An estimated 130,000 high school athletes in the U.S. suffer a concussion each year, and only about half of them are reported. That puts thousands of athletes, who continue playing after suffering a concussion, at increased risk of a permanent brain injury or death.
Scary stuff. But how scary is it for a teenage athlete? Specifically, is it scarier than earning a spot in the lineup and then getting sent to the bench?
Because that's what it comes down to.
Concussions are a complex injury with differences in severity, and experts debate how they should be treated. But nobody debates the importance of an athlete reporting symptoms of a concussion to a coach, athletic trainer, doctor, parent - anyone.
"Fifty-three percent of athletes do not report it," said Steven P. Broglio, a certified athletic trainer and professor at the University of Illinois. "Identifying those concussed athletes is the biggest challenge."
It's a challenge, because some athletes don't know when they've suffered a concussion. Coaches and athletic trainers teach them about the symptoms, such as headache, dizziness and inability to think clearly, but athletes also know that bumps and bruises are part of contact sports. So is toughness, and athletes want to be tough.
But what athletes really want is to be in the game, and that creates the biggest problem. Athletes know that reporting symptoms of a concussion will take them out of the game, and perhaps future games.
Two years ago, the Mesquite ISD began requiring athletes who suffer a concussion to sit out a minimum of two weeks. The policy was developed by Bucky Taylor, who recently retired after 36 years as Mesquite's athletic trainer.
Taylor advocated the policy after he learned about Second Impact Syndrome, which refers to when a person receives a blow to the head before the brain has healed from a previous impact. Second Impact Syndrome has been cited in the permanent brain damage of some football players and the deaths of others.
Again, very scary. So Mesquite's policy must be a good one, right?
Kevin Guskiewicz, Chair of the Department of Exercise and Sports Sciences at the University of North Carolina and one of the nation's foremost experts on concussion management, commends the Mesquite ISD for recognizing the seriousness of concussions. But because the circumstances of each concussion are different, he said, "we cannot manage concussions with a calendar."
And, more important, when there is a mandated consequence to reporting symptoms, the concussion might not get treated at all.
"An athlete could think, 'I don't want to sit out two weeks, the championship's coming up,' " Guskiewicz said. "I'm just going to hold this one to myself."
That's when a concussion is most dangerous.
When athletic trainers know of a concussion, they can conduct cognitive function tests and implement a graduated return-to-play protocol that monitors a player as he or she recovers. It might take a few days, or two weeks, or longer. Each concussion is different.
But unless an athlete tells the coach or athletic trainer, or anyone, the concussion could go untreated. Some concussions are the result of spectacular collisions, but in many more, there is no helmet flying off or player crumbling to the ground. There's usually no loss of consciousness, either, because a 2003 study showed that less than 9 percent of collegiate athletes lost consciousness following a concussion.
In many cases, only the high school athlete will know. He or she must then decide how to respond, and obviously, that's a heavy weight to drop on a kid. After all, a teenager must make the decision using a brain that isn't even fully developed yet.
You can only hope that the athlete makes the right choice. Because this isn't like denying a shoulder injury to stay in a game. This isn't like a hard-headed pitcher who ignores pain, throws too many pitches and ruins his arm. He can live with that decision.
Other decisions won't allow that.