Head Game: Tackling Concussions in High School
On the evening of Aug. 25, 2016, the St. John’s Mavericks junior varsity football team faced off against the Concordia Lutheran Crusaders in the first game of the season.
It was a muggy 82 degrees on Skip Lee Field at St. John’s School in Houston, as the junior varsity cheer squad pumped up the students and family members in the stands.
A few minutes into the first quarter, the Mavericks quarterback threw an interception that was picked up by the Crusaders’ defense. Freshman Luke Venus, a Mavericks offensive guard, chased after the player who retrieved the ball. But before he could go in for the tackle, another player rushed him for the block.
In that split second, approximately 1,600 pounds of tackling force hit Luke as the two players’ helmets collided. Luke, at 5’11” and 190 pounds, closed his eyes and flinched at the moment of impact. When he opened his eyes, he was still standing and ready to play. But the unseen damage to his brain was done.
He powered through the game, playing both sides of the ball as an offensive left guard and defensive tackle. He felt fine until he and his teammates returned to the locker rooms after the game.
“When I was getting out of my uniform and getting into the showers, I started getting this really bad headache,” Luke recalled. “I told my teammates, and they were joking, ‘You better watch out. You might have a concussion.’ I was making jokes, like, ‘I don’t have a concussion. There’s no way. My head is rock hard.’”
But by the time Luke returned home, he began experiencing an onslaught of symptoms. His headache turned quickly into a migraine. He started feeling dizzy and nauseous, and began vomiting almost immediately.
The joke was a reality: Luke had a concussion.
Concussions are a type of brain injury caused by a sudden impact or blow to the head or body that rattles the brain inside the skull. This damages brain cells and causes a chemical imbalance within the cells that disrupts blood flow and impairs the brain’s ability to absorb oxygen and glucose, two essential energy sources for proper brain function.
While it can take days or weeks for the brain to regain its chemical equilibrium, people suffering from concussions can experience symptoms that include mental confusion, disorientation, headaches, nausea and sensitivity to light and noise.
A recent study published in the Journal of the American Medical Association Pediatrics examined concussions in football players ages 5 to 23, using samples of players from youth, high school and college levels. In the 2012 and 2013 seasons, nearly 22 percent of the reported concussions came from collegiate football and nearly 12 percent from youth levels. More than 66 percent of the concussions were sustained from high school football.
Why? Ambitious and overzealous student athletes are driven to succeed in hopes of scoring an athletic scholarship. Some high school football players are not as muscular as others, and size disparities give larger athletes an unfair advantage over smaller players. In addition, teams with a shortage of talent may require players to play both offensive and defensive positions. That was the case for Luke.
“My theory is, playing both sides of the ball caused the players to become tired more quickly and, when they got tired, they started dropping and leading with their heads and started hitting with improper technique,” said Jimmy Roton, Jr., director of sports medicine at St. John’s School. “You can buy all the helmets you want, but if kids are not hitting properly and safely … then the problem is just going to keep on going.”
With high concussion rates affecting a large population of high school football players, lawmakers and medical experts are pushing to make football safer for young student athletes.
In 2011, Natasha’s Law went into effect in Texas, requiring coaches and athletic trainers to take a two-hour training course on concussion protocol, including how to identify and react to concussions. The state law also requires a physician to approve students to return to play.
Previously, coaches were allowed to clear players for practice or games as long as they were free of symptoms for 15 minutes post-incident.
“We are working on reducing the number of concussions with better helmet equipment, neck strengthening, education and rule changes. But are we there yet? No,” said Kenneth Podell, Ph.D., director of the Houston Methodist Concussion Center and neuropsychological consultant for the Houston Texans, Houston Astros, Houston Dynamos, Houston Dash and Rice University Athletics “We need to rethink how football is played at the younger levels. Should a high school player be playing both sides of the ball? How young can they start tackling?”
Because the human brain is not fully developed until an individual reaches age 25, children and teenagers take longer to recover from concussions than adults and are more vulnerable to serious, long-lasting brain injuries.
Podell and his team use a cognitive assessment tool called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) at more than 350 schools and organizations across the greater Houston area. The test measures the severity of a concussion by analyzing the athlete’s attention span, reaction time, memory and problem-solving abilities. The results of the test are compared to the student’s pre-injury baseline test, administered prior to the start of the sports season, to determine the best course of treatment.
“You really can’t see a concussion, unlike a broken arm or something else that you can visually see and appreciate,” said Margie Venus, Luke’s mother. “You can’t see the brain when it’s hurt and you can’t see it when it’s healed. But when you look at the numbers and you see the difference before an injury and after an injury, that’s when you really realize the extent of the harm you can’t visually see.”
Before his concussion, Luke performed well on two ImPACT index scores that measured his reaction time and visual motor speed. But the injury to his brain significantly affected his numbers.
For example, he scored in the 90th percentile for reaction time on the baseline test, but his scores dropped down to the fourth percentile after his concussion.
“It was eye opening to see the impact that one moment can have,” Margie said. “Certainly, you hate to see this happen again.”
