Playing as a tight end and linebacker for Lompoc High School’s football team, Steven Morehart was enjoying a terrific junior season in 2007.
Then, in a contest against Paso Robles, lightning struck.
“From what the trainer told me, I took a short kickoff and tried to run it back through the wedge,” Morehart said. “They busted our wedge, and I put my head down going into the pile and got smacked by four different people.”
Though he couldn’t remember anything after the hit, Morehart told his coaches he was fine and stayed in the game for the Braves’ offensive series. On the third play, a pass from his quarterback hit him in the helmet. He went down and didn’t get back up.
“People were saying they were calling plays in the huddle and I was just staring,” Morehart said. “I couldn’t see the scoreboard, and I was throwing up. I passed out on the sidelines.”
Steven was rushed to the hospital, where he was diagnosed with a serious concussion. He was kept out of football for six weeks and regularly tested by doctors on his coordination and memory. After a month of rest, he was still failing tests and brain scans.
“I was really dizzy and getting bad headaches,” he said. “I’d get sick to my stomach. I couldn’t handle bright lights or loud noises.”
His doctor told him his athletic career would be over if he ever got another concussion. He eventually returned to football for his senior year—but played cautiously. Now a 20-year-old student at Allan Hancock College, Steven is no longer involved in sports.
His younger brother Jake, currently an All-League senior running back at Lompoc, also knows all about the dangers of contact sports. While playing against Righetti in November, Jake took a handoff and burst through the hole with his head down.
“Two guys hit me with their shoulders on each side of my helmet. The next thing I remember, I just got up and started walking off to the sidelines,” Jake said. “For a second, I couldn’t see anything, and once I got to the sidelines I was just dizzy.”
He was pulled from the game and taken to the hospital as a precaution. Doctors diagnosed him with a mild concussion, Jake’s second in his high school career.
“The first time it happened, everything was moving, it was like an earthquake,” he said. “The second time, I just went black.”
For his coach, Robin Luken, it was the kind of hit he worries about.
“He was trying for a few extra yards and got banged,” Luken said. “When you come from the side, there’s not a lot of room for the brain to move left to right. Now it’s bouncing off the skull, and with that impact, now you’ve got a violent trauma to the brain.”
Though Jake was medically cleared to play the following week, he was held out of drills and scrimmages for 10 days and missed two weeks of practice.
The procedure was typical for a high school athlete’s return from a concussion, a recovery process plagued with more questions than answers.
The calculated risks of contact sports
Concussions often occur as a result of head-to-head or body-to-head collisions and are most prevalent in high-impact sports such as football, lacrosse, hockey, and wrestling.
Immediate symptoms include headaches, blurred vision, dizziness, confusion, memory loss, and balance problems. Such symptoms can last from hours to weeks, depending on the severity of the concussion, according to Kevin Guskiewicz, athletic trainer and director of the University of North Carolina’s sports-related traumatic brain injury research center.
“The brain is jarred. It moves around in the cranial cavity and is bruised,” Guskiewicz said. “It’s sort of like an egg yolk moving inside of an eggshell. You just want to make sure you don’t crack the egg.”
Symptoms that last more than six weeks fall into the category of post-concussion syndrome, a chronic effect found in fewer than 10 percent of cases.
Additionally, after the first concussion, Guskiewicz said, the risk of having a second one doubles. Each successive concussion then raises the chances of another occurrence exponentially.
Research shows repeated concussions can result in chronic conditions later in life, including dementia, Alzheimer’s disease, memory impairment, depression, and even death.
Curbing the prevalence of fatal head injuries in high school sports was a major topic of a summit of 30 health care and sports organizations in Sacramento held on Jan. 12 and led by the National Athletic Trainers’ Association (NATA).
“The numbers in the last couple of years have been staggering,” said Mike West, president of the California Athletic Trainers’ Association, a part of the Alliance to Address the Youth Sports Safety Crisis in America. “There’s been at least 115 deaths across the country in athletic participation due to a variety of things, but most predominantly head injury, brain injuries, heat illness, and sudden cardiac arrest.”
