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Quiet No More: The 'Silent Epidemic' of Concussions

by on September 08, 2012 7:28 AM

Nothing.

Garrett Hunter can’t describe what happened in the moments before everything went black as he suffered his very first concussion. It was late October 2011, and Hunter was quarterbacking for Tyrone Area High School’s football team.

One moment he was in the game and the next — nothing.

“I don’t really remember,” the 15-year-old says.

But what he does recall is how much it hurt afterward. The headache. The pain around his eyes.

For Hunter and countless other athletes, concussions — the most common and least serious of traumatic brain injuries — have always been part of the games and an inherent risk when playing sports.

“It was called the ‘silent epidemic,’ ” explains Semyon Slobounov, professor of kinesiology and director of Penn State’s Center for Sport Concussion Research and Service.

Wayne Sebastianelli, director of athletic medicine at the university and the center’s principal investigator, says, “With a concussion, a person can look normal. People thought a headache was part of the game. It’s not. It has to be taken seriously.”

Research into concussions is very much in its infancy, Sebastianelli states. “It’s still a very inexact science,” he says.

Emily Hurd, a redshirt sophomore on the Penn State women’s soccer team, had already suffered two concussions in high school before ever stepping onto campus.

“The first one, I was receiving a ball for a drill and I just got a blunt hit to my head by one of my teammates who just ran into me — her shoulder as she was trying to get out of the way and it went right into my temple,” she says. “It didn’t knock me out, but my contact came out and I was like, ‘Whoa — what?’ I was diagnosed soon after by my coach and my doctor that I had a concussion.”

She recalls that she was told to sit out for a week — no exercising or conditioning.

“I was advised to not watch TV, do any texting or any computers. That didn’t go over too well,” the Seattle- area native laughs.

About a year later, Hurd suffered her second concussion.

“I was going up for a header and I got whaled in the head by someone else,” she says. “I had to get stitches because my head had been split open. I was diagnosed in the ER that I was concussed.”

Although she didn’t exhibit any symptoms or have any problems after either incident, she says there wasn’t any follow-up care or treatment for her concussions.

That’s not surprising, says Ruben Echemendia, a neuropsychologist and clinical psychologist with Psychological and Neurobehavioral Associates in State College. “What’s happened in the past, it wasn’t a serious injury,” he says. “The culture was to play through.”

He says early concussion treatment included grading the trauma on a scale of 1 to 3 with a set of guidelines for return to play.

“It was one size fits all — no differentiation between youths or pros,” he says. “There was no science.”

Echemendia, who started Penn State’s concussion program, has gone on to work on a national scale. He helped the National Hockey League put its concussion program in place, chairs Major League Soccer’s concussion program, and serves as a clinical consultant for US Soccer and the national teams.

He also helped to write the Pennsylvania’s youth-concussion law, which took effect on July 1. The new law requires not only medical clearance for athletes to return to play, but also parental awareness and consent before a child can play, immediate removal from play of a student- athlete suspected of a concussion, and concussion training for coaches.

Hurd says the attention and care she’s received while playing for Penn State offer a stark contrast to her high school experience in Sammamish, Washington.

“Coming here, they take more of a concern for it. It’s a big issue with stuff coming out now with people having careers end due to concussions,” she says. “It’s your brain — you don’t mess around with it.”

Penn State field hockey head coach Charlene Morett says an abundance of caution characterizes the university’s approach to concussions.

“You have to take the ultimate precaution,” she says. “We’re really on the conservative side. You just don’t know.”

Morett says she and her fellow coaches are constantly updated on the latest care and treatment for athletes through meetings and a stream of new information from Sebastianelli. Now in her 26th season at Penn State, Morett says concussion awareness begins even before a student-athlete decides to attend Penn State.

“Even when we recruit student-athletes, we tell students and parents how we’re going to care for them,” she says.

Once on campus, athletes participating in high-risk sports undergo an initial baseline examination.

“We had to come in and do an EKG [electrocardiogram] test — baseline concussion test. We did a physical. I had never heard of an EKG test before coming here,” Hurd says. “I had never seen something so thorough. It was exhaustingly thorough.”

An incident during corner-kick drills at the start of her second year on the team sent her back to the doctors for examination.

“I was in the heading line and I headed a ball and was like, ‘Whoa, that felt weird.’ I was trying to regain my focus and my lucidity. It wasn’t happening, so I went to see the trainer,” she says.

Things became worse for the midfielder as she was driven from practice to the training room.

“They gave me concussion tests — just on paper, asking me certain questions. I failed it pretty miserably,” she says. “I was instructed not to go to practice, not to go to class, not to be on the phone or on my computer — just to stay home and relax and let my brain heal for two days.” But unlike her high school experience, Hurd wasn’t immediately allowed back on the field. “I was tested again and I failed. I was tested the next day and I failed,” she says. When she finally passed, she was slowly phased back into activity. “It’s a whole process,” she says. “You have to pass, like, four tests before you’re cleared to begin to play. And they know whether you’re fudging it or not because of the tests they’re giving you every day.”

Former Penn State men’s basketball player Billy Oliver also is very familiar with the safeguards in place for student-athletes. For much of his collegiate career, he battled concussion-like symptoms, including migraines, that kept him off the court and on the bench.

The New Jersey native says it was frustrating to go back and forth to and from the injuries list.

A breakthrough for Oliver seemed to come on January 5 when he drained seven three- pointers in a 20-point victory over Purdue. But, less than two weeks later, he experienced concussion-like symptoms during the team’s game against Minnesota.

“I was shaken up,” he says. “It was worrisome that it happened so easily.”

