Concussion awareness in youth sports

BY TAD JOHNSON

When Eagan native Natalie Darwitz was playing with the U.S. Women’s Hockey Team during an exhibition game prior to the 2001 World Championships, she fired the puck down ice … then SLAM.

A member of Team Canada bowled her over, sending the 18-year-old Darwitz to the ice. “The girl didn’t care too much about the puck, went for the body and ran me over,” said Darwitz, a three-time U.S. Olympic medal winner. As one of the smallest players on the ice ever since she was a youngster, Darwitz had become accustomed to being slammed to the ice, and, like the fiery competitor she is, picking herself up and continuing playing.

“It was the sensation right afterward, remembering exactly what happened,” Darwitz said of the hit. “After that five-second span, that was the most eerie.” She said she was foggy and dizzy but made it back to the bench at the end of her shift. When it was time for her line to return to the ice she skated around with legs that were uneasy underneath her. She had problems maintaining focus.

Upon returning to the bench, coaches directed her to the team trainer who saw that an eye test indicated she may have had a concussion. “Then the trainer said: ‘I’m going to tell you five words that I want you to remember. I’m going to ask you what these five words are in 10 minutes, a half an hour, an hour.’ ”

For the first time in her career, which has included hundreds of games of youth, Eagan High School, University of Minnesota and international hockey, Darwitz sat out the rest of the game with her first and only documented concussion.

“I believe I probably had a lot more,” she said. “Ten or 15 years back concussions were not a popular discussion medically or as a topic in hockey. Do I believe I had other concussions? Yes.”

Now the topic of concussions in youth athletics is front and center in Minnesota and across America. New state legislation directed the Department of Education and the Minnesota State High School League to craft a concussion awareness campaign, assemble training materials, and establish a strict treatment protocol – one involving complete rest and gradual increase in activities – in treating concussions in young athletes.

New league rules require that an “appropriate health care professional” (a medical professional functioning within the levels of their medical education, medical training, and medical licensing) to be the determinant in whether an athlete can return to the field of play.

Concussion baseline testing is mandatory for all high school athletes competing in contact sports and parents must complete an MSHSL Eligibility Form which has them sign off as understanding Concussion Management protocols. The MSHSL Sports Medicine Advisory Committee highly recommends that every student-athlete and parent successfully complete the “Heads Up: Concussion in High School Sports” course at www.cdc.gov/concussion.

Why all the attention?

The attention to sports concussions among youth is coming to light in large part because of many battles being waged. A very public fight over the new National Football League collective bargaining agreement was struck with many provisions related to taking care of retired players who had suffered concussions that were not treated properly years ago.

Kayla Meyer, a New Prague teen who has suffered two concussions while playing hockey, took her “When in doubt, sit them out” message about concussions to the state Capitol during the past legislative session. She became the very public face of youth sports concussions and her testimony influenced passage of the new legislation. “I don’t want what I’m going through to happen to any other athlete,” Meyer said during her testimony.

The numbers tell the story, too. An estimated 1.6 to 3.8 million sports- and recreation-related concussions occur in the United States each year with 50,000 occurring in Minnesota, according to the Brain Injury Association of Minnesota. It is estimated that 1,000 Minnesota youths (ages 5-18) go to the hospital with sports-related concussions each year, according to a Minnesota Department of Health study.

The association says because sports-related concussions tend to be underreported, the number may be much higher. The incidence rate for concussion is highest among young male football players with ice hockey and lacrosse following behind for boys. Girls sports concussions are seen most often in soccer, gymnastics and lacrosse, according to the association.

Though Darwitz is no longer on the ice competing, she has been thrust into the issue as she has been entrusted with the care of a crew of high school girls hockey players as the new coach of the Lakeville South varsity team. The little girl who grew up raised on contact hockey, crashing pads against bigger and stronger boys, isn’t running away from the challenging environment created by the attention over sports concussions in high school athletes.

