Minnesota's high school athletes suffered about 3,000 sports-related concussions in the past school year, with nearly half of them involving football players and one in 20 resulting in severe symptoms that lingered for more than two weeks, according to a first-ever tally by the state Department of Health.
The figures, released Thursday, are a starting point as Minnesota researchers seek to identify the ages and types of athletes most susceptible to concussions and most in need of awareness about the risks and symptoms of these traumatic brain injuries. "To protect our young athletes, we need appropriate equipment and training on sports techniques," said Dr. Ed Ehlinger, state health commissioner. "We also need to focus on building awareness among athletes, parents, teachers, coaches and health care providers about the warning signs of brain injuries."
The statewide tally of 2,974 concussions from August 2013 through May 2014 was a projection based on 730 concussions diagnosed by athletic trainers at 36 Twin Cities-area high schools.
While the number of concussions was highest among football players, that was partly due to the relatively higher number of players. The rate of concussions in high school football was comparable to the rate for boys' and girls' hockey — around six concussions per 100 athletes.
Rates of concussions were three to four times higher for girls than boys participating in basketball and soccer. Ehlinger said that matches studies nationally showing higher rates of concussions in female athletes in sports played by both genders.
The reasons are unclear, but could have to do with female athletes having less muscle strength in their necks and being more susceptible to concussions, Ehlinger said. Concussions result when a blow to the head or body causes the brain to rattle against the inside of the skull, and can cause a variety of cognitive and memory problems that can last only a few days or linger for months or years.
Taylor Bickman, 19, was leaping for a rebound in a fall 2012 game for her high school team in Randolph, when an opponent's elbow struck her head and sent her tumbling. The ensuing headaches and trouble concentrating soon made it clear she needed to see a doctor.
"It was really frustrating for me," she said. "It was my senior year."
Bickman missed half the season, trying to pass cognitive tests that would give her permission to return to basketball. She continued going to classes, but occasionally had to leave school with crushing headaches. She would lie at home with no noise around her and the lights off.
Now in her second year at Inver Hills Community College, Bickman said she made the right choice slowing down and taking the time away to heal. She still suffers severe headaches that she links to the concussion, though, and isn't surprised at all to learn that girls' basketball has a high injury rate. "It's a physical sport," she said.
The good news is that 95 percent of Minnesota high school athletes recovered from their concussions within two weeks. That is better than findings in national studies that only around 80 percent of concussed athletes recover that quickly.
The optimistic view is that Minnesota school officials are more diligent about holding students out of sports and classroom activities until their brains have healed. Concussed students often report a variety of symptoms that range from forgetfulness to headaches to sensitivity to noise and light.
"We don't have the hard coaches who say, 'Aw, it's nothing. Get back in there,' " said Lori Glover, director of rehabilitation for Fairview's Institute for Athletic Medicine.
However, the higher recovery rate might be due to the fact that Minnesota collected data on concussions from athletic trainers. Researchers elsewhere have collected data from hospital emergency rooms, which presumably means the injuries are more severe.
Education and training
The concussion figures were sought by Minnesota legislators following the passage of state rules in 2011 requiring coaches and referees to complete training in concussion detection and management, and requiring concussed athletes to be cleared by medical professionals before returning to competition. The return-to-play standards were imposed in part to prevent athletes from shrugging off these injuries and suffering second concussions while still recovering from first ones — because of the data showing that those second injuries can lead to long-term thinking problems and brain damage.
"When I was in high school playing competitive sports, we just shook it off and tried to get back on the field as quickly as possible," Ehlinger said. "We now know concussions have a significant medical impact."
State officials were surprised to find a variation by grade level in the concussion data. Among the 730 actual concussions, the number peaked at 219 in 10th grade and then declined to 181 in 11th grade and 139 in 12th grade. It's possible there are simply more sophomores than juniors and seniors involved in high school sports — state officials didn't have a breakdown of athletes by grade level for the study — but younger athletes also could be more vulnerable, said Sarah Dugan, an injury prevention specialist at the health department and leader of the concussion study.
"Athletes who are younger might be getting hit more often," she said. "They may be the smaller players" who take the brunt of collisions with bigger upperclassmen.
State officials hope to address that in future years as they continue to collect concussion cases from high school athletic trainers and expand the effort statewide.
Jack Welter suffered a concussion as a freshman wrestler for Eden Prairie High School in late 2011 — probably during a meet when he was slammed to the mat — but neither he or his parents recognized it until days later when he reported dizziness. His coach pulled him out of practice.
His mother will never forget the trip to the doctor when her son was asked to recite the months backward.
"December, November … February, June."
"I felt awful," Diane Welter said, "because I didn't recognize that anything was wrong. But then you get into the doctor's office and his recall just is not there. It's pretty scary stuff."
Welter was able to remain in school but was held out of sports and kept off video games and television, which can aggravate concussion symptoms. By spring 2012, he had his months down again. He is preparing to return to wrestling this winter for his senior year.
His mother is grateful her son's concussion didn't linger and that his coach was smart enough to detect it.
"It doesn't take a lot," she said, "to get a concussion."