Concussions in high school sports are a growing concern, but with no state oversight, who’s counting?

2013-10-09T08:50:00Z Concussions in high school sports are a growing concern, but with no state oversight, who’s counting?TODD MILEWSKI | The Capital Times | tmilewski@madison.com madison.com

Scott Rohlfing left Verona’s football game at Madison La Follette feeling like his brain was going to bulge out of his eye sockets.

The senior offensive lineman and team captain doesn’t remember much about the Sept. 12 game, but knows he took a pretty good hit to the helmet in the second quarter. He continued to play, but well into the second half, the pain was too much.

"I just could not stand it," Rohlfing said. "The lights were getting extremely bothering. At some point probably midway through the fourth quarter, I ended up just pulling the plug on it and talked to the trainer.

"I sat on the sideline with cotton balls in my ears and basically with my eyes closed and my head down, watching as much as I could just because the sound and lights were pretty intense."

Rohlfing was diagnosed with a concussion. His doctor ordered him to avoid electronics and school work. And state law forbid him from practicing or playing until he received written clearance from a health care provider.

Concussions, traumatic brain injuries that interfere with normal brain function like what Rohlfing suffered, are somewhat common and better diagnosed in high school sports now, and requirements are in place now to prevent further harm.

But at a time when the sports world is increasingly obsessed with numbers — from fantasy sports to "Moneyball" to ESPN’s hiring of Nate Silver — data collection locally on concussions is haphazard and inconsistent. Those looking to find patterns or draw conclusions about how to address the top-reported injury in high school athletics have a difficult, if not impossible, task.

At no point was it required that Rohlfing’s concussion be reported to any officials or organizations. Neither the state nor the Wisconsin Interscholastic Athletic Association, which governs high school sports statewide, requires concussions to be tracked.

Athletic trainers often keep figures for the individual schools at where they work, but there are no published statistics showing how schools in the Madison area and in Wisconsin compare year to year or to each other in how many concussions are suffered.

One local sports medicine expert called that a missed opportunity.

"We certainly have a better idea of what the concussion rate is than we did 10 or 15 years ago, but I think it’s still a moving target. To really know in our area, it’s tough," said Dr. Alison Brooks, a UW-Madison assistant professor in the sports medicine program.

"I could tell you how many clinic visits we’ve had, and we could tell you what the concussion rate was in the studies that we’ve done, but those are a part of research studies and when we quit doing the research studies, there is not any formal injury surveillance system in place that I’m aware of."

So far, the nation’s concussion crisis, displayed perhaps most prominently in pro football, has not led to a push for more information on how many head injuries are being suffered locally.

Some states require schools to report head injuries, but in Wisconsin, the WIAA doesn’t have the personnel resources to take the lead on collecting head injury data, deputy director Wade Labecki said. Besides, there are questions about how accurate figures compiled by school officials would be.

"It’s easy to collect how many broken bones there are because ... it’s visible on an X-ray and fixable with a cast," he said. "Now we’re trying to ask either a lay person — a coach or an AD (athletic director) — to put down the number of concussions without the medical knowledge. Not every school has a medical trainer, so who’s going to do that piece?"

One athletic trainer who frequently blogs at theconcussionblog.org on the issue said there is likely a more troubling reason the statistics aren’t gathered.

"They don’t want to know," said Dustin Fink, who works for a health care provider in central Illinois that contracts with high schools. "That’s the simple answer. I’ll flat out tell everybody that.

"The reason why it’s not being collected at the high school level — or any other level, for that matter — is they don’t want to know the true measure."

Bob Joers, the athletic director at Middleton High School, was curious how many concussions his athletes were suffering on a yearly basis, so in 2012, he asked the school’s athletic trainer to compile the stats.

For the 2011-12 school year, there were 38. In 2012-13, 44 concussions were tallied.

Joers said he wanted to collect the data to be able to see whether efforts to educate parents, athletes and coaches on concussion signs and symptoms were effective.

