NFHS Joins Fight Against Concussions

Since the launch of the National Federation of State High School Associations' (NFHS) new online course entitled "Concussion in Sports – What You Need To Know" on June 1, approximately 55,000 coaches, school administrators, officials, student-athletes and parents have partaken in the 20-minute course, which is available for free on their website.

According to Dr. Michael Koester, chair of the NFHS Sports Medicine Advisory Committee (SMAC) and director of the Sports Concussion Program at the Slocum Center for Orthopedics and Sports Medicine in Eugene, Ore., the course discusses common signs and symptoms, the definition and effects of a concussion from a biomechanical and physiological standpoint, means of recognition and initial management, as well as treatment.

"It teaches the coaches to recognize the signs and the symptoms," said Koester, who helped develop the online course. "We're not asking coaches to make the diagnoses on their own or to take the role of a healthcare provider, but to recognize those symptoms and get them off the field and into see a healthcare provider. If you continue to play once you've suffered a concussion or go back too quickly, you're at risk for making that injury worse."

NFHS Executive Director Bob Gardner said that feedback regarding the course has been "highly positive" among those who have taken it, of which 70 percent are coaches.

The NFHS governs associations that include 19,000 high schools nationwide and 7.5 million student-athletes. Annually, more than 140,000 of those athletes are diagnosed with a concussion according to the study. Koester said that number has been on the rise.

The 2009-10 High School Sports-Related Injury Surveillance Study NFHS surveillance study, in conjunction with the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, examined the incidence rate of concussions from football, soccer, basketball, wrestling, baseball and softball over the past five years. More recently, lacrosse, ice hockey, swimming, track & field, gymnastics and cheerleading were included.

The results of this study have led to increased awareness, rule emphasis and led to the enactment of a new rule that states "Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion, such as loss of consciousness, headaches, dizziness, confusion or balance problems, shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health-care professional."

Football, ice hockey and soccer were identified as the boys sports with the most common concussion occurrences, while soccer, gymnastics and lacrosse ranked the highest among girls sports. Koester indicated, though, that the NFHS trying to avoid the "football stereotype" and is encouraging all those affiliated with any high school sport to educate themselves at nfhslearn.com. Five questions are asked after the online presentation is made, and by passing, the "graduate" can print out a certificate stating that he or she has completed the course.

Long Island athletic departments have taken their own measures to minimize the risk of concussions. According to Syosset athletic director Rich Schaub, who heads up the safety committee in Nassau County (Section VIII) has a recommended return-to-play protocol for those exhibiting symptoms of concussion, where one must be symptom-free to advance to the next day of recovery.

• Day 1: No activity until medically cleared
• Day 2: Low-impact activities (walking, stationary bike, et al)
• Day 3: Aerobic activities (running, skating, et al)
• Day 4: Non-contact skills specific to the sport
• Day 5: Full-contact skills in a practice setting

Suffolk County schools such as Ward Melville, Connetquot and both Sachem high schools have employed ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing, the groundbreaking concussion management program in which students' brain functioning is tested in the pre-season and then again if he or she shows symptoms of a concussion.

With modern technology, athletes are able to take a 20-minute computerized neurocognitive test to build a baseline of pre-injury data in order to help trainers and coaches determine if they are fit enough to return to the field after suffering a concussion. ImPACT is the first, and an extensively validated computerized concussion evaluation system. 

"It's a tremendous thing that's long overdue," said Sachem athletic director Pete Blieberg. "It's another step in protecting the safety of kids and also takes a lot more responsibility on behalf of trainers, coaches and parents. It's something that's taken a long time to get to New York, but it's better late than never."

"I think all these tools are great," Schaub added. "I think we're headed in the right direction."

Section VIII executive director Todd Heimer, the director of athletics at Nassau BOCES, indicated that concussions have been a major item on the NYSPHSAA's agenda in recent years, particularly because a diagnosis is not as cut and dry as a fracture or sprain.

"You're talking about the safety of kids," Heimer said. "It's tough to tell a kid he can't play, but it makes a heck of a lot of sense to try and ward off some long-term problems."