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New concussion law puts Mass. schools, athletes on alert
By Eric McHugh
QUINCY, Mass. — NO helmet. No jersey. No pads. Instead, Quincy High School senior Reggie Cesar's uniform consisted of a backward Minnesota Twins cap, a gray, sleeveless athletic shirt and white football pants.
He looked like a star running back who was taking a break.
Which he was.
A minor ankle tweak was part of it. But so was the fact that the Presidents' tri-scrimmage with Marshfield and Stoughton at Veterans Memorial Stadium last week had been temporarily suspended. One of the Stoughton players had suffered a leg injury that required a trip to the hospital, thereby removing the EMTs who were monitoring the game.
With no safety net in place, officials wouldn't let play resume until a replacement ambulance arrived, so everyone milled around a while.
Cesar took it all in stride. After all, he's used to interruptions.
Take last year, for example, when he missed one game with a concussion.
Actually, make that two games since he can recall virtually nothing about the one in which he got hurt - other than the fact that, ironically, he was playing defense at the time.
"I remember going to make a hit and it didn't go the way I wanted it to," Cesar said.
Instead, it went this way - a Plymouth South player's helmet caught Cesar's flush in the earhole, crumpling him to the ground.
"It was a little wild," Cesar said. "I didn't know what was going on. It was the first time we were wearing (all-blue informs), so I was amped to play and then I remember being on the ground and everyone was quiet. That was the scary part."
Tim O'Brien knows the feeling.
Unlike Cesar, the East Bridgewater quarterback can't pinpoint the specific hit that concussed him during last year's Thanksgiving win over Rockland. He thinks it was more an accumulation of three successive plays that sent him over the edge.
O'Brien appeared fine to the EB coaches when he trotted over to the sideline to receive the next playcall, but when he got back to the huddle he started babbling nonsense.
"It was just weird," running back Casey DeAndrade said. "His eyes were kind of hazy. And just the way he acted, he didn't know what he was talking about."
Ushering in a new era
An Oregon-based pediatric sports medicine doctor, he's also chairman of the sports medicine advisory committee for the National Federation of State High School Associations. Concussions are an important part of his practice. He has first-hand knowledge, too.
Although he joked that he "never moved fast enough to get a concussion" as a two-way high school lineman in rural Oregon, he did crash his motorcycle in junior high. "I walked back home half a mile and had absolutely no idea of where I was," he said. "My symptoms resolved within a day or two, but it was scary."
After decades of shake-it-off attitudes about blows to the head, there's been a sea change in how the sports world views a concussion, which Koester said can be defined as a "traumatic alteration of normal brain function."
A wave of high-profile incidents in pro sports - everything from the NHL epidemic that has claimed the likes of Sydney Crosby and Marc Savard to the rash of helmet-to-helmet hits in the NFL that has led to a flurry of fines and the new kickoff rules - has filtered down to the youth level.
Koester said Oregon and Washington were among the first states to pass laws setting uniform standards for dealing with concussions in grade schools and high schools. Now that trend has reached Massachusetts. The state legislature passed a similar law in 2010, and the state Department of Public Health finalized the guidelines this June.
Covering all sports programs from sixth grade and up for schools that are members of the Massachusetts Interscholastic Athletic Association, the law mandates the following:
Everyone involved with a program - coaches, volunteers, players and players' parents, included - must participate in a state-approved concussion-awareness program before each season. There are two online courses (one run by the Centers for Disease Control and Prevention, the other by the National Federation of State High School Associations) which satisfy this requirement. Schools also can craft their own programs; many have incorporated concussion discussions into their regular preseason get-togethers with parents.
Players must file a history of head injuries with the school before each season.
Any player suspected/diagnosed with a concussion must be removed from practice or a game immediately and is ineligible to return for the rest of the day. In fact, a concussed player can only rejoin competition when he or she has been cleared, in writing, by a doctor, or by an athletic trainer in consultation with a doctor.
During the season, parents must notify the school if a player suffers a concussion outside of sports.
Schools must keep records on concussions and submit that data to the state.
Many schools already had similar protocols in place, and initially there was some blowback from high school administrators about the state piling additional paperwork on them. New Whitman-Hanson athletic director Bob Rodgers acknowledged that ADs were "pulling their hair out" over the summer as they tried to deal with the extra workload - and the daunting challenge of getting all their student-athletes' parents certified for the concussion-awareness program.
Now, however, that storm has passed, and Rodgers says everyone is on board with the new reality.
Just in time, too.
Hingham athletic trainer Al Blaisdell, a 19-year-veteran, said concussions appear to be on the rise among high school athletes who are "bigger, faster and stronger" than ever.
Dr. William Meehan, the director of the Sports Concussion Clinic at Children's Hospital Boston and a member of the DPH's advisory committee that crafted the state concussion guidelines, said that about 15 percent of all high school injuries are sports-related concussions. And while the new rules apply to all sports, even golf and cross country, there's no doubt that football is the chief culprit when it comes to concussions during the fall season.
Kids at risk
Use a properly fitted, high-quality helmet
Wear a good mouthguard.
Use proper tackling form. "Keep your head up. Lead with your shoulders. Never look down. Don't spear anybody," Marshfield senior tailback/linebacker Mike Williams said, rattling off the checklist that is drilled into every player each season.
