By Alex Zdatny and Emily Klingman
Head Athletic Trainer Tim Lengle has 90 seconds to make a decision that could change a student athlete’s career. Everyone in the room is on edge as they watch the examination at the edge of the wrestling mat. Lengle makes the difficult call: The athlete is out of the match. Even though the wrestler said he only felt a little dizzy, the trainer couldn’t send him back on the mat with a likely concussion.
As illustrated by the NCAA’s proposed settlement in a class-action lawsuit, concussions are becoming an increasingly visible issue in college athletics. As student athlete concussions are brought to the forefront of universities’ priorities, increased pressure is being put on the athletic staff to be 100 percent correct in their diagnoses. The problem? They’re asking the impossible.
“Every patient and athlete feel pain differently depending on the side of the brain, so there have always been different opinions on how to diagnose a concussion,” Lengle said. “Almost all the data that we have to manage them is subjective. It’s going to be different from athlete to athlete, patient to patient.”
Lengle explained that the reason concussions are beginning to attract attention in the media is because more athletes are playing college sports and there is an increase overall in sports participants nationwide.
“Concussions occur more now than they did before probably because the number of exposures have increased,” said Lengle. “The number of competitors and the number of times they’re practicing per week has just gone through the roof.”
Of Rider’s 375 varsity athletes across 20 sports, Lengle estimates 15 to 20 percent suffer from concussions every year. In the 2014-15 academic year, Lengle has already had eight or nine athletes who have experienced concussion symptoms.
In a university without NCAA football, which according to the Sports Concussion Institute is the most common sport with concussion risk, that may be an eye-opening statistic. But Lengle believes it would be far higher if Rider had more collision sports.
“We don’t have a true collision sport like football, or men’s lacrosse, or ice hockey,” Lengle said. “We have a club team for ice hockey but that’s not a collegiate team. We do obviously have contact sports, but if you have a football program, or a men’s lacrosse program, or an ice hockey program, you’re going to be dealing with a lot more concussions.”
At Rider, the greatest danger of concussions occurs in wrestling and men’s and women’s soccer.
Where the injury is located on the brain can lead to varied symptoms. There is a wide range including dizziness, fatigue, irritability, and depression. A hit to the front of the brain can manifest different symptoms than a hit to the side of the brain.
However, sometimes, concussion symptoms don’t manifest themselves until the next day and it can become a difficult diagnosis, so different precautions can be taken to measure the brain activities to determine how severe the concussion is.
Concussions are also hard to diagnose in the medical community due to the fact that medical professionals have different definitions of a concussion. However, Lengle said many researchers and doctors are trying to come to a consensus.
“The diagnosis is questionable even within the medical community,” Lengle said. “They’re getting together now and are trying to put that all together but they can’t seem to agree on everything.”
Nonetheless, this data will hopefully lead to better research on concussions. Figuring out exactly what conclusive data experts are agreeing upon becomes another factor in managing concussions. Return-to-play procedures differ depending on which expert is being asked and which research is being consulted.
“It’s very difficult for someone in my position who is trying to consume all of this research and create a protocol to use at this university,” said Lengle. “If the school were to be sued, all a lawyer has to do is find the expert that I didn’t listen to.”
Athletes who suffer from a hit to the head and possible concussion are at risk for further damage. Even if the athlete might not get diagnosed with a concussion right away, multiple blows to the head could cause either Post-Concussion Syndrome (PCS), which according to Mayo Clinic, is a complex disorder in which various symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the concussion, or Secondary Impact Syndrome (SIS), which according to BrainandSpinalCord.org, enhance the vulnerability of the brain and greatly increase the risk of death, even if the second injury was far less intense.
There are multiple computer programs that athletic trainers use on athletes involved in concussions, including a series of tests, that are first taken by freshmen to provide baseline measurements, Lengle said.
“Athletes first take the neuropsychological test, which was developed at the University of Pittsburgh Medical Center,” Lengle said. “If they pass, they can move on to the next level that involves memorization, numbers, and reaction time.”
Once the athlete scores baseline or better, he or she moves on to the balance error scoring test (BESS) which tests balance that must be maintained for 20 seconds. After the BESS test, the athlete would move onto two exertion tests, one that tests the athlete’s strength activity to see if the symptoms have increased or decreased, and another that includes taking the athlete on the field where they are exerted to the point of exhaustion, worse than a practice. If the athlete passed that test, they move on to the Vestibular Ocular Exam (VOE), which involves the ears, eyes, and balance system, Lengle said. Activities such as focusing on the thumb for a long period of time will allow athletic trainers to see if their symptoms have vanished.
Athletes could experience a great range of symptoms such as nausea, trouble sleeping, vomiting, sensitivity to light and noise, irritability, and sadness, Lengle said.
“Six or seven years ago, one of the wrestlers who would never admit in his life that he was sad or depressed, experienced it and ended up having symptoms lasting two months with no motivation to get out of bed,” Lengle said.
He explained how parents and eager athletes often ignore the dangers of concussions.
“A lot of times the parent is the one putting pressure on the medical professional to let the student go back early, and that’s an unfortunate circumstance,” Lengle said. “A lot of times student athletes won’t come to us and roommates or teammates will come to us instead.”
The settlement between the NCAA and athletes suing the organization that is still in the Chicago court is proposing $70 million to be put in a fund to allow student athletes in the NCAA Division I, II, and III in the last 50 years to be eligible to enter a concussion observation program, which includes physical examination, neurological measurements and neurocognitive assessments.
“They’re not going to pay for anybody’s medical bills,” Lengle said. “They are going to follow them, and study them.”
Numerous colleges and universities have taken the NFL’s finances for concussions in perspective and wondered if $70 million was enough compared to NFL’s $375 million that also includes treatment and paid back medical care for players who can prove their injury was concussion-related, Lengle said.
Overall, however, better concussion testing and diagnosis will only benefit the coaches and teams. It will allow them to have more athletes on the field and cause less risk to the health of young student athletes.
“I think there are very intelligent coaches out there who see this and make very good decisions about how to further protect the student athletes and in the end it only benefits them,” said Lengle.
Additional reporting by Alexis Schulz and Thomas Albano