“You have to protect their brains. It is a very delicate topic,” Darwitz said. “For me, I can only tell them that I want them to be tough and know the difference between an injury and an owie.”

Decision is final

In the past, that difference was often determined by the athlete. The coach came up to you, asked you how you felt, and for most young athletes – fearless, naive and willing to please – they would say: “Put me in, coach.”

That is no longer the case.

The new power player on the sidelines at contests and practices is the health care professional, oftentimes a trainer. That person will determine whether an athlete returns to a game or practice after taking a hit. No matter what the coach, player or parents say, the determination is final.

Darwitz thinks the new rules with regard to concussion are positive, but is concerned about some aspects of its implementation. She raises the issue that some health care professionals at league games will not be full-time trainers and as familiar with the players as the coaches. She asks too if they will have enough experience to make a determination about a concussion in the midst of competition.

Darwitz, though, is confident of rule changes with regard to pre- and post-game concussion testing. “That is a great tool,” she said. “It’s a 15-minute test. … But that is not something you can automatically test them with during a game.”

The Farmington School District is having all its contact sports athletes take the Immediate Post Concussion Assessment and Cognitive Test (ImPACT) for 2011-2012. The test is a “video game” that assesses an athlete’s memory, reaction time, cognitive speed and concentration.

“Our main priority is the health and safety of our students,” Farmington athletic director Jon Summer said. “Our goal is to make an appropriate diagnosis and make sure they’re completely healed before putting them back in. … We feel like this is another piece of that puzzle.” He says the test will set standards for athletes, coaches and medical personnel in evaluating and treating head injuries. “What they’re finding is … when a concussion is diagnosed, the worst thing is putting them back too soon,” Summer said.

Dr. Michael Bergeron, director of Health and Safety for Youth Sports, Sanford Health, described concussions – an injury that can occur without bumping the head – as putting the brain into an energy crisis. During this crisis, placing additional burdens on the brain can heighten the risk of long-term damage with a secondary injury capable of producing “catastrophic” results. “The younger brain is much more susceptible,” he said of suffering a concussion.

Dr. Mark Carlson, of Sanford Bemidji Clinic, described a concussion as an injury occurring on the cellular level – one that does not show up on X-rays, he explained. The best treatment is rest, “complete rest,” said Carlson, who professionally has treated young athletes suffering concussions. There is no specific length of time to recover from a concussion – it varies from person to person, Carlson noted. It is known that having a concussion makes have a second more likely, he said.

Darwitz was fortunate that her concussion was mild. She said when she took her post-concussion test, her eye test still indicated she had a concussion and her reaction time was slow. At that point, she said the concussion played mind games on her, which led her to think about things like when she would play again or if she would play again. But two days later, Darwitz passed the test and was cleared to play. “I was totally fine,” she said. “I put it in the rearview mirror. It was behind me.”

She went on to play in three Olympics (earning two silver medals and a bronze), eight International Ice Hockey Federation world championships and was a captain of Team USA from 2007 to 2010. “I know people who have sat out numerous months,” she said. “There is no timetable for return with this injury. That makes it a frustrating injury.”

Diagnosing concussions will require a team effort. Though the health care professional has the final say, coaches and players need to remain vigilant at all times – in practice and games – and know when to have concussion assessment done.

Oftentimes, players continue practicing or playing when taking a big hit. It’s the warrior mentality. Darwitz says she’s the one who needs to make sure players see the trainer. “That is going to be the responsibility of the coach,” Darwitz said. “I feel like I have the knowledge to handle that.”

One thing that is for certain is that concussions will still happen in high school sports. All of the protocols, new safety equipment, education and testing won’t prevent players from experiencing the collisions that result in concussions. But now players, parents, coaches and trainers are better equipped and aware of how to keep young athletes safe after a concussion has occurred.

Tad Johnson is managing editor of Thisweek Newspapers and the Dakota County Tribune Business Weekly. T.W. Budig, ECM Capitol reporter, and Andy Rogers, Thisweek sports editor, contributed to this report. Photos by Rick Orndorf.