Every football fan has seen it and heard it.
That bone jarring hit that levels a player, leaving him motionless on the ground for endless seconds, sometimes minutes. While those hits have been occurring for years, medical professionals are now learning more about the cognitive effects those hits and collisions can have on an athlete.
MORE THAN JUST A BUMP ON THE HEAD
In the past, coaches, parents and athletes themselves have labeled the effects of major hits or collisions with other players as a person “having their bell rung.” Now, these effects are referred to as a concussion, and more and more research on the subject has increased awareness of the dangers associated with this type of injury.
“If it’s the same types of hits and things like we’ve been seeing, how many concussions could somebody like myself have had – having played in the mid- to late-90s – that nobody ever looked at or anything?” asked Adam Fossett, head football coach and athletic director at Childersburg High School. “I don’t know if I had concussions or not. I’m sure there are athletes that I played with that had concussions that nobody diagnosed and they didn’t miss a game or anything like that.”
Dr. Fazal Rahim, a neurologist at St. Vincent’s St. Clair Hospital in Pell City, said a concussion is defined as “any kind of traumatic brain injury, which will affect the way a brain works… a temporary effect on the brain by such trauma, be it a blow during a sports activity or a violent shaking.”
Concussions can occur in many sports other than football, including basketball, soccer, baseball, softball and others, according to the Centers for Disease Control and Prevention. A lot of attention has been given to concussions in football in recent years after former National Football League players have committed suicide, which medical professionals believe could be linked to damage to the brain as a result of the athlete suffering multiple concussions over a period of time.
“The brain autopsies (of deceased former NFL players), when they look at them, they found that the brain showed changes, like diseases that occur in older people, people in their 70s and 80s,” Rahim said.
Rahim said multiple concussions could have long-term effects, such as severe depression, dementia and emotional disturbances.
“The most important thing…anybody who plays a contact sport and gets hit on the head, you have to think about concussions because the symptoms tend to be mild and can be missed,” Rahim said.
Rahim also said doctors are finding more and more issues with what is referred to as Second Impact Syndrome, a phenomenon that has proven fatal in some cases where a person who has recently had a concussion receives another injury to the head, regardless of the severity of the second injury. Rahim said “nobody knows exactly why” that second impact has proven to be fatal in many cases, but it is one reason why physicians tend to be cautious before allowing an athlete to return to an activity after he or she has sustained a concussion.
NO VISIBLE PROBLEM
Concussions can be difficult to diagnose because it’s not an injury a person can see, according to Shaun Duhe, an athletic trainer with Coosa Valley Medical Center in Sylacauga. Duhe serves as the athletic trainer for high school teams at Childersburg, Fayetteville, Sylacauga and Winterboro high schools.
“The thing with concussions that is hard is that you can’t see a concussion,” Duhe said. “If you break a leg or sprain an ankle, you can physically see swelling or bruising or something like that. With a concussion, you can’t see it.”
With no visible injury, the concussed athlete could be led to doubt the severity of the injury, Duhe said.
“So if a person can’t see it, a person may say ‘maybe he’s faking or maybe he’s making it worse than it is,’” Duhe said. “They don’t understand that the person is hurt, but you can’t see that they’re hurt. I think that’s the big difference with concussions. The players who have them, they’re saying, ‘Well, my friends, they’re saying I don’t, so maybe I don’t have a concussion,’ or ‘maybe I should get back out there.’ It’s unlike any other injury in the fact that you can’t see it.”
PROTECTING YOUNG ATHLETES
The Alabama High School Athletic Association and the state legislature now have rules and a state law in place regarding concussions in high school athletes. Gov. Robert Bentley signed a bill in 2011 requiring all athletic organizations to provide information on sports concussions to all athletic participants and their families; ensure that all coaches have training in the recognition of concussions; and immediately remove a participant suspected of having a concussion from participation and not allow the player to return until cleared by a physician. The law mirrors the AHSAA’s current concussion policy.
Fossett and Duhe said athletes participating in any high school sport are required to have the AHSAA’s “concussion information form” on file with the school annually. The form lists symptoms associated with concussions as well as the organization’s concussion policy and requires the signature of both the athlete and his or her parent.
Coaches at AHSAA member schools are required to view an online concussion course, according to Fossett.
“It kind of makes it more meaningful,” Fossett said, referring to the online course. “It makes you as a coach, whether you are a head coach or an assistant coach, more aware of what’s going on, what signs to look for, what you need to do in case there is a concussion. As a coach, you have to figure out what’s important to you. Is that kid’s livelihood important to you or is that possible win important to you? I’d never put a kid in danger or anything like that. I’ve always kept them out if they need to be kept out and let the doctors decide what they need to do.”
During the 2012 football season, Duhe said he believed there were only a handful of athletes who sustained a concussion in the four schools he works with.
According to the CDC, “more than 300,000 sports-and-recreation-related traumatic brain injuries occur in the U.S. each year.” The CDC offers a “multimedia educational toolkit” for high school athletes and coaches. The initiative, “Heads Up: Concussion in High School Sports,” provides information for both players and coaches on concussions, symptoms as well as a video that features “a high school football player who was permanently disabled after sustaining a second concussion during a game.”
KNOWING THE ATHLETE
When dealing with young athletes, Duhe said learning the child, and being able to know if he or she will tell the truth about possible concussion symptoms is important when diagnosing the injury.
“It depends on the person,” Duhe said in response to a question about high school athletes lying about symptoms in order to keep playing. “There are some kids that may not want to be out there, and they will let you know every time something small happens. There are kids who really want to be out there and will try to hide things.
“You have to kind of know the athlete also, and know their personalities to be able to judge whether they’re telling the truth, or if they’re not.”
Duhe said he believes high school athletes are now starting to understand the possible danger associated with concussions.
“I don’t think they realize the full extent of the danger, but I think a lot of them watch SportsCenter, watch TV, hear it on the news, so I think they’re aware of the symptoms and are aware that a concussion can cause this. But they are not completely aware that it can happen to them,” he said.
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