Story by Cole del Charco

CHAPEL HILL, N.C. — Dr. Kevin Guskiewicz is one of the leading researchers on concussions in the world. His research helped pass legislation that requires high schools to teach their players about concussions and safety protocol for head injuries, and he talks about how safe football has become.

In fact, it’s safe enough that he let all three of his sons play.

“The appearance is that it’s a more dangerous sport than ever,” Guskiewicz said. “But the reason we’re seeing a spike in reported concussions is because now people are more informed and are more likely to report them.”

Advances in helmet technology, established protocol and rule changes have led to making the sport safer than it’s ever been, Guskiewicz said.

It’s not that Guskiewicz downplays the dangers of the sport. Quite the contrary: he thinks the more everyone understands head trauma, the safer players will be.

The people who need to be more knowledgeable are players, coaches, trainers and parents. Everyone.

“It takes a community to make sure our kids are safe,” Guskiewicz, who’s also the Dean of the College of Arts and Sciences at UNC, said.

He thinks it’s possible that, soon, helmets could protect players from both concussions and skull fractures — currently an impossibility.

For now, Guskiewicz is looking for the next thing to make the sport safer. It could be getting rid of kickoffs and punts altogether, or requiring linemen to stand to start each play instead of the three-point stances they use with one hand on the ground.

But the most promising is a kind of intervention he tested over the last three years in a research study on limiting the effects of head injuries for at-risk players is the solution.

The research
It’s another day of practice and Guskiewicz and the Gfeller-Waller research team is at a local high school. The first three to four weeks of the season is all about identifying the players who are receiving hard hits disproportionately.

Researchers place a monitor in each player’s helmet to track level of force exerted on the head. High school hits have been measured to average 25g, but concussive level hits ranged from 74-146g.

Then, Guskiewicz and the team started the intervention.

They took the at-risk players and informed them of safe tackling and hitting techniques. The program was behavior modification, called “BeMod” for short.

Those interventions had a proven effect. Now that the final data has been gathered, the researchers plan to publish several studies in the spring.

Football teams at four high schools near Chapel Hill were the subjects of the study: Carrboro High School, Chapel Hill High School, Northwood High School and Orange High School.

One hit that wasn’t measured was perhaps the most dangerous.

‘Pray for Thys’
On Oct. 12, Orange High School freshman was hit so hard that he had to go to the hospital. He was put in a medically induced coma for weeks.

Playing high school football is normal enough — more than 1 million Americans played last season. But Thys Oldenburg’s injury was anything but.

He had three brain surgeries to reduce swelling and bleeding as reported by ABC 11. Oldenburg stayed in a medically induced coma for more than two weeks before being moved from Duke University Hospital to Levine Children’s Hospital in Charlotte. The family could not be reached to comment.

Throughout the rest of the season, opposing teams showed support with everything from helmet stickers with Oldenburg’s number to orange towels. The Orange Panthers even carried a flag with 22 on it while running onto the field before games.

Following Oldenburg’s injury, community members held a prayer vigil. The hashtag “#PrayForThys” was seemingly everywhere. The team still took the field each week, albeit with an injured friend fresh in their minds.

Orange High School’s football coach, Van Smith, declined to comment citing HIPAA laws.

Thys Oldenburg is out of the coma. He’s been eating, taking small steps and speaking. His parents hope he will be out of the hospital by Christmas.

The risk
A concussion is a temporary alteration in brain function that usually evolves over seven to 14 days, Guskiewicz said. When someone has a concussion, they have a higher risk to get another, and their threshold for other injuries can drop.

“I tell people, concussions are like snowflakes,” Guskiewicz said. “No two are alike.”

That means recovery times, symptoms and long-term effects are similar, but distinct. Some people have worse effects from their first concussion, others don’t feel the same intensity of pain until having several. There is still much that is unknown about concussions and head injuries in general.

One of the main reasons more concussions are reported is because more people are aware of them. The trigger for that information came from legislation.

Washington state was the first to create a concussion law in 2009, and within five years, all 50 states and the District of Columbia passed similar legislation. North Carolina’s Gfeller-Waller Concussion Awareness Act was passed in 2011.

In general, the state laws on concussion protocol require 1.) Concussion education for every high school and middle school, 2.) No same day return to play after showing symptoms of concussion and 3.) An athlete can only receive a go-ahead to play by a trained professional.

National discussion about head injuries has evolved to include Chronic Traumatic Encephalopathy (CTE) in recent years which is a degenerative brain disorder normally found in people with repetitive brain trauma. But Guskiewicz is quick to point out that having a lot of concussions doesn’t directly lead to CTE.

“It’s not a clear path that you have concussions and then you develop CTE later in life,” he said.

