It was five years ago, a classic football afternoon. With his mom and stepfather cheering from the stands, Brandon Schultz, a lineman for Anacortes High School in Washington state, took what his mother, Lane Phelan, recalls as a “hard tackle.”
Brandon looked “shook up” and sat out the rest of the game. Later, he told his parents he’d blacked out. For the next few days, he had bad headaches, took Tylenol, and skipped practice.
Nobody thought it was anything serious like a concussion or brain injury. He had just gotten “dinged,” that’s all.
A week later, he played again, his mom capturing every heartbreaking moment on video. He was “slow to get up from a tackle,” she remembers. Moments later, as his teammates huddled, he stood apart, holding his head. Then he collapsed – and didn’t regain consciousness for five days.
Today, Brandon can talk and walk, with a brace, but has trouble organizing information. He lives in a rehabilitation facility, refilling ball washers at a golf course and dreaming, he says, of living “like any other 21-year old man.”
Brandon Schultz has what researchers are beginning to call “second impact syndrome,” a rare but devastating problem in which people, usually young athletes, suffer a mild head injury, return to play too soon and get clobbered again before the brain has fully healed.
If the second injury occurs while the individual still has symptoms such as headache, dizziness and memory problems from the first – whether that’s days or weeks later – the result can be brain swelling and a rapid, massive increase in intracranial pressure.
And that can be “catastrophic or fatal,” according to a 1997 report from the Centers for Disease Control and Prevention.
It’s not just a macho thing, either. It’s cheerleaders toppling off human pyramids, gymnasts faltering on flips, pole vaulters bouncing onto a hard surface.
Overall, there are 300,000 sports-related brain injuries a year, the CDC says, mostly concussions – temporary, trauma-induced alterations in mental status.
Four studies from 1984 to 1994 suggest that 10 percent of college football players and 20 percent of high school football players get brain injuries in a given season. A 1997 study found that 5 percent of kids who play soccer suffer brain injuries.
And professional boxing, which one specialist describes as “premeditated brain injury,” is truly horrific: A 1997 study showed 87 percent of boxers sustain brain injuries.
The effects can be long-lasting. A Johns Hopkins University study of 95 kids with head injuries showed that, a year later, they were more likely than other kids to have behavior problems and be in special education programs.
The fact that many concussions occur without loss of consciousness makes things especially tricky with kids, says Ronald Savage, a psychologist at the May Institute, a private, Randolph-based nonprofit program for people with brain injuries.
If the first injury is missed, he says, “putting kids back in the game too soon can put them at risk for death. Kids don’t just get another serious concussion – they die.”
Neuropsychologist Murdo Dowd of the Spaulding Rehabilitation Hospital in Boston agrees. Asked if he sees a lot of these injuries, he says bluntly: “No. They’re dead.”
Statistically, the incidence of second impact syndrome is unknown, partly because many times the first injury is never formally diagnosed. By the CDC’s count, there were 17 cases of second impact syndrome between 1992 and 1995 alone, and sports medicine specialists think the true number is far higher.
Since 1982, the National Center for Catastrophic Sports Injury Research in Chapel Hill, N.C., has kept track of the injuries that lead to death or paralysis. In some sports, like cheerleading, things have gotten worse as stunts get more dangerous, says Frederick Mueller, director of the center.
In football, they’ve improved. Fatalities at all levels of football peaked at 36 in 1968, he says, when coaches still taught players to block and tackle by crashing head first into opponents. That left 25 to 30 players paralyzed every year.
In 1976, this was outlawed, and better helmets came along, too. By 1997, the numbers were down: Seven high school players and one college player were paralyzed.
Still, many athletes and their parents don’t understand the risks of playing “while still symptomatic from an initial head injury,” says Dr. Robert C. Cantu, chief of neurosurgery at Emerson Hospital in Concord. And there is “no certification of coaches, and therefore individuals coaching the highest-risk sports may not fully understand the risk.”
In theory, the team physician has the final say about when an injured player can go back in the game. But many teams, especially in high school, have physicians at games, but not at daily practices.
Parents can be just as competitive as kids, says Dr. David Burke, director of the traumatic brain injury unit at Spaulding, a martial artist and a team physician at many martial arts events. “I have been happy I am a martial artist when I disqualify [ someone] ,” he says. “That’s the only thing assuring my continued health” when parents and kids protest.
So how can you tell if someone has a concussion and when it’s safe to play again? Doctors aren’t unanimous, but last year, the American Academy of Neurology and the Brain Injury Association issued recommendations now endorsed by many other groups.
With mild concussions – no loss of consciousness, transient confusion, and a return to normal within 15 minutes – you can return to play that day. With moderate concussions – the same symptoms last more than 15 minutes – you should not return until you’ve been symptom-free for a week.
With more serious concussions – including any loss of consciousness – you shouldn’t return to sports until you’ve gone a week without symptoms if the loss of consciousness was brief – longer if it was longer.
“If there is any loss of consciousness, you absolutely, positively, should not return to play that day,” warns Dr. Stephen Rice, director of the Primary Care Sports Medicine Fellowship at the Jersey Shore Medical Center in Neptune, N.J., a consultant to the Schultz case.
“You only get one brain,” he says. “Head injury is serious business.”
As Brandon Schultz discovered. His family sued the school system, arguing it should have had better-trained coaches. Last month, that suit was settled for an undisclosed sum.
The money certainly helps. But Brandon is still washing golfballs and learning to balance a mock checkbook. Does he wish somebody had done something differently?
“Yeah,” he says. “I wish that every day.”
1: Concussion types
A concussion is an alteration in mental status induced by head trauma that may or may not involve losing consciousness. There are three categories:
- Grade 1 – transient confusion; no loss of consciousness; mental status abnormalities last less than 15 minutes. – Management: The athlete can play again that day if symptoms resolve within 15 minutes.
- Grade 2 – transient confusion; no loss of consciousness; mental status abnormalities last more than 15 minutes. – Management: The athlete can play again only after he or she has been asymptomatic for a full week.
- Grade 3 – loss of consciousness, either brief (seconds) or prolonged (minutes or longer). – Management: An athlete who is unconscious for only a few seconds can play again after a full week of no symptoms. If the loss of consciousness lasts several minutes or more, the waiting period is at least two weeks.
Source: American Academy of Neurology
2: Football leads to far more head and neck injuries than any other sport. These numbers are for 1982-97.
|
Sport |
Permanent |
Serious |
Sport Level Deaths disabilities injuries |
|
Gymnastics High School |
1 |
7 |
4 |
|
Gymnastics College |
0 |
5 |
1 |
|
Ice hockey High School |
2 |
4 |
5 |
|
Ice hockey College |
0 |
4 |
3 |
|
Track and Field High School * |
16 |
10 |
13 |
|
Track and Field College * |
2 |
2 |
3 |
|
Football High school |
61 |
147 |
166 |
|
Football College |
5 |
21 |
62 |
|
Cheerleading High School |
1 |
7 |
10 |
|
Cheerleading College |
1 |
5 |
10 |
|
Wrestling High School |
2 |
20 |
11 |
|
Wrestling College |
0 |
1 |
2 |
“(pole vault, discus, javelin, shot put)
SOURCE: National Center for Catastrophic Sports Injury Research Globe staff chart