Vermont high schools have a heads-up mentality about helping student-athletes avoid concussions and get back to the classroom and the playing field safely.
As more stories surface about professional football players whose lives were damaged or destroyed by repeated head injuries — after a lifetime of hits to the head, Patriots tight end Aaron Hernandez ended up killing himself in prison after being convicted of murder; Green Bay quarterback Brett Favre said he doesn’t remember whole seasons — more and more teens understand the dangers of concussions.
“I remember playing football growing up and if you felt like you got your bell rung a little bit, you’d just dump some water over your face and head back in,” said Stowe High School athletic director Kevin Lipple.
“The whole ‘rub some dirt on it and get back up’ mentality is over,” said Tim Messier, athletic director at Lamoille Union High School.
Inside the brain
Vin Faraci is a certified athletic trainer who works at Copley Hospital Rehabilitation Services, helping patients bounce back from injuries or surgical procedures. He also works the sidelines as a contracted trainer for Lamoille Union High School, Peoples Academy and Hazen Union in Hardwick.
Faraci said concussions differ from other injuries because they’re largely invisible. Often, there are no cuts, no bruises, no lumps.
“Sometimes there are very few outward symptoms,” he said.
A concussion can occur without a person ever hitting their head. Instead, it comes from some sort of whiplash.
“If you shake an egg, you can feel the yolk inside move,” he said. “Well, when the head whips, the brain moves inside that skull and can hit the inside of the skull.”
The symptoms might not manifest immediately — no unconsciousness, no stars or dark specks floating around. But they do come, and they can be debilitating.
According to the Mayo Clinic, immediate concussion symptoms can include headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness and excessive fatigue. Later, symptoms can include extreme sensitivity to bright lights or sounds, disrupted senses of taste and smell, depression and sudden angry outbursts.
“The typical concussion might resolve itself within seven to 14 days,” Faraci said. “If they are lasting much longer than that, it becomes much more problematic.”
Return to learn
A high school can be sheer hell for someone suffering from a concussion, with all the noise from students, the bright fluorescent lights, and a trend toward electronic devices such as tablets and laptops.
Therefore, the network of adults and fellow students looking out for a concussed kid’s well-being extends well beyond the field.
Bob Johnson, associate director of the Vermont Principals Association, which oversees all high school sports in the state, said state law requires all schools to have a “return to learn” policy. Act 58, enacted in 2011, stresses the importance of making sure concussions are identified as soon as possible.
Jim Nichols, the head athletic trainer at Northern Vermont University, said getting back into the swing of things is more rigorous than in the past.
“It used to be, turn the lights off and go to sleep,” he said. “Now, it’s more don’t shut an athlete down completely, but do some brain games and light exercise and get the blood flowing.”
Since these are student-athletes — emphasis on student, no matter how many goals scored or home runs hit — return to learn takes priority over return to play.
“If you’re not in the classroom, you’re not going to be on the field, either,” Lipple said.
Many schools have introduced a new test for their student-athletes, one that doesn’t include naming the state capitals or solving for X.
All three Lamoille County high schools require athletes to take a baseline neurocognitive test that measures a person’s basic brain activity. It’s called ImPACT, which stands for Immediate Post-Concussion Assessment and Cognitive Testing.
The testing occurs at the beginning of the school year every two years, and is repeated anytime an athlete hurts his or her head.
The test measures key indicators in the “neuro-cognitive domain,” according to the testing company’s website. It’s taken on an iPad or similar tablet and involves exercises such as matching symbols, manipulating bright-colored objects moving about on the screen, and other things designed to measure whether the brain is firing on all synapses.
It’s a bit like an immensely enhanced digital version of the doctor having you follow his finger with your eyes.
Messier said the test should be done in a calm place, and not right after practice. A new pilot program is allowing kids to take the test on their own devices, on their own time.
Even calling it a test might not be the best thing for some students, especially those who already stress out about taking tests in school, Messier noted. It works both ways — students who underperform on academic tests might be worried about passing this one, while students who normally ace tests might overthink it, because it isn’t really asking subject-related questions.
There have been rumors that teens will try to game the test, purposely underperforming to secure a lower score. Their rationale is that the lower baseline may be close what they would score with a concussion. Therefore if they hit their head, take the test, and score close to that baseline, they can continue to play.
