Georgetown High School football player A.J. Walker hit the back of his head while being tackled during a game against Socastee last month.
He was woozy, but he did what thousands of players have done since football was invented: He told the trainers and coaches he was OK and went back in the game.
“I didn’t want to tell anybody,” Walker said.
After the game Walker admitted to head trainer Chris DeVault that he was not OK, and apologized for lying.
After suffering headaches all weekend, an initial diagnosis of a concussion was confirmed when Walker took the ImPACT concussion test when he returned to school on Monday.
ImPACT is a standardized computer test that measures memory, visual motor speed, reaction time and impulse control. Athletes are tested before the season starts to provide a baseline. If a head injury occurs, or one is suspected, the athlete retakes the ImPACT test and the results can be compared to the baseline.
The test “helps us take the guesswork out of whether a player is OK or not,” said DeVault, who is the senior athletic trainer for the Georgetown Hospital System. He is based at Georgetown High and oversees the trainers at all the county high schools.
Although Walker was feeling better by the Thursday after the Socastee game, the test confirmed a concussion so he did not play against Myrtle Beach that week.
“The kids just want to get out there and play,” DeVault said. “Sometimes we’ve got to make that decision for them.”
“Because our job is to protect these players, we’re going to do everything we can do to try and prevent a problem,” said Dr. Wright Skinner III of Bay Orthopaedic Associates.
Skinner and Dr. Petra Gheraibeh are the team physicians for the county’s four high schools.
As good as the test is, it does not replace the human element of diagnosis.
“The test is a guide, that’s all it is,” Skinner said. “You still have to rely on what you know from a clinical standpoint. Especially regarding returning them to play.”
Skinner said it’s easy to diagnose an injury if a player lands on his head or gets knocked unconscious, but harder in most other cases.
That’s why the human element is so important.
“You have to have a really good relationship with the players,” Gheraibeh said. “There has to be a level of trust between the players and the trainers, and the players and the doctors.”
Gheraibeh and Skinner are on the sideline during games along with DeVault and the county’s other trainers.
Skinner said sometimes players won’t tell the trainers they’re suffering concussion symptoms, but a teammate or coach might say the player isn’t acting normally.
“We’ve been very fortunate that we have coaches that will cooperate with us,” Skinner said. “They don’t even get involved. They let us handle it. They’re really great about that.”
The trainers have the final say on whether a player can return to practice and compete in the next game.
“It takes the liability off the coaches of having to decide ‘is this kid really hurt can we put him back in the game,’ ” said Tyronne Davis, head football coach at Waccamaw High.
The test is also a good tool to gauge how fast a player is recovering from a head injury.
“In the past it was kind of arbitrary, ‘OK we’ll hold you out for a week and then put you back in there and see how you do,’” Gheraibeh said. “Now when we test them again, we test them several times during the week before we let them go back to see if they’re recovering and if they get within a certain range then it’s safe to let them go back.”
During this football season, about 10 players at the county’s four high schools have been diagnosed with concussions.
“With the trainers in place and the tests that could possible save a kid’s life, you use that,” said James “Nate” Thompson, head football coach at Carvers Bay High. “It’s one of those delayed reaction things. He could go home and go to sleep and never wake up.”
DeVault has been working on getting the test for the School District for a few years. The hospital system donated the money to buy the test before the 2011-12 school year started, and the district did limited testing.
This year the district will test all high school athletes playing football, wrestling, baseball, softball, boys and girls soccer, boys and girls basketball and cheerleading.
According to Gheraibeh, girls soccer is the leading sport for concussions.
Skinner said girls are more prone to all kinds of injuries because they’re playing “male” sports.
“They’re doing things that they weren’t physically built to do,” he said.
Athletes take the ImPACT test twice in high school, once in college and then usually every year if they play a professional sport.
The ImPACT test is used by the NFL, NBA, NHL, Major League Baseball, The Olympics, U.S. military academies and the branches of the U.S. military, along with thousands of college and high school.
Much of the increased public awareness of concussions can be traced to steps the NFL is taking to cut down on head injuries. The league is being sued by hundreds of ex-players who claim it covered up the long-term effects of those injuries.
The NFL has outlawed helmet-to-helmet hits and the practice of players leading with their helmets and spearing an opposing player.
“When you watch the NFL and what they’ve done to try and protect the players now and it’s come down to the colleges as well as the high schools,” Davis said.
Even if a hit isn’t helmet-to-helmet, or head-to-head, an injury can still occur.
“No matter how good you can devise a helmet, you’re not going to protect yourself from a direct blow because the brain still moves inside the cavity,” Skinner said. “You can protect the outside with padding all you want to, but that doesn’t stop the brain from shifting when you get hit inside the skull. And that’s where the damage comes in.”
Skinner has some personal experience to go along with his medical training. He suffered four concussions while playing football in high school and at The Citadel.
“It feels like your brain is in a jar and somebody’s shaking it all the time,” he said. That feeling lasted for two or three weeks after the most severe concussion of the four.
Georgetown County is leading the state in safety policies, whether it is the ImPACT test, or the heat index policy, which forbids outdoor practices and competition when the temperature and humidity exceed 104 degrees.
“Our standards are higher than the High School League standards,” Skinner said. “No one can touch us as far as our policies and taking care of our athletes.”
By Chris Sokoloski
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