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Staying Ahead on Head Safety
July 6, 2015
By Rob Kaminski
MHSAA benchmarks editor
Three stacks of concussion-related material offered precious little space on MHSAA Executive Director Jack Roberts’ desk, and perhaps consumed even more room in his head as he tried to wrap his mind around the seemingly daily “latest and greatest” documents outlining signs, detection and return-to-play elements involving head trauma.
Without a doubt, the scene is quite similar on any given day in the offices of his cohorts across the country as school sports leaders are faced with the daunting, dizzying task of devising plans to address concerns aimed at the health of their games.
Lawmakers, rules makers, medical experts and the court of public opinion all want the same thing for student-athletes: a reduction in the chances of head-related injuries. And they all are perfectly willing to offer instant fixes to those in charge.
They often expect those in Roberts’ position to analyze, digest and create action plans as soon as possible without considering the research and resources it will take to get there.
“All parties involved want the same thing. We all want to provide the safest environment for educational athletics through protocols and practices that will offer the most minimal risk of injury,” Roberts said. “But, this can’t be accomplished through unfunded mandates which would stifle the already struggling athletic budgets in many schools.
“Changes have to occur through training and education, orchestrated through state offices and executed locally. And, it takes time to research the best and most effective means. There is so much information, and so many devices in the field today that those in athletic leadership roles almost have to have a medical background as well.”
For instance, there are documents which list as few as five symptoms for concussions, and those listing as many as 15. There are sideline detection methods which purport to take 20 minutes and those which claim to determine concussions in 20 seconds. There are as many return-to-play protocols as there are state associations.
Increasingly, state high school associations are seeking opinions and expertise from local medical personnel. In March, in one of many such meetings, Roberts and other MHSAA staff welcomed several from the Michigan Department of Health and Human Services to their office to discuss sideline detection methods and return-to-play issues.
“There are two areas that concerned us most,” Roberts said. “One, sideline detection of head injuries is inconsistent across the state in terms of both results and resources. Two, we need methods which generate immediate reports and permanent records.”
As the group which convened in March discussed the topic, potential hurdles and new perspectives on sideline management came to the forefront.
On the money and manpower front, who would be responsible for administering sideline tools? Most ideally they would need to be overseen by medical personnel rather than coaches or team managers.
From a perspective standpoint, an interesting view was volleyed out to the group: could sideline detection actually speed up a student’s return to play rather than slow it down? Current protocol prescribes that if competition continues while an athlete is withheld for an apparent concussion, that athlete may not be returned to competition that day but is subject to the return-to-play protocol. And, clearance may not be on the same date on which the athlete was removed from play. Only an M.D., D.O., Physician’s Assistant or Nurse Practitioner may clear the individual to return to activity. With immediate sideline detection, are parties more vulnerable should a student pass immediate tests, only to have undetected effects of the incident increase over time?
“The group shed a different light on the various scenarios, which was a primary purpose for the meeting,” Roberts said. “As one can see, there are so many variables to consider when attempting to determine the next plausible and practical steps toward minimizing and detecting head injuries.
“Further, we have to take into consideration practice sessions as well as competitions, and all sports, not just select sports.”
Adding to the challenge is simply the nature of athletics. Competitors at any level are just that: competitive. Often, students – or their parents – will attempt to hide symptoms or be reluctant to come forward with injuries, particularly head injuries which can’t be seen.
In more cases, perhaps the symptoms simply are not recognized, which is why education is paramount.
First, association leaders have to tackle the due diligence of researching issues and potential solutions to situations currently threatening the well-being of scholastic sports. Considering that some 1,620,000 results are offered when “sideline concussion detection tools” is typed into a search engine, this is a laborious and continual chore.
Such information then needs to be packaged and presented to leaders at the local levels – athletic directors – to pass on to coaches, the individuals who have as much or more influence on students that perhaps any other adults, including parents in some cases.
This is why MHSAA rules meetings, Coaches Advancement Program sessions and other statewide forums continue to bang the drum on health and safety issues; to make sure the messages and procedures reach the student-athletes.
And, it’s why the MHSAA is asking coaches and ADs to be accountable in verifying that the plans in place are being carried out.
Less Could Mean Less
There are times when it’s good to say, “less means more,” but in the case of contact sports, practices and competitions, the idea is for less to mean less. As in less time for collisions to occur yielding fewer injures.
It’s early yet, and one year does not constitute a large sample size, but the MHSAA Football Practice Policy instituted last August could be one step toward reducing head injuries.
