High school concussions are an epidemic: 2 in 10 high school athletes will suffer a concussion this year. What’s worse is that the Center for Disease Control believes those numbers are artificially low due to players not reporting head injuries, or coaches being unaware of a high school athlete’s concussion.
Due to a sports culture that celebrates toughness and incentivizes hiding injuries, high school athletes avoid reporting concussion symptoms. But even one blow to the head causes a lifetime of suffering such as headaches, loss of balance, and a susceptibility to further concussions at the slightest touch.
Hypermasculinity breeds a philosophy that emphasizes athletic performance over health. But with more and more high school players suffering concussions, athletes are beginning to come to a conclusion: we are not optimized for this.
I remember telling myself to get up off the grass and get back into the infield. My team needed me — man up, Garrett. My dad told me to stay down, I remember his hand on my back. I leaned on him to stand up; the baseball dribbled out of my glove. And then I fell. I want to tell you I woke up and helped my baseball team win the game. I hit the game-winning home run. But I don’t remember the final score. I don’t remember anything after my fall.
What are concussions and why are they dangerous?
In October of 2006, high school football player Zack Lystadt made a routine tackle. On the way down, Lystadt’s helmet slammed into the ground. His hands covered both sides of his head. The referee called for an injury time-out, and Lystadt was led off the field. Missing only three plays and half-time, Lystadt made his return for the second half. “He always wanted to be part of the play,” his father, Victor Lystadt, recalls.
At the end of the game, Lystadt collapsed and unconscious. He was airlifted to a nearby hospital where Lystadt underwent emergency surgery to remove the left and right sides of his skull to relieve the pressure of his swollen brain.
Numerous strokes. Seven days on a ventilator. Three months in a coma.
The CDC explains that Zack’s premature return to the game “had resulted in the battle for Zack’s young life, including four weeks in a nursing home, two months in a children’s hospital for rehabilitation, nine months before he spoke his first word, 13 months before he moved a leg or an arm, and 20 months on a feeding tube. It would be nearly three years before Zack would stand, with assistance, on his own two feet.”
Lystadt’s story is a warning to all young athletes who believe that they are invincible and ignore the warning signs of a head injury. The CDC describes a concussion as “a type of traumatic brain injury… caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”
The immediate symptoms of a concussion include headaches and problems with concentration, memory, balance, and coordination. Some concussions will cause a loss of consciousness, but most do not. Other symptoms include repeated vomiting, ringing in ears, and sensitivity to light and noise.
While some of these symptoms will show up immediately, sometimes they do not develop for a day or two after the initial head injury. Symptoms could last anywhere from a day to months after the concussion.
National Hockey League player Sidney Crosby has suffered at least four diagnosed concussions in his professional career. After his first diagnosed concussion, Crosby revealed that the “initial symptoms were so severe he could not drive, watch television or listen to music. He said he had migraine headaches that have continued into the summer…” Recovery time for Crosby was around eight months and forced him to ask the question of whether or not he would be able to step on the ice again.
Crosby returned to the Pittsburgh Penguins but has suffered two more concussions since then. Any shot to Crosby’s head results in talking heads, radio commentators, and hockey fans asking the same question: is this the one that finally does him in? Doesn’t Crosby worry about CTE?
Despite being first recognized in the 1920s, chronic traumatic encephalopathy (or CTE) gained public recognition in the early 2000s because of the research conducted by Dr. Bennet Omalu in his paper, “Chronic Traumatic Encephalopathy in a National Football League Player.” CTE is caused by repetitive brain trauma: from concussions to repeated subconcussive hits to the head. Symptoms of CTE include “memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism, and, eventually, progressive dementia.” What’s worse is that these symptoms appear years or decades after the initial head trauma.
“At some level, concussions result in a brain injury, so we’re certainly worried about the accumulative effects of concussions,” says Gregory Hawryluk, MD, neurosurgeon and concussion specialist at the University of Utah Health. “We’re starting to learn that perhaps these seemingly minor blows to the head… can lead to depression and behavior change.”
