What is a concussion?
A disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head.
What is post-concussion syndrome?
When concussion symptoms do not resolve in a reasonable time frame, athletes may experience chronic headaches, fatigue, sleep difficulties, memory deficits, personality changes, and challenges with academics.
What is Second Impact Syndrome?
Suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences and can cause seizures, swelling in the brain, respiratory failure, and death.
Source: Kettering Sports Medicine
A.J. Conti is an 11-year-old football player who dreams of someday suiting up for the Northmont High School varsity.
But ultimately, the young athlete’s future on the playing field might come down to more than ability. He’s already had two concussions.
“As a parent, you constantly second-guess yourself,” said Courtney Conti, who says A.J. has reached his limit. “There’s no guidebook. I don’t want him to be hurt when he’s older, but he loves it. I don’t know what he’d do without sports, to be honest.”
The Conti family is not alone. Parents, coaches and medical experts nationwide have wrestled with the concussion issue for years, and the brain injury is again in the spotlight with the release this weekend of the movie “Concussion.” The film is a scathing rebuke of the NFL’s response to studies linking the brain disease chronic traumatic encephalopathy, or CTE, to repetitive hits experienced by football players.
Dr. Bennet Omalu, who is portrayed in the movie by Will Smith, wrote a column in the New York Times earlier this month urging a ban of high-impact sports for anyone under 18. That controversial stance has been challenged by concussion experts, coaches and players.
“We do want kids invested in sports and physical activity,” said Dr. Kelsey Logan, director of sports medicine at Cincinnati Children’s Hospital Medical Center. “The vast majority of kids playing football are not going to get a concussion. The vast majority who do get a concussion are going to resolve very normally and have no problems afterward.
“There’s a few people who are going to have problems, and we have to recognize that quickly and take each injury seriously.”
Due in part to increased awareness, more concussions are being diagnosed in all sports — not just football. Head injuries also are common in soccer, wrestling and basketball.
An annual injury survey conducted by the Colorado School of Public Health estimates that high school athletes suffered nearly 300,000 concussions in the 2014-15 school year. That number peaked in 2012-13 at 348,565 — more than double the amount diagnosed four years earlier.
The Centers for Disease Control and Prevention estimates that college athletes account for more than 52,000 concussions each year. And according to Frontline, NFL players have totaled 612 in the past four seasons.
The medical community’s approach to recognizing and treating concussions is ever-evolving, as are the techniques taught by football coaches. They say better equipment and updated protocols have made their sport safer.
“Where are we going in this country? Everything can be dangerous,” Alter football coach Ed Domsitz said. “Our first reaction, it seems like, is to brand something as ‘too this’ or ‘too that.’ So instead of trying to work it out where we make it less dangerous but still believe in the integrity of that sport, we want to say it shouldn’t be part of the fabric of our society. That’s a problem.”
Less contact
Times have changed in football. Gone are the days when coaches denied players water and demanded they hit every day.
“There’s a big emphasis on safety,” said University of Dayton football coach Rick Chamberlin. “We’re only in full pads twice a week during the season, and full contact is very limited. Not much 11-on-11 where (injuries) could happen.”
Domsitz, who has won multiple state championships at Alter, said “we’ve changed what we do.”
“When I started coaching in the ’70s we had loads of contact every day. We don’t have anywhere near the contact we used to.”
The changes have failed to reverse a trend of fewer kids participating in the sport. In Ohio, more than 55,000 teens played high school football in 2008. By 2014, that number had dropped 23 percent to 42,840.
“I’ve got one boy in class who’s a freshman and he looks like he could be a pretty good athlete,” Domsitz said. “I’ve talked to him about football and he said, ‘My dad said it would be OK, but you need to talk to my mother. She doesn’t want me to play.’ ”
Bob Gardner, executive director of the National Federation of State High School Associations, has heard similar stories and calls mothers the “key decision-makers.”
“It’s important as we go forward to appeal to the moms and that they become aware of what things have been done to protect their sons, because the benefits outweigh the risks,” he said. “If we stopped everything that is risky, we wouldn’t let kids drive cars, no matter what age they are.”
Medical advances
Robin Lensch, a certified athletic trainer at Kettering Sports Medicine, has worked the sidelines at Fairmont High School football games for 19 years. Much has changed in how she handles potential concussions.
“Early in my career, we would watch them for 5-10 minutes. If they would clear, they’d probably go back the second half,” Lensch said. “Those trends have changed in sports medicine, for the good.”