The fatalities took place from 2008 to 2009 in 33 states, eight of them in California.
“If athletic programs really looked proactively to care for their athletes, there are factors they could look at that could minimize these types of deaths,” he added.
As the lead author of NATA’s position statement on managing concussions, Guskiewicz called upon researchers, physicians, and athletic trainers to work together to properly treat head injuries. He wants to educate the public on safety without detracting parents from getting their children involved in the physical activity they need to combat rising childhood obesity and diabetes.
“We need to be careful about calling this a ‘crisis’ because we could end up with a bigger crisis, being that we scare parents away from putting their children into sport,” Guskiewicz said. “We need to reassure the community and society in general that we’re working towards solutions.”
One such solution NATA is pursuing includes working with 18th District Assemblymember Mary Hayashi on legislation requiring the state to recognize athletic training as a licensed profession. California is one of only three states in the country—along with Alaska and West Virginia—that doesn’t license athletic trainers.
Given the integral role athletic trainers play in managing serious injuries, Guskiewicz said, the state should eventually require certified athletic trainers in all schools.
“That’s the starting point: putting appropriate medical care into the school settings,” he said. “Ultimately that’s what’s going to help prevent these catastrophic injuries and illnesses.”
The fuzzy logic of concussion prevention
According to the National Athletic Trainers Association, incidences of concussions rank high among the 715,000 sports-related injuries reported each year in high schools. About 8,000 children are treated in emergency rooms each day for sports-related injuries.
Recently, California Athletic Trainers’ Association’s West said, both the number of reported concussions and related deaths are on the rise as a result of players masking their symptoms and coming back to the field before making a full recovery.
“These kids are taught that you’ve got to play through pain, and you’ve go to hide the injuries so you can continue to play—otherwise you’re not tough.” West said. “There’s a difference between being hurt and injured. If you’re hurt, yeah, play through the pain. But to play through an injury can be a catastrophic thing.”
West said high school players are pressured to return to sports before they’re ready, often by parents who fear their child will lose out on a college scholarship.
Lompoc’s Luken agreed. A coach for 30 years, he said parents are pushing their children toward college and pro sports more than ever, and a growing number of athletic careers end before they start as a result.
“People don’t realize when kids are young, their bodies need time to rest,” he said. “We’ve gotten so caught up in this that we’re forgetting that they’re still kids. We’ve got to slow down a little bit and let them have time to go out and just play.”
Luken, who resigned in December but continues to teach, said coaches can only teach proper hitting techniques and make sure they’re conscientious of keeping smaller players where they’re less likely to get hit hard.
“Those are things you worry about when you’re in a contact sport like we have,” he said. “In those situations when you know that the guy is better than yours, you’ve got to be careful because the worst thing that can happen is you end up hurting the guy permanently, and that’s somebody’s son.”
Luken’s own son Bryce suffered a series of concussions during his senior year at Lompoc in 2003. He went on to play at the United States Air Force Academy for one season until another concussion caused him to quit football for good.
Given the sport’s violent nature, coaches and athletic trainers agree head injuries are inevitable, but their seriousness can be mitigated with suitable equipment.
All local high schools are required to use NOC-SAFE certified helmets, the same as used by college and pro teams. At St. Joseph High School and elsewhere, used helmets are returned to the manufacturer at the end of each season for reconditioning, to make sure they meet safety standards from year to year.
“At the high school level, we’ve done a good job with the resources we have to make sure our equipment is fitted properly and is safe,” said St. Joseph head football coach Mike Hartman.
Even if his players aren’t complaining of symptoms, Hartman said he and his coaches keep a close eye out during games and practices for warning signs of possible concussions.
