On the brain

When a forensic pathologist began performing an autopsy on a Hall of Fame offensive lineman in September 2002, he had no idea that he would end up becoming the face of a disease.

The autopsy on retired Pittsburgh Steelers center Mike Webster by Dr. Bennet Omalu led to the widespread awareness of chronic traumatic encephalopathy, or CTE — now all too well-known as the disease responsible for crippling the brains of several prominent football players.

The public’s awareness of Omalu, 47, will rise considerably when he is portrayed by actor Will Smith in a major motion picture, “Concussion,” which opens theaters Friday.

As more has become known about CTE and the risks associated with playing football, the mentality of those associated with the sport has evolved. Decades ago, coaches tasked with instilling toughness in their players would sometimes go to extreme lengths to do so, needlessly exposing young athletes to dangerous situations.

Balancing act

Toughness is still a part of the game of football, as it is with any contact sport. But today’s coaches know that there needs to be a balance between toughening kids up and also keeping them safe.

“Safety’s huge,” Columbus North head coach Tim Bless said. “And we don’t want to injure kids on the practice field and thus never give them the opportunity to compete — and certainly, their long-term health is hugely important.”

But it’s still full-speed, full-contact Friday nights during the football season.

“We’ve got to give them a level of preparation so we’re not submitting lambs to a slaughter in our first contest — because then, injuries are inevitable,” Bless said. “So it’s a very fine line that programs have to walk upon.”

High school coaches and athletic departments must keep athletes healthy and as safe as possible, but also have them to get ready to play the game by the rules of the game, the veteran coach said.

And by the rules of the state.

Leading the way

In 2014, Indiana became the first state in the country to pass a law requiring concussion awareness training for high school and youth football coaches. That same law, authored by State Sen. Travis Holdman, R-Markle, also mandates a 24-hour waiting period for a youth football player suspected of suffering a concussion.

The Indiana Football Coaches Association (IFCA) has been working in conjunction with the Indiana High School Athletic Association (IHSAA) and the National Federation of State High School Associations (NFHS) to help find the proper balance. At its most recent meeting a week ago, IFCA coaches discussed creating even stricter limits on the amount of contact in practices during the season. A proposal will be drawn up and likely presented to the IHSAA next month.

Columbus East head football coach Bob Gaddis, who serves as the executive director of the IFCA, said the most likely scenario is that contact will be limited to two days a week, with time limited during each of those days to somewhere between 30 and 90 minutes. Any changes that get proposed by the coaches and then approved by the IHSAA would likely go into effect next season.

Just as important as the time limitations on contact, however, will be defining what actually constitutes contact.

There are seven different levels of contact, Gaddis said, with full contact — taking a player all the way to the ground — the seventh and final level. One step before that is “thud,” which does not involve taking a player to the ground. Some states already define “thud” as full contact for practice purposes, and Indiana — although it does not currently do so year-round — may choose to follow suit.

Many coaches choose to take advantage of every available minute of contact. Others, however, don’t always feel that it’s necessary.

Both high school coaches in Columbus have both done less hitting in recent years. While that was sometimes a product of having veteran teams that weren’t in need of as much technique work, it was in large part a product of adapting to the times. Some drills that were once looked at as toughening players up are now often viewed as unnecessary physical punishment that serves no purpose.

“There are things that we did two or three years ago that we don’t do anymore, because it’s a point of diminishing returns,” Bless said.

Some drills intended to evaluate toughness and physicality, which also carry risk, are no longer conducted, he said, especially if coaches can assess those traits in other ways.

In addition to limiting the amount of contact, a big point of emphasis has been changing the type of contact.

For example, tackling is being coached far differently now than it was by some in the past in an effort to minimize the impact on players’ brains.

“Keeping the head out of football is huge now,” Gaddis said. “When I played, we were taught to lead with our face and our head. Now, we teach our kids you don’t make contact with your head. You just don’t do it.”

However, no matter how much emphasis there is on technique, there will still be collisions involving the head — in football or any other contact sport.

Helmets are key

In an effort to help minimize potential damage, both Columbus East and Columbus North put a great deal of effort into ensuring that their football players are wearing top-quality helmets.

Gaddis said East football players are outfitted in Riddell Revolution helmets that are sent out to be reconditioned every year and checked for proper inflation levels after every Thursday practice during the season.

North, meanwhile, has been phasing in new Simpson-Ganassi (SG) helmets for the past two seasons. Next fall, every player from the junior class down will be wearing them.

Dr. Cary Guse, who is charged with examining any local athlete exhibiting what Indiana state law defines as concussion-like symptoms, said that he has not seen an actual concussion in any North football player wearing an SG helmet.

“That could just be dumb luck,” Guse said, considering the sample size is still so small.

And while there have been continuous advances in technology, helmets will never be a cure-all — nor were they ever intended to be.

Helmets were meant to eliminate skull fractures, which they have mostly done, but they cannot eliminate concussions. A layer of liquid between the brain and the skull serves as a bit of a buffer inside the head. But no matter how much protective gear is added on the exterior, any sort of hard contact is still going to cause the brain to collide with the skull.

Football isn’t the only sport in which concussions can happen.

Concussion rates are often nearly as high in soccer, hockey and wrestling — and Guse said that he has even diagnosed four concussions in cross country runners this year and five more in swimmers.

Running into a tree during a race or getting inadvertently kicked during swimming practice could potentially cause the same damage as heading a soccer ball or getting tackled at the goal line. There is no such thing as a totally safe sport.

What’s at stake

The most scrutinized sport in recent years, however, has definitely been football. Part of that is because of its popularity.

The NFL is a multibillion-dollar operation, and the game is a cash cow for high schools and colleges alike.

