MONROE - Seeing stars and blacking out are signs a growing number of young area athletes are experiencing - along with the concussions those symptoms signal.
The problem is widespread: More than 300,000 sports-related concussions occur annually in the United States, according to the University of Pittsburgh Department of Neurological Surgery. It estimates the likelihood of suffering a concussion while playing a contact sport is as high as 19 percent per year of participation.
Concussions certainly aren't a new phenomenon. But more awareness of concussions, as well as increased efforts at prevention, have made them a hot topic from local high school fields all the way to professional sports arenas.
"I don't think football is any more dangerous than it was in the past," Brodhead-Juda coach Jim Matthys said. "It used to be if you got your bell rung, then you got back out there. The reality of it is helmets and coaching have come a long way in the last five to 10 years in concussion prevention."
The Monroe Clinic's sports medicine department has seen an increase in treating athletes with concussions just in the past few years. In 2008, the Monroe Clinic treated 13 athletes with concussions. That number more than doubled to 31 athletes in 2010. There has already been 28 athletes treated this year through Sept. 26, according to Eric Katzenberger, practice manager of sports medicine at Monroe Clinic -and that number only reflects the concussions that were managed through the sports medicine department.
"The number of concussions in the surrounding area schools is certainly much higher, as some go unreported while others are managed outside of the sports medicine department," he said.
Given the seriousness of concussions and the hidden damage they can cause, many find it a disturbing trend.
"A concussion is violent shaking of the brain," Katzenberger said. "It causes damage to the brain by shaking inside the skull. We call it an invisible injury. It's not like a broken bone where you can see it on the field."
While there is more advanced treatment of concussions, more technology for helmets and better coaching techniques, there is still no fool-proof way to eliminate concussions entirely.
"There is no way to prevent a concussion," Katzenberger said. "If you are playing sports, you are at risk of a concussion."
Testing eliminates guess work
Monroe Clinic is one of the few hospitals across the state that uses the ImPact concussion-based testing program, which is used by many professional leagues including the NFL, Major League Baseball, the NCAA and NASCAR. ImPact is a computer-based testing program that records an athlete's health history, current symptoms and neuropsychological data before an injury occurs so there is a baseline score. The baseline test measures an athlete's reaction time and concentration through a series of questions.
Under the WIAA's return-to-play policy, an athlete can return to practice and games when they are symptom-free with a doctor or certified athletic trainer's consent. The Monroe Clinic's ImPact testing takes it a step further by having athletes take a test so they can get back to their baseline score before returning to practice.
"It used to be if you had a concussion, you missed one week and if you had a second concussion, you missed two weeks and if you had a third concussion, you missed three weeks," Katzenberger said. "ImPact testing gives us some objective data we can show them. It makes our job easier."
Dr. Joshua Morrison, who works with athletes in the Monroe Clinic's Monday concussion clinic, said for athletes under 18, the second-impact syndrome can be devastating. The second-impact syndrome is a condition in which the brain can swell after a person suffers a second concussion before the symptoms from a first concussion have subsided.
"For many years, players who had a concussion were sent back too early and had another concussion," Morrison said. "There are still some old-school coaches who think if you don't have a broken arm or bone, they feel they should be able to play."
Morrison said the long-term effects of a concussion range from dizziness to headaches to depression and in severe cases, dementia similar to Alzheimer's.
Four of the 14 schools the Monroe Clinic provides service to paid $500 to have all their athletes take a baseline concussion test in August before the prep football season kicked off. The baseline test for concussions was not required, but more than 500 athletes took the test, including Green County Blaze football players.
Katzenberger said all 14 schools participated in the ImPact concussion testing program at some level.
Monroe football coach Curt Miller is a proponent of the ImPact concussion testing.
"It takes the guess work out of things," he said. "Diagnosing it on just one symptom or symptoms is hard to do."
Monroe Athletic Director Dave Hirsbrunner said the high school paid for every athlete to have the baseline test; about ninety percent of the team got an ImPact test.
Despite the advances in testing, there's still challenges in treating concussions - particularly working with a young player who may try to hide details of an injury to avoid sitting out, Katzenberger said.
"It's just getting through that tough mentality," he said. "Kids now feel like they are invincible. It's their futures that we are looking out for. They don't understand that."
Katzenberger said some players with more severe concussions have their school time limited, or have cell phone, texting, TV and video games taken away because the stimulating devices can affect the recovery from a concussion.
Helmets will have 10-year life
Increased awareness and prevention of concussions and other head injuries comes with a cost. After this year, the National Athletic Equipment Reconditioners Association, which oversees refurbishing old helmets, will no longer accept helmets more than 10 years old because of safety concerns.
Athletic directors across southern Wisconsin say reconditioning can range from $30 to $40 per helmet if cleaning is all that needs to be done. The helmet shells are buffed, sanded and interior parts are inspected; those that don't meet guidelines are replaced.
