If you head to a football practice at Whiteland Community High School, you might notice something different about what the players are wearing.

This year, Whiteland football coach Darrin Fisher began outfitting some of his players with The Guardian, a padded helmet cover that claims to absorb up to one-third of the impact from a collision, helping avoid concussions and other head injuries. The Warriors’ offensive and defensive linemen, inside linebackers and running backs — the players most frequently involved in head-on collisions — all wear the protective cover on their helmets during practices.

The pads are used by college programs at Clemson and Florida State and some other Indiana high schools, such as Bloomington South, Fishers and Westfield. Fisher decided to give them a try, and football parents raised enough money to buy the covers, which cost about $35 each in bulk.

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The coach cautions that he doesn’t have any data yet that proves The Guardian works, but he said he believes they’re helping at least a little bit.

“Practice just sounds different,” Fisher said. “I think it’s helped us coach a little bit — when you hear somebody tackle and you don’t hear that crack, you know they’ve used their head a little bit.”

Much of the talk about head injuries in sports has focused on football — in part because it’s the most high-profile sport, but also because concussions are a bit more frequent on the gridiron. Based on estimates from high school athletics trainers across Johnson County, the vast majority of head injuries are incurred during the fall season, with football and soccer responsible for almost all of them.

For example, Franklin Community High School trainer Marcus Davis estimates that he sees approximately 15 to 20 concussions each fall, compared with about five or six in the winter, mostly in wrestling and basketball. Spring concussions are essentially non-existent aside from rare freak incidents, such as one athlete Greenwood trainer Liz Crim recalled who got a concussion from bumping into the corner of a locker.

Determining what will cause a concussion is impossible, since similar contact can affect two different athletes in different ways.

“The simplest little things can end up being a concussion, where other people, nothing seems to faze them,” Crim said.

Recent advancements in the medical field have led to a greater focus on athletics head injuries, and the increase in available data thanks to years of research has left doctors and trainers, along with coaches, athletes and parents, much better informed on the impacts of a concussion.

Though its effects had been seen in professional boxers for years, little attention was paid elsewhere to chronic traumatic encephalopathy, or CTE, until the mid-2000s, when Dr. Bennet Omalu studied the brain of deceased Pittsburgh Steelers offensive lineman Mike Webster. Omalu’s diagnosis of CTE in Webster ushered in a wave of new research into the long-term effects of concussions, especially among athletes in contact sports. A recent study at Boston University examined 202 donated brains from deceased former football players and found signs of CTE in 177 of them. Of the 111 brains belonging to former NFL players, CTE showed up in 110 of them.

Such research is leading to greater vigilance at all levels of athletics, but particularly at the high school level and below.

Tackling the problem

Fisher isn’t the only football coach that has stepped up prevention efforts.

Indiana High School Athletic Association assistant commissioner Robert Faulkens credits the Indiana Football Coaches Association as a whole for becoming proactive in recent years and adopting regulations to help lessen the incidence of head injuries.

In 2014, the coaches association drew up a set of guidelines for the IHSAA governing football practice contact, which prohibit full contact during the summer and on the first three days of preseason practice. Heading into the 2016 season, the associations also decided to limit the number of contact days during the season to two per week in an effort to lower the total number of hits players are exposed to during a season.

“Our coaches did a great job of accepting the fact that it wasn’t going to go away,” Faulkens said. “The Indiana Football Coaches Association took the lead in making sure that Indiana was ahead of this. Either you’re going to do it or somebody’s going to tell you how to do it, and our coaches felt that we’re going to do it the way that we think is best for us.”

Despite those safeguards, concussions are still going to happen in football and other sports. Housed inside the skull with only a thin buffer of fluid, the brain will crash into the skull after any type of hard contact. No amount of protective gear can prevent that. Football helmets were originally designed to prevent skull fractures, which they’ve done with great success, but no matter how many advances are made in helmet technology, they can’t get inside the skull.

But testing has evolved and trainers and doctors can now know with greater accuracy when an injury has occurred.

High schools use Immediate Post-Concussion Assessment and Cognitive Testing, which uses a preseason baseline test to establish an athlete’s normal cognitive function and then compares those results with those from tests given after a suspected head injury. The test requires athletes to answer a series of background questions and disclose the extent to which they feel certain symptoms, then runs through a battery of cognitive tests. Some will test memory by revealing a series of objects or colors and then asking the athlete to repeat the sequence; others test speed by alternating between shapes or colors and asking the athlete to hit a corresponding key as quickly as possible.

Some local trainers said that some students will try to intentionally get a lower baseline score so that a potential concussion might go unnoticed later. Trainers try their best to stress ahead of time the importance of taking the test seriously, but in the cases of those few who are unwilling to listen, the professionals feel they’ve been able do a pretty good job of spotting them and calling them out.

“You’re with the kids a lot,” Center Grove trainer Dave Buchholz said. “So you know how the athlete usually acts, and you can tell when somebody’s not right.”

Last year, after then-Center Grove senior running back Trevor Hohlt took a shot to the head that left him briefly disoriented during the state football game, he insisted he was fine to return to the game. But his performance in the sideline concussion test given by the Trojans’ training staff indicated otherwise. So Hohlt, an All-County performer who now plays at Ball State, was forced to watch the second half and overtime from the sideline. Center Grove wound up losing the game, 16-13.

It was a devastating moment for Hohlt at the time, but his perspective has changed since.

