Reno Gazette Journal tackles issue of concussion in high school football

Coaches and trainers arrived at McElroy's side moments later, and the junior eventually came to. He was loaded onto a gurney and placed in an ambulance, but not before he gave a thumbs up to his concerned teammates.

All told, it was a 20-minute ordeal on the Douglas Tigers' field. McElroy doesn't remember a second of it. 

"I remember getting the play from Coach, running out to the huddle and calling it. And that's about it," he said. "I don't remember the hit at all." 

McElroy had suffered a concussion. 

"It's a little scary," the senior said this week, as he prepares to lead Bishop Manogue into the 2010 season, again as the Miners' quarterback. "I never really thought about concussions, and then it just hit me last year." 

Concussions, and how to best care for players after they have sustained one, are a prevalent topic across all levels of football. And as a new high school season kicks off tonight across Northern Nevada, it does so under new, more stringent guidelines designed to better protect the developing brains of all high school athletes. 

Despite the heightened awareness -- which has trickled down all the way from the National Football League -- experts said many parents, coaches and players still don't fully grasp the magnitude of the problem. 

 "A concussion is a brain injury," said Dr. Richard G. Ellenbogen, a neurosurgeon at Seattle Children's Hospital and co-chair of the NFL Head, Neck and Spine Medical Committee. "When you put it that way, a brain injury, it hits home a little harder. 

 "Awareness is up, there is no doubt about that, but there is still a long way to go." 

Clinically Speaking

A concussion occurs when the brain makes forceful contact with the inside of the skull. Ensuing symptoms can include headaches, nausea, dizziness and vision problems.

Concussions are common among athletes, accounting for about one in 10 sports injuries, according to statistics from the Centers for Disease Control and Prevention. About 1.8 percent of high school athletes -- 140,000 per year -- are believed to suffer concussions, including an estimated 55,000 in football.

There are no statistics available for the number of concussions suffered annually in Nevada. 

Dr. Ellenbogen said 90 percent of concussions do not result in the high school athlete being "knocked out." 

But, with each concussion, it takes less impact to suffer another. And each concussion can be more damaging than the previous. Long-term effects can include memory loss, headaches, dementia and other problems, such as depression. 

Kids also are more susceptible to a concussion than adults. And they take longer to recover. 

McElroy sat out two weeks after his concussion last year -- which was the second of his career -- and returned for the playoffs after being cleared by a doctor. But, "that game was a little fuzzy for me. I took some big hits that game," he said. 

Nearly 40 percent of high school athletes return to their sport before they have recovered, according to an American Journal of Sports Medicine study published last year. 

Getting The Message

Concussions are not new, but over the past decade the stigma of reporting and treating such injuries has faded. 

Thanks to significant education efforts by athletic sanctioning bodies and health organizations, the message has started to register with athletes as well. 

 "There are always some kids who will try and hide it to stay in the game," Manogue trainer Kelly Wilson said. "But most of them are pretty good about letting a trainer to coach know something isn't right." 

In 2008, the Sports Medicine Advisory Committee of the National Federation of High Schools (NFHS) advocated that an athlete with a concussion be removed from play and not allowed to return on the same day. In 2009, that position was adopted by the leading group of sports medicine experts and the NFL.

The NFL recently distributed a poster to all its teams that lays out concussion dangers in stark terms. In addition to listing the symptoms of concussions, the poster warns that repeated concussions "can change your life and your family's life forever."

This year, the NFHS made concussion recognition and management a point of emphasis in each sport's rule book, and has broadened the authority of officials to remove players from a game in the event of an apparent head injury.

 The rule books for most sports previously included language directing officials to remove an athlete from play if "unconscious or apparently unconscious." 

 Now, that language has been changed to: "Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion (such as a loss of consciousness, headache, dizziness, confusion or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional." 

The Nevada Interscholastic Activities Association, which governs high school sports in the state, adopted these guidelines this summer.

"If in doubt, sit 'em out," Dr. Ellenbogen said. "It's not like a bruised knee. With any kind of head injury, they have to sit out."

Reed coach Ernie Howren agreed.

“In this day and age, it’s something we’re conscious of and something our team doctors and trainers are conscious of,” Howren said. “I’m confident every kid out there has been cleared to be out there.”