Varsity Letter

High school football coaches get an education on concussions at Redskins Park

By Preston Williams
Friday, April 30, 2010

Dozens of high school football coaches from Maryland, the District and all across Virginia filed into a tent at Redskins Park on a recent Saturday morning for a seminar on concussions. Their involvement was at once encouraging and worrisome.

It's a credit to the coaches that they turned out for the event; some traveled hundreds of miles for the 75-minute presentation and to watch the Redskins practice afterward. It's also a credit to the coaches that they peppered the guest speaker, Dr. Peter G. Gonzalez, an assistant professor of sports medicine at Eastern Virginia Medical School in Norfolk, with questions.

But at the same time, it was disconcerting to come away with the feeling that some coaches were hearing much of this information for the first time.

There are an estimated 43,000-67,000 concussions -- really just a fancy word for injured brains -- per year in high school football, and about 50 percent of concussions are suspected of going unreported by young athletes.

Football coaches, particularly those at schools without full-time certified athletic trainers -- which in the Washington area includes Montgomery, Prince George's and Anne Arundel counties -- are the first responders to injured players. So these coaches often either make, or help make, the decision about whether a player, including one who is possibly concussed, is fit to remain in a game or continue to practice.

The Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, determined that more than 40 percent of high school athletes who sustain concussions return to action too quickly. Two high school football players in North Carolina died in 2008 from concussion-related injuries.

So if the coaches from these various jurisdictions are asking question after question of the doctor -- some nuanced queries, some more like Concussion 101 -- should we be heartened that they were eager to learn more about keeping their players safe? Or should we be wary that they had so much to ask in the first place?

One coach wondered if players would be better served by being subjected to more hard hits in practice, because they would perhaps build up a tolerance and resistance to the shots that result in their brains colliding with their skulls. No, Gonzalez said tactfully. The fewer hits to the head, the better.

Other coaches had never heard of the ImPACT program, in which athletes take a 30-minute computer test that gauges their neurocognitive functions. That provides a baseline of information. The athletes are re-tested after a suspected head injury. Howard, Fairfax and D.C. schools, among others in the area, use ImPACT.

Other coaches were unaware that athletes who sustain a concussion are two to four times more likely to sustain another, with 80 percent of those repeat concussions occurring within 10 days of the first one. A Time magazine article from 2009 cited a study that found from 2005 to 2008, 41 percent of concussed athletes, at 100 high schools nationwide, returned to play too soon, based on American Academy of Neurology guidelines.

"We can't prevent this first concussion," Gonzalez told the coaches. "What we can prevent is the sequella of that concussion, the second-impact issues, worsening or delaying recovery."

Coaches also learned that only 10 percent of concussions involve loss of consciousness, and that a CT scan might not show any damage, because a concussion is more of a functional deficit than a structural one. Often there is no obvious change in behavior. Yet a concussion that is not properly managed could result in neurological symptoms that last a lifetime, even though players themselves do not fully weigh those consequences.

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