Concussion concerns are changing football, but it's still hit and miss

Football's head-jarring hits appear to be coming as fast and furious as ever.

Despite media scrutiny, congressional hearings, rule changes and a focus on helmet technology, the National Football League's 2010 season featured a record number of reported player concussions, including several to high-profile starters.

The difference: While hard-core fans still might be high-fiving those hard hits on the highlight reel, the NFL has started slapping massive fines on those issuing the punishing blows. And NFL executive vice president of football operations Ray Anderson warned midseason that suspensions were a possibility for especially flagrant hits.

"Players and coaches need to know that accountability is elevated, and we're not going back," Anderson told the NFL Network's Fran Charles in October.

There's a heightened consciousness on the college level, too. University of South Florida coach Skip Holtz said research about the long-term risk of concussions has completely changed how football coaches think about the game.

"We have just taken a much stronger stance on caution with the student athletes today than we have in the past, because we know so much more about it and are much more educated," he said.

While many say the college and pro response is merely meant to mitigate the public finger-wagging, others say it shows an increased understanding of the serious and long-term health risks associated with concussions and other repeated hits to the head.

Unfortunately, that awareness hasn't trickled down fast enough to the high school sidelines, where players and some coaches remain reluctant to report a possible head injury, says Jeff Konin, executive director of the Sports Medicine & Athletic Related Trauma (SMART) Institute at the University of South Florida.

Konin, one of several athletic trainers assigned to monitor the sidelines in Hillsborough and Pasco counties on Friday nights, said little has changed despite the attention and a national high school officials' rule urging referees to remove players if they exhibit concussion-like symptoms.

"It's not making a difference in coach behavior or parent behavior," he said.

An estimated 1.1 million high school students play football in the United States each year. About 55,000 of them will receive a blow that causes a concussion, data show. That total doesn't include players with sub-concussive hits that often go unreported but carry significant risk.

Diagnosing brain injuries is difficult in any situation, but it's especially tough on the sidelines of a high school game, where there may not be anyone trained to assess a player's mental well-being. Inconsistent rules for dealing with head injuries can compound the problem.

For example, in Hillsborough and Pinellas counties, players identified with a concussion by a trainer, coach or a referee can return to play only after receiving a doctor's clearance. In Pasco County, any medical official -- including an athletic trainer -- can clear a player to return to the field.

Leto High head football coach Mike Jalazo said athletic trainers are critical to identifying head injuries in games and, more importantly, in practices. But Leto doesn't have a full-time trainer assigned to the school.

"It's about health and safety for our players. When you don't have trainers at every school, you're asking coaches to try and diagnose injuries, which none of us are qualified to do that," Jalazo said. "If we misdiagnose concussions, we're putting a kid in harm's way, where their future could be in jeopardy."

Gianluca DelRossi, director of USF's Concussion Center, said the cry for more trainers is a sign that prep-level coaches, parents and fans are getting educated.

"I like the direction we're heading," he said.

Changing attitudes - and behaviors -- regarding head injuries will take a lot longer than one season, DelRossi said. He pointed to several local and national signs of a shift, including an ongoing USF study tracking concussion risks of football players at Tampa's Berkeley Prep.

On the national level, a growing number of athletic and medical organizations have announced support for new policies or practices. Notably, the NFL and the National Athletic Trainer's Association (NATA) this month announced a joint effort to implement state concussion prevention laws.

Judy Pulice, NATA's manager of legislative and regulatory affairs, said the groups support standards similar to a law implemented in Washington state. There, players with concussion-like symptoms must be removed from a game or practice, and may return only after a health care professional trained to evaluate concussions says they are OK to play.

Efforts to submit a concussion prevention bill are under way in Florida, said Stephanie Lennon, president of the Athletic Trainers' Association of Florida. She said the bill would include high school and youth sports such as club soccer and Pop Warner football.

Pop Warner, the nonprofit that provides football programs for more than 280,000 children through grade 8, already made its own changes last month. The organization announced it will require a doctor's written clearance before players with head injuries can return.

The most important change, DelRossi said, will come from players, who must juggle the desire to be a fierce competitor with the call to make cleaner, safer hits that don't involve the head. DelRossi said he's not sure today's high school, college and pro players know how to do that. "Do they really understand the consequences?" he asked.

USF freshman wide receiver Terrence Mitchell knows firsthand the danger of concussions; he was hospitalized after being knocked out during a game in his junior year at Hillsborough High.

But it's not something he dwells on, and just one of his teammates knows it happened. A player can't change the way he plays, despite the dangers involved. 

"It was a bad incident, but I got over it," Mitchell said. "It hasn't changed the way I am as a player. I still put my head in there."

Mitchell, like most players, understands that football is violent and dangerous.

"You can't play football scared," he said. "I play every down hard and rough."

DelRossi understands that gladiator mentality, and he knows students and their parents will always be obsessed with the allure of a college scholarship and NFL fame.

But maybe, if the fundamentals of the game are taught differently from the start, the sport might someday be able to reduce the risk of head injuries, he said.

"Maybe we can't make changes with the kids playing now," he said. "But we may be able to make an impact on Pop Warner or the new generation of players."