"If there’s a better way to address something, the way we’re addressing the concussions or something, can we do that?" he said.

His counterparts at area schools report having the same access to figures: the athletic trainer keeps them. Other than using them for outside research studies, though, that’s generally where the data stays.

John McKinley, the manager of outreach athletic training services at UW Health and an athletic trainer at Madison Memorial, said he hasn’t noticed much of an outside push for data collection.

"I think there are means to do it," he said. "I think the question is what’s the best way to do it, and what’s the question that wants to be answered on the back end?"

The reasons for collecting the data, sports medicine practitioners say, are varied. On one hand, it provides a basis for determining whether positive change is happening.

"You have to identify what is the scope of the problem and whether there’s a need to intervene," said Brooks, the UW sports medicine professor. "And of course if you do something to intervene, then you need some sort of proof that what you’re doing to intervene is making a difference."

Fink, who said he started blogging out of frustration with the concussion crisis, said the numbers he kept showed that the high school football team he worked with had six concussions one season and 14 the next.

"I was able to discern that we had more hitting in practice and we had less substitutes in games, or we didn’t have as many kids that (second) year so kids were exposed more," Fink said. "You can take the numbers and see why something would be occurring — level of competition, hours of practice, hitting in practice."

In Wisconsin, state and athletics officials have put the emphasis on education in their tackling of the concussion crisis as it relates to adolescents, who can be more vulnerable and take longer to heal from head injuries.

Wisconsin’s concussion law, put in place last year, mandates youth sports organizers distribute concussion and head injury information sheets to coaches, athletes and parents.

The National Federation of State High School Associations and the federal Centers for Disease Control and Prevention offer free online concussion training courses. The WIAA’s website includes information and a recommended five-step return-to-play procedure.

"We’re trying to educate, and we’re going to see the number of concussions go up through that education," the WIAA’s Labecki said. "We don’t want to scare people, we want to educate people. We know that there’s going to be concussions; there’s concussions every day in life.

"But we know we've got to pull you out. We know you’ve got to be symptom-free. And when you are and you’re healthy, we can put you back in. Because we’re worried about the second impact syndrome," he said. "We’re worried about the kid getting another concussion while still suffering the first concussion. That’s dangerous. Those are catastrophic."

New legislation centers on education and parental approval but doesn’t address data collection. Assembly Bill 293 would require game officials to complete an online training program every three years. Assembly Bill 343 and Senate Bill 258 seek to streamline the parent and athlete signoff process by making them return a signed information sheet only once per school year instead of for every sport the athlete plays.

In other states, the education component of concussion policy is complemented by a collection of actual numbers of head injuries.

Starting in the 2011-12 school year, Massachusetts law required schools to report the number of students who suffered head injuries or suspected concussions during extracurricular athletic activities.

The Boston Globe reported in July, however, that compliance by schools has been poor, and the state was changing the way it asked for data.

In football-mad Texas, the University Interscholastic League keeps a count of football injuries reported weekly. That data has been used to institute a rule change to limit contact in football practice to 90 minutes per athlete, per week.

One measure of recent concussions in the Madison area and an eight-year national study both show significant jumps in the number reported.

Figures provided by UW Health of patients it treated in its sports medicine clinic showed the number of concussions to high school-aged athletes growing from 47 in 2010 to 144 in 2012. This is just one clinic, however; many of those who were injured saw their own doctors at other clinics.

Nationally, since the 2005-06 school year, Dr. Dawn Comstock has reported data on injuries suffered by high school athletes in the High School RIO (Reporting Information Online) study.

In it, certified athletic trainers enter data on injuries weekly, and researchers extrapolate the data to provide a national estimate.

It shows that concussions suffered by high school athletes in seven core sports — football, boys and girls soccer, volleyball, boys and girls basketball, wrestling, baseball and softball — jumped from 133,162 in the 2005-06 school year to 314,329 in 2012-13.

