Can this concussion study work if Texas school districts don’t have to participate?

This week, 24 high school football teams hailing from the tiniest towns that line up 6-on-6, to the mammoth 6A powerhouses will vie for a Texas state championship at AT&T Stadium in Arlington.

The pursuit of schoolboy gridiron glory in the Lone Star State dates back to 1920; at least that was the year of the first University Interscholastic League-sanctioned championship game. Cleburne and Houston Heights clawed to a 0-0 tie to share the inaugural title.

Around that time, the first football helmets — if an insufficiently padded leather skull cap can be called a helmet — began to pop up. The need for the contraption was obvious: Getting cracked on the head really hurt, but it also often caused the appearance of fuzzy, white lights followed by days of dizziness and nausea, irritability, sometimes memory loss and even blackouts.

Over the nine decades to come, helmets would evolve many times. Yet, as the medical community and society gains an increased understanding of concussion and brain injury on short-term health as well as a recognition of frightening long-term risks, much remains unknown about the potential for brain damage later in life, particularly among young, developing athletes who play high school football.

That knowledge gap is the basis for the University Interscholastic League partnering with UT Southwestern in launching the Concussion Tracking Program this school year. Dallas-based UT Southwestern neuropsychologist Munro Cullum is spearheading the effort, overseeing what is billed as the nation’s largest statewide effort to track concussions among youth athletes.

The goal is to record every concussion sustained by a middle school or high school athlete, boys and girls in all sports, and document injury and other details into a centralized database called the ConTex registry. UT Southwestern doctors will then analyze the data and report their findings to the UIL.

Over a period of years, the data will be used to help identify trends and determine whether changes in certain rules, coaching, equipment and field substances are improving player safety.

There’s just been one key obstacle: Participation is not yet mandatory and way too few school districts — about one-third statewide — are participating, severely limiting the data that can be collected.

“I’m always optimistic, but I thought with the UIL promoting this and the [Texas] Athletic Trainers Association supporting this, I thought we’d be upwards of 50 percent at this point, so I was a little disappointed to be honest,” Cullum said, noting it will take hundreds, if not thousands of data entries to begin to discover trends.

Among the 20 school districts in or partially in Tarrant County, only Arlington, Carroll, Fort Worth and Grapevine-Colleyville confirmed they are participating. In those that are not, athletic directors and athletic trainers said they were either unaware of the program or reported complications or confusion in accessing it.

Cullum said he was a bit heartened regarding the participation rate after hearing of difficulties getting similar programs in other states off the ground. He said Hawaii, Colorado, Michigan and Maine are among a handful of states that have started injury tracking programs.

However, no state has the potential of Texas with more than 800,000 students participating in athletics. The UIL is expected to make participation in the program mandatory, perhaps as early as the 2018-19 school year, although a spokeswoman did not return messages seeking to confirm that time frame.

Concussions aren’t rare

Concussion and brain injuries in football have never been more visible than they are right now. In recent years, Chronic Traumatic Encephalopathy, the degenerative brain disease believed to be caused by repeated blows to the head - and found in a growing number of deceased former NFL players - has become a household term.

UT Southwestern describes a concussion as a traumatic brain injury resulting from a bump, blow, or jolt to the head – or to the body — in which the “brain bounces around or twists within the skull. This sudden movement causes stretching and tearing of brain cells, damaging them and creating chemical changes in the brain.”

A growing concern about player safety, and dwindling participation numbers, have decreased youth football participation numbers across the country, and even in football-crazed Texas. The last few years have seen high schools in New Jersey, Maryland, California, among others, drop varsity programs. In Texas, high school football participation numbers have been in decline for years.

Concussions are not a rare occurrence. Aledo school district athletic trainer Troy Little reported 25 football concussions this season in middle school and high school, with 17 sustained by seventh, eighth and ninth graders. He said Aledo coach Steve Wood has changed how his staff teaches tackling technique, has greatly reduced tackling in practice and is determined to eliminate players sustaining a concussion in practice.

Little said he attempted to participate in the program, had log-in problems and never received replies back from program administrators when he sought help, so he has yet to submit any concussion information to the program.

Castleberry school district athletic trainer Taylar Ogden said her concussion count through the first semester of this school year is near 20, including four female basketball players.

