SARANAC LAKE - When today's high school coaches were athletes and slammed their heads on the ice, field or their opponent's helmet, they were told to get it together, suck it up and get back in the game, even after losing consciousness in some cases.
Today, those coaches, trainers and physicians realize that mild traumatic brain injuries like concussions can have much more serious implications if the athlete is not taking the care they should after suffering one, which includes basic bedrest and not returning to play until all the symptoms are gone, symptoms as mild as a headache or trouble focusing.
One of the most difficult aspects of treating concussions in student-athletes is acknowledging when an athlete has suffered one.
Saranac Lake athletic trainer Kevin Moody inspects a player who suffered a concussion during one of the past season’s football games. The player’s mother stands by, visibly worried.
(Enterprise photo — Lou Reuter)
According to the Center for Disease Control, between 1.6 and 3.8 million sports- and recreation-related concussions occur in the United States each year. The variable is so large because concussions are widely underreported or diagnosed by athletes, coaches and physicians.
However, local high school athletic staff members are actively working to improve the assessment, treatment, and communication that is necessary whenever a student experiences a concussion.
What is a concussion?
According to Dr. William Viscardo, Jr., the chief medical officer at Adirondack Medical Center in Saranac Lake, a concussion is a bruise on the brain.
"Your brain is in a boney chamber with space around it," Viscardo explained. "It's the slamming of your brain into your skull that causes the damage."
The implications of a concussion are, most notably, brain cell death.
"Anytime you have any injury there is a certain amount of cell death and some cells that are left in between - not totally healthy, but still alive," Viscardo said. "If you suffer another injury before you are fully healed from the first, that could cause those cells to die along with others that would die from the new injury."
Brain cells, unlike skin, bone and blood cells, do not regenerate. Once you lose them, they're gone.
Although brain injuries are not physically visible, Viscardo said there are important clues to look for after a blow to the head.
"With post-concussive syndrome you can have memory loss, dizziness, nausea, headaches and/or confusion," he said.
But when a concussion can mean the athlete having to sit the bench the rest of the game and most-likely more games to come, many players are reluctant to tell their coaches or trainers.
Coaches taking charge
"If you're 17 or 18 years old, you feel physically invincible and you want to play," Saranac Lake Athletic Director and head football coach Mark Farmer said. "But no contest is worth the health of our students."
Farmer said each coach is required to attend first aid seminars and be aware of the symptoms that follow a concussion. If there is any question in a coach's mind whether a player has suffered a concussion, they are out for the game, he said.
Since implementing ImPACT baseline testing on all the student-athletes, Farmer said coaches and physicians alike are able to have more assurance and guidance as to when a player is ready to get back off the bench and back in the game, or the classroom, for that matter. Both Lake Placid and Tupper Lake high schools use the ImPACT test on their student athletes as well.
"We're always so concerned with when they're going to play again, but at the same time we're shoving them into classrooms they're not ready for either," Farmer said.
ImPACT tests a person's neuro-cognitive abilities, such as reaction time and memorization. If an athlete has a concussion they take the test again and compare the results to the baseline they recorded at the beginning of the season. Once the two match, the student is most likely cleared to play.
Kevin Moody, the school's athletic trainer who attends all football games and home hockey contests, said baseline testing is commendable on the school's part.
"It's another tool in the box, and it provides objective data that we can use and the trainer and school administrators can use to determine what academic loads the athlete can handle," Moody said. "I was a high school athlete back in the 60s and recognition of concussions was basically non-existent. I think awareness and management of concussions in scholastic athletes is considerably better."
Do the risks outweigh the benefits?
"Most physicians don't recommend contact sports, period," Viscardo said. "Everything with medicine is the risk versus the benefit and with kids you have to know whose benefit we are talking about - the kid's? The parent's? The coach's?"
Student-athletes say they play the game because they love the action, the competition and camaraderie that comes with team sports, and for many of them, that outweighs the arguably high risk of suffering a head injury in sports like football, hockey and lacrosse.
Viscardo, however, questions the validity of such motivation.
"If you're a ninth grade hockey player who, let's face it, sits the bench half the game and goes out and gets whacked, what's your hurry to get back in the game?" he asked.
For adults and student athletes alike, though, its hard to come across a person who can say they have never experienced a good, hard thump on the head, but Viscardo warns its the frequency of these events that can have a lasting effect.
"We've all had that happen to us, and most of us are just fine, but that's just one end of the spectrum," Viscardo said. "The other end of the spectrum is Muhammad Ali - boxers, they get punch-drunk. Or Mike Tyson, you know, was he just born that way? Somewhere there is a line."
Viscardo said that line exists at different levels for every person and depends on a person's DNA and the severity and frequency of a person's injuries.
"There's not research that shows how many times it has to happen," he said. "It's very hard to predict who will do poorly and who won't; therefore, conservative restraint should be exercised in all sports."
And although helmets and mouthgaurds don't prevent concussions all together, the protection they offer is far from marginal, he said.