An event that sparked that discussion happened over the summer. NFL player Aaron Hernandez was found to have the highest rate of CTE ever detected among someone his age. The end of his life was a whirlwind of bad decisions which led to jail time for murder and, finally, suicide. Experts wonder just how much CTE could have factored into that kind of decision making.

Even with all the research people like Guskiewicz have done, no one knows exactly what the future for high school players like Oldenburg will be.

As they age, early onset Alzheimer’s is certainly a possibility. CTE may be too; some studies have found victims of car wrecks with no previous head trauma who had CTE after the one hit.

Stopping the damage
Every high school in North Carolina has a set procedure for dealing with head injuries in sports.

North Carolina was ranked as the best in rules and implementation in dealing with traumatic injuries in a study by the Corey Stringer Institute at the University of Connecticut.

Freak accidents can never be fully anticipated, but James Alverson, the assistant commissioner for media relations for the North Carolina High School Athletic Association thinks the pros of playing sports, like learning to be a team player and perseverance, are worth the risk.

“You learn those things better on the field than in the classroom,” Alverson said.

The NCHSAA has taken steps to limit contact time allowed in practices during the season and has even banned contact during the off-season for high school football teams.

But it’s not always easy to report violations of contact at practices and other new rules. Alverson said there is a fine available, but a breach must be reported and confirmed.

Many coaches, players and administrators think improving the technique players use when tackling and hitting can lessen the number of injuries and concussions from normal plays that occur during a game.

A program called “Heads Up Football” addresses the issue with training. It teaches proper technique to coaches in training programs so coaches can then bring those techniques back to their teams.

North Carolina gives high school teams funding for each coach who goes through the training — $25 for the first five coaches to train and $10 for each after that.

It’s directed by USA Football and emphasizes correct tackling and hitting techniques — the same ones used by Guskiewicz during the study. In fact, the researchers used material directly from Heads Up for behavior modification.

In a testimonial video for the program, an athletic director says he came across the idea while realizing youth participation in football was dropping.

A study by the National Federation of State High School Association for the 2016-17 school year found 47,166 fewer players than 10 years earlier.

This results from a variety of factors, but decades of research on head injuries in the full contact sport have yielded results that show the damage a concussion can cause.

Alverson said there has been an increase in participation in non-contact sports and a decrease in contact sports. He didn’t think that could be solely attributed to knowledge of head trauma.

“The rules that we’ve tried to implement can do a nice job,” Alverson said. “But at the same time I think that every parent has to weigh the risks for their child, and we certainly respect their thoughts on that.”

The most recent rule changes to keep the sport safer ban blindside hits of any player on the field, “you have to block with open hands,” and onside kicks going straight into the ground, which often resulted in heavy hits.

“I don’t think you’ll ever make it completely safe in any sport, but I think we’re heading that way,” Alverson said.

Even with required education on concussions, many of the nation’s top high school players have been quoted in a USA Today article saying they didn’t fear possible head injuries.

One even said he’d die to play the sport.

To keep playing
Jean Luc Brown understands the feeling. He’s a linebacker at Mercer University in Macon, Georgia, and has played the sport since 8th grade.

Three concussions. Brown’s first was in 9th grade, followed by two more by the end of his junior year. The first one was the worst.

“It was during a practice, we were just doing a normal screen drill and I was playing running back,” Brown said. “I was running the ball and one of our starting safeties came down and hit me really, really hard. I remember falling down and blacked out for a second, but when I came to I was like that hurt.”

Brown played for the rest of practice because it wasn’t bothering him after a few minutes.

“I finished practice and nothing was really bothering me, but when I finished practice and went home I was like my head still really hurt, and the lights hurt,” Brown said. “I talked about it with my parents and then went in and got a concussion test, and my trainer said it was one of the worst he had seen.”

He was out for five weeks. Seeing bright light set off the pain, so recovery often meant sitting in a dark room. His head hurt like he had a constant migraine and he had difficulty sleeping.

Even though Brown made a full recovery from each concussion, he can still feel some effects. His short term memory is worse, he said, and doing normal, everyday tasks like sitting in class are difficult to focus on.

Brown played at Pace Academy in Atlanta, and his coach was a former NFL player who taught good technique and emphasized safety. His college coaches are focused on the same thing.

“If they see anyone tackling or hitting with bad technique, they’ll stop the play,” Brown said. “They don’t want people to even think that that’s how they teach to hit, either.”

Looking back at his own career, he thinks he may have had more than three concussions, but didn’t know that at the time.

It used to be common to play through the pain: coaches would tell players to “rub some dirt on it” and get back on the field. While Brown said that isn’t the sentiment anymore, there’s still a problem with players knowing enough about head injuries.

He thinks the issue permeates high school, college and even the NFL.

“I think a lot of people will get hit and their head will start hurting a little bit, but then they keep playing even though their head hurts because they don’t know it’s a concussion.”

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