Concussions grew from making up 9 percent of the total number of injuries to 23 percent of high school athletics, although sports medicine providers are quick to point out it’s actually the reporting that’s increasing.

"There isn’t anybody in the field that really is an expert that I know of that believes that there are more concussions today," said Dr. Robert Cantu, the co-founder of the Sports Legacy Institute, a Boston nonprofit that studies brain trauma in sports. "It’s just better diagnosis."

The diagnosis has changed how the Rohlfing family approaches high school football.

After the La Follette game where he was injured, Scott came home and slept, as is recommended. He tried going to school the next day, but he said he was in "zombie mode" and had to return home to sleep some more.

Five days after the concussion, he was in a doctor’s office doing neurocognitive testing to see how he was responding. The answer: He wasn’t ready to get back to football.

The fog in his head finally lifted 11 days after the concussion and he passed his test, which cleared him to return to practice. That week, he went through the recommended steps for returning to game action: light exercise, then more strenuous running, then non-contact drills, then full practice and finally full clearance, with each level taking at least 24 hours.

Fifteen days after her son suffered the concussion, Sharon Rohlfing stood outside the fence at Middleton’s Otto Breitenbach Stadium, waiting for her mother-in-law to join her under the Friday night lights. Scott was warming up with the team on the field.

"This is an important game," Sharon said, "because if he starts to get a headache and he chooses not to tell ..."

She stopped. What did she think would happen if the headaches returned in the rivalry game against Middleton?

"I’m hoping he’s honest," she said.

During the game, Rohlfing was back to normal in a lot of ways. When Verona’s defense was on the field, he prowled the sidelines, screaming "Let’s go!" or "Wake up!" to his teammates.

Scott made some adjustments that have him using his hands and shoulders in blocking instead of his head and shoulders.

"It definitely made me think twice how I was playing and change a little bit that way," he said. "And it helps to put everything in perspective a little bit more."

Sharon won’t be able to watch Scott’s games the same way.

"I think every time he gets on that field," she said, "I’m going to have a little bit of worry."

So what is the proper level of fear to have?

Brooks, the UW assistant professor who also works with the Badgers women’s hockey and men’s soccer teams, said it’s tough to know because the data being used in lawsuits — and being disseminated in the media — often represents the worst-case scenarios related to head trauma.

"Some of that fear is good and some is not appropriate," Brooks said. "But all the attention on some of the athletes who have had very severe outcomes, how as a parent would you not be worried and anxious for your child? But we don’t have any good, longitudinal data to suggest that a high school kid who gets one, maybe even two concussions that are relatively mild and they’re managed appropriately, there’s no overwhelming evidence that that kid is going to go on to have a neurodegenerative brain disease."

Fink, who blogs about concussions and treats them as an athletic trainer, brings the issue back to the availability of data.

"Education, we’re doing a great job there, great inroads," he said. "In terms of collecting the actual number of concussions, it doesn’t matter what level, nobody really wants to know the true number because they’re afraid of what they’re going to find, to be honest with you.

"We need the true number to figure out if what we’re doing is working. If we don’t have a true number and we don’t have a baseline, so to speak, how in the heck are we supposed to know if we’re doing any good at all?" 

Copyright 2015 madison.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

(18) Comments

  1. Cornelius Gotchberg
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    Cornelius Gotchberg - October 10, 2013 9:23 am
    Cheerleading causes the most significant injuries, yet you hear very little about it.

    No one wants to end cheerleading. They're critically necessary for folks that depend on them as much as does the CHOSEN ONE, who needs to have all the Lefties blindly rah rah rahing as they tote mass quantities of water.

    We wouldn't be hearing much from Capital Newspapers Lefty apologist Cheerleaders Carver, Zweifel, Nichols and commenters like @Nav, @Wis_taxpayer, @dakref, @Fact or Fiction, etc.

    Maybe eliminating some Cheerleading wouldn't be so bad after all? Fewer might pull a maxillary muscle or sprain a typing finger, and overuse injuries are ALWAYS a problem.

