Concussions a game changer - Omaha.com
Published Sunday, September 29, 2013 at 12:30 am / Updated at 2:05 pm
Concussions a game changer

Scott Wineman, a junior running back/linebacker for Lincoln Lutheran, gets ready for the first football game of the season against Omaha Concordia on Sept. 6 in Omaha. Wineman has had three concussions, and one last year cut his season short. PHOTO BY MATT MILLER/THE WORLD-HERALD


STAYING IN THE GAME

Three concussions later, high school football player won't stop

By Henry J. Cordes / World-Herald staff writer

Under the glare of Friday night lights, Lyn and Neil Wineman of Lincoln sit atop metal bleachers as their son roams the field, absorbing and delivering the bone-jarring hits that are the very substance of football.

As with most any parents, the Winemans are a complex mix of pride, excitement and anxiety as they watch Scott play for his Lincoln Lutheran High School team.

But the Winemans' anxiety level might well be heightened compared with that of most parents. Because in years past, Scott Wineman has suffered at least three concussions.

That includes one concussion that racked him with raging headaches that no amount of ibuprofen could tame; a concussion that sapped his powers of concentration so much that he never made it through a full day of school the rest of the year.

Despite Scott's burning passion for football, his parents sometimes wonder whether they're doing the right thing by letting the 16-year-old play.

"It's still terrifying,'' Lyn Wineman said. "One of the hardest things was explaining to his grandmothers that we were going to let him play again.''

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Today, it doesn't take a history of concussions for a family to talk seriously about whether a kid should be playing football. The popular sport faces a fog of uncertainty amid fears the invisible injuries could permanently alter young lives.

Some even suggest the sport's very future is threatened.

In reality, despite the furor, little has been proven when it comes to the long-term consequences of concussions.

Nonetheless, the spotlight on concussions has spurred overdue safety changes on and off the football field, ending years of inattention that raised the risk of serious injury for football players like Scott Wineman.

To learn more about the potential danger to the millions of boys and young men playing football — including the thousands in this football-crazy state — The World-Herald recently explored the latest science on football and concussions.

Driving much of the concern in recent years has been research that has linked multiple concussions to a serious degenerative brain disease that causes permanent cognitive decline. Autopsies of dozens of former players — including a few who never played beyond high school — have revealed chronic traumatic encephalopathy, a disease commonly referred to by its initials, CTE.

What's more, there's mounting evidence that the merely routine hits football players take every day in practice and games — "subconcussive blows,'' researchers call them — can accumulate to cause subtle impairment to brain function.

"Football, while I wouldn't say it's in great jeopardy, is not in a very comfortable position right now,'' said Tom Osborne, the legendary University of Nebraska football coach who remains one of the game's most respected names.

But while there are legitimate concerns about the long-term consequences of concussions on the football field, there is also surprisingly little verified science behind it to date.

For every autopsy that has linked a former football player to CTE, thousands of other players have lived full and productive lives without signs of unusual cognitive decline. That suggests it takes something more than just big hits on the football field to trigger the disease.

And research into subconcussive blows is also really just beginning. The long-term consequences of the small changes in brain function that have been observed are unclear. Even those involved in concussion research say scientists are still a long way from proving that hits from football cause serious and permanent brain dysfunction.

"The bottom line is we just don't know,'' said Dennis Molfese, a reknowned psychologist who runs the University of Nebraska-Lincoln's Center for Brain, Biology and Behavior.

Given the unanswered questions, it's arguable the long-term risks of football have in some ways been overblown. But it's also beyond debate that the recent attention has put needed focus on injuries that for too long were considered "just part of the game.''

Scott Wineman follows his blocker in the first football game of the season against Omaha Concordia. PHOTO BY MATT MILLER/THE WORLD-HERALD

Nearly all contact sports have undergone a sea change in recent years when it comes to concussion awareness and treatment, spawning dramatic reforms in the way concussions are diagnosed and managed. Sophisticated memory and attention tests are now commonly used in high schools and colleges to help determine whether athletes have suffered concussions and when it's safe to return to the field.

The days of young athletes rattled by a big blow returning to play in the same game are largely over. In fact, in Nebraska, Iowa and many other states, it's now against the law.

"Telling a player to 'suck it up' or 'shake it off' — we don't do that anymore,'' said Rusty McKune, who coordinates the education program for athletic trainers at the University of Nebraska Medical Center.

