All videos included in this story are segments of GET Episode 3, a video edition of this cover story produced by Sean Kim and Michael Melinger, members the Greyhound News Network and Video Production staffs and editors of the Globe.
Everybody just thought that the helmets would protect you.
-Ben Holman, CHS Graduate
On Sept. 30, during the third quarter of a Pike County High School football game, 16-year-old linebacker Dylan Thomas was carried off of the sidelines on a stretcher.
According to a CNN article, Thomas was wearing a new Safety Equipment Institute-certified Riddell SpeedFlex helmet, and after reviewing game footage, the Georgia High School Association determined there was no evidence he had sustained a major injury during the game.
Yet two days later, Thomas died of cardiac arrest caused by brain trauma in an Atlanta hospital.
Thomas’ story is not unique. A study by the National Center for Catastrophic Sports Injury Research found that of the 20 high school and college-level football players who died in 2017, four deaths were directly attributed to injuries sustained during practices and games. Three of these injuries occurred to the brain.
Despite the research pointing to potential dangers of the sport, for many, it remains an integral piece of the American experience. Football’s influence in the nation’s culture is significant. However, at CHS, football participation has been steadily decreasing over the last decade, and the team is currently almost half the size of what it was during the 2014-15 season. Many athletes are turning to other sports, such as soccer–which has over 90 players this year– where there is less stigma about the dangers and potential for injuries.
With 12 graduating seniors this year, there is concern that the athletic department will not have the numbers to support a football program into the future. The varsity team has no feeder program, like the JV and freshman teams other sports have – Clayton football is appearing to have a dim future.
“Across the country, football participation numbers are down,” CHS athletic director Bob Bone said. “If there are things we can do to increase the safety level, then that’s what we’re going to try to do. And so long-term we hope it makes people feel better about participating in football.”
“Football is a violent game. There is no way to get around that. But if there are things out there that we can due to increase the safety level, that’s what we are going to do,” Bone said.
For several years, the athletic department at CHS has been brainstorming and researching ways they could increase the safety of high school sports, with a focus on football.
Last year, the department found the Riddell Insite Training Tool, technology with helmet inserts that measures the impact a player receives every time he suffers a hit to their head.
The athletic department conducted more research regarding the Insite Training Tool and talked with local high schools that already had the technology. Head coach of the CHS varsity football team, Linwood Barnes, also knew about the tool and began discussions with the athletic department and administration about investing in the helmet inserts.
“The product was going into its second generation this year, which we felt was important because [Riddell] has gotten a lot of the bugs and kinks out of it,” Bone said. “And we felt like for the safety of our kids, this was a good safety factor for them.”
There are three parts of the Insite Training Tool. First is the helmet sensor pad, which is an insert inside the helmet. There are four sensors in each helmet, one on each side, the crown and the back of the helmet. Whenever there is a strong impact, or the force of an impact exceeds the pre-set threshold value on a sensor, the technology will signal an alert to the alert monitor, the second part of the Insite Training Tool.
The alert monitor is a remote that Kristen Saunders, the CHS athletic trainer, holds during practices and games. When the remote receives an alert, it will show the name of the player and the time that the impact occurred.
Before the program had this technology, Saunders tried to watch every hit during practices and games, which was a difficult task for a single person.
“Being by myself [on the field or sideline] is hard, especially when there’s different tackling drills going on. The linebackers practice one side of the field, the D-lines are on the other side and the safeties are elsewhere. So when the players are all spread out on the field, it’s hard to watch each drill, so the new technology is just another tool to help us,” Saunders said.
The third part of the Insite Training Tool is an online computer software that allows coaches to analyze the hits each player receives or takes to the head. After each game or practice, the coaching staff will plug the remote into a computer, and the computer will show the coaches each impact that happened that day, what drill it happened in, where on the helmet the impact occurred and the intensity of the impact.
By implementing this technology into the helmets, the Clayton football program has been able to increase safety and enforce better tackling and hitting techniques.
“It gives me more insight,” Barnes said. “If someone gets a head injury during tackling, I know we need to change that up and try to figure out what we were doing wrong. Instead of having two sets of eyes, I have 30 or 40 sets of eyes because it monitors everybody.”
Bone has also expressed his appreciation for the Riddell Insite Tool’s role in improved tackling technique.
