Matt Vettoretti had a decision to make before the last game of his high-school football season.
The Grade 11 receiver was feeling woozy the day after taking a big hit in practice. He had a terrible headache and a persisting feeling that he may vomit at any moment. It was game day, and a playoff spot was on the line, but as the day wore on, he knew he had to talk to his coach.
Frank Rocca, head coach at St. Benedict Catholic Secondary School in Sudbury, listened to his young pass-catcher and decided he would sit out. The player was crushed, but after an off-season of rest and doctor visits, he recovered and was ready to play again.
"When I see a kid's parents in the local grocery store, I better be able to look them in the eye and know I did what was right for their son," Mr. Rocca said.
Concussion awareness in sports is spreading against the backdrop of news about researchers finding chronic traumatic encephalopathy (CTE) in the brains of dead football players. In addition, there have been recent reports about suicides by athletes in both hockey and football who had previously suffered concussions.
Still, not every teenager would make the same call as Matt Vettoretti did in this tough-minded sport. Further, an ongoing study in Indiana shows a different class of football players altogether: those playing with neurological injury and no symptoms to tip them off.
Small hits, big impact
An ongoing study by researchers at Purdue University is finding startling results when analyzing the brain activity of high-school football players and they hope to devise a safe hit count for young players, similar to the concept in baseball of limiting the number of pitches a pitcher can throw in a game.
Beyond the bone-rattling hits, games are filled with hundreds of smaller blows. The Purdue research team, made up of experts in biomedical and mechanical engineering, neurosurgery and kinesiology, have found that sort of lighter but repetitive contact can also harm the brain.
Their study, which is continuing over several football seasons, made headlines last fall when it found players with no concussion symptoms often showed neurological impairment equal to or greater than their concussed teammates.
The researchers put six small sensors known as accelerometers in helmets of high-school football players in Indiana. Those sensors measured the magnitude of the head blows in G's (gravitational forces) and wirelessly sent that data to laptops on the sidelines. They tested the players' neurological abilities before, during and after the season by giving them the ImPACT test -- a computer exam which evaluates memory and focus -- and took scans of their brains activity using a functional MRI (fMRI).
They measured hits from 14Gs up to a jaw-dropping 300Gs on occasion. They found that as the season wore on, several players were suffering measurable declines in their working memory and in visual memory.
Without symptoms, players have no idea they should see a doctor, no clue that continuing to play with such impairment puts them at risk for further brain injury.
"We're pretty convinced that what we're seeing is the beginning of a path, that doesn't in all cases lead to CTE, but to some sort of neurological damage that has some potential to persist," said Thomas Talavage, a biomedical engineer on the research team.
But there's encouraging news too. As their research published in the Journal of Neurotrama shows, observing such players after a week of rest or an off-season showed brains that had healed considerably.
"If they could come in after just one week off and suddenly look more normal on the tests, we are clearly looking at something that appears to be a short-term injury," Dr. Talavage said. "It can be overcome with some level of rest."
The Purdue researchers have not yet analyzed this season's data in which they have also added a girls' soccer team and a second football team. But interestingly, they have noticed that the number and magnitude of the hits recorded by two football teams – despite a great disparity in success and level of competition between them – are strikingly similar.
They hope to use the data to recommend a safe hit count – a number after which young players should rest or have neurological testing. They have also started videotaping the hits to figure out which kinds of blows seem to be causing the most brain trauma.
"At the end of the day, we're hoping to find out if those impairments are correlated with any visual cues," Dr. Talavage said. "We're trying to give the coaches visual markers and information to be able to intervene and prevent a kid from getting to that point."
How about a hit count?
Most pro football teams typically reserve heavy contact for training camp and game days, yet most high-school teams say they are hitting in practice two to three times per week.
Limiting the exposure to hits sounds like an easy way to help manage the risk. But many youth football coaches would argue there are other factors to consider.
Many say contact practices provides valuable learning time for kids figuring out how to safely deliver and absorb hits, especially those new to the game. The pros can get to game day without contact practices because they have superior conditioning and hitting experience.
