Brandon Reynolds remembers the hit that gave him his concussion two years ago.
He was playing on the Wake Forest-Rolesville, N.C., junior varsity when a blindside shot knocked him, as he put it, "giggly."
"That hit rocked my world," he said.
Reynolds didn't tell any of the coaches that he was unsteady, but a trainer noticed Reynolds and pulled him out of the game.
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Reynolds eventually missed a week of practice and one game as his brain healed.
"They looked after me," said Reynolds, now a 5-foot-11, 235-pound senior defensive lineman for the Cougars.
Reynolds' experience is similar to that of many high school football players who sustain concussions, which are injuries in which the brain stops working normally after it crashes into the skull.
Concussions are caused by a bump, blow or jolt to the head, or direct force to the face or neck that is transmitted to the brain. Although the potential for a concussion is greatest in athletic environments where collisions are more common, it can occur in just about any sport, and should be taken seriously.
Most concussions occur without loss of consciousness. The signs and symptoms can be subtle and people may not even know they have one. Athletes must understand the importance of being honest about symptoms and should not attempt to return to the game until they have been cleared.
For them, the biggest concern is returning to play.
For their doctors, trainers and parents, it's finding ways to make sure that happens safely.
"You can't expect the players to tell you they are hurt," said Wake Forest-Rolesville's Rick Baker, a certified athletic trainer. "They are competitors. They want to play. And even if they are hurt, they don't want to tell the coach they can't play.
"The trainer is the guy in the middle. He can tell both the player and the coach that the player is out until he is well."
Concussions are an unseen epidemic, according to Dr. Kevin Guskiewicz, chairman of the Department of Exercise and Sport Science at the University of North Carolina. The American Association of Neurological Surgeons said 10 percent to 15 percent of high school athletes sustain a concussion each year.
According to the University of Pittsburgh Brain Trauma Research Center, more than 300,000 sports-related concussions occur annually in the United States. High school athletes are particularly vulnerable, with more than 62,000 of them sustaining concussions in contact sports.
Guskiewicz, a national expert on concussions, said players, parents and coaches need to understand that what used to be called "having your bell rung" or "getting dinged" is actually a traumatic brain injury.
"Concussions need to be taken very seriously," said Dr. John Wooten, a pediatric neurologist with Raleigh Neurology Associates and the medical director of the WakeMed Concussion Clinic. "A lack of proper diagnosis and management can result in long-term consequences, coma or death."
The National Center for Injury Prevention and Control notes that coaches should keep a player who has had a blow to the head out of play if they observe him to be dazed or stunned, confused about his assignment, the plays, score, who the opponent is, if he appears to be moving clumsily, or is unable to recall events prior to or after the hit.
Although most concussions are mild and people recover fully from them, they need complete mental and physical rest for the brain to heal. This may take several days or longer.
It is essential that the athlete see a medical professional who deems him ready to return to active playing. If a repeat concussion occurs within a close period of time before recovery from the first one, brain swelling, permanent brain damage and even death could occur. This is called "second impact syndrome."
Doctors know that 95 percent of the second-impact syndrome cases (injuries caused by a second blow before a concussion has healed) involve someone under 18 and that someone who has had one concussion is three to six times more likely to have another.
If a player is suspected of having a concussion he should be removed immediately from play and kept out until evaluated by a health care professional to assess severity. If there is any doubt it is better to err on the side of caution and not have the athlete return to play during that game.
"There are so many things we don't understand about concussions," Wooten said. "The brain of a child is very different from the brain of an adult. Something in an NFL study or in the NHL might not apply to teenagers at all."
An important tool is the ImPACT test, which has been used mostly on college and professional athletes. Some - but not many - high schools across the country used it as well. The 20-minute ImPACT test, which stands for Immediate Post-Concussion Assessment and Cognitive Testing, is taken on a computer and uses patterns, words, letters, shapes and colors to measure reaction time, attention and memory. It helps doctors and athletic trainers gauge how an athlete's brain is functioning after a concussion.
One of the key components in the program is a baseline test administered before an injury happens.
"The real innovative part is the baseline," said Stephen Russo, director of sports psychology at a Broward County, Fla., sports medicine clinic. "We can't predict who will get a concussion, but if we baseline test everyone, we're not firing blind later. You're comparing your results to your results, not a norm."
SIGNS OF A CONCUSSION
Balance problems or dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling foggy or groggy
Concentration or memory problems
SOURCE: Department of Health and Human Services; Centers for Disease Control and Prevention
TIPS FOR PARENTS, COACHES
- Athletes should wear the correct protective equipment for their sport.
- Keep equipment well maintained and monitor for proper fit.
- Create a procedure to facilitate communication between coaches, so if an incident occurs in one sport, all coaches will be aware.
- Parents should be informed about concussion prevention and management and not allow their child to play if they experience any signs or symptoms.
- Educate teachers to observe for behavior or learning problems in the classroom that might be indicative of an undiagnosed concussion.