Many area teams, including Monroe and Brodhead-Juda, send helmets to Riddell to restore the battered helmets. Matthys said that reconditioning helmets for Brodhead-Juda varies, but costs about $1,000 to $1,500 a year. Five to eight helmets every year are destroyed because they have cracks and others are discarded because of their age.
Miller is a proponent of the 10-year limit on helmets.
"It's a good policy," Miller said. "By the time a helmet gets to be 10 years old, it's time to get a new one. It's for safety."
Miller said helmets in Monroe's program get reconditioned every other year and 50 to 60 are sent to Riddell every year.
"We recondition every other year, no matter what," Miller said.
For Katzenberger, the helmet is a double-edged sword: He has seen the helmet used to cause injuries.
"I think No. 1 it does help prevent some head injuries, but No. 2 it also produces a weapon," he said. "It (helmets) gives them a false sense of security because they think they can lead with their heads."
No rules changes on the horizon
There hasn't been a series of radical rules changes on the field by the National Federation of State High School Associations (NFHS) in response to concussions like there has been in the NFL. However, concussion awareness through education and proposed legislation is making safety a priority.
In Wisconsin, the Sidelined for Safety Act bill, co-sponsored by Rep. Jason Fields (D-Milwaukee) and Sen. Alberta Darling (R-River Hills), would require that a person suspected of sustaining a concussion or head injury in a youth athletic activity be removed immediately. Under the bill, a person who has been removed cannot participate in a youth athletic activity until he or she has been evaluated and receives a clean bill of health by a health care provider who has been trained in evaluating and managing concussions or head injuries.
The bill would require concussion education for coaches, players and parents - not only for high school sports, but youth club sports as well.
WIAA deputy director Wade Labecki said the challenge is educating parents and players about the symptoms of concussions.
Thirteen other states have similar legislation designed to protect youth athletes but Wisconsin's "will be one of the toughest concussion laws in the country," Labecki said.
The WIAA has had a policy since 1998 requiring three days of inactivity following a concussion. The WIAA's concussion policy has been expanded to include assessment tests on the sidelines and redefining a concussion by including symptoms that could force players to sit out.
Labecki said 10 percent of the athletes who suffer concussions never lose consciousness.
"The WIAA has been so far out in front of concussions that the NCAA and NFL have to catch up," he said. "It's kind of funny when some NFL big wig comes to our state and says we have to implement this concussion plan. We have been doing it already."
Labecki said the point of emphasis for high school football referees this year was helmet-to-helmet hits and using the proper tackling and blocking techniques.
"As a coach, the only thing you can do is keep the head up when tackling and running," Matthys said.
The problem is widespread: More than 300,000 sports-related concussions occur annually in the United States, according to the University of Pittsburgh Department of Neurological Surgery. It estimates the likelihood of suffering a concussion while playing a contact sport is as high as 19 percent per year of participation.
Concussions certainly aren't a new phenomenon. But more awareness of concussions, as well as increased efforts at prevention, have made them a hot topic from local high school fields all the way to professional sports arenas.
"I don't think football is any more dangerous than it was in the past," Brodhead-Juda coach Jim Matthys said. "It used to be if you got your bell rung, then you got back out there. The reality of it is helmets and coaching have come a long way in the last five to 10 years in concussion prevention."
The Monroe Clinic's sports medicine department has seen an increase in treating athletes with concussions just in the past few years. In 2008, the Monroe Clinic treated 13 athletes with concussions. That number more than doubled to 31 athletes in 2010. There has already been 28 athletes treated this year through Sept. 26, according to Eric Katzenberger, practice manager of sports medicine at Monroe Clinic -and that number only reflects the concussions that were managed through the sports medicine department.
"The number of concussions in the surrounding area schools is certainly much higher, as some go unreported while others are managed outside of the sports medicine department," he said.
Given the seriousness of concussions and the hidden damage they can cause, many find it a disturbing trend.
"A concussion is violent shaking of the brain," Katzenberger said. "It causes damage to the brain by shaking inside the skull. We call it an invisible injury. It's not like a broken bone where you can see it on the field."
While there is more advanced treatment of concussions, more technology for helmets and better coaching techniques, there is still no fool-proof way to eliminate concussions entirely.
"There is no way to prevent a concussion," Katzenberger said. "If you are playing sports, you are at risk of a concussion."
Testing eliminates guess work
Monroe Clinic is one of the few hospitals across the state that uses the ImPact concussion-based testing program, which is used by many professional leagues including the NFL, Major League Baseball, the NCAA and NASCAR. ImPact is a computer-based testing program that records an athlete's health history, current symptoms and neuropsychological data before an injury occurs so there is a baseline score. The baseline test measures an athlete's reaction time and concentration through a series of questions.
Under the WIAA's return-to-play policy, an athlete can return to practice and games when they are symptom-free with a doctor or certified athletic trainer's consent. The Monroe Clinic's ImPact testing takes it a step further by having athletes take a test so they can get back to their baseline score before returning to practice.