Unfortunately, there's no way to completely eliminate concussions. Some players, such as Williams, negotiate their entire careers without one. Others, like Marshfield teammate Joe Hastry, aren't as fortunate. Hastry, a senior tight end/linebacker, said he has been knocked unconscious twice on the field - once five years and again three years ago. "It's a little scary knowing that once you get one the potential to get another one goes up," he admitted.
The cumulative nature of concussions - one can make you more susceptible to another, which eventually can start a cascade - is frightening, especially for teenagers.
"Young people's brains are not myelinated," said Dr. Robert Cantu, a neurosurgeon and co-director of the Boston University Center for the Study of Traumatic Encephalopathy. "The myelin is like the insulation on a phone line [which is essential for the proper functioning of the nervous system]. It's what goes on the outside of an axon [the part of a nerve cell, or neuron, that conducts electrical impulses] that gives it greater strength. So a young brain is more easily injured at lower forces than an adult brain.
"A young brain is proportionally bigger than the rest of the body and is located on top of a weaker neck than you normally are going to have in skeletally mature adults. That also sets it up for great injury. Young brains are more vulnerable, and as a group they recover more slowly from concussions."
Young people are particularly susceptible to what's known as second-impact syndrome, an often-fatal condition in which the brain swells rapidly after a person suffers a second concussion before symptoms of an earlier one have subsided.
"The key is getting them out as soon as they show symptoms and then making sure they don't return to play until they are completely resolved," Koester said. "Far and away, the worst concussions that I see are the kids who continued playing even after they got hit.
"I saw a kid today. He got throttled by an offensive lineman, thrown back on his head, everything went black and he kind of stumbled when he got up, but nobody really noticed and he kept on playing. Now he's had concussion symptoms for the last week and I don't know when he's going to get better because he didn't give his brain that initial rest that it needed. Those kids often go on to have pretty severe symptoms that last for weeks and weeks or longer."
Trainers play key role
Both Cesar and O'Brien tried to return, or stay in, their games but were thankfully thwarted. O'Brien was flagged by his teammates, particularly DeAndrade, who waved him out of the East Bridgewater huddle when he started barking out plays that didn't exist.
"He's my best friend," O'Brien said of DeAndrade. "He knew I wasn't in the right state of mind."
Cesar made it to the Quincy sideline, where he was figuratively hog-tied by an athletic trainer who asked him to repeat a series of words. "I failed it badly," said Cesar.
Meehan called athletic trainers "invaluable and underappreciated" and pointed out that they, along with coaches, are on the frontline of identifying concussed players and removing them from danger.
Blaisdell, Hingham's athletic trainer, has helped his school get out in front of the curve on concussions. He gave a concussion-awareness talk to Hingham parents last year, before it was required by law. And Hingham has used ImPACT computer testing for its athletes for about six years. (This test gives a baseline reading for student-athletes' brain function, which can later be compared to another test given after a possible concussion.)
Unfortunately, not every school can afford a fulltime athletic trainer. Quincy, for example, does not have one on staff, although there was one in attendance when Cesar got hurt. To try to help defray the costs of the new concussion rules, some schools have gotten creative. Blue Hills Regional, for example, has partnered with Brockton Hospital, which footed the bill for baseline testing and will serve as a resource for concussed student-athletes and their families.
Rodgers, Whitman-Hanson's AD, said his school has a similar arrangement with Signature HealthCare, which he said has expressed interest in providing baseline testing for all W-H students, not just athletes.
"I wonder how many concussions I had as a player that weren't diagnosed," said Quincy coach Bill Reardon, who played at Quincy and Stonehill College in the 1990s. "I never had any of those deals where I couldn't remember where I was, but I certainly had a ton of blackouts, what we called the 'white flashes.' I'm sure those were something, but that's just the way it was back then. You got it and shook it off. 'Good hit' and go back in."
"Honestly, when I played in high school, who knows if you had a concussion?" Scituate coach Herb Devine agreed. "If you got hit in the head, you got dinged, you shook it off and you went back in there. There's so much publicity now ... Back when I played in 1989 or '90, we just didn't know enough about it."
Of course, all this increased awareness still butts heads, so to speak, with the macho ethic of football, which exalts individual sacrifice made for the good of the team.
"I still see that out of the kids," East Bridgewater coach Shawn Tarpey said. "They're so young and so competitive and so into it. They just want to get back in there. In football you shake everything else off. In the past you shook off concussions, too."
Not anymore, though - hopefully.
Cesar skipped Quincy's next game after his concussion and said he felt much better after the 13-day layoff. Still, he acknowledged a twinge of guilt about sitting out, even though the Presidents won in his absence.
"I don't want to do damage to my body," he said, "but I don't want to let my teammates down, either. There are times that you push the line, but I feel I've gone about it (the right way)."
Since East Bridgewater didn't make the playoffs last season, O'Brien wasn't tempted to return to the field right away. He detoured to the hospital after his Thanksgiving game and skipped the traditional dinner at his aunt's house. (She sent him over a plate of food instead.)
While O'Brien didn't want to leave his game, he said if the situation arose again, his approach would be simple: "Safety comes first."
DeAndrade, his teammate, agreed. "It's definitely hard to admit that you want to come out because everybody's looking at you as a big tough guy and stuff, but you have to put your health in front of everything else."