Awareness key to concussion prevention
Steps taken to reduce risk to high school athletes
Throughout the past decade, “concussion” has become an increasingly dreaded word in the world of sports. With the growing awareness of the consequences of untreated concussions, being diagnosed with one or more can cause a week on the sidelines, the end of a season or, in some cases, a career.
A concussion — which the University of Rochester Medical Center describes as “a trauma-induced alteration in mental status” — is caused by forceful impact to the brain, such as a blow to the head or any other injury that shakes the brain inside the skull. According to mayoclinic.com, repercussions of suffering multiple concussions or a very serious concussion can result in long-term problems with speaking, motor skills or learning.
In high school sports, concussions are most commonly diagnosed among football players, with that sport being responsible for 53.1 percent of the concussions recorded in a report by the American Journal of Sports Medicine. Boys lacrosse and girls soccer follow, taking blame for 9.2 percent and 7.4 percent of concussions, respectively. The same study also found a 15.5 percent increase in concussions reported among student-athletes every year during the time span, 1997-2008. The study looked at more than 10 million athletes.
In all, experts agree that the best way to quickly diagnose and catch concussions is “being aware,” according to Valor Christian High School athletic trainer Allen Schroeder.
Valor Christian's football team, which is seeking its fifth straight state championship, is among the dozens of squads in Colorado that will take the field this week in the postseason with the threat of concussion ever present.
In recent years, steps have been taken to stem the threat.
In March 2011, Colorado Gov. John Hickenlooper signed into law an act commonly referred to as the Jake Snakenberg Youth Concussion Act. The law is named after Jake Snakenberg, a freshman football player at Aurora's Grandview High School who died in 2004 after suffering an apparent concussion and then continuing to play football the following week.
The guidelines include the requirement to complete an annual concussion recognition education course; the removal of an athlete suspected of a concussion from a game, competition or practice; and medical clearance from a health-care professional prior to returning to play in a game, competition or practice.
But is a law enough? What about the equipment?
Putting a cap on it
At least one piece of football equipment that some believe shows promise in concussion prevention has been outlawed by the Colorado High School Activities Association. The Guardian Cap, a stretchable, soft-shell helmet cover that fits over the helmet, can prevent “the sub-concussive hits,” or “long-term, small increment injuries,” according to Justin Greeley, instrumentation engineer for the Oregon Ballistics Laboratories in Salem, Ore. Greeley spearheaded the experiment to test the change in amount of impact of a helmet-to-helmet collision with and without the Guardian Cap.
“We're not here to determine if (the Guardian Caps) are safe or not,” said CHSAA assistant commissioner Harry Waterman, “We rely on the bodies that do the research.”
CHSAA adopts rules on equipment standards based on research from the National Operating Committee on Standards for Athletic Equipment in Overland Park, Kan.
Athletic equipment must pass a standard test known as the NOCSAE standard in order to be legalized for game play. The Guardian Cap failed to pass the NOCSAE Standard for Add-On Helmet Products certification
Columbine High School once used Guardian Caps for practice exclusively, but stopped using them due to “liability issues through our district,” said Columbine football coach Andrew Lowry.
“I sure wish we could (use them) because I truly believe in them,” he said.
The NOCSAE Standard for Add-On Helmet Products states that no add-on helmet products are permitted for game use without clearance for every single helmet make, model and size. According to the standard, “it is the maker of the product that declares that the product when modified by anyone be declared no longer certified,” said NOCSAE Technical Director David Halstead. “The reason is, it suddenly becomes unclear if the product, as modified, works as intended. It is unclear who stands behind it, both for product warranty, and in the event of injury litigation.”
Within the report by the Oregon Ballistics Laboratories and another report on a similar experiment by Wayne State University in Detroit, it was concluded, in all, that the Guardian Cap reduces the amount of impact from a head-on collision with a regular helmet without any accessories by 33 percent.
However, the NOCSAE standard still does not clear the Guardian Cap.
“They can't test (the Guardian Cap) with every helmet without certain financial issues,” said Greeley. “None of the (helmet companies) want to take on the liability.”
Other similar accessories throughout different sports, however, are allowed and used in games.
Headguards have been introduced to soccer recently because of the rising number of concussions in the sport, especially from girls soccer.
The Full90 Premier protective headgear is one headguard used throughout both boys and girls soccer, but predominantly in the girls sport. The headgear is a padded piece of equipment that covers the forehead and temple areas of the head, locations responsible for the most concussions in soccer.
Headguards have similar problems with the Guardian Cap. There may never be any hard evidence that these padded headbands will prevent concussions. The big difference is that soccer headguards are approved for game use by the NOCSAE standard and by the National Federation of State High School Associations. The main reason for the headguards' clearance is that there is no article of equipment that is being tampered with or added to.
The common theme throughout both of these pieces of equipment, though, is that there is no guarantee of preventing a concussion. Precautionary measures must still be taken to detect and diagnose concussions.
“Most concussion prevention comes in the form of rule changes within each sport,” said Bre Perdue, head athletic trainer for the boys division for Regis Jesuit High School in Aurora. “For instance, in football there is now a penalty for helmet-to-helmet hits. Players are also required to come out of the game for a down if their helmet comes off, and in lacrosse, the penalty was doubled for a check to the head.”
Preventing a second one
Perhaps the most daunting part of a concussion is the possibility of second impact syndrome, which is believed to be behind Snakenberg's death. Second impact syndrome, or SIS, occurs when a person with a concussion is forcefully struck on the head, causing severe swelling in the brain that can result in paralysis or even death.
The recent laws put into place mainly aid in the prevention of SIS. To help diagnose concussions to prevent SIS, various forms of technology are being introduced to athletes on and off the field.
Different forms of technology are being used for athletes in high school sports. Before every season, some schools require each athlete in each sport to take something called an impact test, a test that records a baseline of an athlete's brain's performance. If suspected of a concussion, the athlete retakes the same test to compare to their baseline. A certain score would translate to evidence of the brain not working properly, possibly due to a concussion. Nearly every school in Colorado uses this procedure, or a test similar to it, because of the concussion education laws.
Immediate tests such as the Stat-2 test, a series of questions testing the short-term memory of the patient, are used on-site at the competition or practice to quickly see if a player has a concussion. Medical clearance is required for an athlete to return to action.
Athletes diagnosed with a concussion are recommended to complete a “graduated return to play,” according to Perdue.
“Most graduated return to plays follow the Zurich Consensus Statement on Concussion in Sport,” said Perdue.
The Zurich Consensus Statement on Concussion in Sport is an annual statement on certain medical issues from Zurich, Switzerland. The specified statement recommends the athlete to be symptom-free before returning and then going through a series of steps upon return.
As Valor Christian's Schroeder said, awareness is crucial.
Diagnosing concussions, he said, is about “just making sure the coach or the parent has the training to (know when) to remove an athlete … it comes down to recognition.”