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Original Issue

Football's Big Headache

Concussions can be tough to diagnose—and deadly—in high school athletes

THERE WERE twomoments of pin-drop silence last Saturday afternoon at Ridgewood (N.J.) High'sfootball field. The first was just before the game between the undefeatedMaroons and the Montclair Mounties. Several hundred heads bowed in memory ofRyne Dougherty, a junior Montclair linebacker who died last week after hesuffered a brain hemorrhage while making a tackle in a JV game, less than amonth after suffering a concussion in practice.

The second camewith the game tied at 14 and 1:42 left in the third quarter. Montclair's seniorquarterback Luke Iovine had scrambled toward the right sideline as a wave ofRidgewood defenders washed over him, one of them putting a helmet right on his.Iovine lay motionless on the grass, a faint streak of maroon paint splashedacross his white helmet. After several minutes the dazed QB was helped to thebench, where Anthony Delfico, an orthopedic surgeon who was serving asRidgewood's team doctor for the game, gave him a thrice-over.

"Do youremember who had the ball on that play?" Delfico asked.

"I did,"Iovine replied.

"Do youremember what the play was?"

Iovine thoughtfor a moment and then shook his head, no.

Delfico toldMontclair trainers that Iovine had a concussion. Iovine's father, also namedLuke, a lawyer who was a standout QB for Montclair in the 1980s, made his waydown from the stands to make sure that the man examining his son was not beingoverly cautious because of Dougherty's recent death. "He got hit in thehead, he's dizzy, he has a headache and retrograde amnesia," Delfico toldthe father. "That's the definition of a concussion." Meanwhile, Lukewas in tears, insisting he be put back in the game, which Montclair won inovertime. "I can go back in," he repeated. "I don't understand whyI can't go in." On the way to Valley Hospital, Luke, 17, begged his fatherto turn the car around.

Luke's pleaunderscores the biggest obstacle in football's ongoing battle with concussions:unreliable victims who are part of a macho culture in which playing downinjuries is a hallowed tradition. Concussions "don't show up in brainimaging," says Kenneth Podell, director of neuropsychology and the SportsConcussion Safety Program at the Henry Ford Health System in Detroit. "Alot of times it's based on self-reporting of symptoms, and it's believed about15 to 20 percent of athletes fake having no symptoms to get back in thegame."

Lying throughtheir recently rattled teeth is not just a problem with overeager kids. Lastyear, the NFL faced criticism after reports of several former players who hadbrain damage before their 40th birthdays. Those men often took little or norecovery time following a concussion, and a second concussion before the firstis healed can cause serious damage. However, the outlook for current pros (onaverage, there is one concussion every two games) is brighter than it was fortheir pioneering forebears. Every NFL team now gives players a neurocognitivetest—a battery of memory and concentration exercises—before the season. If theplayer takes a hit, he can be benched until his scores return to thebaseline.

But as long asself-reporting is part of the evaluation, players can, and will, talk their wayback into action. What's truly scary about Dougherty's death—the secondfatality caused by a brain injury in New Jersey high school football thisseason—is that doctors took significant preventive steps in the days before ithappened. Dougherty suffered a concussion on Sept. 18. He was given aneurocognitive test and a CT scan and passed both, but he hid the fact that hewas having headaches from doctors and told them he was ready to rejoin theteam. He was cleared on Oct. 6. "He wanted to play football so bad,"says his mother, Marinalva Schnarr. "That's why he [told doctors] he feltfine." He died on Oct. 15, two days after being rushed from the field witha bleeding brain.

America's 1.2million high school football players don't hit as hard as their college and NFLcounterparts, so they suffer fewer injuries to their arms, ankles, knees andnecks. But teenagers are more likely to be damaged by blows to the head becausetheir brain tissue is not fully developed. A 2003 study found that concussionswere more dangerous in high schoolers, with longer-lived symptoms and apossibility of "second impact syndrome," in which an athlete is hitbefore full recovery from a concussion. (A handful of high school players diefrom apparent SIS each year, but fatal instances of it are almost unheard-ofamong athletes over 18.)

According to datafrom a paper last year in the American Journal of Sports Medicine, a 50-playerhigh school football team can expect three or four concussions a year. Thereare no national guidelines for treating them, and even within the medicalcommunity there is no consensus on how to determine when a concussed athletecan safely return to play. Increased awareness has led to more teams usingneurocognitive testing and coaches preaching safer hitting. But as long asthere is football, bells will be rung and clocks will be cleaned. No equipmentmodification or technology in sight can change that. What makes a helmet goodat transferring force away from the spine—the hard, smooth surface causes abilliard-ball slide when helmets come together—makes it bad at stoppingconcussions, which often result from a rapid sideways motion of the head."It's impossible to eliminate concussions," Podell says. "You wouldhave to attach the helmet to the body so the head would not move at all, andthat obviously will never happen."

In the absence ofa technological solution, athletes must learn to be conscientious stewards oftheir own brain, a lesson the elder Iovine will try to impart to his son. Eventhough he was visibly upset on Saturday that his son would have to leave atight game, by Sunday he was simply thankful that his boy had suffered only amild concussion, and he was ready to use the experience as a chance tolearn—and teach. Later on Saturday he had a talk with his son, telling him tobe more honest about his symptoms than he had been in the heat of the moment onthe sideline. "Football is important," Luke's father told him, "butlife is important too."

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"It's believed about 15 percent of concussedathletes FAKE HAVING NO SYMPTOMS."