Editor’s note: First of two parts on the problem of concussions.

On Maine’s playing fields and in amateur sports nationwide concussions are often viewed no differently than sprained ankles or sore muscles. It is a perception experts on concussions like Dr. Rubin Echemendia of Penn State say is dangerous – because it is so far from the truth.

The reality is concussions are among the most severe injuries. As Steven Ringle, president of the American Academy of Neurology, stresses: “Repeated concussions can cause not only permanent damage to the brain, but even death.”

Concussions have long been accepted as unavoidable injuries in sports. The brain can be damaged simply when it is shaken, as occurs with whiplash.

Yet only recently have doctors come to understand the full range of problems head injuries can cause, from the lingering symptoms caused by multiple concussions to the hidden troubles triggered by minor ones.

“Not too long ago in the NHL, if a player had a concussion it showed toughness. They had a headache and kept playing,” University of Maine trainer Charlie Thompson said. “They realize now with research that it’s a different thing.”

Concussions were long considered a condition of impaired functioning in the brain that followed a violent blow or impact.

A concussion suffered by UMaine running back Bert Rich shows this is not always the case.

When Rich was kicked in the head in the James Madison game this year, he suffered dizziness and amnesia. However, the blow that left him lightheaded was hardly violent.

“I had blurred vision, like when you wake up and get up too fast and you’re dizzy – it’s probably very similar to that,” Rich said. “It was one of my teammates who kicked me. I was surprised. I expected it would take a hard hit. Nobody noticed the hit. My teammate who kicked into me didn’t know it.”

When Rich came off the field after the change of possession, he expected to return. But one of his teammates noticed he was acting strange and told Thompson.

After a series of questions, Thompson decided to sit Rich. Later on, Rich’s condition got worse. He couldn’t remember the start of the game, so he sat for the rest of it – as well as the next one.

Recent findings on head injuries have led pro stars like former UMaine star and Anaheim Mighty Duck Paul Kariya to start wearing more protective equipment. Or some, like San Francisco 49er Steve Young, to consider retirement. Or others, like former NFL players Stan Humphries of the Chargers, Al Toon of the Jets, and Merrill Hoge of the Steelers, to end their careers.

Yet for all the publicity concussions have received of late, methods of evaluating athletes who have suffered them vary. Jerry Diehl, the liaison for sports medicine at the National Federation of State High Schools Association, said in high school sports, evaluation rarely involves a trainer.

In Maine, trainers say better ways to assess high school players with concussions are needed. Some coaches and players say enough is done. But beyond Maine, the cry for improved medical guidance grows louder.

Ringel urges adoption of guidelines for evaluating head injuries.

“Statistically, concussions occur more frequently on the thousands of amateur playing fields across the country, from high school football fields to Little League diamonds,” Ringel wrote in a September article for AAN. “Young males age 15 to 24 have the highest brain injury rates; most of these injuries are concussions.”

Part of the game

When Rich suffered his concussion, he knew what the signs were, because the Black Bear senior had one while playing high school football for South Portland. He felt dizzy, lightheaded, and had trouble remembering everything that had just occurred.

Rich said the experience was nothing to cause concern.

“It’s part of the game,” Rich said. “There are probably more now, with the strength and speed and size of players. The impact is greater. Improved technology is the only thing that would help [prevent concussions].”

Rich said he knows many players who have had one concussion and never suffered another. He likens the injury to pulling a hamstring, something that will happen once and never again.

Not true.

At Penn State’s psychological clinic, Echemendia has found that 50 percent of all ice hockey players who enter PSU and 40 percent of all incoming football players have already had at least one concussion.

The Columbia Sports Lab in Sugar Land, Texas, estimates that concussions in football account for almost 20 percent of all injuries.

According to AAN, in a given football season, 10 percent of all college players and 20 percent of all high school players sustain a concussion.

But the frequency doesn’t seem to bother some Maine high school coaches, who call the injury a minor one.

“I’ve never known anyone who had long-term bad affects,” Cony football coach Ralph Peterson said. “We had a boy two years ago who missed the whole season but he did come back and play the next year. He had one. It was a good one. There were no problems.”

Peterson remains mostly indifferent because he has seen care for concussions improve during his years of competition and his 16 years as a coach.

When Peterson was in high school in Massachusetts in the 1970s, a concussion evaluation involved smelling salts. And that was it.

Peterson recalls the time a star defensive back took a hit and came staggering off the field. He didn’t know what day it was. He was given smelling salts and went back into the game.

Peterson said the careless disregard coaches had back then carried through to college, as well.

“My best friend at Colby, he got knocked out in the first game of the year. I was standing next to him. He was talking gibberish,” Peterson said. “He was talking about Dairy Queen. He played for a while. Nobody knew anything was wrong with him.”

Gardiner two-way starter Vinnie LaVallee isn’t concerned, either. LaVallee believes high schools are taking every precaution by using improved helmets and having trainers at most games.