There is also much promise for further reducing brain trauma through improvements to helmets and equipment, further rules changes, limits on contact in practice and improved detection and treatment.

Researchers at the University of Nebraska-Lincoln are among those at the forefront, looking for answers. One of the things the university's Center for Brain, Biology and Behavior hopes to develop in its new lab beneath Memorial Stadium is a new sideline test that would utilize state-of-the-art brain imagery to help trainers quickly spot a concussion.

As the science continues to evolve, there seems little doubt concussions will continue to be a game changer for America's most popular spectator sport.

Football and concussions have always gone together — not surprising in a game where the ability to deliver, and take, a big hit is a badge of honor.

To players, a concussion has long been referred to as "getting your bell rung'' or ''getting dinged.'' The nonchalant mindset is perhaps best summed up in Osborne's description of how concussions were typically handled during much of his time in the game.

"If you came off the field and your knees buckled and you were disoriented, usually someone would talk to you and hold up a certain number of fingers or ask about your age,'' Osborne said. "And if you could come up with the answer, or reasonably close to it, you'd be sent back into the game.''

Statistical studies support the notion the injury is common in football. University of North Carolina researchers in 2000 estimated that one in 20 high school and college football players suffers a concussion in a given season. And those figures almost certainly don't capture all concussions, as players may be reluctant to reveal their symptoms to their coaches, trainers or parents. Clearly, for those who play football over a number of years, the odds of suffering a concussion at some point are high.

"If we were really able to find out how many times football players get hit in the head and feel funny, I think we'd find the numbers are astronomical,'' said Chris Nowinski of the Sports Legacy Institute, a Massachusetts-based nonprofit that has been sounding alarms about concussions in football.

NU officials would not release statistics on concussions suffered by university athletes. The Nebraska School Activities Association does not collect data on concussions involving high school athletes. But estimated national rates would suggest more than a half dozen NU football players and more than 650 Nebraska high school gridders suffer concussions in any given year.

It's not known whether concussions in football are more likely today than in the past. But as football players have grown bigger and faster, so has the power behind their hits. One physicist estimated such forces have almost doubled in the past century.

"Football is a violent game, which is why we love it so much,'' said Tim Gay, a UNL professor known for his studies on the physics of football. "And when you play football violently, there are going to be physiological consequences, including concussions.''

The current consensus among medical professionals, however, remains that the headaches, dizziness, fogged memory and mental impairments that come with a concussion are nearly always temporary, particularly as long as the brain is given time to heal. Most athletes who suffer a single concussion are free of all symptoms and recover normal brain function in about a week.

The bigger issue posed for a sport like football that's built on human collisions is the potential for repeated concussions. Those more frequently result in symptoms and impairment that can persist for weeks or months.

What's more, in very rare cases, suffering a concussion after a previous concussion hasn't healed can result in catastrophic brain injury, even death. Nationally since 1961, more than 300 high school, college and youth players have died and some 150 others have been left disabled by brain injuries. Nebraska has had at least nine documented cases since 1995 that resulted in lasting disabilities for players.

For reasons that aren't clear, those risks for years failed to produce much reform in how concussions were handled on football sidelines.

It took several high-profile suicide cases involving former National Football League stars to finally put a spotlight on concussion risk. Those deaths in 2009 led to research at Boston University that tied football to CTE, a disease previously linked only to boxers.

That research has left a cloud over the sport that continues to make headlines. The NFL a month ago settled a lawsuit with former players who said the league hadn't done enough to protect them from head injuries. The NCAA faces two similar suits, one filed just weeks ago.

"I think there's a legitimate cloud over the sport,'' Nowinski said in an interview on the day of the NFL court settlement. "No one should have to trade their neurological health for a game.''

The research has also ushered in wide-reaching changes to football, at all levels. Rules changes have sought to reduce the speed of collisions on kickoffs and increase penalties for hits to the head. And nearly all suspected concussions receive much scrutiny in football today.

It's also not uncommon now for players who suffer multiple concussions to make the difficult choice to walk away from the game.

NU's Blake Lawrence intercepts a Clemson pass in the Gator Bowl on Jan. 1, 2009, in Jacksonville, Fla. PHOTO BY MATT MILLER/THE WORLD-HERALD

Blake Lawrence, a former hard-hitting linebacker at Nebraska, didn't think much of the two concussions he suffered as a Cornhusker in 2008. That included one that left him so dizzy he botched a call from the sideline and directed half the defense the wrong way.

