Looking at concussions in high school sports

Note: This article was originally published on Sept. 21, 2013. As such, commentary from the experts interviewed is not reflective of the events surrounding high school football player Tom Cutinella's death.

While the official cause of death is not yet known in the case of Tom Cutinella, a Shoreham-Wading River High School football player who died Wednesday night after collapsing on the field during a game against John Glenn High School in Elwood earlier in the day, it raises the issue of concussions in high school sports that has come under scrutiny recently by medical professionals.

A crushing helmet-to-helmet blow. A quick whipping of the head and neck caused by a jolting hit. A devastating face-plant into the sometimes-unforgiving turf. These are just a few of the ways high school football athletes can fall victim to head trauma and suffer a potentially harmful concussion.

With the fall high school sports season now underway on Long Island, it’s essential athletes are protected from the possibility of brain injury that sometimes accompanies head trauma. Unfortunately, concussions in high school football are sometimes all too common.

Concussions occur from a violent jarring or shaking that results in a disturbance of brain function, according to the U.S. National Library of Medicine. Simply, the brain ricochets off the skull. While many concussions are considered minor traumatic brain injuries, its symptoms range from mild (confusion, headache, light-sensitivity) to severe (loss of consciousness, convulsions, coma). And maybe even death.

“In younger players who are not as muscular, the neck muscles supporting the head may not be as strong, which can worsen the effect of head injuries,” said top-rated Long Island pediatric neurologist Dr. Robin Smith. “The short-term consequences include post-concussion syndrome — significant, persistent and often disabling headaches which can be difficult to treat. Other problems include difficulty with concentration, which impacts their academic performance and mood; sleep difficulties with anxiety and even depression. These can persist for weeks or even months.”

Dr. Smith, who works for NRAD Medical Associates in Woodbury and is affiliated with Cohen Children's Medical Center of New York, said repeated concussions can have long-term consequences, including cognitive impairment. “There is evidence to indicate that even supposedly minor head injuries cause injury to the brain at a microscopic level — interruption in normal metabolic processes and contusions (bruising) of the brain tissue,” he said. 

Each year, emergency rooms across the country treat an estimated 173,285 sports- and recreation-related traumatic brain injuries, including concussions, in people age 19 and younger, the Centers for Disease Control and Prevention reports. Of those reported injuries, 55,007 are related to football.

While those at the helm of Long Island‘s football and athletic programs recognize that concussions are an inevitable risk, preventive measures have been put in place.

“The safety of all our student-athletes is paramount,” said Tom Combs, Suffolk’s Section XI Football Chairperson. “Unfortunately, concussions are a part of all sports, including football. Through proper equipment, techniques and knowledge of what a concussion is, the players are as safe today as they have ever been.”

Patrick Pizzarelli, Nassau County’s Section VIII football coordinator, said although there’s been an increase in reported concussion injuries, he attributes it to a higher level of awareness and education among coaches and parents.

The New York State Public High School Athletic Association’s aggressive approach to increase concussion awareness started July 1, 2012, when it initiated the Concussion Management and Awareness Act, requiring all public and charter schools to comply, beginning with the 2012-13 school year. The mandate requires coaches, physical education teachers, nurses and athletic trainers to complete an approved course on concussion management, and sets standards for the care of athletes who have suffered even minor brain trauma.

“There have been rule changes, [such as] not using your head to block or tackle,” Pizzarelli said. “Also, athletes are taken off the field if suspected of head trauma. I believe we are ahead of other areas in the country.”

The state requires athletes that have suffered head trauma to remain out of play for 24 hours. Dr. Smith said he requires his patients to be symptom-free for about one week before he clears them for return to sports.

“There is a rare and somewhat controversial entity of second-impact syndrome where the athlete has a concussion and then returns to play while still symptomatic, and sustains a second — apparently minor — head injury,” he said. “This leads to a cascade of events with swelling of the brain and sometimes catastrophic consequences, and even death.”

Moving forward, Dr. Smith offers proactive advice for high school football programs and the further recognition of concussions: “From a public health point of view, it’s important to recognize concussions — in terms of the frequency — so that the scope of the problem can be identified and also to enable further studies into the long term consequences,” he stated. “[But] athletes with recurrent concussions should seriously consider not participating in contact sports.”
 

Brian T. Dessart is a nationally accredited Certified Strength and Conditioning Specialist, a New York State Critical Care Emergency Medical Technician and an FDNY firefighter. He can be reached at bdessart@strengthusa.com or on Twitter: @briandessart.