LaVallee has seen lots of concussions but doesn’t think it’s a dangerous injury – even after suffering one this year.

LaVallee still can’t remember what happened after he was hit, when he was helped off the field, or the next 15 minutes of the game. But LaVallee didn’t lose consciousness, so he isn’t worried.

“From what I saw on the film, I walked off myself,” LaVallee said. “I’ve gotten back quite a bit. The time I was treated on the field I don’t remember and I was talking to them the whole time. I did have a loss of memory. But I was always responsive. It wasn’t that serious.”

LaVallee didn’t finish the game, but was back at practice the next week and played in the following game. LaVallee admitted he was a little tentative in his next game. But after he took his first hit, he got back up and felt fine.

LaVallee sees no need for further care of concussions.

“It is part of the game. There is always a chance of getting one. If I had seven or eight that would be pretty bad. I’ve only had one,” LaVallee said. “I heard they get worse as you have more. But from the point of view in high school, every precaution is taken. To do anything else would take away from the game.”

Thompson and Echemendia agree concussions are part of the game. They worry that without greater understanding of the injury many concussions go unrecognized.

“We’re never going to prevent them. If anyone tells you that, they’re crazy,” Thompson said. “To have proper medical evaluation, though, is tremendously important. That is the bottom line.”

Difficulty in detection

If multiple concussions are forcing pro players to consider retirement, there is reason for concern at the college and high school level.

What is troubling for trainers and doctors are the concussions that go undetected. The danger of the unknown can be deadly and at high school the chance of concussions being missed is great.

“Certainly, there are two big concerns,” said Brewer High trainer Wes Jordan, who worked at UMaine for 31 years. “One is post-concussion syndrome… The other concern is second-impact syndrome where, if you return to competition too soon, the second impact is significant [and can kill]. It’s not as rare as we’d like to think.”

Jordan said the incident of concussions at the high school level are less than in college because players do not generate the same speed and force as collegians. The games are not as intense, there are less contact drills.

Many high school coaches share that belief.

However, Echemendia, whose neurological psychological test at PSU was adopted by the NHL, disagrees. He believes concussions appear to be happening less in high schools, but, in reality are happening more and going undetected.

“They exist in high school. The problem is they are not diagnosed because coaches are not educated on what a concussion is,” Echemendia said. “We are fighting the perception that they are not important.”

While Jordan felt more collegians sustain concussions, he agreed the injury goes undetected more in high school.

“Many schools don’t have a trainer,” Jordan said. “Someone gets in danger, the assessment is done by the coach or the assistant coach. They may lack the expertise of a physician or a trainer.”

Jordan estimates fewer than six to eight trainers work full time at the high school level in Maine. He said that needs to change.

As a part-time trainer at Brewer, Jordan said he can not fully evaluate athletes when problems occur. He doesn’t work in close contact with athletes. He is never on the practice field.

But even at the college level where every team has a trainer, minor concussions can be missed.

“Speaking as a trainer, there is no way for me to tell unless something is obvious,” Thompson said. “If [someone] doesn’t say something, I can’t tell if he’s had a concussion. He may have had his bell rung, he may be dizzy, a little disoriented. If you don’t detect it, how would you know?”

Jordan remembers the time a UMaine player made a clean tackle late in a game. The player came to the sidelines, sat down and looked fine. Nothing to cause alarm. At first.

“A few minutes later, one of the kids came over and said, `Fred is acting strange. He doesn’t know who he is or what’s going on,’ ” Jordan recalled. “He definitely had amnesia, even though he’d not lost consciousness.”

Modern medicine has only recently discovered how difficult it can be to detect concussions.

When former New York Ranger Pat LaFontaine suffered a concussion in 1996, it took a visit to the Mayo Clinic to determine the severity.

An earlier MRI had indicated he had suffered no brain damage. More extensive tests at Mayo showed he had suffered a bruise on the area of the brain responsible for personality – and that four earlier concussions had contributed to his depressed state.

Former NFL player Harry Carson said he learned about the long-term affects of concussions only after he suffered his 18th. Carson kept his mental degeneration secret for years out of embarrassment. Only recently has he disclosed his sharp mood swings, headaches, blurred vision and difficulty speaking.

When the AAN’s new guidelines for evaluating concussions were released this year they were endorsed by Carson and former NHL player Brett Lindros, both victims of post-concussion syndrome. The new guidelines were also adopted by organizations like USA Hockey and Pop Warner Football.

Still, coaches like Peterson are not worried. Peterson said helmets are better than they were when he was in high school, trainers are at most games and coaches teach players not to hit with their heads.

“You are going to have head contact, you can’t avoid it sometimes,” Peterson said. “I don’t know how much more we can do. You don’t not let people drive cars because they might get into an accident.”

Saturday, Part II: Decreasing the Danger.