“The key for head injuries is communication. If the trainers and doctors are on the same page, we’re going to plot the right course,” he said. “It’s managing it properly and doing what’s best for the student-athlete. We can train, teach them the right technique, and equip them properly and hope nobody gets hurt. That’s all we can do.”
Making an ImPACT on recovery
Returning too soon from a concussion can delay recovery time and predispose the player to a second injury, according to University of North Carolina’s Guskiewicz. More troubling, however, is the possibility of Second-Impact Syndrome, a catastrophic event where even a mild hit to the head of a player still experiencing effects of an initial concussion can result in brain swelling.
It’s a rare occurrence, Guskiewicz said, but when it does happen, it results in death half the time.
Unlike ankle sprains, broken arms, and other injuries where severity is easily determined, a concussion makes it difficult for doctors to ascertain when a player is ready to return.
One objective method used to determine when a player is fully recovered is computerized neuropsychological testing. One such testing system, called ImPACT, was developed by two doctors in the early 1990s and is currently used by many Division-I colleges.
The ImPACT test begins with a questionnaire detailing past medical history and physical and emotional health. Once a profile is built, the program runs a battery of quizzes involving shapes, colors, and word associations. The tests cover memory, reaction time, and concentration, the three areas compromised following a concussion.
The tests aren’t difficult to implement but are tricky to ace, even without a brain injury, and take about 30 minutes to complete.
Before the start of the season, student-athletes in high-impact sports are given the tests, providing a baseline score that can be used for comparison.
Within 48 hours of a head injury, the player is tested against his baseline scores and given a symptom index. If the scores aren’t close, the player is held out and retested until the results are in a safe zone. The results are sent to the players’ physician, who makes the final determination on a return.
Gino Brunello, owner of SIMS Physical Therapy in Santa Maria, led efforts to bring ImPACT testing to the area more than a year ago.
“It’s finally moving in the right direction with concussions,” Brunello said. “It’s a pretty exciting thing, and it’s the direction we need to be headed.”
The tests are designed to uncover hidden impairments, especially with players eager to return to action who, consciously or not, may not be fully forthright about the severity of their symptoms.
“We haven’t been able to objectify when a kid isn’t ready to go back out there,” Brunello said. “With this test, you can’t fake it. You fake it, you do worse and you’re out longer.”
As part of a pilot program, SIMS staffers are administering the tests to most Santa Maria-area high schools this spring with the help of Marian Medical Center. The hospital recently purchased ImPACT software for all of the local high schools, and plans are in place to expand the testing to Allan Hancock College and every high school sport and athlete.
SIMS’ Malinowski serves as a certified athletic trainer for St. Joseph High School and Hancock and recently administered baseline tests for St. Joe wrestling, soccer, and basketball teams and said the tests take a lot of the guesswork out of determining how long to keep a concussed player on the sidelines.
“The ImPACT tests help reduce that amount of ambiguity because it gives us more quantitative data of when the athlete potentially is ready to go back to play,” Malinowski said. “It’s a great cognitive test that gives athletic trainers another tool to use in their decision. The physician is the ultimate decision maker, but we can give the physician the reports to help them in their decision.”
Members of NATA, a group supporting mandatory pre-and post-concussion testing in all schools, applauded the program.
“I commend any school that is incorporating neurocognitive and balance testing,” Guskiewicz said. “Those programs should be in place at every high school across the country that provides a contact sport.”
While the tests won’t do much to prevent concussions from happening, for athletes like Steven Morehart, who’ve had first-hand experience recovering from the injury, they could go a long way in providing athletes with peace of mind after getting hurt.
“When you sign up to play a sport, especially football, you know the risk that you’re taking,” he said. “It would make me feel a lot more safe being tested thoroughly to make sure I’m ready to play again. I’d be upset if I couldn’t play, but afterward, if I looked back on it, it would be better for my well-being than getting out there before I was ready.”
Staff Writer Jeremy Thomas can be contacted at jthomas@santa mariasun.com.
This article appears in Jan 21-28, 2010.