Concussion Care

Concussion Care

After taking a forceful blow, athletes experiencing any of the following signs or symptoms should be removed from play and examined by a health-care professional trained in concussion evaluation.

The rule of thumb? When in doubt, sit players out.

Observable Signs

• Dazed or stunned appearance.
• Confusion about the game, player’s position, score, or opponent.
• Inability to remember instructions.
• Vacant stare or glassy eyes.
• Clumsy movements.
• Answering questions slowly.
• Loss of consciousness, even brief.
• Mood, behavior, or personality changes.
• Inability to recall events before or after the blow.
• Any seizure.

Self-Reported Symptoms

• Headache or pressure in head.
• Nausea or vomiting.
• Balance problems or dizziness.
• Ringing in ears.
• Double or blurry vision; seeing stars or flashing lights.
• Sensitivity to light or noise.
• Feeling sluggish, hazy, foggy, or groggy.
• Problems with concentration, thinking, or memory.
• Depression, sadness, irritability, or anxiety.
• Change in sleep pattern or trouble falling asleep.

After a concussion, athletes need physical and mental rest—no television, video games, music, reading, computer use, school attendance, or homework. Sleep is essential.

A return to regular activities should take place slowly after all signs and symptoms have resolved, under the supervision of a neurologist or other medical professional. Current medical guidelines call for a graduated series of monitored steps, in the following order, with each successive step allowed only if no concussion signs or symptoms manifest themselves:

1. Total rest.
2. Return to school half days.
3. Full return to school.
4. Light exercise (walking, stationary cycling).
5. Non-contact-sport activities and training (running, throwing).
6. Drills without body contact; light weight training.
7. Drills with body contact; heavy weight training.
8. Game play.

Sources: Centers for Disease Control and Prevention, 3rd International Conference on Concussion in Sport, Ontario Neurotrauma Foundation,

Austin Trenum

AUSTIN TRENUM, 17, fullback and linebacker with Brentsville HS (VA), committed suicide by hanging on 9/27/10.  His parents, Gil and Michelle, who grew up in the football-steeped cultures of Ohio and Texas, said Austin had about 4 concussions.  After being taken to the hospital for a concussion sustained in a game, Michelle asked him if he wanted a Tylenol because he’d had a headache the previous time he’d sustained a concussion.  “Mom, I’m fine.  I don’t have a headache.  Except for my normal football headache.  I get them after every game.”  Some experts believe 8 of 10 concussions go undiagnosed.  A concussion is not a bruise, but a disruption of the intricate system of electrochemical signals that constitute normal brain function, and can drain the brain of energy.  Symptoms include headaches, sensitivity to light, confusion, lack of focus, irritability, and loss of interest in favorite activities.  With rest and a gradual return to regular activity, most athletes who suffer a single concussion experience no permanent ill effects. Some, however, suffer post-concussion syndrome, in which symptoms persist for months or years, in rare cases permanently. Having one concussion may increase the risk of another. Multiple concussions are associated with an increased risk of post-concussion syndrome as well as depression and memory loss.  Dr. Gerard Gioia says the conventional medical wisdom of waking concussion patients every few hours to check for brain bleeding is actually not a good idea, because sleep is essential to allow cells to rebalance themselves.  He says the frontal lobes, which house our executive control centers and constitute about one-third of total brain mass, and are located just behind the forehead, absorb much of the contact in football.  In teenagers, the frontal lobes are still developing and require a great amount of energy to function properly.  Any disruption can affect the ability to reason, to choose right from wrong, to override impulses, to connect current actions to future consequences.  An excellent student and extremely stable individual, Austin Trenum did not show any signs of depression and did not leave a suicide note.  A post-mortem examination showed no signs of CTE.  He had multifocal axonal injury, a condition where axons, which connect neurons and conduct electricity in the brain, are badly damaged.  He had 2 younger brothers who have since stopped playing football: Cody finished his high school season and quit football; Walker suffered a concussion and was persuaded by his mother to stop playing.–“Did Football Kill Austin Trenum?”, 7/23/12, Patrick Hruby.

