The Unseen Injury Gets a Closer Look

Nashoba Regional football fans are all too familiar with the sight of injured players watching from the sidelines on crutches, or with casts on arms, even occasionally in a wheelchair. And then there are the players who have suffered concussions, who seem from afar to be dressed in street clothes for no apparent reason, because doctors haven't yet figured out a way to put the brain in a sling.

Concussions may not leave any visible marks, but this type of brain injury has ominous implications for a player's career and long-term health—and not just in football, but in any sport where an athlete might sustain an impact to the head. As more information becomes available about the effects of concussion, Nashoba Regional is taking steps to reduce the number of players affected and minimize complications by making sure athletes don't return to play too soon.

“What we need to do is educate the players and coaches about how serious it can be,” said Don Napolitan, the Chieftains' athletic trainer. “A concussion isn't something you can see, like a bad knee. So if someone is hurt, it's hard to know if they're actually injured. But the coaches are good about it. They know the consequences. Even if it means their star player's out, they understand.”

For years, it was believed that an athlete didn't have a concussion unless he or she had been knocked unconscious. High school athletes who simply felt dizzy or disoriented following an on-field collision were conditioned by coaches to shake it off and keep playing. But that's changing, as high-profile athletes like former New England Patriots linebacker Ted Johnson have brought the issue into the media spotlight. Johnson, who estimated that he suffered 30 concussions during his football career, believes those injuries led to the depression he is now battling. Research from the University of North Carolina supports this claim; investigators there found that former pro football players who had suffered at least three concussions were significantly more likely to experience depression and long-term cognitive impairment than those with none.

A single concussion is unlikely to have such severe effects, but if an athlete returns to play before the brain has completely healed and sustains another concussion, the resulting “second impact syndrome” can be much worse. That's why Napolitan tries to make sure that players and coaches learn to recognize the symptoms of concussion (see table), and that athletes stay off the field until they are symptom free—not just while at rest but also while exercising or while performing cognitive tasks.

“People are definitely more aware of it,” said team captain Matt Murray, a senior from Stow. “It's always good to err on the cautious side. If I had a concussion I definitely wouldn't play.”

The school has also implemented a computerized neurocognitive test, known as ImPACT, as an additional tool to help determine when the effects of a concussion have fully resolved. Chieftain athletes in all contact sports take the test prior to the start of a season to establish a baseline score. Then if an athlete does suffer a concussion, he or she will take the test again once all physical symptoms are gone. If the post-concussion test score does not approach the preseason baseline score, that's an indication that the brain is still not yet fully healed.

“It's frustrating for the players, because if they've been out for a while, they want to do something to rehab, to make themselves better. With every other kind of injury you can do that,” Napolitan said. “But with a concussion, any exertion takes energy away from the brain and then the symptoms come back. I've seen that several times.”

This year the Nashoba football team also received new Riddell Revolution helmets, which are designed to better protect players from the types of impacts that result in concussion, including side impacts. A February 2006 study published in the journal Neurosurgery found that high school football players who wore the Revolution helmets were 31% less likely to suffer a concussion than those who wore standard helmets. But no helmet can prevent all concussions, as the Chieftains can attest after losing at least four players to concussion this season.

“We've had our fair share of concussions,” Napolitan said. “But one reason is that the kids know more about it and have been more forthcoming, telling us when they're having symptoms. Which is exactly what we want to have happen.”

Concussion symptoms

Headache

Dizziness

Confusion

Post-traumatic amnesia

Fatigue

Nausea/vomiting

Sensitivity to light or noise

Loss of consciousness