Young Athletes Could be Headed for Trouble

Aug. 2--Cody Lehe's life changed in a heartbeat during football practice in the fall of 2006. The senior linebacker and offensive lineman took what everybody remembers as a relatively mild hit -- a small bump to the helmet.

Seconds later, he collapsed.

"Cody grabbed another player's shoulder and fell to his knees," said Becky Lehe, Cody's mother. "Everyone thought he was joking around."

But Cody was not joking. He was lying unconscious on the field at Frontier High School, a small school in Chalmers, a White County town just north of Lafayette.

He'd suffered what doctors would later identify as "second-impact syndrome," a condition in which the brain swells rapidly after a person suffers a second concussion before symptoms from an earlier one have subsided.

Cody's first concussion was caused by a hard helmet-to-helmet hit in a game the previous weekend. For several days after the game he complained of headaches, but a brain scan indicated he could return to practice.

After his collapse at practice, he spent three months in a coma before coming home -- a shadow of what he once was.

Today, he's 21 and lives in his parents' home in Brookston. He spends most of his time in a wheelchair, though he can walk with a walker and assistance from another person. He struggles with his short-term memory.

"He'll often ask, 'How old am I?'" Becky said. "Or he'll say, 'What happened to me? How did I get this way?' That's what saddens me the most."

Cody's case underscores a serious problem in the U.S. -- too many young athletes returning to the playing field too soon after a concussion.

A new three-year study of 100 U.S. high schools found that 41 percent of concussed athletes returned to action too quickly, according to guidelines set by the American Academy of Neurology.

The guidelines say that if an athlete's concussion symptoms -- such as dizziness, headache or nausea -- last longer than 15 minutes, the player should be benched until the symptoms have been gone for a week.

The most shocking aspect of the study -- conducted by the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio -- was the finding that 16 percent of high school football players who lost consciousness due to a concussion returned to the field the same day.

"Any athlete who is knocked unconscious needs to go straight to the emergency room," said Dr. Todd Arnold, a sports medicine physician and co-director of the Indiana Sports Concussion Network in Indianapolis. "That can be an indication of a skull fracture or a bleed that can result in significant, permanent brain damage."

Becky Lehe feels that Cody, like many young athletes, fell victim to a warrior mentality that drives them to conceal their concussion symptoms from their coaches so they can return to action.

"Cody told us he'd played with worse headaches than this," she said. "He said he wasn't going to stand on the sidelines just because of a headache. He was the team captain. Football was his life."

Bloomington physician Rick Weidenbener said this unspoken code of silence is a serious problem.

"Some studies have found that about two-thirds of high school athletes who've suffered concussions said they didn't think their symptoms were bad enough to bring it to someone's attention," Weidenbener said.

Many college football players also are reluctant to report head trauma. A 2002 Indiana State University survey of 457 players, 38 coaches and eight trainers from eight NCAA colleges found three of every four concussions go unreported -- because the players refused to tell their coaches and team trainers about their symptoms.

Arnold said many young players feel lying through their recently rattled teeth is proof of their manhood.

"They see it as almost a badge of courage to keep quiet about their concussion symptoms," Arnold said. "Plus, they just want to get back on the field and play."

Keeping silent about his symptoms cost Ryne Dougherty his life. The junior middle linebacker with the Montclair High School football team in New Jersey suffered a concussion in practice in the fall of 2008. He passed a CT scan and neurocognitive test, but hid from doctors the fact that he was having headaches, telling them he was ready to rejoin the team.

Three weeks later, he was cleared to play in a junior varsity game, during which he suffered a brain hemorrhage while making a tackle. He was rushed from the field on a stretcher and died a week later.

Ryne was one of five high school football players in the country who died last year due to second-impact syndrome. Since 1997, more than 50 high school or younger football players in more than 20 states have sustained serious brain injuries or died from second-impact syndrome, according to research by the New York Times.

Becky Lehe said it's easy for young athletes to get caught up in a macho culture they observe in professional sports, in which playing "hurt" is a hallowed tradition.

"The kids look at the pros who have this gladiator attitude and try to imitate them," she said. "We need to tell our kids to let their coaches know when they don't feel well so they can sit out and get better."

Lehe said she and her husband are allowing their 15-year-old son, Zach, to play football, but only after he promised them he would tell his coach immediately if he experiences any sort of head trauma.

"People have criticized us for letting Zach play, but if Cody had been hurt in a car accident we wouldn't forbid Zach from driving," she said. "We've told Zach he has to listen to his body, and let the coaches know what his body is telling him."

Bloomington High School South football coach Drew Wood tells his players the code of silence is not macho.

