Concussed: Changing the mindset in sports (Part 2 of 2)Premature comebacks are an all-too-common occurrence in high school sports. A 2011 law enacted in Minnesota instituted step-by-step procedures to ensure concussed athletes are not allowed to return to competition before being cleared by a health professional.
By: Rick Weegman, Duluth News Tribune
Grand Rapids’ Andrew Geislinger was checked hard coming across the ice and knocked unconscious during a junior varsity hockey game in the 2009-10 season.
Geislinger, then a sophomore, suffered a concussion and sat out of practice for about a week. During that time, though bothered by frequent headaches, he kept quiet about the problem.
“I was still having symptoms but didn’t tell anyone,” he said.
At his first practice back, Geislinger’s feet were taken out from under him and his head hit the boards. He woke up the next day in the hospital with a Grade IV concussion.
“People thought I was going to go into a coma and then I woke up the next day,” he said. “It was a pretty scary deal.”
Geislinger’s problems lingered. He couldn’t work out for more than 10 minutes at a time without becoming lightheaded and short of breath, while constant headaches and a lack of concentration made his academics suffer.
“My grades completely went downhill and I was depressed for a couple months and totally out of it,” he said. “(Doctors) told me that I could never play hockey again. I still have memory problems from it today.”
Geislinger said his body took six months to heal, and his hockey career came to an end. He wound up being a student manager for the team as a junior and senior.
Geislinger’s premature comeback is an all-too-common occurrence in high school sports. A 2011 law enacted in Minnesota instituted step-by-step procedures to ensure concussed athletes are not allowed to return to competition before being cleared by a health professional. Today’s start of fall practice marks the second year the law is in effect.
“The reason for the law and all of the concern is there are two aspects of a concussion that need to be kept in mind,” said Richard Kanoff, a pediatric neurologist at Essentia Health St. Mary’s Medical Center. “Number one, when someone has had a concussion, they are at more risk to have another one while recovering from the first one. That’s because they can’t concentrate and their physical reaction time is different.
“The other issue when you are recovering from a single concussion is that you are at risk for second-impact syndrome. Young adults and teenagers tend to be more at risk. The physical trauma of a concussion changes the brain’s ability to control fluids and blood volume in the head, so when someone gets injured a second time in close proximity to the first time, they can develop malignant cerebral edema, a swelling of the brain.”
In extreme cases, second-impact syndrome can be fatal.
“After you sustain a concussion, the threshold that a hit needs (to cause another concussion) can decrease,” said Essentia Health orthopedics athletic trainer Bre Braun, who spent seven years on athletic sidelines as a team trainer. “The impact can be less drastic the second time around, so that can cause another concussion much more easily if you don’t allow the brain to heal first.”
At an international conference in 2008, a formula was adopted to use a step-by-step progression before allowing an athlete to return to play.
The first step is to have no symptoms when at rest, progressing to light exercise and eventually non-contact, sports-specific drills before returning to full contact. If athletes fail any of these steps, they must go back to the previous step until passed by a health-care professional.
“The best-case scenario for a high school player is to take at least six days to come back because they have to progress through each step and take 24 hours between each one,” Braun said.
That was the procedure taken last fall by Jake Bischoff, Geislinger’s former teammate on the Grand Rapids hockey team.
Bischoff, a star defenseman who has committed to attend the University of Minnesota, suffered his first concussion early in the season against Virginia-Mountain Iron-Buhl when he avoided a check but still ended up receiving a blow to his head. He went through the step-by-step process of a short workout, followed by a heavy workout and eventually skating drills. He passed the tests one by one — only missing a couple of games — before returning symptom-free for the rest of the season.
“I was antsy to get back out there, but I understood that there are more important things than one hockey game at the beginning of the season,” Bischoff said.
While the new law requires clearance from a health-care professional, some believe it doesn’t go far enough.
“The question is, ‘How do you know when someone has recovered?’ Is that just telling you that they feel great?” Kanoff said.
Kanoff says extensive follow-up testing, including tracking the student-athlete’s performance in school, is necessary.
“What the law doesn’t do is say anything about the management of a concussion, to manage the symptoms or to have medical follow-up,” he said. “It does say that you have to get clearance from a medical professional, but it doesn’t designate who that is. It should be someone who is experienced or knowledgeable in concussions, but that’s left open, and it doesn’t specify that these athletes need to be followed.”
Kevin Merkle, an associate director with the Minnesota State High School League, says the new procedures are working fine but that refining the process is bound to happen.
“We have to get better at the management of concussions, making sure that kids have the right person looking at them and that they go through the right kind of steps before they go back to full speed,” Merkle said. “Once the doctor gives them the OK, they should gradually work their way back into play to make sure there are no repercussions. The real danger, especially with football, is coming back too soon and having a second concussion.”
Implementation of the law came too late to help Geislinger. The 18-year-old still was able to play baseball his final three years in high school and earned a scholarship to play at Division II Winona State.
His injury did help persuade Grand Rapids High School to purchase helmets manufactured in compliance with the Messier Project, a partnership involving NHL Hall of Famer Mark Messier that is committed to reducing the number of concussions through producing better equipment. Other school districts, such as Duluth’s, also upgraded their football and hockey helmets to aid in reducing the number, or at least the severity, of concussions. However, a “concussion-proof” helmet does not yet exist.
Geislinger has advice for fellow athletes, like he did with his friend Bischoff — take it easy if they fear they’ve suffered a concussion.
“I’ve told them, ‘You need to be careful and sit out as long as you want. I know you want to come back and play — that’s what I did — but that’s a big mistake,’” he said. “It can cause you a lot of problems or cost you your life.”