Source: The NapervilleSun [PAUL LATOUR Staff Writer]

Early recognition of concussions essential to health of young athletes

Jon Tomberlin didn't think too much about his headache. He had just finished playing a football game on Sept. 7 his first varsity start for Neuqua Valley and as a blocking tight end, he banged helmets with defensive linemen all night long.

So his headache seemed normal. He mentioned it to a few close teammates, but never told his coaches or the school's athletic trainers, or his parents.

Instead, Tomberlin returned to practice the following Monday with his head still pounding. During contact drills that Tuesday, he had a helmet-to-helmet hit with a teammate during a kickoff return drill.

"That shook me up a little bit," he said.

But he still wasn't sure whether he had suffered a concussion, so again he didn't tell anybody. Like many athletes, he didn't want to show weakness, and decided to play through the pain.

Then came the Wednesday practice. Tomberlin was now feeling some dizziness, but went through with practice. Another helmet-to-helmet collision with a teammate followed. Tomberlin walked to the sidelines and talked to an athletic trainer, telling somebody for the first time he thought he might have a concussion.

"I didn't play after that," said Tomberlin, a junior. "That was my last play."

Although Tomberlin had his season " and quite possibly his football career" ended only three games into his varsity debut, he was lucky. About 80 percent to 90 percent of people who have a single concussion can recover within two weeks. The danger comes when the first concussion isn't diagnosed or reported.

If someone has had three or more concussions " once they've hit that ˜magic number " there is data to suggest the risk of permanent injury is more substantial, said Felise Zollman, the medical director of the Brain Injury Program at the Rehabilitation Institute of Chicago.

A football player with a concussion is not surprising, it's a violent sport. At Neuqua alone this season, 19 players have been treated for the injury. That number may seem high, but considering there are more than 200 players in the entire program, it's about average. The Sports Concussion Institute in California estimates 10 percent of all athletes in contact sports have concussions each season.

What may be surprising is that girls are at a higher risk for concussions than boys, according to a study to be published in the Journal of Athletic Training and first reported by the New York Times earlier this month. The study found that in high school soccer, the concussion rate is 68 percent higher for girls. In basketball, the rate is three times higher for girls.

The difference between girls and boys

Concussions are nothing new for Alexa Bannerman, a former Waubonsie Valley soccer standout now playing at Colorado College. As a junior at Waubonsie, Bannerman suffered one after a midair collision while trying for a header. She fell to the ground, landing hard on her neck.

She remembers blacking out for a short period right after the contact, but she quickly regained consciousness, so quickly she doubts anybody even knew she was out.

"I remember looking up and wondering where am I right now," Bannerman said.

She tried to keep playing, but finally told her coach she needed to come out of the game. When Bannerman got to the bench, she passed out for more than five minutes and was taken to the hospital.

"That one was really scary. It was a pretty serious one," said Bannerman, who has been diagnosed with three concussions, including her first when she was in fifth grade.

The study did not examine why girls have higher rates of concussions than boys, but one possible explanation is that girls don't try to hide their injuries as much as boys might. That explanation, however, can be debunked by looking at Brittany Bock.

Bock, a Neuqua graduate in her junior soccer season at Notre Dame, said she has never been diagnosed with a concussion, adding she was surprised she hasn't. Using her head is a big part of her game and of her 34 goals in college, nearly half (16) have come on headers. That doesn't take into account the many midair collisions she's had, which are far more serious than simply hitting the ball with your head.

I've gotten dizzy sometimes (after a collision)," Bock said. "If I am dizzy, I just float around the field a little until I feel I can bring myself back. But I've never been held out from hitting my head."

That description is consistent with a symptom of concussions, which at the very least are considered mild traumatic brain injuries.

Sometimes the biggest obstacle in diagnosing concussions is getting the athletes to admit they might be injured.

