Concussions in Sports: Brain injury making impact at every level

Dr. Mike Nunley speaks about four or five years ago like it was prehistoric times. In his world of treating concussions, that’s largely true.

Nunley, a clinical neuropsychologist at Memorial Health System’s sports concussion clinic, talks about the primitive care for concussions just a few years ago, how mild concussions were not taken very seriously, the lack of medical knowledge on the subject and the lack of desire for those affected to learn more.

“In the past we said ‘How many fingers do you see? You feel OK? Good, go back in the game,’” Nunley said. “It’s the brain! It’s not an ankle, it’s the brain!”

Concussion awareness is moving at a fast rate in 2011. Guidelines have been introduced by the NFL and NCAA. Colorado followed up a CHSAA guideline with Senate Bill 40, which protects athletes as young as 11 years old in organized club and school sports.

There are many examples why those measures are positive steps. Jake Snakenberg, a 14-year-old football player at Grandview High in Aurora, died last year from second impact syndrome — when someone suffers a second concussion before a first one has healed, and the brain swells. In 2006, Matt Fliney, a tight end at Widefield, suffered from second impact syndrome, and has undergone multiple brain surgeries.

At Air Force, Steve Shaffer was a promising tight end but a pair of concussions in 2008, and the prolonged symptoms after those injuries, forced him to retire. Basketball player Sammy Schafer hasn’t been able to shake post-concussion symptoms from a blow to the head he took in November 2009. Schafer took this school year off because of his constant headache.

The NFL has a long history of concussions. Former Broncos receivers Brandon Stokley and Ed McCaffrey each admitted to suffering multiple concussions. Stokley admitted in 2008 he had about eight or 10 concussions in his NFL career, and suffered at least one more since then, with Seattle last season. McCaffrey had countless concussions, including two in the final three games of his career in 2003. McCaffrey publicly supported Senate Bill 40, named after Snakenberg.

Concussions aren’t just a football issue. Nunley said females are more susceptible to concussions, and the NCAA said that concussions accounted for 11 percent of injuries in women’s soccer in 2009. Major League Baseball (which started a seven-day concussion disabled list this season), the NHL (Sidney Crosby missed most of the season, and the playoffs thus far) and NBA have also had high-profile concussion cases.

“(Athletes) and their parents are seeing so much of it in the media, they’re taking a closer look and trying to learn about it more for their safety and well-being,” Air Force head football trainer Tony Peck said.

Pro leagues have toughened their protocols on concussion. In the NCAA, and in Colorado youth sports, if a player is diagnosed with a concussion he is done for the day. Old buzzwords like “seeing stars” and “getting dinged” are being recognized as concussions, and even those mild concussions can have long-ranging effects. Mild concussions are no longer viewed as a different injury than a Grade 3 concussion, in which a player loses consciousness.

“I get a kid and a parent to the office: ‘He didn’t have a concussion, he just walked off dizzy and things lasted for a couple hours and they were gone,’” Nunley said. “Well, that’s a concussion.”

Even though research on concussions has increased dramatically, there are still questions about what causes the lingering effects of concussions. Concussions happen from sudden force to the brain, shaking or spinning. Usually when the brain is traumatized, blood flow is restricted. The brain needs glucose to function, Nunley said, and that is impaired by the lack of blood flow. Although Nunley said hits to the side of the head are more likely to result in concussions, Peck said in Air Force’s studies on its football head injuries, there has been almost no correlation for what kind of hits cause the injuries, or whether it’s an offensive or defensive player. Peck said Air Force had 16 reported football head injures last year, and since 1998 the Falcons have averaged about 12 per year.

Nunley said researchers can’t say for sure why some concussion symptoms last for months, while for other people the symptoms clear up in days. Nunley said some people might be more at risk for concussions or severe symptoms based on genetics, and he thinks eventually studies could lead to aspiring athletes being warned they are at risk.

“I do think over time we’ll come up with genetics and say, ‘You should go into something else other than football or wrestling, because it’s not going to work out,’” Nunley said.

Age is a big factor in concussions. Recent studies have suggested that athletes under 21 are more susceptible to concussions and warrant even more caution than older players, Colorado College hockey trainer Jason Bushie said.

The baseline test each CC freshman takes becomes even more important since concussions sustained during high school and junior hockey may not be recorded. Some kids may not even realize they sustained one if it is minor. Nunley said baseline concussion tests are common now in NCAA sports, and also widely used in the NFL and high schools.

Trainers rely on the athlete to tell them about previous injuries. Education about potential life-altering consequences has made players more willing to fess up than in years past. But it is far from perfect to rely on a teenager, especially if they are concerned it may hurt their chances at a scholarship.

“Underreporting still remains an issue,” Bushie said. “You collect what you can about their history as soon as the recruiting process allows; certainly once they’ve committed.”

Strides have been made to educate players and coaches, in research and in changes like helmets that can help prevent concussions, and the issue of treating concussions in sports is being handled a lot more responsibly than it was just a few years ago. But concussions can’t be eliminated in contact sports.

“Absolutely not. It’s physics,” Nunley said. “Even if you have the best helmet, so it can take that hit and absorb the force, your brain still shakes inside your skull.”

“It’s never going to change,” said former Air Force cornerback Reggie Rembert, who said he had three concussions in his career. “That’s just going to happen. Players are aggressive, and it’s a collision sport."