So just over a month after one of his best basketball games ever, he retired. Though he left the game for health reasons, he complimented the care he received from the medical staff.

The protocols that Oliver, Hurd, and other Penn State players have to go through have their beginnings from a 2010 NCAA directive that mandated all leagues to have a concussion-management plan.

Soon afterward, the Big Ten established its concussion-management plan for conference schools. A year later, the Ivy League developed a return-to-play concussion checklist.

“We’ve elected to be more cautious than less cautious,” says Roberta Millard, who is one of the team physicians for a number of Penn State sports, including men’s and women’s soccer, women’s basketball, men’s and women’s swimming and diving, and softball.”

There’s always a team physician present, she says, adding, “Our office hours are on the field. It’s part of our job.”

Millard shows her calendar, which is filled with colored dots to denote what game she’s working on any particular night. “Green means it’s a basketball game. Red means it’s track,” she explains.

Morett says, “We’re lucky — we have certified trainers at every practice and doctors at every game.” The team physicians have the ultimate say

in whether an athlete can return to play or not after suffering a concussion. It’s a heavy responsibility for Millard, especially when she has to tell an athlete they can no longer play.

“Any motivated athlete puts blood, sweat, and tears into a sport,” says Millard, who also swam for Penn State from 1978 to 1982. “I had to retire a young woman in her first and only concussion after her junior year. Ultimately, that responsibility is on our shoulders.”

Local high school athletes with concussions also get similar attention to that given Penn State athletes.

Adam Day, manager of athletic-training services for University Orthopedics Center, says his trainers’ efforts don’t end on the field.

“We do our best work with the schools, not only the coaches, but with the school guidance counselors and teachers,” he says of University Orthopedics, which serves State College, Bellefonte, and Mifflin County school districts. “They’re student-athletes, not just athletes. A lot of times these kids are suffering. They’re symptomatic and having difficulty in math class. The bigger picture is getting everyone educated and on the same page.”

Although attitudes toward concussions have begun to shift, the culture change is nowhere near complete.

As the NFL faces concussion lawsuits from thousands of former players, current players such as the Pittsburgh Steelers’ Troy Polamalu have admitted to hiding concussions from their team’s medical staff.

As reported by ESPN.com on July 18, Polamalu told the Dan Patrick Show, “When you get your bell rung they consider that a concussion — I wouldn’t. ... If that is considered a concussion, I’d say any football player at least records 50 to 100 concussions a year.”

The four-time All-Pro safety continued, “Somebody may say, ‘Is your knee messed up?’ It may be kind of messed up but you just kind of push yourself to be out there with your brothers. I wouldn’t say there are any major lies where I totally lied my way out of concussions. In fact, during concussions, if it’s serious enough, you can’t even be conscious enough to lie.”

What players such as Polamalu say is the heart of the problem, Sebastianelli says.

“That gladiator mentality has got to be minimized,” he says. “There’s a difference between being tough and being reckless.”

On top of that, players are bigger and faster than ever, making a physical game even more dangerous.

That being said, the experts also note that a high-profile death such as retired NFL linebacker Junior Seau’s suicide in May isn’t the ultimate fate for everyone who suffers a concussion.

“Given what has been portrayed in the media, the flipside is ‘I don’t want my child involved in that sport,’ or, when they get one concussion, they don’t want to give that child the risk,” Echemendia observes. With parents, “I talk about the risks and benefits. And there are lots of benefits from playing sports.”

The culture surrounding concussions continues to evolve, and change will take a number of years to complete, many experts say.

“Players are more willing to report when they’re having them, but there’s still also a lot of reticence,” Echemendia says.

He says that as today’s youth athletes mature, they’ll take their awareness of concussions with them into the collegiate level and beyond.

“It’s through educating student-athletes and parents. They’re more sensitive to the injuries,” Day says. “A teammate might say, ‘Hey trainer, my buddy’s not doing so well. You may want to check on them.’ There’s an awareness that simply wasn’t there before.”

Back at Echemendia’s State College office, Garrett Hunter is undergoing a battery of tests to see if he can be cleared to resume play after suffering a second concussion during a flag- football game in April. As his balance is checked, his father, Barry, asks Echemendia whether a certain-model helmet might be good for his son.

Echemendia explains that a good helmet is nice, but no helmet is concussion proof. “It’s a false sense of security,” he says.

That’s one of the biggest misnomers out there, Sebastianelli states. Whether it’s a football helmet or some other type of headgear, “nothing is concussion proof.”

He adds, “Helmets are good at preventing skull fracture and death,” but there’s no way to mitigate the physics of the jolts bouncing the brain around in the skull that causes concussions. “It’s the starting and stopping.”

Although they’re rightfully concerned, Hunter’s parents say they never considered asking Garrett to stop playing football.

“Absolutely not,” says Barry Hunter. “Only if it was no longer safe. I have complete faith in his doctors. And it would be Garrett’s choice.”

Players such as Oliver say fear can’t be the prime motivator.

“Don’t stop something on the fear of getting hurt,” he says. “You’ve got to go for it. There’s no point in sitting out. If you happened to get injured, that’s how life goes.”

For Oliver, life — without regrets — goes on after basketball. After completing an internship with FBR Capital in New York City this summer, he’ll return to campus to finish his degree. Oliver says he wants to work with the basketball team in some capacity and is considering pursuing a master’s degree.

“I’m happy that I picked Penn State. I don’t think I could have changed anything at the end,” he says. “I’m glad I got to play, though.”



Curtis Chan is coordinator of college relations for the College of Engineering at Penn State. He also is an adjunct instructor in the College of Communications, and graphics advisor for The Daily Collegian.
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