The Longevity Project: Traumatic brain injury and concussion protocols in youth sports
Editor’s note: This is the second in a weekly series called The Longevity Project, a collaboration between The Aspen Times and the Glenwood Springs Post Independent. Read part 1, “Traumatic Brain Injuries in the High Country” in the Oct. 17 Post Independent.
Every high school sports sideline, courtside or team box in Colorado has an extra-special set of eyes and ears on the action.
While the coaches and players focus on trying to call or make the best play, athletic trainers are close by intently focused on the heads themselves.
If a player stays on the turf, floor or ice for an extended time after a play, or gets up a little wobbly, certain concussion protocols must be followed, per state law which is now written into the rules of the Colorado High School Activities Association.
“Sometimes you see a hit or a fall, or something that might cause a concussion, and it’s our job to assess the kid from there,” said Ryan Erickson, Certified Athletic Trainer (CAT) for Roaring Fork High School in Carbondale.
“Other times you don’t see what happened, but a kid will self-report or come over and say they’re not feeling right,” he said.
Then there are times when it’s not immediately obvious to the player or the sideline staff that an injury may have occurred, or, in the heat of game battle, the player won’t speak up right away.
That’s when those eyes and ears have to be especially astute in order to keep health and safety at the forefront of youth sports.
Erickson is part of a team of CAT’s sponsored by Valley View Hospital/Valley Ortho in partnership with the Roaring Fork School District to provide preventative services, emergency care, therapeutic intervention and rehabilitation for student-athletes at Glenwood Springs, Roaring Fork and Basalt high schools.
Erickson’s work, along with Marni Barton at Glenwood Springs and Mike McCann at Basalt, covers the gamut of sports-related injuries and medical conditions. But concussions and protection against traumatic brain injuries (TBIs) through very careful “return-to-play” policies and procedures are a major focus.
At National Athletic Trainers’ Association conferences he’s attended over his 18 years as a trainer, Erickson said that about a third of the overall attention is given to concussive head injuries. That includes prevention, treatment and rehabilitation.
“It’s a major topic, and there is lots of new research coming out constantly,” he said.
The texts he used in college in 2005 on the topic might as well be tossed out, but not because the people who were researching and studying it at the time didn’t know what they were doing, he said.
“They were the leaders in research and the care of concussions,” Erickson said. “It’s just that so many new things have come to light, and we need to stay up with that.”
The Colorado Legislature in 2012 passed Senate Bill 40, or the “Jake Snakenberg Youth Concussion Act,” named after an athlete from Grandview High School in Aurora who died after suffering a concussion during a football practice.
The law laid out a series of measures and protocols to protect young athletes from head injury during sports, including:
- Requirements for coaches to take annual training around proper concussion protocol.
- Immediately removing athletes from play who sustain a suspected concussion, and not allowing them to return to a game or practice the same day.
- Notifying parents if their child has been removed from play due to a suspected concussion, and providing them with information about signs and symptoms so that they can monitor their child at home.
- Ensuring that a health care provider evaluates the player and gives written clearance for them to return to play, including practices and games.
Kim Gorgens is a neuropsychologist, board-certified in rehabilitation psychology, and also a professor for 22 years at the University of Denver. She helped write Jake’s Law, and continues to be a brain injury policy advocate.
“At the time, Colorado was really out in front in responding to the risks due to concussions in sports,” she said. “There’s been a real push since then to quantify the risk for players, so that those in charge can make the right decisions.”
Gorgens gives TED Talks on the subject, focusing on preventative measures in youth sports, from pee-wee leagues through middle school and into high school, return-to-play policies and sharing information about DU’s biomarker studies around the long-term impacts from head injuries, including dementia and other conditions that appear with age.
“There is a lot of research on some of the poorer outcomes, so that we can better understand what confers the risk for these really terrible outcomes,” Gorgens said. “We are coming to understand youth sports brain injury from every angle, and we’re working really hard to do better by coaches, trainers and parents who are out there coaching on the sand lots.”
Sideline protocols are critical when it comes to avoiding successive concussions, which can lead to more severe TBIs.
When a suspected concussion occurs, coaches and trainers get involved by checking for any immediate symptoms and questioning the players directly involved or who might have witnessed what transpired in order to know what to look for.
“We gather the history of what happened, look for any symptoms they may have at the moment, test their balance and just generally observe them and their behavior,” Roaring Fork’s Erickson said.
Symptoms typically include headache, dizziness, nausea, vision problems such as double vision, and sudden sensitivity to light or sounds.
“From that, it’s usually not very hard to determine if they have a concussion,” Erickson said.
But that’s not his call. A medical doctor is often on site at the game or event, or on call so that they can come and give the diagnosis.
Concussions aren’t limited to contact sports, either, he said.
“Football gets all the attention, because of the violent nature of the sport,” Erickson said. “But soccer can have as many or more concussions, and in basketball you have kids taking charges and hitting their head on the hardwood.”
Oftentimes, it’s not the initial blow from contact with another player that causes the concussion, “it’s you falling hard and hitting your head on the ground or the court,” he said.
Prevention key, but no fail-safes
DU’s Gorgens is also involved on the technology side of protective sports equipment — another science that’s ever-evolving, but an area where youth sports programs have a hard time keeping up.
And it’s an area where Colorado has fallen behind other states on the prevention side, due to high equipment replacement costs and a lack of routine equipment replacement plans, Gorgens said.
Following the implementation of Jake’s Law, school districts across Colorado were able to ride a funding push to buy new, more-advanced football helmets and other equipment, such as extra-protective Guardian caps that can be used on helmets during practice. Some soccer teams also began using protective headgear.