“It seemed like I had one per week between high school and middle school [football],” Ogden said. “Coaches are teaching not to lead with the head, but it can be a struggle. I got frustrated with the referees as well. I know if I can hear it, they can, too. Concussions are very prominent right now. We’ve talked about it a lot and it’s all of our jobs together to help protect the kids.”

Ben Bowles, athletic trainer at Burleson Centennial High School, reported 18 concussions in all sports this semester. The count was 12 in the school’s football program. He provided the Star-Telegram his medical spreadsheet that showed players who sustained a concussion were held out of their sport for an average of 22 days. One ninth-grade football player was held out 37 days and another 32 days.

Bowles said concussion polices are much stricter today than when he got out of school in the early 2000s.

“We kind of understand what’s going on now, we’re kind of the voice of the athlete to coaches instead of having the football coach make the decision,” Bowles said. “It’s no longer suck it up, get him back out there. Now we understand what concussions are and the significance of them.”

While none of these athletic trainers are participating in the program for various reasons, all said they are proponents of it.

What to believe?

Cullum, whose own son, now 23, played football in middle school before giving it up for soccer in high school, said he would continue to allow his son to play today. He said it is “unfortunate” to hear that some high school football programs are shutting down touting concerns about head injury, saying, “that might be an overreaction.”

“I want to caution parents to not over-interpret some of the headlines that they’re seeing,” Cullum said, noting that he receives raised eyebrows when suggesting he’d allow his son to play football.

Cullum said the media tends to play up certain studies, such as the Boston University report in which 110 of 111 brains of former NFL players were found to have CTE, while largely ignoring other studies. He noted a July report in which 3,904 men who played high school football in Wisconsin 60 years ago were found to be no worse off neurologically than those who didn’t play.

However, even the study’s senior author, Dylan Small of the Wharton School at the University of Pennsylvania in Philadelphia, said those findings might not be applicable to today’s players because the game has changed, players are bigger and have played longer starting in high-functioning youth leagues.

“There’s a lot of concern out there about these brain injuries and what’s going to happen to these kids later in life. Right now, we don’t know who’s at risk for that disorder,” Cullum said, referring to CTE.

“We need to learn about how often this injury is occurring and then we need to find those individuals who seem to be either symptomatic, develop symptoms later, whose symptoms don’t go away or those who have no symptoms whatsoever within just a matter of hours to start learning about who is really at risk for problems down the road.”

Should be mandatory

That’s not a good enough answer for sport risk management expert Kimberly Archie. She lost her son at age 24 in a motorcycle accident. He played football from the age of 7 to 17 and was found to have Stage 1 CTE.

Even before her son’s death, she was involved in brain injury research in football, having served as a consultant on a legal case about head injuries in the NFL. In the process she interviewed more than 1,000 players. Last year, she co-founded Faces of CTE with North Richland Hills resident Cyndy Feasel, whose husband Grant, a former NFL lineman, died from CTE.

Feasel’s book, After the Cheering Stops: An NFL Wife’s Story of Concussions, Loss and the Faith That Saw Her Through, chronicled their struggle.

Archie’s interviews with all those NFL players, she said, made her start to recognize behavioral quirks her son was exhibiting. She staunchly disagrees with Cullum’s observations that the jury remains out on brain injury and the connection to long-term risk. She applauds high school programs that are shutting down over safety concerns and parents who hold their children out of tackle football, if not altogether, at least during their formative years.

“Once you know there’s no helmet made for kids, that there’s more regulation for a Halloween costume that’s an NFL player than the helmet my kid strapped on when he got CTE from just taking too many hits, when you realize that the NFL professionally trained medical staff can’t see a concussion when it’s obvious to everyone viewing it, why would I think they can find it at the high school or youth level?” Archie said.

“Parents aren’t buying it anymore. When you put that all together, the repetitive hits, the helmet not made for a kid, what makes a parent think it’s going to go better for a high school kid? How would you sell that to a parent?”

As long as football continues to be played, the brain injury debate will rage on. One thing Cullum and Archie can agree on is the importance of full participation in the UIL/UT Southwestern tracking program.

“It should be mandatory to track it,” Archie said.

This story was originally published December 20, 2017 at 3:31 PM with the headline "Can this concussion study work if Texas school districts don’t have to participate?."