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With danger of concussions better known, high school football programs take notice

September 23, 2018

Dr. Michael Collins, director of the Concussion Program for UPMC Sports Medicine, conducts a presentation titled “Understanding Concussion Today” at the UPMC Center for Sports Medicine facility on the South Side.

Running back Logan Harmon took a handoff in Apollo-Ridge’s 2017 season finale against Valley High School. He hit the hole, but he didn’t see the Vikings defender converging on him.

“I got hit by a big kid,” Harmon remembered a year since he was diagnosed with a concussion.

Apollo-Ridge’s training staff pulled Harmon from the game, effectively ending his freshman season.

Such hits happen at all levels of football -- head contact between players or between a player’s helmet and the ground. And over the past decade, research into head injuries is bringing more scrutiny into such hits and their potential impact on the players’ future.

As research continues into the effect of concussions and other head injuries on former NFL players, the effects -- and some of the worry -- are trickling down to the high school level, where more attention is being paid to the injury, and players, coaches, trainers and officials are adapting.

A study released in Journal of the American Medical Association in July 2017 reported the brains of 110 of 111 deceased ex-NFL players exhibited signs of chronic traumatic encephalopathy, a progressive, degenerative disease caused by repeated blows to the head.

CTE research dates to 2002, when former Pittsburgh forensic pathologist and neuropathologist Bennet Omalu -- depicted in the 2015 movie “Concussion” -- discovered the disease in the brains of a handful of former NFL players, including ex-Pittsburgh Steelers Terry Long, Justin Strzelczyk and Mike Webster, and in the decade-plus since, many more cases were discovered in former NFL players.

What made the 2017 study noteworthy at other levels was the revelation that players at the college and high school level exhibited CTE, and while the high school cases were mild, those players still showcased cognitive, mood and behavioral symptoms.

According to UPMC research, 5 percent to 8 percent of high school football players will suffer concussions this year.

“Obviously, all the stuff that’s going on with the professional level, with trying to keep the game safe, you’re aware of it. But you don’t really think it’s an issue until you start getting hit in the head and start to realize the severity of it,” said Brett Laffoon, a former Penn-Trafford and Grove City quarterback who stopped playing football in the fall after suffering two concussions in less than a year.

“It starts to not get to you, but it starts to affect you a little bit. You don’t want to think that concussions are controlling you from playing the game.”

‘When in doubt, get them out’

As awareness and research into concussions increased, so has education about prevention and treatment.

Dr. Michael Collins is director and founding member of the UPMC Sports Medicine Concussion Program and an expert on the injury.

He said increased research into concussions reveal the importance of early detection and treatment of the injury.

If a player continues playing for just 15 minutes after the initial injury, the average recovery time doubles from 19-21 days to 40.

With that number in mind, it puts the onus on coaches, trainers, officials and players themselves to recognize the early symptoms.

Collins said the biggest on-field indicator is dizziness -- even more than loss of consciousness.

“When in doubt, get them out,” he said.

“There’s tremendous progress that we’ve made in terms of assessing this injury, understanding what type of concussion a patient has, matching the right treatment to the right problem, actively rehabilitating it, and getting kids safely back to play,” Collins said.

“I would actually argue it’s never been safer to have a concussion than right now because we know so much more currently than we had in the previous decade before then in terms of how to evaluate, manage, treat and rehab this injury.”

Alle-Kiski coaches’ view

Matt Morgan and John Skiba played football a decade apart at Pitt, Skiba in the late 1980s and early ’90s and Morgan in the late ’90s and early 2000s. But the attitude around concussions at that point was pretty similar.

“As far as a player at Pitt and the NFL, kind of you didn’t want to even talk about it (for the) simple fact that you felt like you’re painted as the soft guy,” said Morgan, now the coach at Plum. “You didn’t really talk about it too much because it wasn’t considered as serious as it is now.”

Added Skiba, Apollo-Ridge’s coach: “We’re getting more heads-up on things and understanding things more now. Before, that was just a ding or a ring or whatever you wanted to call it back in the day. ... I don’t have the effects right now, not yet. But the way we are now, we’re so on top of our game, prevention-wise.”

UPMC hosted a Concussion Education Program for WPIAL schools in April 2017 featuring former NASCAR driver Dale Earnhardt Jr. All schools were invited to the session, which included presentations about signs and symptoms, treatment options and more.