"You need to have two days where you bang and run things at full speed because these kids are just learning, and they wouldn't be safe on game day without that learning," said Mr. Rocca, who was an offensive lineman for the Canadian Football League's Hamilton Tiger-Cats before taking up coaching. "I'm not saying you need to have contact throughout the whole practice or take guys right to the ground, but you need to have a period of 12-on-12 when they go full-tilt to get them ready."
Others puzzle over the logistics of actually keeping track of the hits.
"That study looks good, but hard to implement," said Jeremy Conn, football coach at Ballenas Secondary School on Vancouver Island and a member of the B.C. High School Football Association's concussion committee.
"Coaches in the [United States] are often paid to coach, whereas here coaches [and trainers] are all volunteers. So it would be hard to have the time to set up and do that."
Many wonder what would constitute a hit, who would keep track and how schools, clubs and parents could afford the testing.
"Anything that creates a safe environment would be a good thing," said John Paton, executive director of the Alberta Schools' Athletic Association. "It becomes an issue of affordability because if you're looking at testing, re-testing, who's going to do the re-testing? Are they sufficiently qualified?"
Catching up to the baseline trend
MedStar Health Research Institute in Baltimore, Md., this year released results of its 11-year survey on the incidence of concussions in 12 high-school sports in a large public-school system in the United States. It found that football was responsible for more than half the 2,651 concussions recorded between 1997 and 2008. In the U.S., 31 states and the District of Columbia have passed a student-athlete concussion law governing things like return-to-play protocols and concussion-recognition training. Eleven more have similar legislation pending.
There is no such law in any of Canada's provinces or territories.
Clinical Medicine Research Group Ltd., a group licensed to administer the ImPACT neurological test, says that while interest in baseline testing for hockey players has skyrocketed recently, it can't say the same for football.
For example, in Ontario, the group says it has had inquiries about its programs, including baseline testing, from organizations representing more than 95 per cent of the minor-hockey players in the province. By comparison, they have only heard from organizations (schools and school boards) representing less than 2 per cent of Ontario's high-school football players.
"I can tell you we have more downhill skiers in our database than football players," said Johnny Chehade, director with CMRG's concussion-management program. "We have a long way to go in reaching football teams in terms of baseline testing."
Canadians taking action
Education and training is under way all across Canada, but still, you find some teens who don't feel comfortable disclosing symptoms.
"Most players, they're afraid of coming off the field – they don't want coach to get mad at them, or they don't want to lose their spot," said Ashton Adams, a senior defensive lineman at Jacob Hespeler Secondary School in Cambridge, Ont.
"To be honest, I'd probably stay on. Just because I like to tough it out."
Giving players the information and providing the right culture for teens to speak up is key to many new initiatives spotted across the nation.
Many provincial athletic associations are now making concussion-awareness training mandatory for coaches and mandating a doctor's note before an athlete can return to play. Some boards have concussion committees, and some are mandating daily football practice plans so they can monitor the drills. Mr. Rocca said his school has been talking to a local hockey league to learn about its experience with baseline testing, and some Toronto high-school coaches arranged a presentation from noted concussion researcher Charles Tator.
The Canadian Football League is stepping up, too. It started a nationwide awareness program involving all levels of football in Canada, sending out posters and flyers to Canada's teams that include concussion symptoms and a list of what to do if they arose. They will also partner with CMRG's concussion-management program on a session for athletic trainers.
Edmonton Eskimos offensive lineman Patrick Kabongo played host to a concussion workshop for minor football association, the Edmonton Chargers. The Toronto Argonauts are subsidizing helmet certifications and athletic therapists for teams in the Toronto District School Board.
Matt Vettoretti says the blitz of recent awareness is changing the way his teammates feel about concussions.
"I never thought about concussions when I first started playing," he said. "But now I'm an 18-year-old kid, and who knows where football is going for me. It's frustrating to be told to sit out, but think about the rest of your life."