The changing definition of concussion and… - Wyoming Medical Center

The changing definition of concussion and why it matters to young athletes

By Kristy Bleizeffer Dec 23, 2014

Sports equipment

Not so long ago, an athlete who “saw stars” after a hard hit was often encouraged to shake it off and get back in the game. Concussion symptoms often weren’t recognized or only considered serious if players lost consciousness. It was a dangerous way of thinking.

On Jan. 19, Wyoming Medical Center will up with Natrona County School District to teach parents, athletes, coaches and physicians why the symptoms of concussion must never be ignored. It’s the first time the hospital and school district have partnered for this kind of education.

Frank Martin

Frank Martin

“The old definition of ‘getting your bell rung’ and being able to go back and participate is changing. If you ‘got your bell rung,’ then 99 percent of the time you have been concussed to some degree,” said Frank Martin, athletic trainer for Natrona County High School.

“Whole lotta Shakin’ Going On: Changing the culture around concussion for athletes of all sports” is a presentation by neurosurgeon Dr. Don Penney and orthopedic surgeon Dr. Clayton Turner.

They will be joined by John Howell and Joe Jurevicius, members of the 2002 Tampa Bay Buccaneers Super Bowl championship team.

Don Penney, M.D.

Don Penney, M.D.

The goal of the partnership is to promote safe participation in a wide range of sports, not to discourage young athletes from doing the activities they love.

I think the end goal is to teach parents and athletes that we have a safety net here within the school district, and that our trainers, coaches and physicians recognize concussions and know how to recommend the appropriate guidelines for returning to play. But the guidelines need to be followed, and parents and athletes need to be honest about their symptoms,” said Penney, a neurosurgeon with Advantage Orthopedics and Neurosurgery in Casper.

In this interview, Martin and Penney talk about this unique education partnership and why it’s important.

What is the purpose of this concussion talk?
Martin: To get people to recognize concussions so that they can get the proper care. We’ve seen a lot of education and a lot of media attention on concussions. Sports are a great thing. Contact sports are a great thing. We just need to educate people on recognizing the signs and symptoms of head injuries and concussions, so they can get good medical care.

Penney: The definition of concussion has changed. For example, they used to say that there were about 300,000 concussions a year in the United States, but that was only for concussions resulting in a loss of consciousness. When you look at the true definition of concussion, there are actually 1.9 million concussions per year.

If you are looking for somebody getting hit in the head, you will miss a lot of concussions. The published statistic is that in 35 percent of all college football concussions, there was no blow to the head. A concussion is any blow to the body with enough force to shake your brain inside your skull. That can come from a fall, tripping over your own feet, falling off your skates, or whatever.

Martin: In the school district, we find that more concussions are caused by the ground or by a tackle that causes a whiplash. Rules have stopped a lot of the spearing and the cut blocking, so people are trying to create rules to make the contest safer. It has eliminated a lot of that type of head injuries.

Concussion symptomsDr. Penney, what physiologically happens to the brain on the second hit after a concussion?
Penney: What we all fear, what we do not ever want to see in this state, is something called second-impact syndrome. That is, if you do not follow the concussion guidelines and return an athlete too early to competition, they could suffer malignant brain swelling after a relatively minor second blow. Every year, there are about 19 of these cases in the United States, and they are often fatal.

What about parents or athletes who say the risk is too great? Do the benefits of sport participation outweigh the risks of injury?
Martin: Being part of a team, just like military service, teaches discipline and dedication. It’s the idea of belonging to something bigger than yourself. I have been a trainer here for 30 years, and being part of a team is one of the greatest things that a lot of these kids will ever do. I played basketball and football in Saginaw, Mich. I have one or two friends that when I go back for class reunions, our team is the first thing we talk about: The rivalries, the football games.

When you think about your high school days, what do you remember about them? It is those things that you did together as a group – your achievements and accomplishments. Natrona County High School, for example, just won the state football championship in Laramie. What better thing to be involved in for those 80 to 90 kids who got to experience that?