“What makes it kind of scary a lot of times is if you have a rolled ankle, you see swelling,” said Norwin coach David Brozeski. “If you have a broken arm, you put it in a cast. Concussions, you have symptoms that could be different from the same person multiple different times, or multiple different people. That could be a little scarier.

“But I think what’s nice is the awareness, the education, how the game has changed in terms of teaching the game to be a safer game ... all those things are very positive things for the game.”

Preseason baseline testing can help determine in-season concussions, and Brozeski said the knowledge about concussions is making everyone more cautious.

No standard treatment

Collins said research has identified six types of concussions, each affecting a different function: anxiety and mood, cognitive, migraine, neck issues, ocular and vestibular conditions.

Each different type of concussion comes with its own treatment option: No longer is there a one-size-fits-all approach.

Collins said rest is necessary for migraine concussions, but exercise is pushed heavily for those that are affecting anxiety and mood.

“You prescribe a very individualized set of activities to rehabilitate the concussion,” Collins said. “The advances that we’ve made are really on the treatment end of it.

“If you think about it, there’s 25 or 30 different types of knee injuries. Why do we think there’s one type of concussion (when) the brain is infinitely more complex? That’s what we’re learning.”

‘I wasn’t in the right state’

Laffoon scrambled out of the pocket in the fourth quarter of Grove City’s 2017 season opener at Juniata and dove forward for extra yards, his head landing in a “weird position” and a defender crashing on top of him.

The sophomore quarterback “couldn’t see straight,” so he called timeout, went to the sidelines and took off his helmet.

“I knew after it happened I wasn’t in the right state, and it wasn’t that hard of a hit, either,” Laffoon said. “It was the shock of the way I hit the ground. I had to stop playing after that.”

Grove City reported for preseason camp earlier this month, but Laffoon wasn’t there, holding to his September 2017 retirement from football.

The former Penn-Trafford star suffered his first diagnosed concussion as a Grove City freshman, taking a hit under the chin as he looked for an open receiver downfield.

“That one I don’t remember,” he said. “I just remember kind of snapping back into it in the locker room.”

Laffoon talked to his parents before the 2017 season about giving up the sport if he suffered another concussion. It came in the season opener, and Laffoon announced his retirement shortly afterward.

Parents more cautious

Concern over head injuries led former Wisconsin and San Francisco 49ers linebacker Chris Borland to retire in March 2015 after just one NFL season. After watching the movie “Concussion,” former Mars star John Castello decided to turn down FCS football offers in favor of playing basketball at Shippensburg.

Brozeski, Morgan and Skiba said they hear from parents concerned about head injuries, which in turn is having an impact on turnout.

“There’s been so much media attention and so much everybody talking about it, and I think parents understand they don’t want to put their kid in that situation,” Skiba said. “I think they see, is this going to pan out, is football going to be the step they need to take to get a kid into college? If not, why put your kid in that position?”

But the coaches see positives. Morgan said helmets are much improved from when he played, and coaches are emphasizing less contact in practices and better tackling techniques.

“They make sure you’re safe, making sure we get our head up when we’re tackling,” Norwin senior safety Jayvon Thrift said. “That’s probably one of the main goals they’re trying to do: Get our head up and make sure we have a nice base, so we secure the tackle and be able to get them to the floor hard and also at the same time safe.”

The Ivy League banned tackling in practice in 2016. In the WPIAL, teams didn’t put on pads and weren’t allowed full contact until training camp began Aug. 13.

Expert: Still OK to play

Still, it’s hard to avoid injuries in a full-contact sport such as football.

“Linemen, every play you’re hitting,” Morgan said. “It doesn’t matter if you’re offensive or defensive lineman, you’re hitting. You can’t avoid it, there’s going to be head-to-head contact at some point in the majority of your plays. Linebackers hit hard, running backs hit hard, so those are major collisions. Receivers going over the middle, there’s major collisions. It’s some stuff you can’t avoid.”

Morgan believes, however, that football can have a positive impact on players’ lives, and he’d like to see those qualities emphasized more. Brozeski, a former player at IUP, has four daughters, but he said he’d have “no doubt” about letting a hypothetical son play.

Collins said the increased knowledge surrounding concussion treatments leaves him confident that, provided players receive effective, timely management and treatment of their condition, and they don’t return until ready, he feels “very comfortable” about them playing football or any other sport.

“We don’t ever want to see a kid have a concussion, clearly,” Collins said. “But the reality is if it does occur, the great, great, great majority of the time we can treat them and get them back to the sport they love.”

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