With an increase of concussions on the field and in the news, high school coaches and medical professionals now say when an athlete sees stars, it's time to take off the helmet. 

Playing It Safe

What's really on the line has nothing to do with winning district titles or neighborhood bragging rights.

Try telling that to a senior running back whose team is down six points in the fourth quarter with fourth and goal on the 40 yard-line. Then, only one thing is on the brain: touchdown. Not the 280-pound charging lineman. Not the few inches of plastic shell and air pockets that separate skull from skull. That's the problem. Today's athletes are as stubborn as ever when pulled from a game because of an injury. But when it comes to concussions, many athletes just aren't hard-headed enough.

Two weeks ago Dallas Cowboys' quarterback Troy Aikman suffered a weeklong series of headaches after a blow to the head gave him a concussion. Still, doctors said it was OK for him to play in the following Monday night game against Minnesota. A third-quarter sack left Aikman with his second concussion in eight days. That makes six in 11 seasons.

At the same time, Steve Young's career with the San Francisco 49ers may be over because of four dangerous concussions in three years.

Recently a female James Madison University basketball player announced she won't quit the game she loves, despite two concussions received in only three days. And just weeks ago a high school football player in San Jose, Calif., died from his second career concussion. Only now is it proof that two was too many.

Whether all-pro or amateur, athletes are getting more than the wind knocked out of them. This is nothing new. But today, area high school coaches agree that many of the games being played are different from the milder games they played in the 1960s and '70s. And what's more, athletic trainers and doctors say that shaking off a head injury is not simple: It's stupid.

"Kids today are bigger and stronger than ever," says Lloyd Swelnis, head football coach and athletic director at Manchester High School. In his 23-year career at the Chesterfield County school, Swelnis says he's seen most every kind of sports-related injury imaginable. "In the late '50s and '60s when I played ball, I can't believe there weren't a lot of guys out there playing with concussions who shook it off and thought it was no big deal." But since that time, researchers have learned much more about the brain and the danger of repeated blows to the head — they can kill.

Doug Cutter M.D., sports medicine physician at Chippenham Medical Center, sees six or seven high school athletes each season who sustain some degree of a concussion during a game or practice. The biggest concern is what's called the second impact syndrome in which a mild injury is compounded by a second impact. "It can cause death," cautions Cutter intently, as appears to be the recent case with the 15-year-old football player in San Jose.

In response to increased risk, standards for helmets have become more strict: Helmets are good only for six years, and each year they must pass strict reconditioning guidelines for safety and durability. Also, the Virginia High School Athletic League passed rules a few years ago against spearing — lowering the head and charging straight ahead at the opponent.

Perhaps the most important rule of the league is that every team has a medical trainer present at games. It is also recommended that an ambulance be standing by. But Cutter says the rules are "not as enforced as they should be" and not all schools have the trained medical assistance on hand at every game.

"There is at least one injury a season that shows the symptoms of being a head trauma," Swelnis says. And in today's game where the school could be held liable, safety far outweighs the allure of victory. "We err on the side of safety," says Swelnis. He confesses every coach and every school is concerned about being sued by parents should something go wrong. "Those days of shaking it off, taking it like a man and jumping back in the game are gone, and it's all about liability."

Moreover, Swelnis says the fear of tragedy is heart-stopping. "It's a frightening thing down the road if you're wrong."

Much of how the brain works still is mysterious to researchers but Dr. Alan Towne, a neurologist with the Medical College of Virginia at Virginia Commonwealth University, says the most significant advance to be made is an easy one: that head injuries can and should be identified as serious before the chance for a second blow occurs.

Towne, a member of the American Academy of Neurology — a national board that grades concussions as level one, two or three and recommends guidelines for treatment — acknowledges brain injury causes more death in football than any other kind of injury. "People used to say they say saw stars," says Towne "and they may have never lost consciousness. But that's a concussion right there." At MCV, Towne says he sees one severe head trauma case involving a high school-age player every few years — where a player is left with memory loss, chronic headaches, even seizures. And sadly, Towne recalls one death in the last 10 years. "All concussions are serious," warns Towne.

It's three o'clock on November 11 and the stadium lights are on. The muddy field gets caught in more than 70 pairs of cleats pounding the ground as if it were a cutlet. The chalk marks painted on the field are faint, but the players know exactly where to go. Below the goal post Coach Richard McFee stares resolutely at his team from the golf cart he uses since his recent knee surgery. At 8-2, the Huguenot Falcons are gearing up for their district playoff against Henrico High School.

The bodies line up before him and wait for his command. They know the drill: clap, clap, clap; pat-to-the-chest, pat-to-the-chest. Clap, clap, clap; pat-to-the-chest, pat-to-the-chest. Over and over. Then snap. The play whips into action as hard plastic-padded chests and shoulders smack together, then break away. But the gold helmets recoil from contact. The players know better than to get their heads in the thick of things. Especially at the last practice of the season, the day before a playoff game.

McFee's players look a little different from the guys he played with back in the '60s. With Huguenot linemen averaging 6-foot-3-inches and 280 pounds, hitting a lineman is like running into a cement wall. "I was a big guy at 5-feet-11-inches and 190 pounds back then," McFee laughs, remembering his days as a linebacker for Arizona State in the '60s. "Today, I'd be an itty bitty guy."

McFee's got his fingers crossed for his team — and his son Marcus, a senior fullback at Penn State. And so far, his son's only injury's been a pulled groin. "I'm superstitious," he confesses. "In 26 years I've never seen a serious concussion on the field. I guess I'm fortunate."

Others haven't been as lucky. Cutter remembers an episode years ago when a player took a crushing hit on a kick-off return. When the play was over, the boy didn't move. "There was no response," recalls Cutter quietly. The player briefly lay unconscious but quickly came out of it. That vision still shakes Cutter today.

When these incidents occur it is the call of the medical trainer, not the coach, to determine the player's ability to go back into the game that day, the next day or in two weeks. That's probably a relief to coaches, who'd rather not make the weighty decision. But whoever makes the decision, Cutter says, it comes down to the player's safety before all else: When a kid insists he can play and you know he shouldn't, Cutter says, "You take his helmet and that's

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