Research also shows that there is a correlation between head injuries and suicide: “ of 7,418,391 people in Denmark over age 10 found that 7.6% had received medical care for a traumatic brain injury over a period of 34 years between 1980-2014, 34,500 or so people from this cohort died by suicide in the same time period.”
A 2018 study profiling 20 cases of head injuries in athletics revealed story after story of athletes coming back from a concussion only to suffer recurring symptoms after their return. One of them profiles an 18-year-old high school wrestler who reported his third sports-related concussion. “His initial course suggested postconcussion symptoms for 1 month, which resolved fully but were followed by recurrent depressive episodes…Upon returning to wrestling, he noted minor practice head contact led to recurrence of prior symptoms.” The littlest of head injuries can result in the reappearance of symptoms.
Other athletes returning to the game put themselves in constant danger. Second-impact syndrome occurs when an individual suffers a second head injury before the symptoms of the first injury have resolved.
A study by Barry P. Boden, M.D., from the Orthopedic Center in Rockville, Md, revealed: “High school football players have more than three times the risk of a catastrophic head injury than their college peers.” These catastrophic injuries are the result of incidents like Lystadt’s, where an athlete is allowed to return to the field without proper precautions being provided.
Scientists are making great strides in learning about the brain and head trauma, and we are still only just learning about the long-term effects of concussions on athletes.
Growing up in Buffalo meant you only had two seasons: “Snow” and “Not Snow.” “Not Snow” lasted for about three months andit was perfect skateboarding weather: typically 70 degrees with sunny skies. “Snow,” on the other hand, continued the rest of the year, which meant my friends and I needed to find a winter equivalent to skating.
My dad, an avid skier, suggested I go with him and try out a pair of skis at our local mountain, Holiday Valley. I instead chose snowboarding; it was the closest any of us could get to skating when there was snow on the ground. We didn’t just want to feel invincible during the summer.
Unfortunately, winter sports didn’t have the accessibility of skateboarding, so our time on the hill was limited to when we could get a ride, or when our high school Ski Club would take us. That meant we had to make every run count.
As soon as we’d get to Holiday Valley, the first thing we’d all do is race up to the Snoozer lift, the only ski lift that dropped you off near a terrain park. Rails to grind, tabletops to jump, and a freshly groomed half-pipe at the bottom littered the trails. Carving my way down the mountain, I’d find myself floating in the air; one hand gripped onto my board, the other flared out for the style. My board carving into the powder at the bottom of the pipe to get enough speed to get a bit of air off of the lip.
It was the last run of the night. My friends and I had little time to make it down the trail before the buses back to the island left. Standing atop Mardi Gras, the longest, flattest trail on the mountain, Dan turned his board sideways for the descent, waving his arms for us to follow. Together, we carved through the snow, our waxed boards gaining speed. This trail was for amateurs.
We started to slow down towards the bottom of the trail; I went to my heel edge to slow down. Not paying attention to what was in front of me, the steel caught a piece of ice. I lost control. My board slipped out from under me. My head slammed down onto the hard ground. I don’t remember anything that came after. A crack ran down the back of my helmet.
I remember how fragile I felt when I was in the doctor’s office — how the fluorescent lights in his office gave me headaches, how he told me that I shouldn’t snowboard again that season. I should know better than to risk my health, my mom told me.
My parents wanted me to wear a helmet every time I went skateboarding or bike riding after my first concussion even though I wore one while snowboarding. But there was a difference: everyone wore helmets while on the snow, but we were too old to wear one on the street. Mom and dad just wanted to protect my head.
I resisted. The helmet throws my balance off. The helmet is smelly. The helmet makes me look like a dork. I shrugged my parents off, throwing the helmet away when I was out of their view. I wasn’t going to be the dork wearing a helmet.
A few weeks later, my skateboard wheels crunched along the pavement of the street, I kept my focus on the rail in front of me. At the precise moment, I slammed my back foot down, raised my front and straightened the trucks over the rail.
