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How to play smart and reduce the risk of concussions

This article first appeared in the St. Louis Beacon, Sept. 16, 2010 - Jared Hagely couldn't help himself. Suddenly he was in tears. Then he started laughing.

But this wasn't funny.

During a varsity football practice two years ago at Francis Howell High School in St. Charles County, Hagely, then a sophomore, was blindsided by a block during a punt return drill near the end of practice.

He picked himself off the turf and kept playing, but after the day's final whistle, while gathered with his teammates, he leaned in and asked one of his friends when practice was going to start. When the friend looked at him quizzically and told him practice was over, Hagely burst into tears, followed by laughter, then more tears.

The friend alerted coaches that Hagely was acting strangely. After looking him over, coaches quickly alerted the team trainer.

A short time later, while in the emergency room with his mother, a doctor confirmed what everyone suspected: Hagely had a concussion.

He had never lost consciousness and had only slight memory loss, indicators of a mild, first-degree concussion. Still, it made a strong impression.

"I had blurred vision, deja vu and my emotions were all over the place," Hagely said. "You're really confused, and you don't know where you are."

It's a story that could take place on any high school football field, soccer pitch, basketball court, baseball diamond or ice rink.

Concussions are a reality of youth sports, especially in the violent game of football, which has the highest rate of traumatic injuries among organized sports.

When it comes to recognizing and treating concussions, however, a recent study in Pediatrics magazine indicates that parents, coaches and players are more aware of the risks involving head trauma, and more prone to seek the proper treatment.

The Pediatrics study found that emergency rooms visits for concussions for 8- to 13-year-olds doubled from 1997 to 2007, and tripled for 14- to 18-year-olds. Those numbers don't necessarily indicate a spike in concussions, but rather, a spike in the number of concussions that are properly diagnosed.

Bryan Koch, Hagely's football coach at Francis Howell, agrees that awareness about concussions has been on the rise in the last decade. How coaches and players view head injuries has changed drastically since he was playing football himself at Francis Howell in the late '90s, then as a tight end and offensive lineman at the University of Illinois, from 2000-03.

"As soon as a kid says they're getting headaches or they're dizzy, there really are no more 'dings' to the head," Koch said. "As soon as something like that comes up, we send them to the trainer immediately and let them diagnose it."

Bob Bunton, who has been coaching football at Parkway North High School in St. Louis County for 29 years, said that years ago, playing through the pain of a head injury was seen as being tough. Nowadays, it's seen as stupid.

"I always laugh at the guys who say things like, 'Well, in my day,'" Bunton said. "Well, you know what? In my day, in the '70s, we were stupid enough to take salt tablets before we went out for two-a-days. Now, how dumb is that? We've evolved in education. I read these articles about concussions. Personally, I think we have evolved in terms of coaches."

More enlightened, but not invincible

Football has evolved markedly, as well, in regard to safer equipment, most notably with helmets.

On its website, Riddell touts research that shows a 31 percent reduction in the risk of concussion in players wearing its Revolution helmet. Xenith, founded by Dr. Vincent R. Ferrara, a former quarterback at Harvard, markets its X1 helmets with the slogan "For the Enlightened Warrior." The new company says its Adaptive Head Protection system, combining integrated technologies, is designed to reduce the sudden movement of the head by adapting to different energy levels.

The X1 and the Revolution are light years ahead of the headgear worn by players when Bunton was in high school. The coach said he shakes his head at the thought of how little protection the old suspension helmets of his era offered.

"I'm surprised that we didn't have more head injuries," he said.

Bunton, like Koch, is quick to point out, however, that while the new helmets reduce concussions, they are not 100 percent concussion proof. Bunton has yet to have a player on his roster suffer a concussion this year, although he attributes that string of good fortune to luck more than state-of-the-art helmets.

Koch added that the promise of safer helmets often leads players to think that they can't get hurt.

"Our district provides us with the best helmets on the market, and I think sometimes the kids think, OK, I've got the best helmet on the market, I'm indestructible now. What it comes down to: Kids still need to learn the right technique. They still need to learn not to lead with their head and not hit things they can't see, keep their head up, keep their eyes up."

Bunton said teaching proper technique with tackling is essential to keeping players safe, and stressed that, as a father, he pays attention to what his youngest son is learning while playing youth league football.

"I have a real problem with some of these guys who coach little league football. I tell our guys on staff, some of these people are dangerous. They have not been trained or educated to coach. Their experience is playing football and thinking that these kids are supposed to be headhunters and all that. That's such a dumb mentality in my opinion."

'Like a car accident'

Even with proper coaching, safer equipment and more alert coaches, recognizing and properly treating concussions can be tricky.

A player may feel inclined to fib about symptoms to get back on the field sooner. Coaches, parents and trainers are often prone to take that player at his word.

Hagely said navigating through recovery after he suffered his first concussion, then a second last fall as a junior, was a process that proved difficult both times.

He wanted to get back on the field, and, after the initial symptoms went away, Hagely said being completely honest about something like a small headache was difficult, especially when, to his teammates, he looked fine.

"It's a really serious injury, but it feels like you're almost babying yourself," he said. "You're injured, but in your head, you feel like you can still play because it's not like you have a broken arm or a broken leg. But it's just as serious."