Beginning this past football season, the number of practices with helmets, shoulder pads and full pads were limited to start the season, and preseason “collision” sessions were limited to one per day. During the season, such practices were limited to two per week, while the length of practices was also regulated.
Dr. Steven Broglio of the University of Michigan Neurosport department is conducting a three-year study of the Ann Arbor Gabriel Richard football program with the assistance of Richelle Williams to determine the “Effects of Concussion and Sub-Concussion.” The study began in 2013, one year prior to the new MHSAA guidelines.
Research in 2013 showed approximately 650 “impacts” per player. In 2014, the number dropped to approximately 500 impacts per player. Impacts are defined as greater than 10 gs of acceleration. Williams stated that a slap on the back is 4 g, coughing is 3.5 g. On average, a helmet hit is 25-45 g. Concussions usually happen (roughly) between 80-150g.
An encoder is embedded into each football athlete’s helmet which monitors head impacts and exactly where the impact is located. Williams sits at each practice and game and through a pager identifies the player’s number and impact from a hit of 90g or more.
They are also looking at those who do not sustain an impact concussion, but rather sustain multiple head impacts and whether those multiple head impacts lead up to brain changes (measured through EEG).
The initial findings, as submitted by the study team, indicated two reasons why there were fewer overall impacts from 2013 to 2014:
Primary reason: The MHSAA adoption that became effective in August 2014 with new limitations that were placed on “collision practices” and conditions that full pads could not be worn until the fifth day of team practice.
Secondary reason: Fewer players evaluated in 2014 than 2013.
Fit for a King?
Editor’s Note: There are many sideline detection tools on the market, as a quick Google on the topic will reveal. The following, the King-Devick test, is among the highly recommended tests, summarized here simply to provide an idea of the types of systems available and how they operate. The following is from King-Devick’s website.
The King-Devick Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test is an accurate and reliable method for identifying athletes with head trauma and has particular relevance to: Football, Hockey, Soccer, Basketball, Lacrosse, Rugby, Baseball, Softball and Other Collision Activities.
King-Devick Test is an easy-to-administer test which is given on the sidelines of sporting events to aid in the detection of concussions in athletes. King-Devick Test (K-D Test) can help to objectively determine whether players should be removed from games. As a result, King-Devick Test can help prevent the serious consequences of repetitive concussions resulting from an athlete returning to play after a head injury.
How King-Devick Test Works
Concussions are a complex type of brain injury that is not visible on routine scans of the brain, yet are detectable when important aspects of brain function are measured. King-Devick Test (K-D Test) is a two-minute test that requires an athlete to read single digit numbers displayed on cards or on an iPad. After suspected head trauma, the athlete is given the test and if the time needed to complete the test is any longer than the athlete’s baseline test time, the athlete should be removed from play and should be evaluated by a licensed professional.
Remove-From-Play vs. Return-To-Play
Both remove-from-play and return-to-play decisions are crucial in concussion recovery. It is critical to remove a concussed athlete from play in order to prevent further damage. It is also extremely important to keep the athlete from returning to play until they have made a full recovery. There are tools to assist in making both remove-from-play and return-to-play decisions.
King-Devick Test for Remove-From-Play Decisions
- Quick, objective sideline testing
- Measures impairments of speech, language and other correlates of suboptimal brain function
- Instant screening feedback in minutes
- Administered by parents, coaches, athletic trainers and medical professionals in remove-from-play decisions
- Neurocognitive Testing for Return-To-Play Decisions
- Computerized concussion evaluation system (in the computer lab)
- Measures verbal and visual memory, processing speed and reaction
- Tracks recovery of cognitive processes following concussion
- Assists clinicians in making return-to-play decisions
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MHSA(Q&)A: Mendon football coach John Schwartz
February 2, 2012
John Schwartz didn’t really want the Mendon football head coaching job when a group of players convinced him to take it before the 1989 season. And his first contract started out on a napkin. The rest is history.
Mendon won its 11th MHSAA football championship this fall, downing Fowler 33-0 in the Division 8 Final, to tie for third-most football titles won by one program. Schwartz has coached in the program for all 11, including 10 as head coach, and his record of 236-39 gives him a winning percentage of .858, tops in the MHSAA record book. He recently was selected as this year’s recipient of the high school Duffy Daugherty Award, annually given for career contributions to the game. He follows recent winners Ralph Munger of Rockford and Herb Brogan of Jackson Lumen Christi.
His Mendon teams have had just one losing season. And although he retired a year ago after 36 teaching middle school science, and then fought off cancer over the summer, he has no plans to leave his post on the Hornets’ sideline.
How would you characterize your program?
