Concussion protocols inconsistent at southern Illinois high schools

Daniel Bethers | @DBethers@ DailyeGyptian com

When you hear the word “concussion,” it’s easy to picture six-foot-tall juggernauts blasting across stadium fields, sending their opposition rag-dolling to the cheers of thousands of spectators. Previous coverage can have the effect of inuring audiences to the morbid realities of brain injuries in professional football, rendering news about the health of a select few millionaire athletes sterile and distant. The concussion reform efforts of years past have lost their novelty, even though new research continues to take place at accelerated rates. What many don’t see in the limelight of media coverage is the concussions in our own backyards, sustained by potentially vulnerable high school and college athletes who don’t have the resources and constant professional medical attention that professional athletes enjoy.

According to Illinois concussion law, schools are required to have a designated staff member responsible for concussions and programs that safely return students to academic and athletic participation after they receive concussions. Out of 10 Southern Illinois high schools, all have medical professionals present at sporting events throughout the sporting calendar. Eight of the 10 schools have medical professionals observing practices when they can (depending on the risk of injury in the sport). Still, many high schools don’t provide their own medical professionals, instead relying on contracts with local hospitals and colleges to provide athletic trainers and doctors covering their area, which can result in less coverage of potentially dangerous events than if schools had resident professionals.

“SIH (Southern Illinois Healthcare) provides the athletic trainers to some high schools, but we’re only there two times a week for school visits, meaning checking injuries and coverage of the games,” said Sarai Yates, coordinator of sports rehabilitation at SIH and a certified athletic trainer at SIH for 20 years. “We’re not at every practice and we’re not at every sport. I think it should be covered more. Obviously, most concussions are gonna happen at practices, not at games because you have kids who maybe don’t play as well, don’t hit as well - or maybe they’re learning to hit - or that’s when they try the new cheerleading pyramid and they drop someone on the head. I truly believe every school in Illinois, high school and junior high, should have an athletic trainer on-site at school during practices and games, but there’s no law. That’s not forced everywhere.”

Specifically, Illinois concussion law requires high schools to have designated concussion officers to supervise games and practices and create concussion protocols at each school, preferably medically trained. In practice, the law allows schools to contract with medical professionals or even use completely untrained concussion officers if the expense of having medical professionals on staff is prohibitive.

“Are we really covered here in Southern Illinois? We’re doing the best we can, but no,” Yates said. “Those little schools are not. Murphysboro and Marion are really the only schools in this area that have a full-time athletic trainer on-site at all times. And then there are the schools we cover, and that’s close to every school.”

In the local area, financial resources remain the main issue in getting professional supervision for athletic events.

“It comes down to money and being able to have staff there whereas, you know, the local high schools have one athletic trainer, you know, for all their sports,” said Dr. Scott Schonewolf, SIU’s Director of SIU Sports Medicine Fellowship as well as the Medical Director for the SIU Center for Family Medicine. “Now, the NCAA and high schools, you know, mandatory you need to be at more of these anywhere where you could have collisions - what we’d call a collision type sport. So it should be there for football, men’s and women’s basketball, soccer, baseball, softball, anywhere we could have that now. But you have your athletic trainer, that is at every practice and everywhere. If you were at the professional level, yes, there might even be a physician there but I don’t know that for sure. They’ll also have ten trainers vs one or two. At the high school, you have one.”

SIU itself sports 12 athletic trainers including assistant and intern athletic trainers (not including Schonewolf and Dr. Jose Aliling, a fellow in sports medicine at SIU), nearly one for every sport and with two additional interns covering football.

As for the rest of Southern Illinois, the quality of their care really depends on the location, schools size or wealth and whether or not institutions with resources like SIU’s can reach them.

“We try to provide the best care we can. But yeah, the quality of care may be a little bit decreased and it’s just location. If you’re at a big high school with lots of money, you might even have your own, you know, physician that’s contracted with them,” said Schonewolf. “It’s unfortunate, but it’s understandable that schools don’t have athletic trainers at every event. I mean, there are some poor school districts in this state and even, I came from Pennsylvania, where they just don’t have the money or resources. So you use EMS. And we have that, we have had some away teams coming into our local high schools and they don’t [have athletic trainers] and they use our trainer and that is fine. Athletic trainers will help out the best that they can to both teams.”

Research done by the National Library of Medicine shows that athletes are more likely to have a concussion during a practice rather than a game. In those findings from 2015 to 2019, 72% of concussions occurred during practices. Another contribution to the high percentage of concussions within practice would be the high amount of practices compared to games. Another interesting statistic is that 48.5% of concussions occurred during preseason training, despite preseason representing only 20.8% of the football season.

Aliling said some schools he’s worked with even have problems providing equipment to keep athletes safe, relying on used safety equipment donated by the community.

Oftentimes this equipment is underinvestigated, despite the fact that it could provide inadequate protection due to crack and wear.

For smaller schools, like the ones in the area, players are at high risk of having a concussion go completely unnoticed.

According to the University of Pittsburgh Medical Center and the University of Michigan concussion center, five out of 10 concussions go unreported every year within sports. Two out of 10 high school athletes in contact sports get a concussion within a year. Contact sports are primarily football, wrestling, soccer, and hockey. Basketball, baseball, and softball are additional sports at the high school level that can feature a handful of concussions.

Jaryd Clark, a former multi-sport athlete at Frankfort Community High School in West Frankfort, has his own concussion story, and it shows just how easy it is for a concussion to go unreported or overlooked.

During a high school football game in September of 2015, Clark was struck with a friendly fire blindside hit. Playing defensive end, Clark was attempting to tackle the running back when he was involved in a helmet-to-helmet collision with a teammate. Clark has a hard time remembering most of the specifics, but some were too eerie to forget.

“I was knocked out cold for a second. When I stood up, the sky was green, and the field was blue.”

Clark said.

This happened during a game, yet Clark wasn’t evaluated until after the game. He finished the game after an obvious crushing blow to the head. A blow that left Clark laying on his back and needing assistance to get back to his feet. Still, he remained in the game. During the postgame, it was quickly determined that Clark had indeed suffered a concussion.

“Bright lights would cause headaches and loud noises as well. I could just tell that it wasn’t normal.” Clark said.

Clark was forced to sit out of practice for a week and would miss one game as well. He was given some headache medication that helped the pain wear off after four days. Clark returned two weeks after the injury and still didn’t feel 100% healthy.

“I had a couple more during practice throughout the season for sure, I just wasn’t evaluated for whatever reason. I was having the same symptoms and they didn’t check on me at all. They never really evaluate for hits during practice.” Clark said.

When no medical professionals are available to observe teams, coaches are the next line of defense against injury. They are expected to know what concussion symptoms are and how to respond when an athlete takes a heavy hit. All 10 southern Illinois schools confirmed that every coach must watch a set of concussion training videos prior to each season, often in meetings with all the other coaches.

Players are also expected to watch concussion videos prior to the start of their sport’s season. Not all 10 schools could confirm whether their student-athletes had watched concussion prevention and treatment videos prior to the 2022 school year. A major problem, particularly among high school athletes, is that the athletes often don’t know what concussion symptoms are. Even if they are aware that something is off and they’ve taken a large hit, some athletes feel like playing through an injury is more important than their health.