Brett Cde Baca

BRETT CDE BACA, middle linebacker with St. Ignatius HS (SF, CA) and Trinity College (CT), sustained 2 concussions in 2013 training camp at Trinity that affected him more than 6 months and forced him to withdraw from the college.  He played middle linebacker and fullback for 10 years. Baca underwent treatment that included more than 100 sessions of hyperbaric oxygen therapy and eventually recovered and graduated, now working at a San Francisco tech company.  His parents, Darren and Jill Cde Baca, started a foundation called One Hit Away to promote education and awareness of sports-related head injuries and disseminate information on brain healing.   “Parents turn son’s concussions into an opportunity to educate”, SF Chronicle 3/29/15, Ron Kroichick.

Gary Plummer

GARY PLUMMER, 55, linebacker with San Diego and San Francisco, 1986-97, was diagnosed with early onset dementia in November 2014. “Your helmet is a weapon, and it always has been,” he said. “I had a headache for 11 straight years.” Plummer was in denial about the trauma to his head and didn’t think he’d ever had a concussion, since he’d never been knocked out cold. He once stormed out of a panel discussion on concussions organized by agent Leigh Steinberg after yelling, “You guys are a joke.” He said he felt reassured by “being lied to by the NFL.” He worked for years as a 49ers radio analyst, but when he started working for the Pac-12 Network, he struggled with memory. “I couldn’t think fast.” While playing, Plummer, who also played 3 years in the USFL, believed that players who retired because of injury were weak.  He’s also suffered from depression, especially after the suicide of his good friend and former teammate Junior Seau, who committed suicide in May 2012 by shooting himself and was found to have CTE.—“Young 49er’s retirement kick-starts discussion about the dangers of football”, SF Chronicle 3/18/15, Ann Killion. “League of Denial”, Steve Fainaru & Mark Fainaru-Wada.

Mosi Tatupu

MOSI TATUPU, 54, running back and special teamer with New England and the LA Rams, 1978-91, died of a heart attack in 2010 and was found to have CTE in October 2014, a day after his family learned he’d been elected to the Polynesian Football Hall of Fame. Tatupu left a family dinner at a restaurant after his first home game with New England and was found vomiting profusely in the parking lot by his wife, Linnea Garcia-Tatupu. Her father, a former boxer while in the marines, knew that Tatupu had suffered a concussion. The fan favorite from American Samoa underwent distinct behavior changes in his early 30s, growing aloof and forgetful, frequently misplacing things, and drinking heavily. His metamorphosis caused his 20-year marriage to unravel. In CTE the abnormal buildup of tau protein prevents the brain’s nerve cells from making normal connections with each other, eventually killing them. The buildup causes erratic behavior, memory loss, depression, and ultimately dementia. Tatupu’s son, Lofa, 32, played 6 seasons with the Seattle Seahawks and wants his 2 sons, one nearly 4 years old, and the other 6 months, to eventually follow in the family footsteps, which terrifies Linnea. “I’m not going to lie: I loved football up until I became involved with somebody who played the game. I am not going to recommend any sport where you can’t protect the very thing that is meant to keep you alive. If your brain doesn’t work, there is precious little else that will.”—“Years of battering took toll on 1980s Patriots star Mosi Tatupu”, 1/27/15, Kay Lazar.

ALS-Concussion Link Found

Boston University neuropathologist Ann McKee says that brain damage can lead to amyotrophic lateral sclerosis (ALS), a disease that strikes 1 in 100,000 people in the general population, slowly destroys muscles, and usually leads to death by respiratory failure. McKee says toxic proteins that form after brain trauma and lead to depression and dementia may also cause ALS. HBO Real Sports said it is aware of 14 NFL retirees afflicted with ALS, also known as Lou Gehrig’s Disease. At least 8 Canadian Football League players have been diagnosed with the disease.—“Boston University study by Ann McKee finds link between concussions and Lou Gehrig’s Disease”, 8/17/10, Michael O’Keefe.