"You have some kids who want to be tough guys, but we try to teach them that they should not keep quiet about a concussion," he said. "Most players are out of the game for good at age 22, unless they're talented enough for the NFL. That means they have a lot of life left after football, and we want them to be healthy for those years."

Edgewood football coach Jerry Bland concurs.

"Kids want to play, but we tell them, 'You only have one head; be smart with it,'" Bland said. "We urge them to be honest with us about how they're feeling."

Eastern-Greene football coach Luke Dean remembers trying to conceal a couple of concussions he suffered while playing football in high school.

"I tried to hide it from the coaches because I wanted to play," he said. "But that wasn't very smart. I think today's players are better educated about concussions."

One of those better educated players is Leon Beckum. In 2007, when playing linebacker for Bloomington High School North, he took a blindside hit during a game at Columbus North just before halftime. He said he wobbled into the locker room in a dazed state.

"I'd lost my memory," he said. "I was asking everyone who was winning the game."

Beckum informed his coaches, who took him out for the remainder of the game.

"Fortunately, it was a minor concussion," said Beckum, now a junior linebacker for the Indiana University team. "I was able to play the next game."

The Centers for Disease Control and Prevention estimate the number of sports concussions ranges from 1.6 million to 3.8 million a year, with the huge range explained by officials' suspicions that many go unreported.

When it comes to the number of concussions young football players suffer, no hard figures are available. But a recent study estimated that each year in the U.S., more than 40,000 high school football players suffer concussions from hard hits.

According to statistics gathered by the National Center for Injury Prevention, 47 percent of high school football players incur at least one concussion each season. Of those who suffer a concussion, 35 percent say they had more than one concussion in the same season.

A concussion is a change in the mental status of a person caused by an impact to the head -- producing such symptoms as memory problems, dizziness, headaches, confusion, blurred vision or even a loss of consciousness.

Arnold, the Indianapolis doctor who specializes in concussions, said that contrary to popular belief, a concussion is not a bruising of the brain or bleeding on the brain.

He said it's an injury that alters the function of the brain.

A concussion causes the arteries in the brain to constrict, slowing blood flow to the brain. At the same time a mixture of calcium, glucose and other elements floods the brain, creating a biochemical crisis.

"The blow changes the way neurons (brain cells) communicate, slowing down the thought process," he said. "It's like taking a fast Pentium computer and turning it into one of those old Texas Instruments computers I grew up with."

Arnold said when an athlete returns to the field too soon after having suffered a concussion, the athlete runs the risk of incurring a second brain injury that is far more serious than the first.

Called "second-impact syndrome," it causes rapid brain swelling and often leads to death or permanent brain damage. Most cases occur in young people, who are thought to be particularly vulnerable to the disorder.

"Because the skull is fixed, it has a hard time accommodating the swelling of the brain," Arnold said. "This can cause devastating effects."

Arnold cites the case of 16-year-old Jaquan Waller, who in the fall of 2008 suffered a concussion during football practice at J.H. Rose High School in Greenville, N.C.

There was no certified athletic trainer educated in concussion management at practice, so the youngster was examined by the school's first responder, who cleared him to play in a game two days later.

During that game, he was tackled and -- moments later -- collapsed on the sidelines. He died the next day from what was determined to be second-impact syndrome. The medical examiner said neither impact would have been sufficient to cause death in the absence of the other.

"The second blow is usually fairly minor," said Weidenbener. "With a brain that's already concussed, it doesn't take much of a hit to cause second-impact syndrome."

Even if a concussed player waits until he's fully healed before returning to action, he still may be in danger if he suffers multiple concussions -- which increases the risk of long-term damage to the brain.

Called "repetitive head injury syndrome," it occurs when a person suffers a series of concussions over time, even if the symptoms from those concussions are given sufficient time to disappear.

"The effects of concussions are cumulative," said Weidenbener, the Bloomington physician. "When you get past a certain number of concussions, you need to give up the game to avoid the risk of permanent brain injury."

That's what happened with Bloomington South football player Taylor Crousore, who decided -- at the urging of Wood, his coach -- to give up football last year after suffering several concussions.

"It wasn't worth it for him to keep playing football," Wood said. "He's got his whole life ahead of him."

Former NFL stars, such as Steve Young, Troy Aikman and former IU quarterback Trent Green, who started for the St. Louis Rams and Kansas City Chiefs, retired from football after suffering multiple concussions during their careers -- concussions they feared threatened their long-term health.

The NFL has recently faced questions about the way it handles concussions after four former players in the league were found to have significant brain damage as early as their mid-30s.