“If a kid hit somebody and he has lowered his head and the impact is on the front part of the helmet then that will show up on on the readout. We’re then able to make adjustments in the coaching. So when you put everything together, [the Riddell Insight Training Tool] increases safety and acts as a teaching tool,” Bone said.
However, the helmets are not capable of reporting the severity of an injury a player receives as a result of a hit.
“Helmet accelerometers give you useful information but they don’t tell you if you have a concussion,” Dr. Roseanne Naunheim, associate professor of emergency medicine for Washington University in St. Louis at Barnes Jewish Hospital said. “They tell you how hard you’ve been hit, but don’t tell you what’s going on inside the brain.”
Because of this, when she recieves an alert, Saunders will pull that player out of the game or practice and will conduct an examination to determine if the player has been injured by the high impact hit. She receives on average two-to-three alerts per game and one-to-two each week of practice.
If the player is suspected of having a concussion, he must be cleared by a physician before they can return to play. From there, a player must be symptom-free for a full day before he can begin the five-day procedure for returning to the field. On the first day, the player undergoes a light cardio workout, which increases to a more strenuous workout on the second day. By the third day, a player can participate in half of a non-contact practice. After four days, he can once again fully participate in practices, and by the fifth day, can return to the field during games. According to Saunders, if at any point during the process a player shows symptoms, he must return to step one.
Even at the national level, the NFL has made efforts to make football a safer game. In March, before the 2018-19 season, the organization instituted a rule that would penalize a player for lowering his head to initiate a hit with an opposing player. This sets a precedent for safer tackling across all football levels.
“Whenever there are rule changes in the NFL, the changes will trickle down to college football and then the high school level,” Saunders said.
Initially, the team experienced an adjustment period with the new helmets. At the beginning of the season, Saunders was getting many more alerts than she does now. However, this new technology has helped the players develop safer tackling techniques.
“The guys were made more aware they need to stop leading with their heads. So now they’re just more aware of how to tackle and they’re not leading with their head anymore,” Saunders said.
Although Clayton is using the second generation of the Insite Tool, Saunders has noticed some faults in the technology.
She said, “I’ve had alerts and then the player comes off and they’re fine. And then I’ve also had a player come off on the sideline saying that he has a headache and I didn’t have an alert.”
Even though high school and college football programs across the country use helmet accelerometers, there are some medical experts who do not think the Insite Tool technology is worth the investment.
We really hope that our students and our parents too understand that we’re trying to do everything we can to be as safe as possible. I think a big concern is the concussions. Obviously we can’t take that concern away, but maybe we can soften that a little bit. We’re doing everything we can”
— Bob Bone, CHS Athletic Director
“In an accelerometer helmet, the accelerometer is just an extra bell and whistle that is unnecessary at this point and may led to more confusion and worry than help for a lot of people,” Mark Halstead, director of the Washington University sports concussion program, said. “I would not recommend [accelerometer helmets] at this point … They are more utilized in a research setting than they are to help someone on the field right now. Helmets still serve a purpose, like preventing bleeds in the brain or skull fractures, but they don’t do a very good job reducing concussions.”
“We really hope that our students and our parents too understand that we’re trying to do everything we can to be as safe as possible. I think a big concern is the concussions. Obviously we can’t take that concern away, but maybe we can soften that a little bit. We’re doing everything we can,” Bone said.
Second impact syndrome, or SIS, occurs when a concussed person receives a second impact to the brain and can result in rapid swelling and potentially lifelong negative effects. This commonly occurs to athletes who are released back into play before they fully recover from concussions.
“When you’re doing an evaluation for a concussion, you ask when their last concussion was, if they’ve had one, and another big question is to ask how long it took for them to recover from that concussion, because once you do sustain a concussion, each time after, the recovery time is longer,” Saunders said.
ImPACT (Immediate Post-concussion Assessment and Cognitive) testing was developed in 2002 and is the most widely-used computerized concussion evaluation system in the nation. It is designed specifically for use alongside other tests, and never alone.
The test is administered to student athletes at the beginning of their season, where it determines a baseline for their cognitive ability. It is administered again after a concussion has been diagnosed, and given time to recover to determine if the athlete has returned to their baseline. If they have, then they are allowed to return to play; if they are not they remain on the sidelines.
The test itself cannot determine if an athlete has a concussion, or diagnose it. According to Saunders, it is more useful for determining when an athlete can return to the field.
