<br>Adrian Taylor, an all-state quarterback at Speake High in 1994, said he never heard the word “concussion” when he played football.

But increased awareness and other factors have led to alarming increases in reports of concussions at high school athletic events — so much so that Alabama has joined others in making laws to protect athletes. And the message is this:

Concussions are a real and growing danger and happen more often that we know.

“I got my bell rung and several of my teammates did,” Taylor said. “We got a drink of water, cleared our head with some smelling salt and went back into the game.”

Taylor’s son, Gabe Vernon, is a senior running back at Lawrence County High, and Taylor said he talks with his son about running techniques so that he can avoid helmet-to-helmet contact. Such contact is believed to be the most common cause of concussion on the football field.

“I tell him to avoid direct hits,” Taylor said.

Alabama and more than 30 other states have adopted laws that govern how coaches deal with players who show concussion symptoms. Alabama now requires coaches — middle school and high school — to receive training on how to recognize symptoms of concussions. Schools are required to have “concussion information forms” on file for all athletes.

Gone are the days when trainers can put an ammonia capsule under an athlete’s nose and return him to the game, said Drew Ferguson, director of sports medicine at the Concussion Clinic in Birmingham.

Ferguson served on the state’s concussion task force that helped develop the law.

He said a 2009 incident involving a 13-year-old middle school student in Washington — and an ongoing lawsuit against the National Football League — played significant roles in eliminating the badge of toughness associated with playing after a concussion.

“Twenty years ago, we, including the medical community, just didn’t know what we know about the brain today,” Ferguson said.

A study published in the American Journal of Sports Medicine in 2011 said concussions in high school football increased 8 percent annually between 1997 and 2008. The same report said there were 60 concussions for every 100,000 games or practices.

With football having the highest rate, the Centers for Disease Control and Prevention estimates that as many as 3.8 million athletes suffer concussions every year. The effects on an adolescent brain is unknown, the CDC noted, but it is suspected that it takes longer for younger athletes to heal compared to college and professional athletes.

Before the Alabama High School Athletic Association adopted guidelines, Children’s of Alabama hospital in Birmingham treated an average of 20 athletes per year for concussions. It opened the Concussion Clinic in 2009. In 2010, the clinic treated 60 athletes — three times its previous average.

Then last year, with the new law in place, the number mushroomed.

“We saw 360 individual patients,” Ferguson said.

Shift in approach

Tanner High football coach Laron White has been an eyewitness to football’s shift on treating head injuries.

When he played at Courtland High and for the University of Alabama, he said players got “woozy” all the time.

“You just got up, went back to the huddle and kept rolling,” he said. “It was a sign of toughness because you didn’t want to let the guy who hit you believe you were weak.”

The culture started to shift when former Pittsburgh Steelers center Mike Webster died in 2002. The four-time Super Bowl winner and NFL Hall of Famer was homeless when he died.

His doctors said concussions during his 17-year career damaged his frontal lobe — causing cognitive dysfunction — and led to his emotional and physical decline after football.

While studies existed to show that concussions were a problem at the high school level when Webster died, the movement to address the matter didn’t begin until after Zackery Lystedt’s injury in 2006.

The 13-year-old suffered a concussion in a middle school football game in Maple Valley, Wash. He collapsed after returning to the game.

Lystedt survived surgery and went on to graduate high school. But three years after his injury, Washington passed the Zackery Lystedt Law, which prevents athletes who have suffered a concussion from returning until cleared by a doctor.

Alabama law

In that same year, the AHSAA drafted its first rules governing concussions. Last year, the state Legislature made the AHSAA policy into law.

“It’s an acknowledgement that (parent and athlete) understand our concussion policy,” AHSAA Director of Communications Ron Ingram said.

AHSAA tweaked its concussion rule before this season.

“If a player suffers a concussion today, that player can’t return to play until the next day, regardless of whether cleared by a doctor or not,” Ingram said.

This change was designed, in part, to help coaches who were pressured from parents to allow their children to return as soon as possible.

White, in his 10th year at Tanner, said he has pulled one player because of a concussion. But he knows of cases where coaches were pressured to put kids back into big games.

White also said players are reluctant to tell you when they are hurt because of new rules.

“We have to pay attention and be smart,” he said of coaches. “We know when a player gets up and he’s not right.”

Tanner has certified trainers at practices and games.

Although Austin High is only three games into the current season, head coach Jeremy Perkins already has pulled one player showing concussion symptoms.

Because of privacy requirements, he could not release the player’s name or talk about specific symptoms.

“I knew the kid had concussion signs, so I sent him to a trainer,” Perkins said. “The trainer concurred with me, and the player didn’t return until he was cleared by a doctor.”

Like most programs in the area, the first thing coaches do at Austin is take the player’s helmet if concussion signs exist.

“We monitor our kids, and their health and safety always comes first,” Perkins said.

What happens in the brain to cause a concussion is not pretty, but Ferguson said sometimes it takes the bare facts to get the attention of athletes.

He said head trauma happens when the fluid between the brain and skull is “out of whack” and the brain hits the skull.

Ferguson said less than 10 percent of concussions result in loss of consciousness, but almost all leave symptoms like headaches, confusion, nausea, dizziness and blurred vision.

He helped establish the Concussion Clinic, which provides evaluation, treatment and medical clearance for youth and teenage athletes to return to play.

Between 40 and 50 percent of the athletes treated at the clinic are football players.

“The awareness of concussions is certainly a lot better than it was 20 years ago,” Ferguson said. “But we still have a long way to go.”

What is a concussion?

A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way the brain normally works. Concussions also can occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.

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Symptoms

The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Symptoms can last for days, weeks or even longer.

The most common symptoms after a concussive traumatic brain injury are headache, amnesia and confusion. The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.

Signs and symptoms of a concussion may include:

Headache or a feeling of pressure in the head, temporary loss of consciousness, confusion or feeling as if in a fog, amnesia surrounding the traumatic event, dizziness or “seeing stars,” ringing in the ears, nausea or vomiting, slurred speech and fatigue.

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Alabama’s concussion law

Gov. Robert Bentley signed Alabama’s concussion law June 9, 2011. House Bill 108 requires:

• Youth athletes and their parents must be educated about the nature of concussion and brain injury. On a yearly basis, a concussion and head injury information sheet must be signed and returned by the youth athlete and his/her parent prior to starting the sports season.

• Coaches to receive annual training to learn how to recognize the symptoms of a concussion and how to seek proper medical treatment for a person suspected of having a concussion.

• A youth athlete suspected of sustaining a concussion or brain injury in practice or a game must immediately be removed from play and cannot return to play until a written clearance is received from a licensed physician.

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Return to play

The Concussion Clinic at Children’s of Alabama was established to provide evaluation, treatment and medical clearance for “return to play” for youth and teenage athletes in our community. Athletes should not be returned to play the same day of injury. When returning athletes to play, they should follow a stepwise symptom-limited program, with stages of progression. For example:

• Rest until asymptomatic (physical and mental rest)

• Light aerobic exercise (e.g. stationary cycle)

• Sport-specific exercise

• Non-contact training drills (start light resistance training)

• Full contact training after medical clearance

• Return to competition (game play)

There should be approximately 24 hours (or longer) for each stage, and the athlete should return to stage 1 if symptoms recur. Resistance training should only be added in the later stages. Medical clearance should be given before return to play.

CHILDREN’S OF ALABAMA HOSPITAL