Tommy Mason

TOMMY MASON, 75, running back with Minnesota, LA Rams and Washington, 1961-71, died on 1/22/15. The first draft pick in Vikings history suffered multiple concussions during his career and was part of the “88 Plan,” a program that provides up to $88,000 per year for care for former players suffering from dementia or Alzheimer’s.—SF Chronicle 1/23/15, AP.

Daniel Bukal

DANIEL BUKAL, 29, quarterback with Notre Dame College Prep (IL), 1999-2003, has filed a lawsuit as a lead plaintiff for former high school players as a whole against the Illinois High School Association (IHSA), saying it didn’t do enough to protect him from concussions when he played and still doesn’t do enough to protect current players.  He received multiple concussions at the suburban Chicago school and, a decade on, still suffers frequent migraines and has experienced notable memory loss, according to the suit (he did not play beyond high school).  The IHSA did not have concussion protocols in place at the time, the suit alleges.—“High school head injury lawsuit filed in Illinois”, 12/29/14, AP.

Jonathan Stoddard

JONATHAN STODDARD, 2013 graduate of Medina HS (OH), has filed a lawsuit against the school district stating that he was injured in an August 2012 football practice when he was hit in the chin by the helmet of another player, and that the team’s athletic trainer recognized Stoddard displayed 22 signs of concussion and a neck injury.  The suit claims several days later the coaches ordered him to resume practice, even though he was never medically cleared to resume sports activities.  A month later he was injured in a game and, according to the suit, “…dazed and injured, but was not removed from the game.  Later, when he walked to the sidelines, he was unable to recognize some of his fellow players.”  The suit claims Stoddard had not recovered from the first injury when he was hurt the second time, resulting in a “double concussion.”  Stoddard said he has obtained medical treatment and hospital care, but the injuries caused a “decreased ability to enjoy a normal healthy life.”—“Student-athlete’s suit: Pushed to play with pair of concussions”, The Medina Gazette 12/6/14, Nick Glunt, Gazette online.

Concussions & Deaths

Of the nearly 1500 Missouri high school football players who suffered concussions in 2012, the majority returned to play within 2 weeks. This raises concerns among doctors about “second-impact syndrome,” an often fatal condition that occurs when a player suffers a second concussion before the previous one has healed.  According to Brett Osborn, a neurosurgeon who has studied concussions in sports, adolescents are most susceptible to second-impact syndrome because their brains are still in the maturation process.  Osborn recommends players sit out at least 6 weeks after a concussion, even if it’s mild.  Missouri law requires only 1 day and Kansas has no timetable.  High school athletes suffer concussions at twice the rate of college players, according to the Institute of Medicine and National Research Council (October 2013).  Brian Mahaffey, who has written about concussions in the journal Missouri Medicine, advises that high school athletes should be symptom-free for 7 days before returning to the practice field (10 days for middle-schoolers).  “Can you have one concussion that causes permanent damage?  You most certainly can,” said Mahaffey.  According to the National Center for Catastrophic Sport Injury Research, there were 17 deaths across all levels of football in 2013—all 17 were high school players.  High School Football Fatalities: 2013: 17…2012: 9…2011: 13…2010: 11…2009: 16…2008: 14…2007: 9…2006: 13…2005: 10…2004: 11…2003: 7…2002: 9…2001: 18…2000: 14.  The numbers include both direct and indirect fatalities.  A direct fatality is classified as one that results directly from participation in football.  An indirect fatality is one caused by systemic failure as a result of exertion while participating in a football activity.—“After a concussion, it’s unclear when—or if—high school athletes should return to action”, 10/24/14, Sam McDowell, The Kansas City Star.