“Of course [ImPACT testing] is a tool, so it’s not like the end-all be-all, it doesn’t mean that if you’re even with your baseline then you’re good to go. We use it as another tool for helping assess when [players] are ready to return to play,” Saunders said.
Impact testing costs $15 per individual test to administer before the season. After a diagnosed concussion, retaking the test costs another $30. The tests can also be bought at a group rate for a slight discount.
A study conducted in 2007 by the University of Illinois determined that the test had less reliability and usefulness than what would be accepted. Out of the 100 people who they tested, and then retested using the ImPACT test, the correlation between initial and final scores ranged from 0.15 to .39, where 0 represented no correlation and 1 represented complete correlation. This compares to the usual accepted correlation, a minimum of 0.75. Other reports show that there have been cases where ImPACT testing failed to detect concussions.
Unfortunately, the tests to diagnose and determine the severity of concussions are widely unreliable. Baseline testing has been accepted as one of the most reliable and useful tools when determining return to play, although no test can give an accurate diagnosis every time.
“Some kids never return to normal,” Naunheim said.
Concussions and traumatic brain injury (TBI) have become synonymous with American football. After a player’s first concussion, he or she become three times more likely to receive a second and eight times more likely to receive a third.
Some kids never return to normal.”
— Dr. Roseanne Naunheim, Washington University in St. Louis, Barnes Jewish Hospital
A concussion, a mild TBI, is the result of blunt trauma, occurring when someone receives a blow to the head. The rotational movement of the brain inside of the skull during this period causes the brain to hit the interior of the skull, bruising at points of impact. The brain experiences a shearing of axons that contributes to decreased cell function and can cause loss of consciousness.
“There are about 2,000,000 visits for concussions in pediatrics per year, but we don’t actually know how many occur because most people don’t come in,” Naunheim said.
While these cannot be solely attributed to football, according to the Brain Injury Research Institute, 20 percent of high school football players will suffer a concussion at some point during their careers. (Note: The print issue of this story incorrectly stated that concussions were the number one cause of death in children and young adults, not Traumatic Brain Injuries. Concussions are a form of Traumatic Brain Injury. Motor vehicle accidents are the number one cause of TBIs.)
Players who suffer concussions typically experience post-impact symptoms. In the short term, these include headaches, loss of memory and confusion.
“If you talk to someone with a concussion, they will ask ‘what happened’. You’ll explain it to them, but then five minutes later they will turn and ask ‘what happened’ again.” Naunheim said.
However, long term post-impact symptoms can be severe, with the potential to leave lifelong impairments. Treatment and management of these symptoms have evolved significantly as neuroscience in this field has developed.
“When I was doing my training it used to be that we would actually allow athletes to go back to play after 15 minutes if their symptoms went away,” Dr. Mark Halstead, director of the sports concussion program for Washington University said.
Currently, the Missouri State High School Activities Association (MSHSAA) requires a standard five-day return-to-play procedure following the diagnosis of a concussion. Clayton not only follows the MSHSAA procedure, but uses Riddell’s InSite accelerometer technology to keep players safer.
“There’s actually some very sophisticated monitors that they use for research for concussions that they put into helmets to determine if there is a certain g-force when a hit happens that causes a concussion,” Halstead said. “The problem is that there’s not a high level of a g-force when a concussion occurs.”
As a result, this presents limitations to Riddell’s technology. The g-force measured can not be a conclusive factor in determining a brain injury because TBI can be present at a hit that does not necessarily reach the sensor threshold. However, electroencephalography can be used to better determine if a player has a concussion. Electroenclephlagrams (EEG) measure electricity in a brain to predict if someone has a TBI.
According to Naunheim, who works with a company called brainscope to compare thousands of EEGs, the measurements produce a number on a scale of 0-100 correlating to the likelihood of a concussion.
“When you are asleep, or if you are using drugs, those waves change. And also if you’re concussed, your brain waves slow and the difference in connection between one electrode and the next takes longer,” Naunheim said.
One of the biggest health concerns in football at the professional level is chronic traumatic encephalopathy (CTE). This degenerative disease results from repeated concussions, TBIs and blows to the head in general. A brain suffering from CTE will lose mass over time, leading to memory loss, erratic behavior and impaired judgment in a player.
However, there is little evidence this disease has an impact on high school football. A study by the Mayo Clinic revealed that there was no increased risk of dementia, Parkinson disease or ALS among adults who had played football in high school when compared to non-football playing colleagues.