As a past football player, did you ever wonder what all the fuss was about when people started really talking about concussions? You probably took a couple of big hits in your day.
Martin: I visualize it differently, because when I was young, I had a severe concussion. I was hospitalized for a week. There was a period of time in my life when things were really scrambled for me. I had trouble in reading, writing and doing arithmetic in school. As I was educated in athletic training, I recognized that the concussion was severe enough that it set me back for years and years.

That is why moms and dads need to be educated on this. They need to understand that when Johnny falls out of a tree and hurts his head, or whether it is a snowmobile accident or a football game, that they need to take the proper steps so Johnny doesn’t get that post-concussive syndrome.

In what other sports are concussions a risk?
Dr. Penney: In 1939, the Journal of the American Medical Association published a paper by Dr. Maitland who talked about being "punch drunk” in relation to boxing. That is where it all started, but any sport has the potential to cause a concussion: Soccer with the heading of the ball, rodeo, mixed-martial arts, rugby. I read a paper that in Illinois, women’s field hockey is the leading cause of concussion.

concussion suspectDid you play sports?
Dr. Penney: Sure. I grew up in Canada, so I played hockey all the way through college. I lost a few teeth doing that, but I did not get my brain scrambled.

Do you believe people can participate safely?
Dr. Penney:
Absolutely. The benefits of sports – the comradery, the team bonding, putting the team ahead of self – outweigh any type of risk-benefit ratio as far as concussions. I think that now we play in a safer environment. We are better at recognizing concussions and our coaches are good about taking the players out and letting them sit on the bench when concussion is suspected.

What about the athletes (and the parents) who still do not want to report symptoms because they are afraid they might be benched?
Martin: Yes, it is a problem. I think too many parents live their athletics through their kids, and everybody wants to have their children achieve and be the best. That is who we are really trying to reach with this talk. A game or a championship is not worth the risk of second impact syndrome.

It’s easy to recognize a knee injury or an ankle injury because Johnny limps, he cannot run or he cannot jump. You cannot see that in the brain.

What happens when concussion is expected in a school athlete?
Martin: State law reads that every school district has some kind of concussion protocol in place. It may be as simple as the coach determining whether Johnny will participate or not. It may be as complex as we have here in Natrona County where athletes have to pass an InPACT Test and be released by a physician.

Even if a physician sends back a note back saying Johnny is cleared to participate, if he failed the InPACT Test, we hold them out seven days and retest. If they report to me that they have symptoms of headache or vision problems, we still have the ability to hold them out. (Find the district’s full concussion policy on pages 46-50 of the Athletics and Activities Handbook.)

Is every athlete in the district given ImPACT test before the season?
Martin: Only those sports that we choose that are contact sports, and only at the high school level. Those include football, soccer, wrestling, basketball, specific sports for track such as pole vaulting and high jump, and our divers in swimming. We also include cheerleaders.

Penney: There are other tests that are out there, the important thing is that there is a systemized way of assessing an athlete.

The other important thing is making sure parents and athletes are forthright and honest about their symptoms. They should feel comfortable enough to come in and say, “I took a blow there, and I do not feel well.” But they feel like it is not macho to sit at the end of the bench. That has to change.

If you go ...
Joe Jurevicius

Joe Jurevicius


John Howell

  • When: 6 p.m. Monday, Jan. 19
  • Where: Parkway Plaza, 123 W. E St.
  • Who: Presenters include Don Penney, a neurosurgeon with Advantage Orthopedics and Neurosurgery; Dr. Clayton Turner, orthopedic surgeon; John Howell, safety of the 2002 Super Bowl champion Tampa Bay Buccaneers; and Joe Jurevicius, 2002 Super Bowl champion Buccaneers’ wide receiver.
  • Meet-and-greet: Stay after the presentation for autographs, door prizes and refreshments. We will give away tickets to Denver Broncos, Nuggets and Avalanche games.
  • Cost: Free
  • More:‘Whole lotta Shakin’ Going on:’ Changing the culture around concussion for athletes of all sports