San Luis Obispo County doctors and high schools team up on concussions

An innovative cooperative effort between local doctors and San Luis Obispo County high schools is focusing new attention on the threat concussions pose for young athletes.

Before the start of classes this year, seven county high schools — Arroyo Grande, Mission Prep, Morro Bay, Nipomo, Paso Robles, San Luis Obispo and Templeton — teamed with Sierra Vista Regional Medical Center and San Luis Sports Therapy to bring ImPACT Concussion Testing to student athletes.

The program provides a 20-minute normal (or baseline) brain test for athletes at the schools. Those who have been assessed with a head injury return for follow-up testing so that physicians can get objective results of cognitive symptoms to compare to original scans. That has made return-to-play decisions less of a matter of guesswork.

“It’s nice to have a baseline on individuals,” Paso Robles football coach Rich Schimke said. “It’s good to have that data and statistics to go by.”

Greater awareness

Throughout the football season this year, concussions have received increasing attention at all levels of the sport. They’ve been discussed by members of Congress, re-evaluated throughout the National Football League and college ranks, and prominently featured as a topic on ESPN shows.

In the past, coaches throughout San Luis Obispo County found their staffs and players too often having to engage in uncertain determinations about head injuries.

When players would suffer concussions, deciding when they’d safely be able to return to play was always a subjective quandary, inviting varying opinions from doctors, athletic trainers, parents and players themselves.

This fall, there was objective help, from which informed, medical decisions could be made.

All seven schools had football players sustain concussions resulting in follow-up testing during this past season, according to Stacey Ritter, the director of sports medicine and athletic training services at San Luis Sports Therapy. Each had at least one player held out from playing for a prolonged period of time.

“It gives us some objective data to make a return-to-play decision,” said Dr. Otto Schueckler, a sports medicine specialist with Central Coast Orthopedics and the program’s medical consultant.

“The coaches like it because they get a definitive yes or no. It’s statistical and gives everyone confidence in the decision.”

‘The gold standard’

The same kind of testing program is also used throughout the NFL, Major League Baseball, Major League Soccer and several other professional leagues, as well as more than 350 colleges.

“It has become the gold standard,” Ritter said.

The schools have yearlong subscriptions that provide 300 baseline tests apiece and cover various sports throughout the fall, winter and spring seasons.

Football has the highest concussion rate for boys, while soccer does for girls.

The packages include 30 possible follow-up tests during the course of the year. Subscriptions were provided at no cost to the schools thanks to funding from Sierra Vista and San Luis Sports Therapy.

The program is in its third year of use at Mission Prep, where roughly 80 percent of concussions over the past three years have been of a mild grade, meaning players were cleared to return for the next game, Schueckler said. The other 20 percent of the time, he said, the test results have warranted a player missing at least one game to fully recover.

Two years ago, Mission Prep’s Justin Mott had to retake the test more than once.

“I thought that maybe something was actually wrong with me,” Mott said, “and maybe it was to my benefit that I wasn’t playing.”

Better diagnoses

Overall, Schueckler said, concussions likely aren’t on the rise and could perhaps be declining thanks to safer equipment. Rather, they’re more proactively diagnosed now.

“It’s a really exciting time right now in sports medicine,” Schueckler said. “People didn’t know how important it was. In the future, there can be cognitive impairment for these kids. If you have a mild brain injury and get a second injury, the damage can be exponential, not additive.”

Concussions suffered this year by high-profile quarterbacks such as the University of Florida’s Tim Tebow, as well as the Pittsburgh Steelers’ Ben Roethlisberger and the Arizona Cardinals’ Kurt Warner, have prompted considerable discussion on ESPN’s “Outside the Lines.” Additionally, Mike Leach recently lost his job as Texas Tech’s head coach after school officials determined he had mistreated one of his players who had suffered a concussion.

At a House Judiciary Committee meeting last week, Rep. John Conyers Jr., D-Mich., the committee chairman, called for a safer culture in football all the way down to its youth levels. Meanwhile, former NFL offensive tackle Kyle Turley told members of the committee that the St. Louis Rams once cleared him for full-contact drills just four days after a concussion he sustained seven years ago, despite the fact he still had a severe, lingering headache.

According to an October story by the New York Times, it’s believed that depression typically linked to football-related brain damage has played a role in the deaths of at least eight former NFL players who died between the ages of 36 and 52.

The NFL started its concussions committee in 1994. But only recently has the league begun implementing and enforcing stricter return-to-play guidelines after coming under fire from retired players for allegedly not caring for them after injuries.

The league has mandated that each team hire independent neurologists as advisers, formed a partnership with brain researchers from Boston University and is studying helmets more in depth.

Need for honesty

In the past, Ritter of San Luis Sports Therapy said, doctors and trainers were sometimes at the mercy of players’ testimonials, which may not have always been entirely truthful due to athletes’ attempts to be cleared to play earlier.

Of course, Mission Prep lineman Domenic Baima pointed out, players can still be prone to produce answers to doctors that would enable them to be cleared earlier.

After getting a concussion in November, Warner told the Arizona Republic, “That’s the whole key with this issue — is a player being honest?

“It’s hard to choose to sit out,” Warner added, “because you wonder if your teammates second-guess you.”

Still, players’ awareness at all levels seems to be growing.

“The players have a better understanding now of why we make the decisions we do,” Ritter said. “Once they see that their cognitive function has been affected by a head injury, they’re able to understand and appreciate why we hold them out. There’s tangible evidence as to why we’re doing it.”