"It used to be if you had a concussion, you missed one week and if you had a second concussion, you missed two weeks and if you had a third concussion, you missed three weeks," Katzenberger said. "ImPact testing gives us some objective data we can show them. It makes our job easier."
Dr. Joshua Morrison, who works with athletes in the Monroe Clinic's Monday concussion clinic, said for athletes under 18, the second-impact syndrome can be devastating. The second-impact syndrome is a condition in which the brain can swell after a person suffers a second concussion before the symptoms from a first concussion have subsided.
"For many years, players who had a concussion were sent back too early and had another concussion," Morrison said. "There are still some old-school coaches who think if you don't have a broken arm or bone, they feel they should be able to play."
Morrison said the long-term effects of a concussion range from dizziness to headaches to depression and in severe cases, dementia similar to Alzheimer's.
Four of the 14 schools the Monroe Clinic provides service to paid $500 to have all their athletes take a baseline concussion test in August before the prep football season kicked off. The baseline test for concussions was not required, but more than 500 athletes took the test, including Green County Blaze football players.
Katzenberger said all 14 schools participated in the ImPact concussion testing program at some level.
Monroe football coach Curt Miller is a proponent of the ImPact concussion testing.
"It takes the guess work out of things," he said. "Diagnosing it on just one symptom or symptoms is hard to do."
Monroe Athletic Director Dave Hirsbrunner said the high school paid for every athlete to have the baseline test; about ninety percent of the team got an ImPact test.
Despite the advances in testing, there's still challenges in treating concussions - particularly working with a young player who may try to hide details of an injury to avoid sitting out, Katzenberger said.
"It's just getting through that tough mentality," he said. "Kids now feel like they are invincible. It's their futures that we are looking out for. They don't understand that."
Katzenberger said some players with more severe concussions have their school time limited, or have cell phone, texting, TV and video games taken away because the stimulating devices can affect the recovery from a concussion.
Helmets will have 10-year life
Increased awareness and prevention of concussions and other head injuries comes with a cost. After this year, the National Athletic Equipment Reconditioners Association, which oversees refurbishing old helmets, will no longer accept helmets more than 10 years old because of safety concerns.
Athletic directors across southern Wisconsin say reconditioning can range from $30 to $40 per helmet if cleaning is all that needs to be done. The helmet shells are buffed, sanded and interior parts are inspected; those that don't meet guidelines are replaced.
Many area teams, including Monroe and Brodhead-Juda, send helmets to Riddell to restore the battered helmets. Matthys said that reconditioning helmets for Brodhead-Juda varies, but costs about $1,000 to $1,500 a year. Five to eight helmets every year are destroyed because they have cracks and others are discarded because of their age.
Miller is a proponent of the 10-year limit on helmets.
"It's a good policy," Miller said. "By the time a helmet gets to be 10 years old, it's time to get a new one. It's for safety."
Miller said helmets in Monroe's program get reconditioned every other year and 50 to 60 are sent to Riddell every year.
"We recondition every other year, no matter what," Miller said.
For Katzenberger, the helmet is a double-edged sword: He has seen the helmet used to cause injuries.
"I think No. 1 it does help prevent some head injuries, but No. 2 it also produces a weapon," he said. "It (helmets) gives them a false sense of security because they think they can lead with their heads."
No rules changes on the horizon
There hasn't been a series of radical rules changes on the field by the National Federation of State High School Associations (NFHS) in response to concussions like there has been in the NFL. However, concussion awareness through education and proposed legislation is making safety a priority.
In Wisconsin, the Sidelined for Safety Act bill, co-sponsored by Rep. Jason Fields (D-Milwaukee) and Sen. Alberta Darling (R-River Hills), would require that a person suspected of sustaining a concussion or head injury in a youth athletic activity be removed immediately. Under the bill, a person who has been removed cannot participate in a youth athletic activity until he or she has been evaluated and receives a clean bill of health by a health care provider who has been trained in evaluating and managing concussions or head injuries.
The bill would require concussion education for coaches, players and parents - not only for high school sports, but youth club sports as well.
WIAA deputy director Wade Labecki said the challenge is educating parents and players about the symptoms of concussions.
Thirteen other states have similar legislation designed to protect youth athletes but Wisconsin's "will be one of the toughest concussion laws in the country," Labecki said.
The WIAA has had a policy since 1998 requiring three days of inactivity following a concussion. The WIAA's concussion policy has been expanded to include assessment tests on the sidelines and redefining a concussion by including symptoms that could force players to sit out.
Labecki said 10 percent of the athletes who suffer concussions never lose consciousness.
"The WIAA has been so far out in front of concussions that the NCAA and NFL have to catch up," he said. "It's kind of funny when some NFL big wig comes to our state and says we have to implement this concussion plan. We have been doing it already."
Labecki said the point of emphasis for high school football referees this year was helmet-to-helmet hits and using the proper tackling and blocking techniques.
"As a coach, the only thing you can do is keep the head up when tackling and running," Matthys said.