Local football coaches say the game has been made safer over time as MU Health care aims to continue the protocol process

COLUMBIA, Mo. (KMIZ)

Local football coaches recognize that rules and protocols have progressed over the years to make the game safer, and MU Health Care aims to continue addressing the issue with the opening of a sports concussion clinic.

The center, which is now opened in Columbia, is designed to accommodate a patient as early as less than a week after their injury, to evaluate them, to address and diagnose their concussion, find out what further needs they have, and how to mitigate their symptoms and prevent long term consequences.

MU Health Care neurologist Komal Ashraf says, "It's really important that a person be supervised when they return back to play so it's not zero to 100 and they start playing right away. This clinic is going to allow for follow ups and supervision as a person does return back to play."

When someone takes a hard hit to the head, the brain bangs against the skull which bruises the brain and causes a concussion. "When that happens and there's injury to brain cells, we also see that there's a chemical response that causes more inflammation, and more pain and sensitivities, and a recruitment of other cells to kind of clear up the damage, which can also in a sense indirectly set off a cascade of injury to the brain," Ashraf said.

Football teams across the area say their head injury protocols start even before the season. "There's basically a pretest so before the season starts to get a baseline, we ask the kid a whole bunch of questions, see where they're at and then once the season goes on, if a kid gets any type of questionable head trauma, they're able to go back and look at these questions, ask the same ones then compared to see how the kid did," said Hickman head coach, Cedric Alvis.

Changes have been made to the game, as of 1996, the NFL implemented a rule change that banned helmet-to-helmet hits initiated by defenders when their helmet is targeted at the head of an offensive player.

Players can now be ejected for a helmet-to-helmet hit. "Any athlete that's the worst thing that can happen, not being able to play. So when you see these dudes that are being rejected, and are not able to play then that kind of resonates with people, it means a lot more when you're not able to go out there and suit up," Alvis said.

Ted LePage, head football coach at Blair Oaks, said there has been change between football now and when he played growing up. "It used to be give them an aspirin, put a bandaid on and go back to work," LePage said.

"Some may argue that the new rules take away from the sport and the game, but we also have to consider the longevity of brains, the production that a person might have in society and what might happen to that if they have repeated and recurrent head injuries," Ashraf said.

Ashraf also said that technology and leagues are always trying to make their equipment better, make education better, and make intervention and evaluation faster, but on the other hand she said it is part of the nature of the game.

"I think it's impossible to say you're going to remove concussions completely, but to minimize them and do better and just educate people on what can happen once you get a concussion is the most important thing," Alvis said.

LePage also said harder hits happen more often in today's game of football.

"In the 80s, we played football in about an 11-yard box and what I mean by that is there wasn't a lot of the field being used. Everything stayed inside. So the hits weren't as big and dramatic," LePage said. "I called it blunt force, you just ran in about a three or four yard area and you make contact there. As this game's advanced, there's the whole length of the field and the whole width of the field that people are using now, so there's a lot more opportunity for people to run at each other, with further distances away there's a lot more force than what used to be."

The understanding of concussions and chronic traumatic encephalopathy (CTE) has evolved over the past several years and helmet designs are now just starting to catch up with the research.

Helmet designs are now made specifically to protect against concussions after research found that most concussions were caused by hit impact to the side of the head or jaw.

Alvis said part of the helmet progression is the transition of sizing. He said it used to be players would get a helmet size (small, medium, or large) but now helmets are made for specific heads. "What size head do you have? What kind of head do you have? What's the shape of your head? Those are all the questions that we have to ask before we can get them, and this is to alleviate pressure on certain parts of the head."

Not only have helmets advanced, but LePage said one dramatic change in safety has been in crack back in the cheap shot blocks behind the scenes. "On special teams, it used to be we used to work around a big wall return and we would catch guys blindsided and it was part of football and I hate to admit we applauded it. It was an exciting time now when you really look back at it, you're like, that's not safe," LePage said.

LePage says coaches need to take proactive steps on their own against supporting helmet-to-helmet contact. For example, he said at Blair Oaks if a coach sees somebody take a cheap shot or use their head at practice, they eject them from practice, just like what would happen in a game.

Alvis said Hickman takes steps at practice of teaching hawk roll tackling. "We take the head out of it, we teach to go low at the legs, the head is always aside from the body, we never go head to head," Alvis said.

At the end of the Blair Oaks season, starting quarterback Dylan Hair was taken from the game in an ambulance after suffering a head injury. LePage said Hair started 39 games, and he's never seen him take a hit like he took that night.

LePage said when Hair went down, protocols began. "First of all, what's your name? Where you located at? What just happened? What's the score the game just things to see if they have it," LePage said. Dylan answered a lot of those questions correctly, but when he sat up he was asked, "Do you feel your fingers, your toes? He said no, they're numb so that's when we laid him back down to extra precautionary situations and that got scary."

Hair took three weeks to recover from the concussion and returned to the basketball court on Tuesday.

Once a player is diagnosed with a concussion it also takes several steps to get them back on the field.

"It's a seven day protocol that you have to go through," LePage said. "The first day you do like 15 minutes of very light conditioning. Then, you go to second base then you each day you work back into it. After the seventh day, whoever is doing the protocol, either the athletic director of the trainer, they have to sign off that they cleared all of that and then you start to work them back in a progression of practice."

Although advancements in the safety of football continue to be made, coaches say things can still be done to decrease the number of concussions that are happening each season.

"I think we still need probably another official on the field. I've seen the helmet the helmets very often, and it gets missed because with only having five officials on the field it's hard to see with the amount of speed that goes on in the game," LePage said.

Ashraf says there's no resource like this clinic in the region. "We would hopefully be able to address the needs of the community as far east as St. Louis, as far west as Kansas City, North as the southern Iowa border and also up to the North Arkansas border," Ashraf said.

Players are advised to see a doctor as soon as they develop any of these problems:

• headache
• dizziness
• feeling sick or throwing up
• difficulty with coordination or balance
• blurred vision
• slurred speech or saying things that don't make sense
• feeling confused and dazed
• difficulty concentrating, thinking, or making decisions
• trouble remembering things
• feeling sleepy
• having trouble falling asleep
• sleeping more or less than usual
• feeling anxious or irritable for no apparent reason
• feeling sad or more emotional than usual

Anyone who would like to schedule an appointment at the facility can contact MU Health Care at 573-882-2663.