They missed. I missed. My head karanged against the metal, my body flailed to the ground. For weeks, my head buzzed, my ears rang.
I never told my parents. It was time to put away my skateboard.
What is “play through culture” and how is it affecting high school concussions?
Third down and ten, the Indianapolis Colts are up on the Pittsburgh Steelers 17- 9. Colts quarterback Jacoby Brisset rushes to the line of scrimmage. He gets the snap, Steelers’ defensive lineman bust through the pocket. With nowhere to go, Brisset scrambles to his left, his eyes darting back and forth, looking for open space to run.
There: the five-yard line.
Brisset shifts his body weight to the left as the linebacker grabs his legs, spinning Brisset around. Twirling and losing balance, Brisset falls to the ground. Number 90 on the Steelers lowers his head and the crack of two helmets colliding rings through Lucas Oil Stadium.
Brisset lies on the ground. His hand holds the back of his head. And silence as his arm droops down, and Brisset’s body goes limp for just a second.
Within a few minutes, Brisset was back on the field. Soon after the game, Colts officials announced that Brisset had developed concussion symptoms which often includes headaches, confusion or memory loss, and dizziness.
A culture of hypermasculinity where tired gender norms push young men beyond their limits, physically and mentally, exists in athletics across the country, leading to life-altering effects, and potentially deadly consequences.
According to a study sponsored by the National Academies Press: “The game and the team are more important than their individual health and that they may play through a concussion in order to avoid letting down their teammates, coaches, schools, and parents.”
Brisset’s story is common in professional sports. A 2011 study by Brian Benson revealed that “one in five National Hockey League players who sustained a concussion during a shift in the regular season went back on the ice that same game.” Every one of those players became more susceptible to further, more debilitating head injuries the second they stepped back on the ice.
Switzerland soccer player Fabian Schär clashed heads with another player. The crowd watched Schär lay on the ground motionless. “Georgia’s Jano Ananidze tried to stop the 27-year-old’s tongue from blocking his airway. Schär had around five minutes of treatment from medical staff before completing the game.” Schär already had a concussion and played anyways.
The lack of understanding around concussions is dangerous. High school sports culture is leading to players refusing medical treatment, or ignoring the symptoms. A 2013 study by Cincinnati Children’s Hospital examining high school football players revealed that many young athletes are refusing to report symptoms to team doctors or coaches.
The study reveals that more than half (53%) of high school students continue to play when they suspect they have a head injury and only about half (54%) would report their suspected injury to a coach. Clearly there’s education around concussions, but not enough; “concussions represent an estimated 8.9% of all high school athletic injuries.”
Athletes would rather suffer in silence rather than let down their team, coaches, or themselves.
“There’s a machismo to sports, whether you’re male or female,” Dustin J. Fink tells the New York Times. He’s an athletic trainer who supervises a dozen sports at Mt. Zion High School, in Illinois. He adds, “It’s most often seen in professional sports, where they are celebrated for being warriors and champions, for doing everything they can to stay on the field and play.” Those moments of athletes pushing through pain to achieve greatness are commodified into advertisements, sports radio talking points, and make their way into the psyche of young athletes and parents.
The need to push through pain is sometimes cyclical. Parents push their teenage athletes beyond their limits.”My dad would say, ‘Play unless you can’t walk.’ And with some injuries, like broken fingers, you can play through the pain. But once your brain is hurt, it’s hurt. Yet what gets instilled in the child is, ‘You play no matter what.'”
Dilip Patel’s study on youth athletics simplifies the message presented to young athletes: “The importance of winning reinforces the message that winning at all costs is a success in life.”
Love of the game.
As I grew up, I moved away from skateboarding and snowboarding and back into my first love: baseball. Concussions seemed less common in baseball than extreme sports or football and hockey. I worried about my head.
Studies show that over ten years, 112 Major League Baseball players were put on the disabled list due to a concussion, with a majority of those concussions being the result of contact with a batted ball.