The internet is rife with stories of athletes, especially at the professional and collegiate levels, “sandbagging” their concussion tests. But Messier said ImPACT testing isn’t the end-all and be-all of measuring concussions and getting a kid healthy.
“It’s a tool in the bag of tools to bring a kid back into play,” Messier said.
Those tools include other digital tests that measure cognition, such as one called XLNT Brain. There’s also the BESS (Balance Error Scoring System) Test, which measures how steady a person is on their feet.
And then there’s the tried and true variation of follow-the-finger type of test, calls a vestibular ocular motor test.
“I think we’re seeing better and better tools being developed,” Nichols said.
Dearth of data
Vermont high school athletic directors, coaches and trainers can’t really tell you how many athletes have suffered concussions or which sports produce the most head injuries. They can’t tell you if things have gotten better as the national spotlight shines more brightly on star athletes whose lives were changed by concussions.
Johnson said there is a national database for “catastrophic injuries,” but it’s only as good as the people who report to it. And not everyone admits to having had a concussion, or they might not even know they had one.
“There are a lot of unreported concussions going on,” Johnson said. “It’s like trying to herd cats.”
Faraci thinks athletes may be getting fewer concussions, thanks to improved equipment — helmets, pads, mouth guards — as well as rule changes regarding contact in sports.
But, he said, more concussions are being reported. And that’s a good thing, because concussions are cumulative; each subsequent one brings more and more danger of permanent brain damage
“Twenty-five, 30 years ago, the evaluation and management of these things was very different,” Faraci said. “Are there more concussions? My gut says no. I think we have gotten better at reporting them.”
There’s a contact sport for every season in high school — football in the fall, ice hockey in the winter, lacrosse in the spring. And the Vermont Principals Association requires each school to have a certified trainer at each of those events.
But Messier said it’s a good idea to have a trainer at the non-contact sporting events, too. When referees officiate a game like soccer or basketball, their word is the final one when it comes to pulling a kid out.
If there’s no trainer, the ref can tell a player who may have hit his or her head to get back on the bench, and the coach can’t object.
Stowe High School had a full-time athletic trainer on staff for the past few years, but she took a job at a collegiate program. Lipple said the school hopes to replace her soon. For now, all the coaches are trained in concussion protocol. And parents and others in the stands are more likely to report something than in the past, knowing the dangers of concussions.
“There are so many eyes on the field, and that’s a positive thing,” Lipple said.
Johnson said schools like Stowe, that have their own athletic trainer on staff — when the spot gets filled, that is — have a leg up on making sure kids are getting back to their studies and their athletics safely.
“If you have someone there full-time, it’s even better, because in reality, a lot of concussions don’t happen in games, but at practice,” Johnson said.
Although contact sports like football, hockey, lacrosse and wrestling are the ones given the most attention and concussion protocol mandates, Messier said he’s seen kids get their noggins knocked elsewhere.
“Probably every athletic director has seen a potential concussion in every single sport, even golf,” he said. “Wherever there’s movement and activity, there’s room for an injury. And wherever there’s room for injury, it could be a head injury.”
Students from all three Lamoille County high schools play on a cooperative football team fielded by BFA-Fairfax and Lamoille Union.
Nichols said that, “hands down,” football is the sport with the most concussions. The second and third? Women’s soccer and women’s basketball.
Soccer is a sleeper one, especially for girls. Heading the ball may be the most obvious way to suffer a head injury, and Faraci noted that adolescent bodies are still growing and often the teens haven’t built up enough strength to absorb the ball, or haven’t mastered the heading technique adequately.
Messier said almost all youth soccer coaches and many high school coaches have moved away from teaching kids how to head the ball in practice. Gone are those days where coach would punt the ball or toss it high and encourage Johnnie or Janey to get under it and put a head on it.
And school concussion protocol by and large applies only to high school varsity and JV athletics. Plenty of kids suffer injuries, including head injuries, from all manner of activities, whether it’s on the swing set or monkey bars, on the sledding hill, or falling off a bike or skateboard.
“There really are so many ways to get concussed before you even get to high school,” Messier said.
When monitoring of athletes and their injuries doesn’t typically take place until high school, that means there’s a decade of possible head injuries that occurred before their teenage years. And Faraci said head injuries only get worse each time.
“It takes less force to give you similar injury, or a similar type of force will give you a worse injury,” he said.