“Obviously, in the moment, I was literally trying to do everything to get back on the field, because I knew it was my last game as a high school football player,” he said. “So I was fighting it — I really wanted to go back out there and try to help my team win and everything. Probably a month after or so, I think I saw the bigger picture, and I realize that they were just doing it to keep me safe.”

A generation ago, it was common for athletes to go back into a game minutes after sustaining a concussion, and there were no rules in place to prevent them from doing so. Thanks to improved science and a greater understanding of the long-term impacts of such injuries, that mentality has been largely phased out and more safeguards have been established.

Local trainers have been pressured by parents — many of whom remember being able to play through “headaches” themselves — to clear their sons or daughters to return to action quickly.

“You just explain to them that, ‘Hey, we’re doing the best thing for your kid. You don’t have to like it, but this is what we think is right,” Franklin trainer Marcus Davis said. “Medicine has changed; we’re trying to do better for your kids than what you got.”

In the past, coaches might have pressured trainers into putting an injured player back in the game, but now are generally more aware of the risks of potential long-term damage.

“The coaches understand now, and I feel like they’ve evolved in that sense,” Edinburgh trainer Ben Bingham said. “If it’s an ankle sprain, they’ll ask, ‘Can you tape it? Can he go on that?’ But they understand that once I suspect a head injury, it’s out of their hands. I’ve never had a coach push me to get a kid through.”

Keeping an eye out

Fostering that sort of understanding among the athletes is important, and efforts to educate kids about the potential long-term damage from concussions or repeated hits have been increased in recent years. That doesn’t mean, however, that the message is always getting through.

“The biggest problem I run into with kids is sometimes they’ll take a hit and they know they’re not okay, but they won’t come and talk to me,” Crim said. “And I can’t see if someone has a headache or see if they’re feeling nauseous; those aren’t signs I can see.”

Students have become more understanding of the risks. Hohlt and most of his peers have come to realize over the years that a little extra glory on the field isn’t worth risking irreparable damage, he said.

“If you can avoid it, don’t mess with it,” he said. “Just trust the trainers.”

Caleb Spayd of Greenwood, a junior at Roncalli who plays for the South Stars hockey club, suffered a concussion in October and chose to sit out the remainder of the season. He once had dreams of trying to play hockey at the junior level or in college, but he’s re-evaluated his priorities after his injury.

“I’m more focused on school and the rest of my life now,” he said.

Crim said that athletes are policing their teammates more vigilantly, too.

“I’ve even had other players come up to me and say, ‘Hey, you need to go check on so-and-so; I don’t think they’re okay,’” she said. “That’s encouraging for me to know the kids are starting to get it.”

Trainers and doctors are trying especially hard to guard against second-impact syndrome, a potentially fatal condition that can arise when someone suffers a second concussion before the previous one has healed completely, which is why schools have become much more cautious about pushing athletes back into action too soon.

Crim tries to reinforce the seriousness of second-impact syndrome with Greenwood athletes, letting them know that it would almost certainly mean the end of their athletic careers — and could very well mean death.

At Center Grove, any athlete with a suspected concussion has to come to the training room every day and go through a 22-item symptom checklist, Buchholz said. The athlete grades himself from 0 to 6 on a range of symptoms that includes head and neck pain, balance, hearing and vision problems, confusion, drowsiness, irritability and difficulty concentrating or remembering.

Once the athlete is clear on each of those items, they can start working through a five-day return-to-play schedule. Day one can involve light activity such as riding on an exercise bike, walking or light jogging. On day two, their activity can have moderate intensity, including some light weight-lifting. The third day can include high-intensity activity without contact, and the fourth day can include contact in a controlled practice setting. On the fifth day, the athlete may return to competition.

“So everyone asks, ‘How long am I going to be out?’ “ Buchholz said. “And I say, ‘Until your symptoms go away, then add five days.’ So if it takes nine days for your symptoms to go away, then it’s a 14-day recovery.”

For trainers and doctors, the safety of the athlete will always be the top priority, but it’s still difficult to tell athletes what they don’t want to hear.

One of the hardest moments for Crim was last football season, when a freshman football player was told by the doctor that because of multiple concussions, it wasn’t safe for him to play anymore.

“That’s the hardest thing in the world to tell a kid,” Crim said. “But I think people have to understand, at 25 years old, you could still have a very long, healthy life. Instead, do you want to play football for another four years and have a shortened life span?”

Buchholz, who was on the Center Grove sideline when the decision was made to pull Hohlt from the state title game, echoes that sentiment.

“At the time we’re making the assessment, the situation is irrelevant,” he said. “But I’m human. I understand it’s a very important game and that kind of stuff, but I can’t compromise my principles and my training to appease somebody.

“If something drastic were to happen afterward and we were aware of it, it would be a really, really bad situation as opposed to hurting somebody’s feelings or making somebody upset.”

At a glance

The IHSAA has established a concussion protocol meant to guide schools through what to do when an athlete has sustained a suspected head injury. A look at some of the key points:

  • No student athlete should return to play or practice on the same day of suffering a confirmed concussion.
  • Any student athlete suspected of having a concussion should be evaluated by a health care professional that day, who can give the OK to return after confirming they do not have a concussion.
  • Any student athlete with a confirmed concussion or head injury should be medically cleared by a doctor before practicing or playing in a game. Players should follow a step-by-step protocol and delay their return if they experience any signs or symptoms.
  • If an official suspects that a player has suffered a concussion or head injury during a game, the official should notify a coach and ask that the player be examined and then file a report with the school.
  • An assigned IHSAA tournament physician’s decision regarding any potential concussion, or to forbid an athlete to play, may not be overruled.
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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.