and seminars to educate parents about concussions and how they can be detected and addressed.

“Bones heal and you can get kind of normal function back, but once the brain gets damaged — I mean, they can heal to a certain level, but it can’t completely heal,” De Leon said. “We need our brains, it’s our executive functions. If that gets damaged, having a good leg doesn’t really help us out.”

Nationwide concussion awareness and treatment has endured a massive overhaul over just the last 18 months. As awareness is raised about the long-term effects of not properly treating concussions, through movies, for example, public education on the subject is increasing. Athletes are becoming more aware of the importance of not playing with concussion symptoms.

“The days of you getting your bell rung and going back into a game are over,” said Dennis Zink, the athletic director at Palm Springs High School. “And it’s because the attitude toward concussions is changing.

“That’s really been the biggest thing.”

The concussion discussion has helped drive mainstream awareness, but in a lot of ways, the general public had been left in the dark about the severity, in part because until recently the NFL refused to acknowledge the catastrophic long-term effects of repeated head trauma.

“Where the NFL has helped is they’ve put the spotlight on it,” said Roger Blake, the CIF executive director. “But the NFL also kept it from moving forward much quicker.”

Blake decided not to wait on the NFL. In 2007, he and the CIF’s Sports Medicine Advisory Committee (SMAC) sat together wondering what to do about the ongoing problem that seemed to be getting worse by the year.

Ongoing research has found evidence to suggests female athletes are concussed more frequently than their male counterparts, primarily in sports such as soccer, lacrosse and basketball, and that recovery time is typically longer than it may be for males. Researchers are studying the trend further and forming data, which as of now is inconclusive.

The Centers for Disease Control reports that approximately 3 million sports and recreational concussions occur every year — a number Curtiss, the concussion consultant, believes is vastly underreported. Research shows that catastrophic head injuries and long-term cognitive disorders are a direct result of injured athletes returning to play too soon after a concussion, and that proper treatment is necessary for an individual to return to proper health, even after symptoms desist.

With harrowing research emerging and data linking concussions to severe long-term cognitive disorders, the CIF state office initiated a change in its policy regarding head trauma. If an athlete is suspected of having a concussion, they must see a physician before returning to play. Before then, it was largely up to the parents or the coach.

Studies have shown that a concussion to a child under the age of 15 will be a more severe injury to the brain than that of an adult. Therefore, recovery time will be longer. The risk of long-term cognitive damage can be more astringent if not treated properly.

SMAC took another step in concussion protocol in 2010 by offering mandatory training for coaches to help them recognize concussion signs and symptoms.

The information prompted SMAC to take the next evolution in concussion protocol. In January 2015, CIF implemented the “return to play” rule in its bylaws. It requires a player to sit out at least five days after suffering a concussion, no exceptions. It was a way to avoid having parents take their children to multiple physicians, shopping for approval, which was becoming more common.

The science behind concussions over the last five years has provided insight into the effects. Significant head trauma sheers the neurons, and potassium, calcium and aluminates are released, which stops the brain from producing energy for about six days. Then the blood flow returns to normal in about 9 to 10 days.

Much of the reasoning behind waiting a period of time before returning to play is that in some catastrophic injuries, it’s the second impact that does the most damage. If a brain hasn’t fully recovered from the first concussion, and is then hit again, research shows that it can be catastrophic, even deadly.

“The diagnosis is really different today than it was three or four years ago,” said Curtiss, the concussion consultant. “It’s not always getting your bell rung, but the multiple impacts over time. It could take a very little blow to put someone over the edge. Symptoms could be delayed.”

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CIF, concussions, football, Marty White, nfl, SMAC, News