"I understand a lot of athletes just want to play, but you have to take into account the safety of it," said Mandy Gacek, the head athletic trainer at North Central College. "I'll take helmets away from football players so they can't go back in the game. You have to educate the athletes on what the dangers are."

Making an impact

Today's poster child for concussions is NFL quarterback Trent Green, who was recently placed on injured reserve by Miami after suffering another one. His season was also cut short last year because of a concussion while with Kansas City.

Tony Strickland, the director of the Sports Concussion Institute, estimates there are between 1.8 million and 3.6 million sports-related concussions each year. But he said a disproportionate amount of attention is paid to elite athletes.

"The majority of those occur in youth, between the ages of 12 and 18; that's where the problem is," he said. "And, unfortunately the greatest risk for adverse consequence to concussion is in the same group. The structure of the brain is still evolving for them."

While the NFL received much attention for instituting mandatory baseline testing this season, the practice has been going on for several years at area high schools, including Neuqua and Naperville Central. Both schools use ImPACT, a computer-based program that provides a baseline score by measuring such things as an athlete's short-term memory and reaction time. The program also includes a section that checks athletes for 22 symptoms. If athletes answer yes to any of the symptoms, they then grade the condition from 1 to 6.

When Tomberlin took his first test, his memory score was 99, which placed him in the 97th percentile. When he took it again six days after being diagnosed with a concussion, his score dropped to 79 (20th percentile).

His symptom score went from 1 to 64, which is far below the maximum 132, but high enough to indicate a concussion had occurred.

"It really gives you a flavor for how that short-term memory is just gone," said Laura Tomberlin, Jon's mother.

Perhaps the biggest advantage of using the program is that it provides an objective tool for measuring concussions.

"This is so clear-cut," said Neuqua athletic trainer Mark Florence, who has been using ImPACT for two years. "Now it's on a piece of paper and here is why you're not playing. This makes it more concrete to athletes to parents to athletic trainers."

When Naperville Central athletic trainer Bill Hughes began using the program four years ago, he had to keep a football player from playing with a concussion. Having something tangible to show the athlete might have been the only way to keep him off the field.

Once the player resigned himself to being benched, he told Hughes he hadn't had feeling in his left arm since suffering the concussion.

"That macho syndrome is alive and well," Hughes said. "And we have to fight it on a regular basis."

Enough's enough

Awareness is the key to keeping athletes safe when it comes to concussions. The sooner the symptoms are recognized, the sooner an athlete can recover.

But even with all the information available, it's not always enough to prevent an athlete from playing through a concussion, as Neuqua freshman student football coach David Ricca discovered this season. Ricca suffered a severe concussion as a sophomore at Neuqua when on a ski trip to Alpine Valley with a youth group.

He slipped on some ice at the bottom of the slope and slammed his head into a nearby fence. He was unconscious for 30 minutes and later learned another concussion could be fatal. That ended his football playing days, but Neuqua coach Bryan Wells kept him on as a student-coach, helping with the defense.

This season, Ricca said one of his players suffered a concussion, but came back with a doctor's note allowing him to play anyway.

"There are students who have so much heart, they're not going to take themselves out of a game," Ricca said. "They think they need to suck it up and play through. That's the worst thing they could be doing. I will keep a kid out, even if he's a star player, because his health and well-being are not worth the win."

Like Ricca, Tomberlin's playing days are likely in the past. He turned in his uniform and equipment shortly after learning he suffered a concussion and was told by a neurologist that another brain injury could have serious consequences.

The headaches that made it nearly impossible to concentrate in school have subsided somewhat. Instead of a constant pounding, he said they come and go throughout the day now.

Wells extended the same offer to Tomberlin he gave to Ricca, but the idea of being around his friends and not being able to participate was too much for Tomberlin. He went to Neuqua's Week 5 game against Larkin, but hasn't been back.

"If I would have dealt with the first one properly I probably could have been back practicing and playing the next week," Tomberlin said. "But instead I tried to play through it. You got to realize enough's enough."