Most injuries, especially muscular and skeletal, suffered by athletes during competition are pretty obvious. But concussion (head trauma) injuries can be more challenging to detect.
Over the decades, many athletes in various sports have come off the field after suffering a head injury and soon returned to play. They sometimes received brief medical attention, or just returned to the field without anyone noticing their injury.
Not properly responding to those injuries has often resulted in long-term damage.
But thankfully, things have changed in recent years as educational awareness for coaches, athletes and parents, plus baseline testing for athletes, has intensified at all levels of sports - from professional to college to high school and youth competition.
"Everyone is stepping it up," said Pine River-Backus activities director Randy Schwegel, who played high school and college sports in the 1970s. "We're now looking at (concussion injuries) that we blew off back when we were in high school. They would put a little smelling salt under your nose, and you were good to get back in there.
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"But it's so much different now. If there's any suspicion (of a concussion), then we pull the kids from the game and start (the evaluation process). For the health of the athletes, and for safety and liability reasons, schools need to have something in place."
Schwegel, and the PR-B athletic program, started working last spring with Big Stone Therapies of Baxter. Those medical services included a focus on concussion awareness and response.
"Each baseline computer test is good for two years, so we started doing the testing with three grades last spring and we will do the other three grades this fall," Schwegel said. "The kids answer a series of tests for recognition, memory and reaction where their response and accuracy are measured. If needed, we can then compare the scores of an athlete who is injured. We offer the testing service, but students and athletes still have the option to go through their family doctors."
Jeff Donatelle of Big Stone Therapies works with area high schools, but adds that his company has offices around the state that work with many other schools.
"We provide medical services, part of which deals with concussions," he said. "Besides Pine River-Backus, we also have been working with Pillager School the past three years. The body of research is growing, and we're realizing the effects of concussions."
PR-B and Pillager, along with other area schools like Pequot Lakes and Brainerd, have increased awareness of concussion injuries in recent years. The efforts were inspired by the Minnesota State High School League's implementation of the National Federation of State High School Associations (NFHS) rules related to concussions and concussed athletes.
The basic rule in all sports is: Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional.
"The state high school league came out with a protocol four or five years ago that includes concussion training and awareness," Schwegel said. "We're also going to have a trainer at varsity football games, and at our school one or two nights a week to visit kids in various sports dealing with nagging injuries."
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Pequot Lakes has done the baseline testing the past three years, according to activities director Marc Helmrichs.
"We haven't done impact testing every year, but we do pre-test our athletes as part of the (MSHSL) concussion protocol," he said. "Concussions really moved to the forefront as the high school league has become more proactive. They do a good job of getting the information out to the schools. Coaches are also required to take annual testing (involving concussions) as part of the continuing education requirement."
Pequot Lakes football coach Chip Lohmiller, who has played high school, college and professional football, appreciates the increased focus on concussion injuries.
"It was different when I played because we didn't have the awareness that we have today," he said. "It's important for coaches of all sports to recognize any concussion symptoms, and not be afraid to sit them out. We use a lot of caution dealing with (a possible concussion)."
Lohmiller adds that preventative efforts are important, especially in football. He said coaches and players need to "make sure their equipment fits" while coaches teach the fundamentals, like not leading with your head when making a tackle.
Brainerd Warrior football coach Ron Stolski agrees with Lohmiller.
"We've always tried to teach safe play as it relates to concussion management, especially that you don't lead with the helmet," Stolski said. "Every coach on our staff must also pass a concussion management test, and we have a certified trainer on the sideline.
"There's no question that (high school) football has never been safer. And high school football isn't played at the same speed as college or professional. But safety of the athlete is paramount, especially starting at a young age (with Brainerd Youth Athletic Association football players)."
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Stolski, who's also executive director of the Minnesota Football Coaches Association, said it was also important to educate the athletes about concussion injuries.
"Athletes are taught to watch other athletes, and let the coaches know," he said. "It's nothing to do with toughness. Athletes are as tough as ever, but they're also smarter."
Donatelle agrees.
"The challenge is how to educate the kids and parents without making them scared (of the risk of a concussion)," he said. "We just want them to be smart. Knowledge is power."
Stolski adds that Dr. Sandra Bond Chapman, founder and chief director of Center For Brain Health at the University of Texas, concluded from her research that "the benefits of youth football to health and well-being exceed the risk of permanent brain injury. In most cases, concussions can be treated, and cognitive function can be regained."
The MSHSL Sports Medicine Advisory Committee highly recommends that every student-athlete and parent should successfully complete the "Heads Up: Concussion in High School Sports" course. It can be accessed at: www.cdc.gov/concussion .
