Concussions: An Unseen Injury

Ian Quinn doesn't even remember the hit that caused his second concussion.

It was the first day of football practice for the Simley High School student and local Boy Scout. After suffering his first mild concussion last spring, he spent much of the summer off his feet recuperating from ongoing headaches.

Finally, in early August, he was deemed healthy and allowed to start exercising. But the reprieve didn't last for long. During drills, Quinn went down a second time. He was diagnosed with another concussion, and expects sit out the rest of the 2011 football season as a result of the injury.

"It's disappointing [to miss the season]," Quinn said. "I stayed home all summer."

Repeated concussions, like those Quinn suffered, are one of the targets of a new law passed in May by the Minnesota state legislature which requires high school and youth coaches to take concussion-awareness tests, and for players to receive medical clearance before returning to play after such an injury. The law went into effect mid-August for high school athletics and Sept. 1 for youth programs.

Concussions are often an “unseen” injury: you may not have a lump on your forehead and you may not be bleeding—but the damage is there. In the short term, concussions—a traumatic brain injury that changes the way the brain functions and is often caused by a blow to the head—can cause headaches and nausea. If untreated or ignored, especially in younger athletes, the long-term damage can be far worse. In recent years, numerous studies and a flurry of media coverage have drawn attention to sports-related concussions and changed the way athletes, coaches and medical professionals think about them.

Sitting It Out

One of the primary purposes of Minnesota’s new concussion legislation is to keep athletes off the field until they recover from a concussion. And that’s important, according to Heather Bergeson, a sports medicine physician at the TRIA Orthopedic Center in Minneapolis, because it puts the decision into a medical professional’s hands rather than a volunteer or youth league coach who is unfamiliar with the symptoms.

Once the signs of concussion are gone, Bergeson recommended that athletes slowly return to play, doing light workouts before going back to practice and game play. That process could take at least a week—or more.

In reality, the law changes little about the way Simley coaches and staff approach concussions, according to Athletic Director Will Short. However, the law does ensure that all coaches, including junior varsity, B-team, middle school and youth league staff, will receive the training. In the past, Short said, only head coaches for teams were required to take the short online training course. All coaches at Simley took the course this summer, Short added.

"The way the trainers and coaches are trained to deal with the concussion [under the new law] is exactly the way they used to train them—what changed was the amount of people who got trained in the concussion training," Short said.

When they see an athlete get hit hard or collide with someone else in a play, the coaches will typically take the player aside and ask them if they’re feeling all right, Short and Simley High School Football Head Coach Rex King said. If the student shows any of the possible symptoms of a concussion, or complains about dizziness or loss of memory, the coach then refers the player to a trainer, who does his own evaluation. If the trainer suspects a concussion, he or she will refer the player to a medical professional for a diagnosis.

If diagnosed, the students are out for a minimum of two weeks, according to school policy.

Media Attention

The topic of sports concussions started gaining steam in 2009, when autopsies of several deceased former National Football League players revealed they suffered from brain damage caused by repetitive trauma—a condition known as chronic traumatic encephalopathy (CTE).

Researchers found that out of seven players who died by the age of 50, six of them suffered from CTE. The condition can cause problems with memory loss, concentration and coordination, according MayoClinic.com.

The NFL findings, along with a 2008 U.S. Army study that found that soldiers who suffered concussions are more likely to develop post-traumatic stress disorder, caused a “wave of awareness,” said David King, executive director of the Brain Injury Association of Minnesota.

Since then sports concussions at every age level and sport have received some attention.

Bergeson said although there is much more attention being paid to sports concussions, there is much more to understand. But one thing that medical professionals do know, Bergeson said, is that younger athletes tend to take longer to recover from concussions than adults. This is likely because their brains are still developing, she said.

And while the medical profession is still somewhat in the dark about the long-term effects of concussions, it’s important to take a conservative approach to treatment, she said.

“This law is a good framework to approach this systematically,” Bergeson said. “I think it’s a good thing for kids and their health.”

Everyone is Different

Bergeson explained that concussions are caused when the brain is moved inside the skull, either from a direct or indirect blow.

There are numerous symptoms of concussions, Bergeson said, and people often display them in different ways. Some might feel nauseous, while others may suffer memory loss.

Working as an athletic trainer for the University of Minnesota football team more than a decade ago, Brent Millikin, president of the Minnesota Athletic Trainers’ Association, recalled one player who couldn’t remember what stadium he was in or what team he was playing against after sustaining a major hit.

In that instance, it was obvious that the player had suffered a major head injury. Other times, it’s not so clear.

“There are some challenges” to identifying concussions, Millikin said. “It’s not like an ankle sprain.”

Even during those times, if a player had a concussion Saturday, but felt better Sunday, he’d often be back on the field Monday, Millikin said.
          
“We know we need to be more conservative now,” he said.

In addition to the growth in awareness, player’s equipment has also gone through drastic improvements over the last two decades, both Short and King said.

“The helmet that we played with in the mid-90s, which didn’t change much from the mid-70s, couldn’t even shine a light on helmets today,” said King, a former football player. All of the helmets the Simley football program uses have four- or five-star safety ratings, and the whole middle school team was equipped with new helmets this summer that have improved side-impact protection, King added.

“It’s different than a broken leg or pulled muscle,” King said. “When you’re dealing with somebody’s brain…that’s the next 80 or 90 years of their life.”

Editor's Note: This story is part of a three-part series examining the new state law on sports-related concussions in Minnesota youth sports. The series was reported by John Hageman and Inver Grove Heights Patch Editor David Henke, and edited by Regional Sports Coordinator Mark Remme.

YESTERDAY (Part I):

TODAY (Part II): Why proper recovery steps are important to an athlete’s long-term health.

TOMORROW (PART III): How one young woman’s testimony helped get the law passed, and how it affects youth sports.