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Concussion awareness prompts schools to adjust their programs

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Concussion awareness 1

Bulletin photo by Jonny Clinton Tackle football is the leading cause of concussion among organized high school sports, and the game has been in the national spotlight following a number of high-profile lawsuits by NFL players. In response to growing public awareness, the Wyoming High School Activities Association has changed the rules for both football games and practices to increase player safety and reduce the number of concussions.

Typically, after winning a state championship, a coach can look forward to a bump in the number of players who come out for the team the next year.

That’s not the case for Buffalo High School football coach Rob Hammond. After winning the 2A state title in 2018, the football team’s numbers are down, a trend that is part of a bigger national trend. High school participation in 11-player tackle football is at its lowest level since 1999-2000 with just over 1 million players, according to the National Federation of High School Association’s (NFHS) latest participation survey released in August.  

“Numbers are down nationwide,” Hammond said. “Wyoming is following that trend. We’re following that trend.”

While there are likely many factors in play, including athletes who “specialize” early in their careers and the decline of the three-sport athlete, Hammond said, the national attention on concussions is taking its toll on coaches’ ability to recruit young football players.

“Football is always the target,” said Ron Glassock, Clear Creek Middle School activities director and seventh grade football coach.

“Football is an easy target because people think of the contact and helmets hitting.”

Statewide, in 2018, about 200 fewer players played high school football in Wyoming than the previous year, according to the NFHS participation survey. During that season, Wyoming had as many high school football teams as it’s had since 2012 – 51 11-man teams and 16 6-man teams. But despite the number of teams remaining constant, about 4.8% fewer players suited up than the average number of participants over the preceding 16 years.

Over the same time period, the average number of participants in boys basketball declined by 0.7%, while the number of teams was largely unchanged. Average annual and overall participation in boys track actually increased during the same period, with the number of teams remaining relatively stable with 68 to 72 teams in any given year.

While there is still much that we don’t know about concussions and brain health – including why some people seem predisposed to concussions or why some head impacts lead to concussions and others don’t – for Johnson County Public Health Officer Dr. Mark Schueler, the relationship between blows to the head and concussions is clear.

“The brain is very complicated,” Schueler said. “If you go bashing it around, it’s likely to not work very well. It causes some micro-trauma, swelling, electrical disturbance, alters blood flow – it interferes with the normal function.

“There’s clearly an association – the more times you get hit, the more likely you are to see those changes. The connections are pretty strong. The likelihood is high enough that we’ve got to go with this theory.”

For Hammond, the connection is less definitive.

“A lot of the research that came out about concussions and CTE (chronic traumatic encephalopathy) was really premature,” Hammond said. “It’s good that we’re learning to protect kids, but a lot of studies came out and we just freaked out.”

Concussion awareness 3

Bulletin photo by Jonny Clinton The Wyoming High School Activities Association limits the amount of contact permitted during practice.

A totally different game

In addition to coaching the Bison football team, Hammond is a dad with two sons who play football and hockey – a sport that also has the potential for blows to the head, so he understands parents’ concerns and doesn’t discount that there is a risk to players. But he said it’s important for parents and players to know that the game is “totally different” than it was when his players’ parents were in high school, with many changes made to increase player health and safety.

“When I grew up, it was a different game,” he said. “The equipment was different, the technique was different – we hit with our heads. And we didn’t know what we do now about concussions; we just said you got your bell rung. Unless it was really bad, you played through it. It’s a lot safer game now.”

One of those added precautions is limiting player-to-player contact during practice. Per Wyoming High School Activities Association rules, player-to-player “live action and thud” contact is limited to no more than three practices per week and 90 minutes per week; during the preseason, the WHSAA permits 120 minutes per week.

“We’re limited to a few hours of contact per week,” Hammond said. “We use tackling dummies to teach those guys how to tackle without body-to-body contact.”

That is a change that is proving to reduce risk to players.

According to a study in the journal “Pediatrics” published last week, between the 2013-14 and 2017-18 school years, football concussion rates during competitions increased, but practice-related concussion rates dropped.

Another notable change to practices is the time devoted to perfecting tackling technique.  

“It’s a different technique,” Hammond said. “We’re teaching the guys how to play the game without using their heads.”

Glassock said that working on a players’ form is now a critical part of coaching, and coaches receive training on how to coach tackling.

“What coaches are aware of is instruction,” Glassock said. “We spend more time teaching the process and technique for tackling.”  

