CHICAGO — The scowl that creased Troy Piccinini’s face on a recent afternoon was not the game face of a football player, at least not this fall.
Piccinini, 16, just had struggled through tests of his short-term memory and other cognitive functions. After suffering three concussions in as many years, the drills are as familiar to the Conant High School junior as any he’s done on the field.
A week before the Cougars’ first game, the hours-long battery of tests ended with neuropsychologist Dr. Jill Dorflinger gently offering advice that left the defensive end slumped in his seat.
“I’m going to suggest you not play football this year,” she said.
Even a few years ago, Piccinini and any number of young athletes might have been sent back into a game only minutes after “getting his bell rung.” But as the high school football seasons are kicking off, there’s an unprecedented awareness of brain injuries which may be slowly transforming the football culture.
A report last year by the Centers for Disease Control and Prevention found that from 1997 to 2007, the number of emergency room visits for sports-related concussions had doubled for children ages 8 to 13, and more than tripled for high school-age athletes. And it’s not just football — but soccer and even cheerleading.
The reason, says Dr. Hossam AbdelSalam, a neurologist at Alexian Brothers Neurosciences Institute, is heightened awareness by coaches, parents and players.
“There are probably not more concussions. There is more awareness,” AbdelSalam said. “Ten years ago, they would dress and go home and rest a couple of days and play again. That is not going to happen anymore.”
While most of the attention has been on the pros, many are taking a closer look at what contact sports are doing to kids.
For the first time this season, a state law in Illinois requires any high school athlete who shows signs of concussion to be cleared by a medical professional before returning to the field.
Prompted by concerns from parents, many schools had already adopted policies, and an increasing number of schools perform testing to evaluate a player’s brain function before and after injury. Coaches and parents are crowding seminars on head injuries, and the number of youth athletes treated for concussions at hospitals nationwide has more than doubled since 1997.
Illinois was the 28th state to adopt concussion laws, standards that are backed by national campaigns by brain injury advocacy groups, pediatricians and a public that has seen a number of retired star athletes — including former Chicago Bear Dave Duerson — suffer untimely deaths linked to brain trauma.
Piccinini suffered blows to the head in each of the last three seasons followed by months of lingering headaches, moodiness and memory lapses that are symptoms of post-concussion syndrome, his mother and doctor said.
“As a mother, I would like to think I would have known something was not right with Troy,” said Maribel Piccinini. “But without all the hoopla, would I have known about it? Probably not.”
Her son is disappointed, but focusing on the big picture. “I’m just going to try to come back next year and just have some fun as a senior. It’s annoying, the irritability, the headaches, just forgetting everything,” said Piccinini. “I just thought it was normal.”
In fact, the battery of testing that followed each of his concussions is becoming the norm for many young athletes as a growing body of research has pointed out the danger of head injuries to still-developing brains.
“I recently had a parents meeting where the first few questions all had to do with concussions … and that never used to happen,” said Craig Buzea, who has 29 years of football coaching experience under his belt, the last two at Homewood-Flossmoor High School.
“This (concussion awareness) will be the new dynamic of how you play the game,” Buzea said. “People will take notice and try to do things in a different way. I think everyone will be forced to.”
At Homewood-Flossmoor and many other high schools, that means rarely going through a full scrimmage during practice. “Why have a train wreck every Monday through Thursday, when you know you’re going to have one on Friday?” he asked.
Technology and education is changing, too.
Where coaches once would hold up two fingers to gauge mental fitness, there are now more sophisticated tools for young athletes, similar to the ones used by NFL players. A computer test called ImPACT, for example, provides a baseline for physicians and trainers to help determine when it is safe to resume play.
In addition, the CDC and others have launched education campaigns, complete with posters and brochures for locker rooms. Many schools tout their state-of-the-art helmets and other equipment, designed to protect the head like never before. There’s even a phone app, created by the University of North Carolina, with step-by-step instructions on what to do if you suspect a concussion.
But it’s just not enough, said Dan Bernstein, who co-hosts one of Chicago’s most popular sports radio shows on WSCR. Bernstein has been “on a soapbox” about the perils of youth football, including the fact that he would not let his own children suit up.
“Only let kids play if you’d let them box,” he said.
Bernstein said his position has brought him a deluge of hate mail from rabid fans who love hard hitting. But he reluctantly wrote off youth football after reading the research, including a 2010 Purdue University study finding that players at an Indiana high school showed impaired neurological function even when they hadn’t been diagnosed with a concussion.
“What causes brain damage is football,” he explained. “Until you can put padding between the brain and the skull, all you’re doing is improving the quality of the collision.”
But some people think that maybe we’re becoming a bit too cautious. More parents are willing to bench their kids, not just during the recommended recovery period, but permanently, said Dr. Beth Pieroth, a neuropsychologist whose practice booms during the school year, and who also consults on brain injuries for Bears, Blackhawks, Fire and White Sox players.
“When I first started, I felt like I was screaming into the wind … Now I worry that the pendulum has swung into crazy land, that people are proactively pulling their kids out of sports,” said Pieroth, whose sons play hockey.
“We have to realize that there are very good outcomes for patients who get proper treatment, and that there are a lot of great things that come from children playing sports. … We can’t put their heads in bubble wrap.”
However, Pieroth points out that Illinois’ new law and measures like cognitive testing aren’t cure-alls. Brain injuries are more difficult to detect than broken bones — concussion damage isn’t visible in X-rays or CAT scans — and dedicated athletes often will ignore or mask symptoms.
Lisa Saviano, a nurse, thought nothing of it as she watched her 15-year-old daughter, Emily Witt, suffer what she thought were minor knocks to the head in a soccer tournament last year. When her daughter, an honor student, complained about headaches and trouble concentrating days after the tournament, Saviano took her to the hospital.
“And all I could think was ‘Oh my God, we missed a concussion,’” recalled the Bartlett, Ill., mother, who has sons who play football, hockey and lacrosse. “I felt so guilty … I am a nurse and it just blew right past me.”
A neurologist ruled Emily had suffered a concussion. She would end up missing the rest of the season, but returned to play last spring.
“I think for things to really change, everyone has to work collaboratively,” Saviano said. “A lot depends on the coaches … that they’re not going to yell ‘Suck it up … You’re fine. Finish it.’ That parents aren’t going to yell ‘Hit ‘em again,’ and that the kids are going to be honest about their injuries.
“We all need to send a message that nothing is more important than your brain.”