Lensch said part of her toolbox now includes more sensitive eye tests to detect brain injuries.
“If there’s a lot of nystagmus or slowed eye movement, that can even be more sensitive than if an athlete is telling you, ‘I feel dizzy, sick to my stomach and have a headache.’ ”
Legislation to address the issue — Ohio’s Return to Play Law — went into effect in April 2013, providing guidelines for concussion treatment, including no same-day returns. Concussed athletes must pass several steps and be cleared by a doctor before they can return to practice.
The law also addresses concussion education for all coaches and the parents of athletes.
Increased awareness has led to more diagnosed concussions. Dawn Comstock, an associate professor who oversees the Colorado injury survey, says medical personnel may even be over-reporting because they tend to err on the side of caution.
“From a clinician’s standpoint it’s been much easier to appropriately manage (concussions) than it was five years ago because parents are much more aware of the issues,” Cincinnati Children’s Logan said.
That wasn’t the case when Anthony Conti, A.J.’s father and one of his pee-wee coaches, played at Northmont.
“They didn’t have the people on the sideline watching like they do now,” he said. “You go to the Northmont sideline and there are like six doctors down there.”
Conti played in the mid-90s when it was common to play through a concussion. Trainers are doing what they can to change that mentality.
“Back in 2007-08, about 10 percent of all athletes who had a concussion returned to play the same day, and 16 percent of football players who lost consciousness were allowed to play in the same game,” said Comstock. “That is now below 2 percent. It does still occur, partly because of a lack of trainers, and in rare instances symptoms don’t present right away.”
In every sport
The number of concussions in football is much higher than in other sports, but other athletes are not immune to head injuries. More than one-third of all diagnosed injuries in girls soccer are concussions, the highest percentage among high school sports.
Gregory Myer, research director at Cincinnati Children’s Sports Medicine, said one of the worst concussions he’s seen involved a cross country runner who ran into a tree. Lensch said the worst she’s seen involved a student who was injured at his part-time job.
But football remains the primary concern of those studying concussions. Logan, whose division at Cincinnati Children’s focuses on research and prevention, says the sport needs to change.
“I’m a huge football fan, but I’m less of a football fan than I was five years ago,” she said. “I think the culture of it still promotes things that are not healthy. We’ve got to get rid of everyone going for the big hit, and playing through concussions. That’s not easy.”
Zebbie Borland, whose son Chris stunned the football world by retiring earlier his year after playing just one season in the NFL, agrees with Logan’s assessment.
“I thought if he got hit and could still walk and talk, he was OK,” she said of the Alter High School graduate. “When you’re a middle linebacker you’re supposed to hit someone even when they don’t have the ball. His whole life he only played at one speed; he can’t back off.”
Danny Leach, a senior captain on UD’s football team, missed two games this season with a concussion. He suffered the injury against San Diego but didn’t report his symptoms until after the game.
Leach, a safety, said damaging collisions are inevitable in football.
“It happens so fast back there. You see a ball in the air, you see a receiver and you react,” he said. “The goal is to deliver a hard blow, not a dirty hit. You want to tackle correctly as hard as you can, hoping you can break up the pass. You’re not going out there with malicious intent, but football is tough and is meant to be played hard.”
What’s next?
Concussion research is relatively new, providing hope that researchers will make significant advances in coming years.
Myer is studying ways to slow the brain’s movement during impact. He is experimenting with a collar that slows blood flow from the brain; he demonstrated it on CNN last week.
The theory: If there’s more blood in the brain, there will be less space for the vital organ to move. He said football helmets can prevent only so many injuries.
“Everyone’s chasing that approach, but from a physics perspective that makes zero sense because a helmet adds mass and leverage,” Myer said. “It’s not the skull you’re protecting, it’s the brain. The brain already has a helmet, it’s called a skull. So you have to find a way to reduce that movement inside.”
But young A.J. Conti, who suffered concussions during the third and fourth grade, says his new Riddell Speedflex helmet helped him make it through this season with no problems.
“To spend $400 on a helmet so your kid’s head is safe? I’m going to do it,” Courtney Conti said. “It’s definitely a good investment.”
Those differing views about helmets represent the unknown about concussions: Nobody can gauge their impact with 100 percent certainty.
“We do not have a truly objective, universally accepted diagnostic tool,” Comstock said. “I think that will happen. In the relatively near future we’ll have either a blood marker or some kind of protein marker or imaging technique, something.
“We’ll have the equivalent of an X-ray or a lab test. Once we get that, so much of what we think we know about concussions will be thrown out the window.”
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