"You wear a helmet so you don't die," Viscardo said. "You have that helmet on so all you get is a concussion and not a cracked skull."
On the field, in the stands and in the classroom
By EMILY HUNKLER, Enterprise Staff Writer
SARANAC LAKE - Sue Cherny and her husband Tim Burpoe hold their breath every time their son Steven hustles out onto the football field, and after seeing him knocked unconscious and taken off the field on a stretcher and straight into an ambulance, who could blame them?
"But Tim said to me, 'He can't play scared, he can't know we're nervous,'" Cherny said.
"We all hold our breath, but we never tell Steven," Burpoe said. "He can't go out there thinking he's going to get hurt because then he might as well put the pads away and play tennis."
Steven Burpoe has had two concussions in his four years on the Saranac Lake High School football team: The first, his sophomore year, knocked him completely unconscious and took him nearly a month to fully recover from; the second, his junior year, was not nearly as severe.
Steven, a wide receiver and safety, stands at six feet, four inches tall, much taller than the defensive opponents whose whole purpose on the field is to keep him from catching the ball - usually that means knocking him to the ground.
"These two little urchins just came up and whacked him," Burpoe said, describing Steven's first concussion-causing impact. "I think he was out before he hit the ground."
Understandably, Steven doesn't remember much from the first incident.
"I have this vague glimpse of the field," he said. "I remember asking the score of the game to my parents lots of times and when they would tell me, I thought, 'Yeah, I knew that.'"
Cherny said when Steven woke up Saturday morning in the hospital, he was seemingly normal, even doing his homework. It wasn't until that afternoon that the symptoms started.
"In the early afternoon he started getting sick, couldn't focus, constant headaches," Cherny said.
It took four weeks for the symptoms to subside. By that time, the season was long over. He had missed the most anticipated game of the year against Tupper Lake and didn't get a chance to play in the playoffs.
The second concussion was worse in some ways, though.
Steven said he remembers being hit hard on the chin and falling to the ground. He wasn't knocked unconscious, but he needed a teammate to point him in the direction of the bench.
"I was going inside at half-time, and I kind of ran into the side of the door and then Kevin (Moody) saw me and brought me off to the side," Steven recalled. "He asked me a bunch of questions with numbers and memorization that I couldn't answer, and I didn't know the date either."
Steven said he was upset he didn't get to finish the game, but it was the coming game that he was really frustrated to miss.
"With the first one I was pretty messed up, so it did stink not to be able to play, but I probably couldn't have gotten in there anyway," he said. "The second concussion, I was really sad because I had to miss the Tupper Lake game, and I thought I was going to get to play. I still had all my senses, and I was just watching my team lose. That really stunk."
For each concussion, Steven's parents decided to leave the return-to-play decision up to the team's athletic trainer, Kevin Moody, and keep emotions out of the equation.
"It's really a psychological thing, not only for the parents, but its got to be for the kids, too, because they look OK and they act OK," Burpoe said. "I'm glad I didn't have to make that decision. I didn't want to have that on my conscious, having guilted my kid into playing before he was ready."
One aspect of Steven's injuries that was largely disregarded was his inability to perform well in class in the weeks following the concussions.
After his first concussion, Steven stayed home from school on Monday, but returned Tuesday to take a standardized test.
"He said he couldn't even focus to get his name bubbled in on the sheet," Cherny said. "He had his friend that was sitting next to him fill it in for him."
"It's very frustrating, those weeks after the concussion, when the teachers were not informed of his injury," Burpoe said, adding that Steven's grades fell from As to Ds and Fs. "We really need to make a point of managing concussions and letting the parents who are going through it know that there are people talking on their behalf - teachers, guidance counselors, coaches, trainers - so they know what's going on and know that there are going to have to be some accommodations until the kid is far beyond showing the symptoms."
Steven said making sure your teachers know what's going on is one of the most important aspects of recovery.
"I think it's really important to tell your teachers, because last year my teacher's weren't informed, and I took two math tests and I just really bombed them," he said.
Thankfully, Steven made it through this year's season without incident and not only did he help the Red Storm win the Mayor's Cup against Tupper Lake, but they made it to the state semi-finals, too.
Steven now wears a specially designed mouthgaurd and chinstrap to help prevent concussions.
"Because he is so tall, it was blows that were underneath the chin or close to the side of the chin that caused these concussions, that's why we looked into the chinstrap and mouth guard," Burpoe said.
Despite the fear and worry Steven's time on the field may cause his parents, they fully support him and look forward to him possibly playing in college next year.
"As a parent, you can't be overprotective, then nobody would play football," Burpoe said. "It's a contact sport. The idea is to knock the other guy down, not pull the flag from their belt. That's the whole essence of the game and concussions happen."
"And I'll be holding my breath through all of those games, as well," Cherny added.
Contact Emily Hunkler at (518) 891-2600 ext. 24 or firstname.lastname@example.org.