    The Gotch
  2. Norwood44
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    Norwood44 - October 10, 2013 9:13 am
    True. The people who led the examination of the existence and effect of CTE were NFL football players, their families and doctors. Your assertion that the concussion discussion is a left wing conspricacy is off base. Hell, the NFL is the largest sports brand in American. College and high school football are flourishing in most areas. But football has never done a very good job of understanding it's risks, Hell,,,when we played they wouldn't give you WATER! You can't leave the health of players in the hands of morons. If you want to save the game, make it safer and don't deny the risks. Minimize them. The ones who are going to kill the game are the ones waving the American flag at the Super Bowl.
  3. truedat
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    truedat - October 10, 2013 8:27 am
    It is surely not a right wing movement that dislikes football.

    And a very mature comment you made, must be so proud of yourself. Congratulations.
  4. truedat
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    truedat - October 10, 2013 8:24 am
    Youth 4th grade soccer is far more dangerous than youth fb. Well known fact for 20 years.

  5. toby
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    toby - October 10, 2013 4:18 am
    Youth Tackle FB for 4th Graders is absolutely insane! The kids can't even lift up their arms to catch a ball they are so weighted down with equipment. I watched a game recently & kid broke free & it looked like he was running in sand. On top of it you get some volunteer coaches at that age who think their coaching an NFL team.
  6. Crow Barr
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    Crow Barr - October 09, 2013 10:02 pm
    truedat---where do you get that liberals are anti football? I'm a bleeding heart liberal and I like football. No relatives of mine playing now.

    Also, if, as you proclaim, football is a republican sport, then most of the players are republicans, brain damage not a problem there, and if they self destruct for liberals entertainment, so be it.
  7. truedat
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    truedat - October 09, 2013 2:12 pm
    i know the game very well, started playing when i was 8, done playing at 22 (yes college, not flag football)

    Here is, IMHO, the truth, my take....take it for what it is worth -

    1. Whether it was 1950 or 2013, if you play football...there is a risk, everyone knows it. head, knee, paralysis. It has always been there. Same with boxing, right? This is simply another chapter, and it is due.
    2. The sport, country, fan base, and political environment moved quick and slow on this at the same time. As the article points out, 10 years ago....getting your bell rung was not what it is today. As a football society/country, we went from 'no big deal' to talk of outlawing the sport very quickly. Have you seen the “Death of football” article? Does the NFL, Dr's, others hiding what was known factor in. you bet.
    3. It's been at least 7-8 years of 'concussion awareness', and every year it gets better
    4. As with anything of this nature, there is going to be a under reaction, and over reaction. if feel a middle of the road approach is best.
    5. Football is not the only sport where concussions happen, how come nobody is talking about hockey or boxing, or MMA? Why, because hockey's scope, revenue, popularity, $$$$$, is 1/20th of the NFL. And culture of the game, does anyone foresee former NHL players suing over concussions, I don't. A concussion is a concussion, but we are only talking about NFL, why is that? Money
    6. Nobody is talking about the NCAA. For every NFL player that has brain injury, there are 200 college players, its higher numbers, and more hitting. College has Spring Ball, and more physical weekly practices.
    7. If anyone in the NFL/NCAA hid info on this on purpose, they should go to jail for a long time.
    8. Now that the NFL settled, nobody can sue again on the topic. That's double jeopardy.
    9. By the way, study after study show youth football is the safest sport. Those little guys can't generate enough force to cause a concussion until they are about 14/15. It is what it is.
    10. Have I had concussions, yes, do i think I have CTE, brain damage. Maybe. But i knew the risk. Was it pointed out to me in a legal waiver. No. But i knew. Every football player knows after they get there bell rang. to each is own decison.
    11. If you take the collision aspect out of the game, what is it? Harsh to say, but it's not football anymore.
    12. Lengthen the grass to slow players down, lessen the width of the field (less velocity at impact), and take facemasks off. Concussions will go down, how much who knows. But those will not happen.