The rules of the game have changed, too, with an eye to decreasing head-to-head contact and blows to the head.

“One big one is you cannot hit a player blindside,” Glassock said. “That flag was booed a lot when the rule first came out, but more and more people know why that play is flagged.”

Rules now stipulate that players – whether as defender or ball carrier – must initiate contact with their hands.

“Some of the plays that would have made the highlight reel five years ago would be a penalty now,” Hammond said.

The equipment is changing too, Hammond and Glassock said. Helmets are better at deflecting blows thanks to helmet construction and technology.

Helmets must also be recertified for safety and efficacy every two years. According to BHS Activities Director Ryan Mader, every two years a professional comes into the school, examines the helmets and sends those that need reconditioning back to the factory.

Concussion awareness 2

Bulletin photo by Jonny Clinton

Kendra Shultze is brought down from behind this spring at Buffalo High School as the Lady Bison took on Powell. According to a report in “Pediatrics,” girls soccer is the second riskiest high school sport; football is the riskiest.

It’s not just football

Nationally, football has been in the spotlight with a number of high-profile players retiring early from the NFL. Players’ lawsuits seeking damages for cognitive or neurological problems they say were caused by repeated blows to the head have kept the spotlight trained on the league – and the sport.

But, football is not the leading cause of concussions in children ages 5 to 18. Bicycling is.

According to research from Brain Injury Research Institute, by number, bicycling causes the most concussions in children ages 5 to 18, followed by football, basketball, playground activities and soccer.

In this part of the country, falls from a horse or a four-wheeler cause a significant number of concussions, Dr. Schueler said.

Among organized high school athletics, data published in “Pediatrics” last week indicates tackle football led the pack with 10.4 concussions reported among 10,000 “athletic exposures” – the number of practices and games in which an athlete participates. Girls soccer was the next riskiest with 8.19 concussions per 10,000 athletic exposures. Boys ice hockey, with 7.69 concussions per 10,000 athletic exposures, is third.

“We really don’t have that many head trauma injuries in soccer,” said longtime BHS boys soccer coach Dick Edgcomb. “It comes more from collisions; it’s when players tangle and heads collide. Or a player gets closer to the ground and gets kicked, or they fall and their heads hit the turf – and the ground is practically frozen in the spring.”

Although many focus on the hazards of heading the ball, a new study of high school soccer players by researchers at the University of Colorado found that contact with another player was by far the most frequent cause of concussions among female and male players.

Edgcomb understands why heading looks so potentially dangerous, and why it is prohibited in many youth leagues.  

“In our youth soccer, they don’t allow heading until U14 – when the kids are more developed,” he said. “When kids come up to BHS, they aren’t very good at the technique of heading because they haven’t done it. So we have to teach that when they come in as freshmen. I can see why the youth program doesn’t allow it.”

The study’s authors predicted that “banning heading is unlikely to eliminate athlete-athlete contact or the resultant injuries.” They noted that soccer had become a much more physical sport in recent years, resulting in more collisions between players.

“I saw the game in Illinois get super physical – they used to call it gorilla ball in the early ’90s,” Edgcomb said. “In Wyoming, the athletes are getting faster and stronger, so the potential for more collisions is there. It’s maybe not our style of play, it’s just the level of athleticism.”

Edgcomb said that, as a coach, he favors a more conservative style of play that better protects his athletes from injuries of all sorts.

“Actually, in Buffalo, we’re not physical enough in many respects,” he said. “We have what we have – 25 to 35 kids and you have to get through a season with that number of kids. You can’t have injuries to get through a season. So in our practices we steer away from physical confrontation because you don’t want to see anyone get hurt in practice.”

But, as a longtime observer of the sport, Edgcomb said that changes in officiating practices also influence how physical the game has become.

If referees can’t keep up with the faster pace of play that is common now, players look for opportunities to get away with more physical play.

“Are we able to referee tight enough to keep the players under control?” he said.

And for new referees, “getting their groove, if you don’t call the fouls early, high school boys remember who fouled them. High school kids remember, and so the potential for retaliation is there,” Edgcomb said.

Kaycee football

Kaycee Buckaroo gridders sprint around the practice field last week at KHS as they prepare for a 2018 zero week matchup. According to figures released in August, Wyoming is part of a larger national trend, with fewer athletes participating in tackle football.

