On the second play of a recent football game, Deerfield High School quarterback Mac Mansavage smacked his head on the ground as he was tackled by an opposing lineman. He was dizzy and had a headache, but shrugged it off and told no one. This was football, after all, where “bell ringers” are considered part of the game.
As the game progressed, his parents noticed from the bleachers that their youngest son didn’t have his natural rhythm on the field. A coach wondered why Mansavage seemed unusually angry. And by halftime, though Mansavage still said nothing of a headache, the athletic trainer found that the boy was slurring his speech and having trouble concentrating.
Ultimately, an ambulance rushed the 16-year-old junior to the hospital where he was diagnosed with a concussion, a result of trauma to the head. Although cleared to play the rest of the season, he will be watched carefully–and a little nervously–by trainers, coaches and his parents, thanks to mounting awareness and evidence that multiple concussions can have much more serious consequences than once thought.
Often unrecognized or downplayed as a minor headache and something to “shake off,” concussions increasingly are being diagnosed as potentially life-threatening to young athletes whose developing brains are more vulnerable to injuries, doctors say. Studies have shown that a player who suffers a second blow to the head before the first one has healed is at risk of sudden, irreversible, fatal brain swelling, a condition known as Second Impact Syndrome.
Of course, concussions always have been a part of contact sports such as football; every week NFL players are knocked down and sometimes knocked unconscious. But several factors, including the retirement of high-profile athletes such as former New York Jets wide receiver Al Toon, former Bears fullback Merril Hoge and hockey star Pat LaFontaine due to repeated head injuries, have heightened awareness of the problem and triggered new medical studies into how concussions are managed.
Just last week, Bears defensive back John Mangum announced his retirement due to lingering effects of a concussion he suffered Sept. 20.
Moreover, though helmets and other equipment have improved, sports experts note that players are bigger–many high school players are well over 200 pounds–and are tackling harder than ever before. Additionally, in a sports-obsessed culture, playing hurt is expected, even celebrated. And for the high school athlete, the pressure to play through injuries is more intense when college scholarships are on the line.
“You are seeing more and more athletes with concussions,” said Dr. James P. Kelly, director of the Brain Injury Program at the Rehabilitation Institute of Chicago and one of the nation’s leading neurological specialists. “The (players) collide with maximum velocity. They’re not trying to tackle people; they’re trying to knock them into the next county. That’s what the pros do, and that’s what the kids emulate.”
Incidents of recurring brain injuries are being reported in increasing numbers, according to the federal Centers for Disease Control and Prevention in Atlanta, most involving males between 16 and 24. The repeated concussions can lead to brain atrophy and cumulative neuropsychological deficits, medical experts say.
Meanwhile, doctors are at odds over the best way to treat head injuries. No one knows exactly when an athlete should be returned to the game or how many concussions is “too many.”
“One thing that has long made us uncomfortable about the treatment of head injuries is there is no scientific knowledge about when kids can go back,” said Dr. Joseph Congeni, medical director of the Sports Medicine Center at Children’s Hospital Medical Center in Akron, Ohio. “A kid might look like he has a mild concussion, but two or three hours later, he is in the emergency room, throwing up. That’s what worries us all.”
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About 300,000 people a year suffer brain injuries from sports, according to estimates by the Centers for Disease Control. But exact numbers are sketchy and likely underreported because there is no statewide tracking of head injuries and no mandatory reporting required by high schools or coaches.
Doctors say athletes at all levels who suffer concussions are frequently allowed back into games too soon. Exacerbating the problem is that many young athletes don’t realize they’ve had one. About 90 percent of concussions do not involve a loss of consciousness.
“I just thought I had my bell rung,” Mansavage said. “I felt a little out of the ordinary, but I didn’t want to go out.”
Already this football season, Mansavage, Highland Park’s Mark Burrell, Hinsdale South’s Mike McCord and Carmel’s Jon Styx have had concussions or head injuries. Fenwick defensive back Scott Theis will miss the next few weeks on a doctor’s recommendation after experiencing dizziness.
Sandburg High running back Brian Corcoran, who suffered a concussion last year, was taken out of a game last week after a head-on collision with a big linebacker. Though his injury turned out not to be head-related, athletic trainers and coaches weren’t taking any chances that he would experience Second Impact Syndrome.
Last year Wheaton-Warrenville South quarterback Jon Beutjer and Lane Tech’s Nick Pancatto both suffered concussions. Beutjer is playing again this year. Pancatto is not: He collapsed on the sideline, went into a coma and nearly died.
Mansavage said doctors thought if he had briefly left the game after the initial head blow, he likely could have safely re-entered in the second quarter. Instead, he tried to tough it out and received continuous knocks to his head during the entire first half. Eventually, he was mumbling when he spoke, and teammates saw his eyes roll back in his head.
Kelly, of the Rehabilitation Institute, describes a concussion as a brain injury resulting from the brain being shaken inside the skull. Confusion and amnesia are its hallmarks, and early symptoms include headaches, dizziness or nausea. Days or weeks later, victims may have lightheadedness, fatigue, irritability, intolerance of bright lights or loud noises, ringing in the ears or anxiety.
Kelly called concussions a “silent epidemic” in 1991 when he developed guidelines with the Colorado Medical Society, because they received remarkably little attention compared with other neurological illnesses such as Alzheimer’s disease and strokes.
But though doctors agree that anyone with symptoms of an initial head injury should not go back into a game, there are no standard return-to-play recommendations.
Kelly developed guidelines for the Brain Injury Association and the American Academy of Neurology. Other standards in use were developed by Robert Cantu, chief of neurosurgery at Emerson Hospital in Concord, Mass.
“Most high school kids, when they’re injured they try to hide it,” said Deerfield athletic trainer Florin Mitran, who estimates that minor concussions, called grade one, occur maybe two or three times a game. “Kids really should be honest with their athletic trainers. There is no use hiding anything.”
Mansavage received that same message from his parents, who, despite wholeheartedly supporting athletics, wouldn’t mind if their son gave up football and stuck to baseball, where he also excels.
“Watching your son lie perfectly still in a neck brace, not moving a finger, toe or hand is the scariest thing in the world,” Mansavage’s father, Art, said. “We made him promise again if he takes any kind of hit he will say something.”
Mansavage promised. But he also wonders if, when the adrenalin is flowing, his team is trailing and he is leading the game-winning drive down the field, he would be able to take himself out.
“It did make me think,” he said of his injury. “I probably would. But I’m not sure.”
Tribune photo by Candice C. Cusic