stock Oak Tech football Nov 2013

Football players practice last week at Oakland Technical High School. Credit: Jane Meredith Adams, EdSource Today

As the high school football season winds to a close and players prepare to put their helmets away, athletic officials are hoping that a new law requiring coaches to be trained to spot concussions in players has made the high-contact game, and all youth sports, safer.

The California law, which went into effect in January, is one of a slew of laws and initiatives across the nation intended to address under-reporting and under-treating of youth concussions, a brain injury usually caused by a blow to the head.

The law mandates that high school coaches be trained to identify and respond to the symptoms of concussion, which include dizziness, nausea, headache and light-sensitivity. While many symptoms appear to resolve quickly, the injuries have been associated with complicated and even dire outcomes in youth.

In August, Tyler Lewellen, a 16-year-old defensive safety at Arlington High School in Riverside, collapsed after a tackle and died following surgery to relieve swelling on the brain. The coroner has not yet released the official cause of death.

Junior Lamont Reed, 16, who plays fullback at Oakland Technical High School, recalled a helmet-to-helmet tackle in the first game of the 2012 season that left him so disoriented he asked a teammate, “Did I play yet?”

Overcome by dizziness, he didn’t hesitate to tell his coach he wasn’t feeling well, he said. He left at halftime to see a doctor and was out of play for six weeks, plagued by migraines, sleepiness and sensitivity to light, he said.

He missed a few days of school, but returned to keep up with assignments. “I wore dark sunglasses because of the light,” he said. Recovery was slow. “It was harder for me to concentrate in class.”

Football, the most popular high school sport in California by far, has the highest incident rate of concussion of any boys’ youth sport, according to the National Federation of State High School Associations, an Indianapolis-based national membership organization that collects data on high school sports injuries. For girls, soccer has the highest concussion rate.

More than 3,000 of the 102,500 high school football players in California are expected to suffer a concussion this year, based on national prevalence rates cited by USA Football, a nonprofit organization whose funders include the National Football League. But authorities don’t believe that figure captures the prevalence of the potentially serious injury, and a report released Oct. 30 by the Institute of Medicine and the National Research Council called for more comprehensive data, saying “much remains unknown about the extent of concussions in youth.”

In California, high schools are not legally required, even under the new law, to collect data on concussion injuries. And under-reporting remains a problem, the Institute of Medicine report said, in part because of a sports culture that discourages athletes from admitting they have a concussion, an internal injury that can be difficult for observers to detect.

Many young athletes say that the game and the team are more important than their individual health and that “they may play through a concussion to avoid letting down their teammates, coaches, schools and parents,” the report stated, citing surveys of young athletes. The Centers for Disease Control states that it is important to rest and avoid strenuous physical or mental activity after a concussion to help the brain to heal.

Beyond winning

The new law is a companion to a 2012 law that says athletes who have suffered concussions must be removed from the game and may return to play only after being cleared by a health professional. While laws are important, some say the sports culture needs to put a higher priority on the health and safety of players.

“We need to re-frame the thought process of coaches, parents and athletes to recognize that safety has to trump concerns about playing time, winning games, proving their ‘toughness’ or staying attractive to college recruiters,” said Tina Syer, chief impact officer at the Mountain View-based Positive Coaching Alliance, a nationwide organization that works to train coaches and parents on how to create a supportive team environment.

Requiring that coaches be trained to spot concussions is an important step in improving sports safety, said Roger Blake, executive director of the California Interscholastic Federation, the governing body for high school sports.

“Now that more people understand and can recognize the signs and symptoms of concussions, the number of reported concussions has increased,” he said. “This is a big positive.”

While it’s unclear how many coaches have so far received the training, from January through September 32,270 people in the state took a free online concussion training course recommended by the California Interscholastic Federation. Most of those taking the training were likely coaches, according to the federation, which says there are 65,210 high school coaches in California. Coaches are required to take the training every two years when they renew certification for cardiopulmonary resuscitation, which is also required for all coaches in the state. Coaches must provide a certificate showing proof of the concussion training to the school.

Football players practice at Oakland Technical High School. Credit: EdSource Today, Jane Meredith Adams

Football has the highest incidence of concussion among boy athletes. Credit: Jane Meredith Adams, EdSource Today

The trainings have made a difference, said James Coplan, who took the training for his work as athletic director at Oakland Technical High School – as has the widespread publicity about the possible long-term effects of repeated concussions on professional football players. The NFL recently agreed to pay $765 million to settle a concussion lawsuit brought by more than 4,500 players and their families. Coplan said that a Frontline news report on concussions in the NFL, “League of Denial,” was “a wakeup call” that educated him about the vulnerability of the brain.

“We are much more conscious, in all sports, that concussions are serious issues,” Coplan said.

Coaches would rather err on the side of caution, he said, if they suspect a student has sustained a brain injury.

“It could be star quarterback with three minutes left in game and he’s coming out,” he said.

Research on how concussions may harm the developing brain is still beginning, said Mayumi Prins, associate professor of neurosurgery at UCLA and one of the authors of the report from the Institute of Medicine. Adolescence is a time of tremendous changes in neural connections, Prins said.

“The frontal cortex is the last structure in the brain to evolve, and that structure is key in decision-making and executive function,” Prins said. “Obviously, any kind of injury may affect a system.”

Jane Meredith Adams covers student health. Contact her or follow her @JaneAdams. Sign up here for EdHealth, EdSource Today’s free newsletter on student health.

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