Currently, there is no medication to cure concussions. The standard protocol is to rest, avoid strenuous physical activity and abstain from using electronic devices until the symptoms fade—challenging tasks for many passionate athletes.
“I started getting angry at myself because I wasn’t able to play and that was something I wanted to do very badly,” Luke said. “But I learned that I have to let my body heal because if I don’t, there can be even worse side effects in the future.”
After sustaining a concussion, it’s common for students to experience difficulties remembering lessons, concentrating in the classroom and managing schoolwork. In addition to the mental strain, the bright lights, screens and loud, noisy hallways in schools can also exacerbate concussion symptoms and prolong recovery time.
“Especially in the daytime, he appeared okay, but sometimes I would pick him up from school and I’d ask, ‘What happened in this class or that class?’ and he’d go, ‘I truly don’t remember much about it,’” Margie recalled. “It was very much like the lights were on, but nobody was home.”
It took Luke about four weeks of rest before being cleared for football practice. During that time, he was not allowed to watch television or look at computer or phone screens.
To ease concussed students back into school, Podell recommends a modified class schedule and workload—including no school or half days, less homework and fewer tests, and no extracurricular activity until symptoms clear up.
Pros and cons
Over the past decade, the NFL and the National Collegiate Athletic Association have come under intense fire for failing to act when football players have sustained damaging hits to the head.
In 2016, researchers at Boston University linked the degenerative brain disease known as chronic traumatic encephalopathy, or CTE, to dozens of former players, including Frank Gifford, Junior Seau and Ken Stabler. Currently, the condition can only be diagnosed posthumously by analyzing the brain tissue of athletes who have sustained repeated head injuries and concussions.
In response to growing criticism, the NFL and NCAA instituted new rules to mitigate risks and improve player safety.
In 2011, the NFL moved kickoffs from the 30-yard line to the 35-yard line to increase touchbacks and reduce kick returns, widely considered to be among the most dangerous plays in football.
The NCAA followed suit the next year and also moved touchbacks to the 25-yard line. This rule change vexed many coaches who believed it would jeopardize the nature of the game, though it proved to be effective in decreasing the number of concussions.
Spotters were placed in the press boxes to monitor the game and watch for players exhibiting concussion-like symptoms. More coaches began to pull their players out of games and get them into treatment earlier, and players started to be fined for violating concussion protocol.
It’s not a perfect system and, most likely, never will be. Players will continue to get injured from crushing hits at every level of the game, yet football remains an inveterate obsession for many Americans, including Luke Venus.
“Football’s my No. 1 sport,” Luke said. “Ever since I could remember, I’ve always wanted to walk out into the stadium with thousands of people cheering me on, and be on national television.”
He was indoctrinated at an early age. Since the age of 4, he has watched teams including the University of Notre Dame and Louisiana State University compete on the field. His father, who was an all-American high school football athlete in Mississippi and fullback for Ole Miss from 1971 to 1974, often shared memories of the good ol’ days.
“My dad would always tell me stories of him and his friends in high school and college. That made me love football even more,” Luke said. “He was my role model. I wanted to be him.”
While violent, football can also benefit children and teens. The highly cardiovascular nature of the game helps combat obesity, heart disease, diabetes and other chronic illnesses. Football also encourages social and emotional growth by teaching sportsmanship, teamwork and the value of hard work.
But because there’s an inherent risk of concussion and injury in football, the onus is on parents to determine whether the benefits outweigh the risks. And the spectrum of risks is broadening. Recent research findings from UT Southwestern Medical Center in Dallas showed concerning changes and abnormalities in the brains of 24 high school football players over the course of one season, even though none reported concussions.
“We know that some professional football players suffer from … CTE. We are attempting to find out when and how that process starts, so that we can keep sports a healthy activity for millions of children and adolescents,” said the study’s lead investigator Elizabeth Moody Davenport, Ph.D., a postdoctoral researcher at UT Southwestern Medical Center, in a press release.
For parents and young athletes, concussions are “a scary thing to think about,” Roton said. “I think all we can do is give them the information—the pros and cons—and help them make an educated decision.”
Part of Podell’s job is counseling parents on how to transition children into a different sport if football poses too great a risk to their physical and cognitive health.
“It’s a difficult situation, but it’s a very important life lesson where this is what you’re dealt, so how do you make the best out of it?” Podell said. “My allegiance and my concern is for the health and well-being of my patients, presently and in the future. How that affects the continuation of the sport or the team, I really don’t care.”
For Luke, a concussion didn’t compromise his love for the sport. He plans to continue playing football in hopes of getting recruited by his dream school, the University of Notre Dame. But he has a newfound appreciation for player safety and will be more cautious, play smarter and not be as “aggressive or stupid and charging at people with my head,” he said.
“Before I had my concussion, I would make jokes with my friends about it and say that it’s only mental,” Luke said. “But after this incident, I’ve realized how severe this can be and how
it can really impact your life and your future. Now, looking back, I realize this is an issue that needs to be fixed for this sport because this is a really great sport, but the safety of the people who play it is just as important.”