    Political - There is a movement in this country to start banning everything that is associated with a certain 'right wing element' of our society that the left doesn't like or can't stand, the constitution, American flag, religion, guns, competition, etc etc. Our country is turning into a ultra politically correct, non competitive, no-mental toughness society. There is segment of our country that dislikes our country, how it was founded and what it is now. They want to reshape the culture and fabric of our country and football is a big piece of that pie.

    Football broke the color barrier long before baseball or any other aspect of our country did.

    I will say it.....The left/liberals want football banned. the movement has started. The left hates football for every element that make it what it is. It's winners and losers, competitiveness, masculinity, "barbaric", they want everyone playing soccer. They want the death of football. Will it happen, i hope not. Plus it generates too much money.

    But at this rate, what will football be in 25-50 years? Should the game evolve, yes/no, who knows?

    It's a collision sport, not a contact sport. It is what it is. Be on the leading edge medically and safety wise. Educate players and parents, enforce concussions guidelines. But ultimately, the player knows the risk and reward.

    The good of football outweighs the bad any day of the week. Football is the greatest team sport ever invented. It is the opportunity cost of such a great sport.
  8. tomtom33
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    tomtom33 - October 09, 2013 1:32 pm
    Nerf ball leagues and Frisbee golf.
  9. tomtom33
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    tomtom33 - October 09, 2013 12:32 pm
    The State does not have to run everything. Isn't it just possible that the local school districts could handle some things?
  10. PapaLorax
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    PapaLorax - October 09, 2013 12:28 pm
    girls soccer is the sport with the second highest number of concussions...shut down football and it becomes the first. Then what?
  11. PapaLorax
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    PapaLorax - October 09, 2013 12:26 pm
    they do not play with the speed and mass that causes concussions...the only concussions I have seen are from head hitting hard ground...and that could be any sport.
  12. dakref
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    dakref - October 09, 2013 10:16 am
    The WIAA does not want to get involved in this issue because then they would have to do something.
  13. Crow Barr
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    Crow Barr - October 09, 2013 9:48 am
    Awesome two hour show on last night about concussions, NFL fighting the data that is real. Like tommytommy## and global warming.

  14. 196ski
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    196ski - October 09, 2013 9:48 am
    "What gets measured gets done"

    Who ever collects the numbers, and we all know those numbers are high, would then have the responsibility to ACT.

    The NFL just settled with the players union for something like 750 MILLION dollars because the union claimed the NFL knew about the traumatic brain injuries and ignored the data.

    Too many kids with concussions, many times multiple concussions, that can have life changing consequences. The treatment for these concussions is stay at home and stay off electronics until the brain can heal. This can take weeks, and the effects are cumulative. No school, no doing homework at home, is that worth it for a 14-18 year old kid?
  15. davea
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    davea - October 09, 2013 9:33 am
    If there was "money" in for him and his friends, he'd be all for a new law, and bigger Government!
  16. jarvis8484
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    jarvis8484 - October 09, 2013 9:20 am
    tomtom . . . I see your insightful comments all over this site . . . and this one is just as lame as most of the others. That's all you could come away with from this entire article . . . "No State oversight? How can that be? Let's pass a law or two or more." You're not concerned that this athlete had a severe head injury but for some reason couldn't take himself out of the game until the pain became so intense he could no longer continue?

    The state of Wisconsin has no formal data collection pertaining to high school athletes and related head injuries. That's an issue that needs to be dealt with. The safety of these kids needs to be front and center. We should be doing everything we can to make participation as safe as possible.
  17. toobad
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    toobad - October 09, 2013 7:04 am
    Dane County has youth fb for fourth graders! The kids are so small and the helmets so big in proportion to their bodies that they look like human bobble head dolls running around. They can't help but to hit each other with their heads because their heads are so big and their necks so small.
  18. tomtom33
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    tomtom33 - October 09, 2013 7:03 am
    No State oversight? How can that be? Let's pass a law or two or more.
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