Concussion protocol

Mike Engling is a physical therapist at Johnson County Healthcare Center who has worked with the concussion protocol in Johnson County Schools for close to a decade. He takes concussion diagnosis and treatment seriously – he’s seen every concussion sustained by BHS students in the past 10 years and knows that brain blows can be life threatening.

In August, Rock Springs High School football player Jaciel Granados suffered a head injury at practice that led to a flight to Salt Lake City to undergo brain surgery.

According Mader, the district’s concussion protocol starts before a student athlete laces up his or her sneakers for the first time as a freshman.

Mader said that any freshman that signs up for an impact sport – football, volleyball, soccer, diving, basketball and pole vaulting – must first take a baseline ImPACT test. The test is offered free of charge to all student-athletes who participate in contact sports at BHS, Clear Creek Middle School and Kaycee Schools.

The computerized test measures students’ verbal and spatial memory, their reaction time and cognition. For example, the test may display a list of words and instruct the test taker to memorize the list. Then the test will ask the test taker to recall as many of those words as possible. The test results reveal how that person’s brain is functioning compared with age-matched students across the country.

According to Engling, having a baseline reading of the student’s brain function is vital in evaluating that athlete after he or she has experienced concussive symptoms.

If a student sustains a blow that coaches feel could cause a concussion or if a student presents with concussive symptoms – headache, sensitivity to light, confusion, forgetfulness, slurred speech or nausea, among other symptoms – the student must be evaluated by a medical professional, Mader said. The student will also retake the ImPACT test so that medical personnel can compare the student’s current brain function to the preseason baseline function.

The test is just one of the indicators medical professionals use, Engling said.

“Our protocol to return to play is you have to pass the ImPACT test; you have to be symptom free with exertion and pass a physical examination with a physician,” Engling said. “The state requires a physician to clear the player to return to the sport.”

The real benefit of the state rule requiring a physician’s clearance, according to Glassock, is that it takes the guesswork out of returning players to the sport.

“It’s made coaches’ jobs easier because we’re not the ones diagnosing concussions now,” Glassock said. “If you have symptoms, you’re immediately removed from the game.”

Returning to play is the goal of nearly all student-athletes after a concussion. Engling said that depression is a possible side effect of sidelining students because their sport is “part of their identity.”

“Most of the time, with concussions, the kids are begging to come back,” said Hammond. “It probably is frustrating for them because they have to clear every test.

“But it’s made it easier. I don’t have to have this debate: Well, he’s a senior and this is his last home game. Now we just defer to the doctors.”

Engling works closely with athletes, coaches and physicians to help kids heal.

“Our rehab team provides guidance with focus on rehabilitation and exercise,” Engling said. “The system works well. The recovery can work well if we do the process right. Essentially, I treat them as if there were my children – what would I want before they return to play?” Engling said.

Engling and Mader said that coaches are more aware than ever before of concussive symptoms and athlete safety.

“We do have kids who hesitate to report,” Mader said. “But our coaches do a good job. If they see a symptom or have an inkling that the athlete could have a concussion, they are out.”

Parents are also more informed and understand the risks associated with contact sports. In preseason meetings, Mader and coaches provide parents with a list of symptoms associated with concussions as well as the district’s concussion protocol.

“We’ve had a student who had a number of concussions, and it was the parents who stepped in and said, ‘You need to find another sport,’” Mader said.

A cost-benefit analysis

Glassock and Hammond both know that their sport is taking a beating in the public arena, and neither sugarcoats that a contact sport – any contact sport – comes with certain inherent risks to players.

“I’m worried that people are taking away a game that teaches kids so much – teamwork, work ethic, leadership,” Hammond said. “I think it’s the ultimate team sport; it’s a good thing for kids to go through. I don’t want the game of football to go away, and I don’t want to risk a kid’s health, either.”

It’s also one of the few sports that anybody who shows up gets to be on the team, no cuts involved. A boys basketball team is always going to be limited to 12 players, but in football, “everybody can have a role,” Glassock said. “The numbers are dropping, I get it. But it’s still too bad; it’s still a great team sport.”

It’s a cost-benefit analysis, but Engling isn’t sure that kids understand the potential for long-term side effects.

“I don’t think the kids understand all the long-term effects of concussion,” he said. “Medicine doesn’t yet.”

“I think it’s good that we’re more aware of concussions,” Dr. Schueler said. “It’s a real dilemma, especially with football because you love it, but we’re realizing maybe the cost was higher than we initially thought. I think there are some serious decisions parents have to help their kids make.”

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