Although often overlooked, non-head injuries can greatly impact a student’s health and performance in the school environment. Broken bones and sprained ankles often require time away from school to deal with, thus potentially causing a student to miss valuable educational time. A student could also receive an injury that could more directly impact a student’s schoolwork, such as a broken hand that could hinder notetaking or testing.
“There’s a chance that someone could go out there and they could have a really serious injury to their chest and they can die from that. Or there’s a risk that they tear their ACL and maybe never get back to sports,” Halstead said.
According to Naunheim, there is still much that medical professionals do not know about the impact football has on players. However, new research continues to bring new issues to light.
“It’s like smoking when my parents were growing up. You learn a lot over time, and what seems fairly straightforward and matter-of-fact now, there was a learning process that went into that,” Holman said. “Everybody just thought that the helmets would protect you.”
“I grew up in a small community where football was everything,” Jason Julian, Clayton parent and former division 1 football player said.
Julian started playing football when he was eight in Knoxville, Tennessee. He came from a football family: his two older brothers both played, and his mother was an athletic trainer. In high school, Julian’s team won the state title, and he went on to play for the University of Tennessee. There, he won two more championships.
Julian stopped playing around the age of 23, but has stayed close to the game since. For the past 18 years, Julian has coached football at both a college and high school level, and now his son, a freshman, plays for Clayton’s team. He has seen how the attitude toward the dangers of the sport has changed and evolved since more research has been done into the long-term effects.
“I can honestly say that I never remember a discussion occurring about a concussion,” Julian said. “I don’t think people avoided talking about it, but you understood that getting hurt was something that happened in football. The concern about that aspect of the game has changed so drastically that it’s actually changing the entire culture of the game.”
Despite decreasing participation in Clayton’s program, football is still the most popular high school sport in the nation, with over one million participants each year. For many students like Julian, football is deeply ingrained in their own family history and culture. Many who do play would not consider giving up the game, despite knowledge of potential dangers.
“It requires a physical, mental and emotional toughness that other [sports] don’t,” Julian said. “Young men to have to dig down, persevere and endure through pain past the level that they ever thought they could go.”
To some players from lower socioeconomic backgrounds, football offers the chance at scholarships and the pursuit higher education. For these students, given their economic situations, a college degree would not even be in consideration if football had not given them the opportunity. However, Julian believes that the majority of players commit to the sport solely out of love of the game and the sense of community it builds.
Until he entered as a freshman, CHS class of 2014 alumnus Paul Kodner had only ever known education in the setting of a private Jewish day school. The switch to a larger public district like Clayton was difficult. However, Kodner began practicing with the football team over the summer and found refuge in the tight-knit bonds he formed with his fellow players.
“Before school even started, I had an entire team of friends who would become my brothers,” Kodner said.
CHS class of 1990 alumnus Ben Holman shares a similar sentiment with Kodner. Holman played four years of football at CHS, then went on to play another four at the University of Pennsylvania as a tight end.
Throughout his career, Holman sustained six concussions; three during his time at Clayton. Despite his injuries, Holman never thought about quitting.
“There is a sense of brotherhood, any time you work hard together towards a common goal, not exclusive to football,” Holman said. “When you are forced through good times and bad together you form a bond like no other.”
The physical and mental value the players see in football is mirrored by the financial benefit colleges and NFL teams receive. According to the U.S. department of education, in 2017 football was the most profitable NCAA program, netting over $1.7 billion across all schools. This number is over five times times the profit of the next highest-grossing sport, men’s basketball, which only garnered $329 million. Other sports such as soccer and baseball result in net negative profits, costing more than they earn.
College sport culture revolves around football. The sport is idolized through homecoming games, tailgate parties and large parades and is central to the college experience. Unified students inundate stadiums in support for their team. Football has influenced educational institutions in America more than any other sport.
This trend is reflected at a national level. According to marketwatch.com, the NFL generates over $13 billion a year, followed by MLB at $9.5 billion. Football is the truly “American sport.” But this leaves an unanswered question: why?
Maalik Shakoor, CHS class of 2014 alumnus, played football throughout high school. He believes that our society drawn to football because of the reason it is now controversial: the violent nature.
“It’s a gladiator sport, it’s primal, that’s why we watch it,” Shakoor said. “The culture of football has changed a lot, but at the end of the day, it’s like trying to make a gun fight safe. It all comes down to technique, properly hitting, keeping your head up and being safe.”
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