But high-profile suicides of once-revered NFL stars such as Webster, Dave Duerson and Junior Seau have put a spotlight on the sport and its effect on the brain.

The scrutiny has been met with resistance at the professional level.

“Concussion” shows the great lengths to which the NFL went to discredit Omalu over the years — and many other coaches, players and fans also wonder whether the scientific community is at war with the game.

For the NFL, the threat is largely financial. For high school coaches, it’s something else entirely.

“I think it is the natural emotion to feel like our game is under attack,” Bless conceded. “Certainly, it’s not the dollars-and-cents issue that it is at the professional level — but it’s participation. And if enough parents and children get apprehensive about playing the game, obviously, that affects our game. And we’ve seen that locally and nationally; youth football levels are lower.”

The numbers at the high school level haven’t really been affected yet. But as the generation of children whose parents have become more apprehensive due to increased awareness about CTE grows up, it may begin to impact high school programs.

“Yeah, I’m concerned about it,” Gaddis said. “My concern is that there’s going to be a lot of negative publicity out there. I think we have to make sure that there’s a lot of positive publicity.”

Gaddis said he expects that to be an effect the movie ends up having.

“As guys that are interested in keeping the game alive, keeping it around, we have to show the value of the game,” Gaddis said. “We have to show that it’s valuable for a young person to be involved in. And is that going to be tough? I think it’s going to be real tough.”

It could be even tougher with such a high-profile film coming out.

Although the amount of effect “Concussion” will end up having on a football-obsessed nation remains to be seen, the audience likely will be large.

Even people associated with the game who might not want to hear what the movie has to say are probably going to check it out — out of curiosity, spite or a desire to get more information.

“It’s not going to be something that I’m going to enjoy going to watch,” Gaddis said. “But I’m going to go watch it. I’m going to try to learn from it.”

The more educated that coaches, players, parents and everyone else become, the better.

More well-informed coaches can make the game safer.

More informed players will play with more sound technique and be less susceptible to injury.

More informed parents will be equipped to make decisions about whether or not to let their children play football or any other sport.

Guse, for one, hasn’t been scared off.

“The benefits of sports outweigh the risk of concussions overall,” he said.

At the movies

“Concussion”

Starring Will Smith, Gugu Mbatha-Raw, Alec Baldwin, Albert Brooks

Where: AMC Showplace Columbus 12, 555 Creekview Court, Columbus

When: Opens Friday, 1:25 and 7:15 p.m.

Facing the problem head on

The Indiana High School Athletic Association (IHSAA), the Indiana Football Coaches Association (IFCA) and the National Federation of State High School Associations (NFHS) have taken numerous steps over the past decade to lower the risk of concussions in student-athletes.

Here is a timeline.

2005-present: Through the National High School Sports‐Related Injury Surveillance System and Dr. Dawn Comstock, the NFHS and its member associations started to use comprehensive injury data as a resource in the writing of rules.

2008: The NFHS Sports Medicine Advisory Committee advocated that a concussed athlete must be removed from play and not allowed to return to action on the same day. The IHSAA followed the lead of the NFHS and began to develop its own concussion protocol.

2009-present: All NFHS rules publications added guidelines for management of a student exhibiting signs, symptoms or behaviors consistent with a concussion. Any such athletes are to be removed from competition immediately and not allowed to return until cleared by an appropriate health care professional.

2010: The NFHS developed its Concussion in Sport online course at nfhslearn.com. This course is mandatory for every high school football coach in Indiana.

2011-12: The NFHS Football Rules Committee adopted Concussions Related to Proper Use of the Helmet as a Point of Emphasis.

2013‐14: The Indiana Football Coaches Association proposed language to the IHSAA speaking to preseason and summertime limitations on activity days and full contact. The IHSAA unanimously approved the new language into its bylaws.

2014: Indiana became the first state in the nation to require concussion awareness training for high school and youth football coaches. The legislation, authored by State Sen.  Travis Holdman, R-Markle, also called for a 24-hour waiting period for a youth football player suspected of suffering a concussion.

2014: The NFHS Concussion Summit Task Force met in Indianapolis and adopted recommendations for reducing the amount of full contact in practices. Based on these recommendation, state associations crafted their own policies for implementation in the 2015 football season.

2014: The NFHS Football Rules Committee adopted a definition and penalty for targeting aimed at preventing players from hitting an opponent — primarily with the helmet — above the shoulders.

2014‐15: The IHSAA developed an online tracking system whereby member schools may report a concussive event involving a student-athlete — in a school setting or otherwise. Athletic trainers report statistics to the IHSAA for data comparisons and study.

2015-16: The IFCA continues to have discussions about live contact, focusing on in‐season practices. The group met last week and is expected to submit a proposal to the IHSAA in January.

Hard to measure

Are concussions among local athletes up or down in the past few years? It’s hard to tell.

Any student-athlete in Columbus that exhibits concussion-like symptoms ends up seeing Dr. Cary Guse, and he has seen a fourfold rise in the number of such athletes coming to him in recent years — but that doesn’t necessarily translate to a rise in the number of actual concussions.

There are, he says, a few different reasons why he’s seeing so many more patients.

First, the new Indiana state law has set definitions for concussions and concussion-like symptoms, and any athlete showing those symptoms has to be withheld from action until being cleared by a doctor.

Second, Guse is the only doctor in town doing the clearing, because he said “the other doctors in town don’t want to deal with it.” He’s also the only local doctor administering the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) Test.

For those reasons, Guse is hesitant to compare local numbers from eight years ago to local numbers now, but he estimates that overall “the numbers are probably static in terms of the true number of concussions” that he’s seeing.

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Ryan O'Leary is sports editor for the Daily Journal. He can be reached at roleary@dailyjournal.net or 317-736-2715.