I played third base — the corner infield spot. I wasn’t worried about getting hit by a ball.
But one evening, under the setting sun in Tonawanda, the batter blooped a pop fly right in between the third base and the left fielder. I watched the red stitches on the ball spin higher and higher as my feet tracked backward off of the infield dirt and onto the grass. I hollered, “I got it.”
The left fielder didn’t hear me.
I remember my body sliding onto the grass, my eyes staring at the falling baseball. The ball dropped and I reached my glove out, and darkness.
My friends tell me the left fielder’s shoulder rammed into the back of my head. I lay motionless on the ground for a second. I regained consciousness as Dad ran out onto the field. I tried to wave him off. He lifted me up. My legs wobbled, and I fell back onto the ground. I wanted to go back in because I thought my team needed me. If I was to become a hero, I needed to tough through the pain.I imagined this moment memorialized at family gatherings or fourth of July parties with friends for years to come. “Remember the time Garrett got knocked out, caught the ball, and kept playing?” It’d be history.
But it wasn’t. And I don’t remember much of it. I ask my friends to remind me of what happened.
I’m thankful that my dad kept me on the bench that evening.
How are we addressing high school concussions?
Washington passed the Zackery Lystadt Law, which “prohibits young athletes who were suspected of sustaining a concussion from returning to the game without the approval of a licensed healthcare provider,” in 2009.
By 2014, all 50 states and the District of Columbia passed laws that enact “return to play” rules for high school athletes. The NFL Player Health and Safety commission lists out the three key concepts that make up all of these laws.
- “Athletes, parents, and coaches must be educated about the dangers of concussions each year.”
- “If a young athlete is suspected of having a concussion, he or she must be removed from a game or practice and not be permitted to return to play—when in doubt, sit them out.”
- “A licensed healthcare professional must clear the young athlete before he or she can return to play in the subsequent days or weeks.”
A 2019 study revealed that regulations like the Lystadt Law have helped decrease the number of recurrent concussions among high school athletes. John Leddy, the medical director of the Concussion Management Clinic at the University at Buffalo in New York, explains the study’s significance to CNN: “There was reduced rate of recurrent concussions, and I think that speaks to the fact that we now have legislation in every state that says you have to pull a kid out of sport when a concussion is suspected.” Athletes aren’t allowed to come back into the game, or activities until approved by an outside physician.
Despite advances in medical training and awareness about brain trauma, high school concussions are still an epidemic that coaches, parents, and athletes need to take more seriously.
What more can be done to prevent high school concussions?
Laura Dreer, the director for Psychological and Neuropsychology Clinical Research Services at the University at Alabama, believes the research needs to go further. “We need more studies at the high school level, and even backing it up further with the little kids, to get more longitudinal data and better understand this issue so we can do things to prevent it, manage it and hopefully keep kids safe but active as well.”
One of the roadblocks that remain for players, parents, and coaches is the narrative around playing through injuries. Young athletes are bombarded with news stories about injured athletes not contributing to their team or how it’s always the next man up after an injury.
But professional athletes are beginning to take their health into their own hands. 24-year-old former NFL player Joshua Perry retired from the league after suffering his sixth concussion.
In a detailed post on Twitter, Perry wrote, “The easy part was understanding that my health and my well-being is more important than just playing the game… It wasn’t from a high velocity, big contact play,” He continued, “It was a very pedestrian thing, and that was a huge concern to me. The last thing I want to do is put the health of my brain and my future well-being in jeopardy over a game and a paycheck.”
Ending the culture of resistance.
The rate of high school concussions, while lower, is still startling. A culture where playing through injury or underreporting head trauma to avoid sitting out is one that we all need to change.
Our brains are fragile, the symptoms of a single blow to the head can reverberate for a lifetime. Repeated subconcussive hits have been proven to cause symptoms years or decades after the initial injury.
High school concussions and the dangerous culture around sports will continue to be an epidemic until we realize the truth: we are not optimized for this.