High school varsity football programs on Long Island are putting in place new measures to guard against the effects of concussions.
The Island's 116 varsity teams are taking the steps to comply with a state law signed by Gov. Andrew M. Cuomo in September. Among the law's key points:
Putting concussion management teams in place.
Implementing sideline testing procedures to diagnose potential concussions during games.
Following stringent return-to-play criteria.
The high school football season officially ends today with two Long Island championship games; a Catholic League all-star game will be played next Sunday. As the season winds down, there is heightened awareness of the perils of concussions largely because of the impact on professional players, who have suffered debilitating illnesses. The new state law came on the heels of the NFL's widely publicized emphasis on reducing and punishing helmet-to-helmet hits.
A study provided to the National Federation of State Athletic Associations Sports Medicine Advisory Committee revealed that concussions accounted for more than 20 percent of all injuries reported for the 2010 high school football season in the United States.
Sixty percent of all concussions were the direct result of helmet-to-helmet hits, according to the National High School Sports-Related Injury Surveillance study, which was conducted with High School Reporting Information Online.
New York was the 33rd state to enact a youth-concussion law, and it pertains to all sports. The law takes effect in July.
Injury difficult to spot
Shortly after the state law passed, on Oct. 15, Ridge Barden, 16, of Birdlebough High School in upstate Phoenix, died after a helmet-to-helmet collision in a game. The tragedy served as a reminder of how important concussion awareness can be.
"As a coach, I'm disappointed for the kid because we got this far," Vito said. "But of course what the damage could be from coming back too soon is not worth anything in sports."
Kevin Kilkenny of Generations Physical Therapy in West Islip, the athletic trainer for the West Islip and Islip football teams, said that because concussions are not structural injuries and aren't visible, recognition can be tricky.
"The easiest thing with a concussion is when a player is knocked out or they come to the sidelines and they're staggering and they're dizzy," Kilkenny said. "It's the one where the kid comes over and says, 'I got my bell rung. I've got a headache.' Those are the tough ones . . . I usually hide their helmets so they don't try to sneak back into the game."
Under the new law's guidelines, Kilkenny would also evaluate the player by performing verbal tests to assess memory and concentration. The New York State Public High School Athletic Association has developed a DVD as a tool and has posted valuable concussion information on its website, www.nysphsaa.org.
Management team is key
Many on Long Island have already been following the procedures recommended in the new law. "If a concussion is suspected, that player is automatically removed from the game," said Dr. Michael Kennedy, a Huntington-based sports medicine physician who works with the Valley Stream school district.
A major component of the state's law is for each school to appoint a concussion management team. It should include, where possible, the school nurse, trainer, doctor (or doctors), chief medical officer (who signs off on clearing an athlete to return after a concussion), coach and athletic director.
Return-to-play protocol generally involves a step-by-step progression that begins when the athlete is symptom-free without exertion. Then comes low-impact activity; aerobic activity associated; noncontact drills; full contact in practice.
If concussion symptoms recur at any of these steps, the athlete reverts back to the previous step. "Each one of these stages could take two days," Kennedy said. "So you might be out 10 days. But it's so important. Sometimes athletes don't show symptoms until they start the aerobic activity, or the contact. Then guess what? They can't play."
Dr. Karl Friedman, the coordinating physician for Nassau football playoffs, said, "Until recently, there was no formal protocol to follow to make a decision on when an athlete can return to play. Years ago, it was arbitrary. Now we have something tangible to work with. Is it ideal? Is it optimal? No, because the brain is a very sophisticated organ. But it's a tool."
Athletes who sustain concussions are at increased risk to suffer another one after returning to play. Teenagers are considered more likely to get concussions and take longer to recover.
And, in the worst-case scenario, there is the potentially fatal second-impact syndrome.
"We are looking to avoid second-impact syndrome at all costs," said Dr. Steven Rokito of the North Shore-LIJ concussion management program, who is an attending physician for the Islanders, Ducks and nine Nassau County high schools.
An example of the syndrome: A 16-year-old high school football player is tackled. He gets up and runs back to the huddle. He seems wobbly, then collapses.
"He tries to stand again but he can't," Rokito said. "The trainer and the coach come over but now he's unresponsive."
What happened, Rokito said, was the player was tackled helmet to helmet a week earlier and returned to play the same day, when he was seemingly OK.
"This is exceedingly rare, but there are several [deadly] cases per year like this reported in the United States," he said.
Federal bill in the works
Sen. Charles Schumer (D-N.Y.) has proposed federal legislation requiring improved safety standards for football helmets used in high school and youth leagues.
Schumer, a co-sponsor of the Children's Sports Athletic Equipment Safety Act, cited a growing number of head injuries as the impetus for the bill.
Dr. Hayley Queller, from Orthopedics Associates of Long Island, said numerous school districts cannot afford things like preseason baseline testing or a computerized concussion evaluation system. Some districts have doctors on call, but not on the sidelines.
"Numerous schools do not have full-time athletic trainers," Queller said. The state law suggests trainers but does not mandate them.
"No school should be without a trainer," said Queller, who works with several Suffolk County high schools. "They play an intricate role, not only in concussion management but in muscular-skeletal care as well."
Still, Ray Nelson, executive director of Excel Rehabilitation & Sports Therapy of Ronkonkoma, said, "We are leaps and bounds ahead of where we were, even a year ago."
SIDELINED ATHELETE RETURN POLICY
To resume contact sports, a sidelined athlete must follow a medically supervised stepwise process known as Return to Play Protocol. The process goes as follows:
1. No exertional activity until symptoms go away for 24 hours.
2. Light aerobic exercise such as walking or stationary bike. No resistance training.
3. Sport-specific exercise such as skating or running.
4. Progressive addition of resistance training may begin.
5. Non-contact training/skill drills.
6. Full-contact training in practice setting.
7. Return to competition.
Source: National Federation of State High School Associations