I think we have very good coaches and I think the kids respect the coaches, and they know the coaches think more of them than just being football players. They care about them. We have their attention, and what we really try to do is form a team concept as soon as we can. We try to stay away from giving any one person too much recognition. We don't give out MVP awards at the end of the year. It's a program where we're all in it together: coaches, kids and community. We try to get the best out of the kids, give the kids the best shot we have at being the best we can be.
How does a small school continue to reload every season?
My first year there, the first thing I did as a head coach was I started the junior high program. I think that's where everything starts. We even have the younger kids called the rocket kids, and those coaches come in and talk about (football) terms so when kids move from one level to another there's no re-teaching. Everyone has an ego, coaches have egos, and they like to do some things differently. But we don't have that. They do what we do. We give them a lot of flexibility, but we have certain drills we want to run. By the time we get them, these kids are in tune with what we are doing. The summer program also is something I started my first year as head coach too. ... It means that during the season we can concentrate more on teaching than conditioning.
You went from 3-6 in 2006 to 12-0 in 2007. Explain how you bounced back.
The losing season we had, we didn't have a lot of kids, and our two best kids were hurt early in the season and couldn't play. We never did bounce back. Even in that season, we were ahead at halftime in all but one game. We just didn't have enough to come back and pull the game out, and we had some very tough games. It wasn't a good season, but I thought those kids played awfully hard for what we had. We got a lot of experience, and it paid off the following year.
Our JVs practice with the varsity. When I work with inside linebackers, I work with (grades) 9-12. Kids learn quicker from kids than from coaches, as far as I'm concerned. ... Football's really changed. It's become a lot more complex. I think we have to delegate more and more every year so we can stay with the changes. It's too much for one person. I remember my first three, four or five years it was just three of us at the varsity level. The other two, neither one taught at the school. We were pretty successful right off the bat, and we started getting more and more interest from people. Now 9-12 we have seven coaches, and we have three at the junior high, and all the coaches but two have played for me. They know what I expect, what I'm looking for, what I want. ... And they want to win. I'd be lost without those guys.
Are there certain seasons that have meant more than others?
The first year I took the job, in 1989, we went undefeated and won a state title. A lot of those kids are very good friends of mine yet, and they're pretty special to me. They were a big boost to my program. In the '95 year, my son was a sophomore on that state title team. I remember a lot about that team.
They all have something they did very well. They either threw the ball well or played great defense or had a big line. When I hear a year now, I think about those teams.
You grew up in a small town (Colon) and have taught and coached in a small town. Was that important for you to do?
I've never taught anywhere else. I never felt I really had a reason to leave. I've gone through at least six superintendents since I've been there. The fourth or fifth said to me, "The only thing that bothers me about Mendon is these people think an awful lot of winning. There are other things." He asked me, "How do you feel about it?" I said, if they didn't feel that way, I wouldn't be here.
Who was your biggest coaching influence?
I would say Morley (Fraser, Jr., under whom Schwartz was an assistant for three seasons). Years before I got there, Mendon was pretty good in the early 70s, and then in the mid 70s football wasn't very good. I was the JV coach the first year, and the second year after two games they brought me up to varsity. The best thing I did was I told them I would not take the head job, but I'll assist. I knew (Fraser) was the kind of person and personality we needed there. It wasn't necessarily all of his football knowledge, but his energy and excitement that he brought to the game.
You said during the Finals postgame press conference that you'd battled cancer during the summer. How did you come back, and did you ever think that might be time to step down?
Everything's fine. I had coaches that took over. At the same time that that happened, I was retiring. If you retire in Michigan, you can't be at the school for one month. So I couldn't be at summer weights all the way through June. So my coaches did all the summer weights. But I had no intention of stepping down. If something (bad) came down ... but once they said they got it, everything went as normal.
After a championship season, how do you ramp things back up for the next fall and a new group of players?
When we go to the playoffs, we take all the JVs unless there are couple who don't want to go. They experience that and get an extra five weeks of practice if we win a state title. And they're excited about it. They want to do that. They’ve' tasted it, and they want a part of that the next year. We remind them it's not what you did, it's what can you do for me now. ... This is your year.
We talk about winning state championships from day one. A lot of people say we shouldn't do that, but why not? Isn't that the ultimate goal? I can't imagine telling a team we think we could be 7-2 this year. We expect to be 9-0 every year. Of course, that's not going to happen. But at same time, I think the losses make you better the following week. We've won state titles where we haven't won the league title. ... You get better.
PHOTO: Mendon coach John Schwartz talks things over with his players during the Hornets' 21-14 win over Decatur in the 2002 Division 7 Final at the Pontiac Silverdome.