But much of that equipment is now at or beyond its lifespan, leaving school and club sports programs to hold fundraisers to buy new equipment, Gorgens said.
“We’re having bake sales for brain health, which is sad but true,” she said.
“It is an expense, and it’s an ongoing expense. And it’s an investment that school districts, especially the smaller ones, really wrestle with,” she said.
Gorgens said there may be opportunities for high school sports programs to obtain equipment through corporate research sponsorships, similar to college and professional programs, to test some of the newer advancements. Helmets can be equipped with what are called accelerometers, which measure the G-force and provide important research data, she said.
“Manufacturers need that field research,” she said.
Glenwood Springs High School head football coach Tory Jensen said much of the protective equipment in his program is at the end of its life cycle. But even that seven-year-old equipment is far superior to what he used in his playing days, and even in his earlier coaching days at Roaring Fork High School in the early 2000s.
“We had terrible equipment when I played, and we hit 10 times harder than we do now,” Jensen said of the evolution of his sport.
“It’s a conversation that has been going on at the high school level for, what, 20 years now,” he said. “It’s a question of how we help our athletes work through playing a collision sport, and it’s difficult. As a coach, it’s unnerving when a head injury happens. You don’t want to see any athlete, or any parent, go through it.”
It’s the down side of any sport, whether it’s a collision sport like football, or even skateboarding, skiing and snowboarding, or mountain biking.
“We are a very active community, and we put ourselves at risk all the time,” Jensen said. “It’s definitely a part of our culture in this valley, no matter what you do.”
More to prevention than padding
There’s a lot more to prevention than just wearing the proper, up-to-date protective equipment.
As Erickson said, “There’s no perfect helmet.”
For Jensen’s football squad, it starts in the weight room.
“The number one thing we do to prevent those kinds of injuries is getting into the weight room and doing the strength and conditioning training you need to help your body absorb the contact that comes with football,” he said.
That can apply to any sport, really.
“We work on the preventative piece year-round, just trying to get in the weight room as much as possible and working on our strength and conditioning, so when a collision happens you’re less likely to get injured.”
“Neck strength in particular is a really important predictor in avoiding head injuries,” she said. “That’s one of the reasons we’re really focusing now on the junior high kids, because they don’t have the neck muscular build yet to be able to take those hits.”
Strength and conditioning is a big part of recovery from a head injury, too.
“The physical therapy field has really emerged as a leader in successful treatment, which runs upstream to doing more on the prevention side,” Gorgens said.
Proper conditioning is a practice Jensen said he carries into his athletic pursuits as an adult.
“I play hockey all winter long,” he said. “It’s not really a contact sport but, yeah, there’s contact, whether that’s a collision with another player or contact with the ice.
“Think about it; a bunch of old dudes on skates, sometimes things don’t go the way you want it to.”
Staying properly hydrated during physical activity is also key to avoiding injury, including head injuries, Jensen said.
One of the things he emphasizes with his athletes is avoiding energy drinks and certain supplements, which can have the negative side effect of causing dehydration.
“Part of the concussion prevention piece is dehydration, because your brain works within a liquid base that helps protect itself from bumping into the skull,” he said. “If you’re on a two-hour mountain bike ride and crash in the last hour when you’re dehydrated, it’s going to have more of an impact on your body.”
Recovery to return
“The only healer in a brain injury is time. It just takes time,” Jensen said.
A bad concussion can sideline a player for the rest of the season, if not longer. That’s just one of the risks, he said.
The statistics coming back from the National Football League around prevention and proper recovery when concussions occur is encouraging, and something youth programs can learn from, Jensen said.
During the just-concluded NFL preseason, the league reported 70% fewer concussions than in previous years, after new safety measures were put into place.
“I think it would be silly not to follow down that path and get all of our kids doing the same things,” Jensen said.
Erickson said the brain should be treated like any other muscle that gets injured.
“You have to work that injury out, same as any other muscle,” he said.
It can take some athletes longer to recover than others, which is why the return-to-play procedures are so critical. Initially, there’s a five-day progressive return protocol, but the doctor’s advice is the last word.
“We refer to the doctor to say do or don’t return to play,” Erickson said. Initially, that may even include a doctor’s order to stay home from school for a period of time and to not engage in other activities.
“We start with light activity, then gradually increase that activity, and if the symptoms come back, then they’re not ready to return to play yet,” Erickson said. “If they clear all the steps, they’re usually ready to go.”
It’s also important to understand that no two concussions are the same, and no two people are the same when it comes to sustaining a concussion and recovering from one.
“I played a lot of rugby, and I know there are people who have coconut heads, and who can just take more than another person,” Jensen said.
Still, “Every time you get hit in the head, it’s got to add up,” he said.
Brain Health & Injury
The Longevity Project is an annual campaign to help educate readers about what it takes to live a long, fulfilling life. This year’s project will focus on the critical and relevant topic of brain health after injury.
Our panelists are experts in treating concussions and TBI. They will share the latest research, treatments, physical therapies and how concussions impact aging. Whether for themselves or someone they know, attendees will learn useful takeaways for optimizing brain health after injury.
WHEN: Nov. 10
WHERE: TACAW, The Arts Campus at Willits
TIME: 5 p.m. Meet and Greet; 5:30-7 Panel Discussion
TICKETS: Can be purchased online at https://events.cmnm.org/e/longevity2022
The Buddy Program rang in the holiday spirit with their annual Gingerbread House Workshops in Aspen and Carbondale.