Then in the spring of 2009, he suffered a third concussion. That's when Husker coach Bo Pelini took him aside.

"If you were my son,'' Pelini told him, "I wouldn't let you play anymore.''

The Kansas native realized then how serious this was. After suffering a fourth concussion the next fall — on a hit so minor, he couldn't believe it — Lawrence, too, decided he was done.

He went to see the trainer and then turned in his helmet.

"It was very difficult,'' he said. "But it kind of clicked in my mind. I had to protect myself.''

So what is the future of football? Clearly, if more and more parents decide the game is not worth the risk for their kids, its future is in doubt, Nowinski said.

"If they don't sign up when they're 6,'' he said, "do they show up when they're 14 or 16?''

But he and others note that the game has been threatened — and has evolved — before. More than a century ago, the deaths of 18 youth, high school and college players in a single season had many calling for the brutal sport to be banned.

Instead, President Theodore Roosevelt convened a panel in 1906 that pushed for rules changes and reforms, including the formation of the organization that is today's NCAA.

Most who study concussions and those close to the game say they're optimistic that with continued progress in addressing concussions, it will ultimately be possible to preserve the rugged ethos of football while also protecting the lives — and brains — of those who play it.

"The sport of football is so ingrained as an American pastime, it's difficult to imagine football not being part of our lives,'' Lawrence said. "But football as we know it is going to change.''

* * * *

Despite having suffered three concussions, Scott Wineman plays on.

But it's not as if he or his family takes a concussion lightly. Quite the contrary. They know from experience what a serious and debilitating injury it can be.

That the 16-year-old junior at Lincoln Lutheran High School remains on the football field is a testament to the body's ability to heal, today's improved management of concussions, his family's faith and support, and the power football holds over the young men who play the game.

Wineman doesn't remember the play in which he received his first concussion, a little more than four years ago. Nor does he remember anything that happened right after the first-quarter hit — even though he played for the rest of the game.

Wineman was a seventh-grader when a big, strong player on the other team got a forearm beneath his chin and sent him flying backward. He landed hard on the back of his head. He writhed a bit, but soon he was back on his feet.

For the next few plays, it seemed Scott didn't know what he was doing. He missed a couple of assignments, and his coach pulled him. His parents watched from the bleachers as Scott relentlessly begged his coach to put him back in the game.

After sitting out for a short time, he did return, and he played until the final whistle — but not before hitting his head a second time when he was grabbed by the shoulder pads and pulled down from behind.

After the game, a coach sought out Wineman's parents.

"Scott got hit pretty hard, but he still remembers his phone number, so I don't think he has a concussion,'' Lyn Wineman, Scott's mom, recalled the coach saying.

The Winemans don't blame his coaches for not being more aware of what had happened. They were caring and compassionate coaches, Lyn Wineman said. There just wasn't as much awareness about concussions back then.

Neil Wineman (first row) and Lyn (second row, green sleeves) watch their son play on Sept. 6. PHOTO BY MATT MILLER/THE WORLD-HERALD

Scott's first memory after that game is riding in the car with his parents. He realized then that he couldn't remember anything that happened during the game. His parents became concerned enough that they called Scott's doctor and headed for the hospital.

An X-ray revealed a shocker: Scott had suffered a neck fracture. He'd been lucky, really. A more severe break could have been paralyzing. He was fitted for a neck brace.

His neck healed in about two months, and by all accounts he should have been fine.

Except he wasn't. From day one of his injuries, Scott started and finished each day with severe headaches. The kid who had always been an A and B student now had to be prodded to do his homework. He couldn't focus. And he would often go through erratic mood swings.

His parents finally figured this wasn't some kind of teenager phase.

He ended up in the brain injury program at Lincoln's Madonna Rehabilitation Hospital. It turned out that in the focus on Scott's serious neck fracture, the possibility he had suffered a concussion had been lost. In fact, it was thought he had suffered two concussions during that game. That would help explain why instead of clearing up in a week or two — as is typical with concussions — his symptoms persisted.

Testing at Madonna revealed Scott was unable to maintain his concentration for long periods of time. He took a mental acuity test and scored 94 percent. After several hours of rigorous mental activity, he was tested again and scored 4 percent.

