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On Sept. 18, 2015, PBS's "Frontline" released a damning report that revealed that 87 out of 91 brains of deceased former NFL players tested positive for the degenerative disease known as chronic traumatic encephalopathy, more commonly known as CTE.

For anyone who's been following the concussion crisis within the NFL, this information isn't surprising. It's become common knowledge over the last few years that the repetitive blows to the heads that NFL players endure does have a long-term effect on the health of the athletes and their brains. However, nobody was prepared for the 96 percent rate of CTE found in the brains studied by researchers at Boston University and Department of Veteran Affairs.

What many people may have failed to realize, however, is that damage to the brain isn't just occurring in football, and it also can begin long before an athlete reaches the professional level. The occurrence of sports-related concussions is a rapidly growing crisis that extends as far down as youth sports — the time when a human's brain is most vulnerable to head injuries and when most concussions occur.

It took decades of science and research to finally realize the long-term consequences that head trauma in sports can have on the the brain.

It didn't take York County nearly that long to make sure it was doing something about it.

Local impact: 

York might be a relatively obscure town in south-central Pennsylvania, overshadowed by larger surrounding cities such as Philadelphia, Baltimore and Pittsburgh.

But that hardly makes the area immune from the dangers of concussions.

According to Dr. Jim Gilhool of OSS Health, he treats, on average, 100-150 high school athletes a year for concussions, or about two to three per week. West York athletic trainer Eric Rodgers said that he typically deals with a concussed student at West York every other week. And WellSpan Health's sports medicine director, Dr. Mark Lavallee, said that, according to an algorithm created by a team of doctors and physicians at WellSpan Health used to identify concussions, they treated 2,466 concussion patients in 2014.

With more awareness being given to concussions, and the rising number of athletes who are experiencing them, especially at the high school and youth levels, it's valuable to have proper testing methods in place to better monitor concussions. In York County and other parts of the state and nation, schools and athletic programs use the ImPACT concussion baseline test.

Recovering from a concussion: In York and Adams counties, the schools that participate in the York-Adams League each align themselves with a company that administers these tests. How ImPACT works is that students will take the test before entering high school — some schools test athletes at the middle-school level as well — as the baseline for how they perform at normal health.

"The test measures a lot of different things — immediate and remote memory, reaction time, consistency, errors, hesitations," Lavallee said. "It's pretty amazing."

The goal of the test is to then act as a baseline for how the student performed with no concussion symptoms, so that in the case of an athlete suffering a head injury, the physicians can go back and re-administer the test after the athlete suffers an injury and get an idea of just how severe it is. Rodgers said that, typically, he tries to wait up to 72 hours following the player's concussion to administer the test, so some immediate post-concussion symptoms, which can provide false or skewed results in the test, can subside.

"I do like it because I think it helps out a lot to look at where you were and where you are now after you got the concussion, and it makes it easier to diagnose," Gettysburg senior quarterback and linebacker Tyler Wilt said about the ImPACT testing back in August. "And I think it makes it a lot safer.”

Wilt's teammate, senior running back/defensive back Elijah Johnson, added: "You feel safer coming out and playing. You really feel 100 percent with the test because you know what's right to play and what's not."

If the athlete fails the test, then they have to wait another 48-72 hours to re-take the test. Should they pass it and get cleared by a physician, then they can be released back to the school athletic trainer, where they will go through the state-mandated "return-to-play" protocol.

To begin the protocol, the athlete must go five days without showing any signs or symptoms before they can begin incremental training. Once they get to the training, they might start with something small, maybe about 15 minutes of light running on a treadmill, Rodgers said. If the athlete passes that stage and returns the next day without any symptoms resurfacing, then they'll move to a more intensified workout, which could include longer running and then some push-ups and sit-ups. That process continues until the athlete finally goes long enough without experiencing any post-concussion symptoms and can return to full activity. However, the minute the athlete experiences any sort of symptoms following a day of exercise, it's back to square one.

"Everything is relative to if they have symptoms," Rodgers said. "So, for instance, if we have an athlete who does Day 2 and they come back in Day 3 and they're like, 'You know, I have a little bit of a headache today,' or 'I'm looking at the lights in class and it made my head hurt again,' then it's right back to step one because you're back to being symptomatic.”

Room for improvement: Even with the awareness being shown to head injuries, Gilhool still feels as though there is room for improvement, especially within club sports.

Most of those teams don't employ team athletic trainers, so it's completely up to the athletes to disclose when they've suffered some sort of head injury. While several club teams in York County participate in the ImPACT concussion testing program through WellSpan Health, not all do.

"Those travel teams, those club teams during the summer that may not have the athletic trainer there, the coach that isn't a high school coach, that may not have that education (may be an issue)," Gilhool said. "So, I think the summertime and non-high-school related areas may need to be addressed."

The athletes who participate in high school sports are, quite often, also playing on club teams that may lack the necessary resources to have an athletic trainer onsite at all practices and games.

Nationally, all 50 states have legislation in place that mandates certain procedures be taken should a youth or high-school-level athlete suffer a concussion. Former Pennsylvania Gov. Tom Corbett signed the state's law on Nov. 9, 2011, and it took effect on July 1, 2012.

However, even with all the seemingly progressive-thinking legislation and guidelines, this new overt era of monitoring concussions hasn't been without obstacles.

In early December, three high school students and their families in Lawrence County — a suburb outside Pittsburgh — filed a lawsuit against the PIAA saying that the state's governing body of interscholastic sports did little to protect them from, or help them with, concussions suffered while playing high school sports. Two of the athletes, Dominic Teolis and Kaela Zingaro, said they were not properly treated and were allowed back to action before being fully healed. The third, Jonathan Hites, said he suffered severe post-concussion symptoms that took him more than a year to get cleared from, and that he still experiences social and learning difficulties from the head injury. Within the lawsuit, the families outline a list of points from the legislation passed in 2011 that the PIAA violated by failing to adhere to them, one of which was administering preseason and midseason concussion baseline tests.

Education is essential: Schutt and Riddell — the two leading football helmet manufacturers — both offer educational videos and learning tools on their websites to teach ways to prevent athletes from putting themselves in vulnerable spots to sustain head injuries. The National Athletic Trainers Association (NATA) also has a DVD on concussion awareness and prevention.

On top of that, all coaches and teachers are required, by law, to go through concussion education sessions called BrainWise if they're coaching at a high school. There is also a similar program for monitoring heart issues called HeartWise.

With more and more focus given to concussions, the importance of the issue is finally starting to trickle down to the most important figures in athletics — the athletes themselves. They are the ones who know their conditions best following a shot to the head, and ultimately they know their brains best. Knowing the long-term effects multiple concussions can have on their future health is starting to have an impact.

"Sometimes it's not the first," Rodgers said. "Sometimes it's the second or third, it just really depends on the athlete, but, sure, I've had those athletes who are hesitant to go back to sport."

A few decades ago, the lasting impacts of concussions on an athlete's overall well-being was a minor concern. Now, it's understood that it could potentially be fatal.

"We are always very cautious in making sure that people's hearts and brains are well-protected," Lavallee said. "Hearts and brains are two things that you don't get a lot of second chances on in sports."

— Reach Patrick Strohecker at pstrohecker@yorkdispatch.com. 

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