After his son's first concussion, Gary Hagely said the doctor's advice was to wait a week after the last headache before playing again. Once symptom free, his son re-integrated himself into physical activity with things like riding a stationary bike, plyometrics, then sprints. At the first sign of a headache, the directive was to stop. In total, during his sophomore season, Jared missed three games -- two JV, one varsity --- and sat out more than two weeks.

The second concussion came late during the season last fall when the side of Hagely's head collided with the knee of an opposing team's running back during a tackle in the open field. Gary Hagely said, one play later, he could tell from the stands that his son wasn't right.

"When he got up, he walked kind of goofy and not like himself," Gary Hagely said. "You can always tell how they carry themselves on the field, when they're your own kids. He's not walking like his normal walk, strut, or whatever you want to call it."

Hagely came out of the game shortly after that, and after a trainer diagnosed another concussion, she motioned for both parents to come down to the sideline.

Once again, there were tears and confusion.

"He wanted to go back in, but at the same time, he knows that he shouldn't be going back in the game," Gary Hagely said. "He cried a little bit, and was mad, just mad that he couldn't go back in. Pretty much knew something had happened with him having a concussion again."

Again, Hagely went through the protocol of waiting to be symptom free, before re-integrating himself into physical activity. And, after consulting with coaches, Gary Hagely opted to buy his son a Xenith helmet.

"Working with coach Koch, it was decided that the only way he was going to get to play was with a Xenith helmet," the father said. "We had him fitted for it, and then he ended up wearing it the last two games of the season."

After two concussions in consecutive years, Hagely, who has dreams of playing either college baseball or football, said it didn't cross his mind to give up football and just focus on baseball. But getting back on the field certainly wasn't easy.

"It's like if you get in a car accident," he said. "You're timid to go back out there and drive again. I was real scared to get hit head-on again. I've been more smart about hitting with my shoulder pads."

A safer playing field

A new bill in Congress, the Congressional Treatment and Care Tools Act, or ConTACT, aims to establish guidelines for concussion prevention, identification and treatment. The bill, co-sponsored by Rep. William Pascrell Jr., D-N.J., and Rep. Frank Pallone Jr., D-N.J., proposes standards for when student athletes can return to the playing field after a head injury. It also proposes giving grants to schools to conduct neuropsychological testing.

During a hearing in Congress last week, Dr. Vic Kapil of the Centers for Disease Control and Prevention's National Center for Injury Control and Prevention testified that concussions, if sustained repeatedly, can have a cumulative effect and lead to long-term brain damage. That includes mild concussions.

The long-term effects of repeated concussions don't fit into an easy-to-navigate grid, said Dr. Tyler Roskos, a neuropsychologist and assistant research professor at St. Louis University School of Medicine.

"These injuries affect people differently," Roskos said. "A seemingly mild injury for somebody may be a worse injury for somebody else, depending on the context.

"If someone sustains a concussion in that game, they should be taken out of that game, and they should not return until they've been officially assessed by a medical professional who can give an opinion to that person about when it's most appropriate to play," he added. "Now, the caveat would be, it's very difficult to determine when that point is."

Returning too soon ups the risk of sustaining another concussion. And, from personal experience, Roskos knows that repeat concussions can take their toll in the long run.

The range runs from less-serious ailments like post-concussive syndrome, which can feature persistent headaches, dizziness, memory loss, depression and lack of motivation, to worse-case neurological disorders like Alzheimer's disease and dementia.

Playing smart

Last fall, after his second concussion, Hagely said he noticed he had a hard time focusing in school, suggesting it felt like he had attention deficit disorder, and that he would forget things he felt he should know.

The symptoms wore off after a few weeks, but he said he still occasionally has a hard time remembering certain things. Hagely knows what the studies and the doctors say. He knows that it's definitely easier to get another concussion now that he's already had two. He also knows that a third concussion would put him at a greater risk of serious long-term health problems.

Koch and his coaching staff know all this, too, which is why this fall Hagely has been limited to mostly playing on defense in varsity games, even though he's a talented receiver, as well. His coaches have also relieved him of punt returning duties, where big hits are common.

Still, it's football, and Hagely knows from experience that all it takes is one hit. He's willing to take his chances.

"There's no way I'd give it up," he said. "Not at all."

As for his father, who started his sons playing youth football, and who loves watching Jared play, Gary Hagely said his son's decision is his alone.

"We're not pushing him to go out there," he said. "That's the one thing that I've always been adamant about. I want him to do it because he wants to do it, and not because dad's been involved with it and we love watching him play. We've been adamant about that, because it's his life."

But that doesn't mean mom or dad will stop worrying.

"As a parent, at any time it could happen," Gary Hagely said. "You just don't know."

Info on concussions

There are three different grades of concussions. The severity determines how long before a player can safely return to sports:

* Grade 1 concussions involve no loss of consciousness and cause a temporary change in mental state -- confusion, disorientation and trouble focusing, resolving within 15 minutes.

* Grade 2 concussions are similar but the confused mental state lasts longer than 15 minutes.

* Grade 3 concussions include a loss of consciousness, no matter how long.

Nate Peterson is a former sports editor for the Aspen Times and a freelance writer whose work has appeared in the Beacon, Colorado newspapers and The New York Times. 

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