"By lunchtime each day, he was toast,'' his mother recalled.

For the rest of that school year, Scott took regular breaks during the school day — resetting his brain, they called it — and also left early.

A summer break without schoolwork taxing his brain was a big help. In the fall, he stayed away from football and joined the cross country team. The physical activity also seemed to help heal his brain. Scott's schoolwork was back up to par, and he was feeling like his former self again.

Except for one thing: He really, really, really missed football.

In eighth grade, Scott ran cross country and track and even wrestled, a sport that carries its own concussion risk. But it wasn't the same.

Since first grade, football had been his game. He loved the camaraderie with his teammates. The weekly gladiatorial combat. The discipline and life lessons it all teaches. After more than a year without football, he wanted badly to play again.

His parents were sure Scott's football days were over. But they spoke with his doctor at Madonna, and the response surprised them.

Part of my job, his doctor said, is to get Scott back to doing the things he likes. He shouldn't live in fear.

All kinds of stipulations were imposed, but as a high school freshman at Lincoln Lutheran, Scott strapped a helmet back on his head.

His mother will never forget his first game back, in the fall of 2011. She was scared to death. But the freshman got in for a couple of plays late in the game and things went fine, as they did the rest of the season. Scott was ecstatic. His parents breathed sighs of relief.

Then, just before the start of his sophomore season, a year ago, Scott was horsing around with friends at a lake and hit his head on a dock.

It didn't seem so bad. But days later, when the hitting at football practice started, the headaches came back. He was diagnosed with another concussion.

There was serious discussion about whether this should be the end of football for Scott — which he got very emotional about. But through working closely with his doctors and school trainers, the Winemans again found a path allowing Scott's return.

Though it had been only three years since his previous concussions, things couldn't have been more different in how school and youth teams were handling the injuries.

A state law had just taken effect a month earlier requiring coaches to be given access to training on how to recognize and deal with concussions. The law also barred a player's return from a suspected concussion without medical clearance.

Lincoln Lutheran, like many schools, was now giving its players preseason tests to gauge their memory, concentration and processing speed. The results help guide decisions on whether kids have recovered. Scott had taken his baseline test days before the lake accident.

Scott, his doctors and trainers followed the new protocols, which kept him out until his symptoms were clear and his cognitive tests were back to normal. Even then, he was eased back to the field.

He missed the first four games but then returned to play as an undersized, 155-pound nose guard, helping his team to the state playoffs.

He also returned with an understanding: One more concussion would mean the end of football.

"We've had the discussion that Scott has 'one more punch left on his ticket,' '' Lyn Wineman said. "As much as he loves the game, he is a bright kid with a fantastic future ahead of him. We are not going to risk that.''

Earlier this month, Scott and his Lincoln Lutheran teammates kicked off their 2013 season in west Omaha, against Concordia High School. The 5-foot-7, 165-pound junior was playing a much expanded role, starting at running back and linebacker, and rarely leaving the field.

Scott Wineman was back in uniform to play Omaha Concordia on Sept. 6. PHOTO BY MATT MILLER/THE WORLD-HERALD

His parents watched from the stands as Scott logged numerous carries and blitzed with abandon from his linebacker spot.

His mom was surprised, and a little concerned, to see how many more solid hits he was taking and delivering than the previous year when playing in the middle of the line.

"Being out in the wide open where he can get hit harder is a little nerve-wracking,'' Lyn Wineman said at halftime.

Several times during the game there were players down on the field.

His mom worried. Is it Scott? But each time it was another player, dealing with a leg cramp on the hot and humid evening.

By the end, Scott had scored a pair of touchdowns on hard-nosed short runs and had racked up numerous tackles. But the Warriors couldn't keep up, falling 42-20.

Scott was sweaty, battered and clearly disappointed when he met his parents at midfield.

But most importantly, Scott's head felt fine. And that's something he and his parents won't ever take for granted.

As darkness fell over the stadium, Scott expressed the mantra that now guides him each time he pulls a helmet over his precious brain and head.

"Play every play like it's my last.''

ALSO READ:

Is there a link between football and CTE?

Frequently asked questions about concussions

Contact the writer: Henry J. Cordes

henry.cordes@owh.com    |   402-444-1130    |  

Henry's a general assignment reporter, so he could end up writing just about anything, though he usually focuses on public policy matters affecting the state, region or nation.

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