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Weston Smith was a sophomore tight end on the Laguna Creek High School football team when, his coach says, he was drilled in a helmet-to-helmet hit that slammed his head to the ground.

"It was like my sophomore year and it was just like a play where I didn't see the guy coming and he just hit me," said Weston, now a senior. "It wasn't like, like black. (But) I had trouble getting up and stuff."

"[They did] concussive tests on the side and I just stayed out the rest of the game," Weston added.

His experience was not atypical for the sport. There are 11.2 concussions for every 10,000 games and practices in football, according to a 2012 study by the Institute of Medicine.

And those are just the known brain injuries.

But things may be changing. The NFL concussion lawsuit, present and past pro players coming forward about the concussions they endured over years of playing, and the death of NFL linebacker Junior Seau are forcing prep and youth gridiron programs to be more cognizant of brain injuries and to gradually take steps to try to prevent them.

What is a concussion?

"The definition we usually use is an injury caused by a blow to the head or the body changes the way the brain works," said Dr. Catherine Broomand, a neuro-psychologist and director of Kaiser Permanente's Youth Sports Concussion Program.

A helmet protects the skull but not necessarily the mind-numbing shot the brain takes in a direct hit. Broomand said it doesn't have to be a big hit to cause a brain injury.

"Everyone's concussion threshold is different," she said.

Roger Thorn, the board of directors president of the youth football Jesuit Jr. Marauders, uses an analogy to explain it to his young players.

"You put a peach in a box, you drop the box, the peach is protected. Pick that box and shake it and see what happens to that peach? You take it out and that peach it gonna have bruises and dings on it. That's your brain in that box," Thorn explained.

A brain injury can manifest itself in four areas, according to Broomand. The symptoms can be physical and include headaches, nausea, dizziness, sensitivity to noise and light or being dazed or stunned. There also can be cognitive symptoms, such as difficulty remembering or concentrating, confusion and responding to questions slowly. Brain injuries can impact sleep patterns and cause drowsiness. And there are emotional symptoms, including mood changes and irritability.

But despite those serious symptoms, many athletes won't tell their coaches when they've suffered a significant head injury.

"I think in high school you have some of that because they want to be in the game so much, but they downplay the symptoms," Laguna Creek High School Athletic Director Cory Clounce said. "They're not too forthcoming how hard the hit actually was. Part of that is machoness -- especially guys. They're been told they're gonna get hit and they have to get through it."

"Me, as an individual, I would keep it between me," Laguna Creek senior defensive tackle and wide receiver Romainia Tyson said.

There are several efforts to educate parents and players about brain injuries. On Jan. 1, 2013, California began requiring high school coaches to take a free online concussion awareness course that is approved by the Centers for Disease Control and Prevention. The purpose of the course is to help coaches better understand concussions so they can recognize their symptoms and get young players to the sidelines quickly to assess if a hit to the head has caused an injury.

"We take that decision out of the kid's hand," Clounce said. "While the coach might be the bad guy for the moment, [it's] for the greater good and parents will appreciate it."

Some schools, school districts and youth football programs also are using a more definitive method to determine if a player has suffered a brain injury. It's called MindGame, and it requires a student athlete to take a brain activity test before beginning practice and play. When a player sustains a head hit, his doctor can assess his brain function against the brain activity test to help determine the extent of injury.

MindGame is used by the Elk Grove Unified School District, which includes Laguna Creek High School, as well as by Jesuit High School and its feeder program, the Jesuit Junior Marauders, among others.

If the player has been determined to have suffered a concussion, he is held out until medically cleared. The California Interscholastic Federation (CIF), the governing body for high school sports, has a form that it recommends the injured player's physician to complete before allowing the player to return to the field.

While prep football programs are getting used to recognizing the significance of concussions on the still-developing prep player's brain, Broomand maintains multiple brain injuries to an athlete are even more of a concern.

"It's that repetitive getting hit over and over, the brain jostled around in the skull over and over that's more important than the concussions themselves," the doctor said.

That is what happened with Seau, whose autopsy showed chronic traumatic encephalopathy (CTE), a degenerative disease believed caused by multiple hits to the head.

Convincing kids and their parents that getting hurt playing football can potentially have long-term effects isn't an easy sale.

"I got a lot of resistance, especially from fathers," Broomand said. "Parents seem much more responsive and concerned when their child is injured."

Prevention

In an effort to prevent brain injuries, some football programs are teaching tackling and hitting techniques that aim to take the head out of the impact. Thorn's Jesuit Jr. Marauder program is utilizing "hawk" tackling, a rugby style of hitting advocated by Pete Carroll, the head coach of the NFL champion Seattle Seahawks.

"It's a different type of tackling than what I was taught in the '70s growing up playing football," Thorn said. "We were taught put your face mask at your opponent's numbers, you square and you have to have that hit with the tackle. The old style of tackling was primarily face mask of an opponent of a defender ... meaning that you wanted to create the largest, most forceful impact on the upper bodies.

"The problem with that is, of course, as you lean forward to gain momentum the head comes down and head goes forward," Thorn said. "It became more common practice in the '50s and '60s when face masks and plastic helmets became popular to use the head as a tackling tool. All of the force creates a tremendous amount of g-force in the brain in the skull, which causes the brain to slam in the side of the skull.

"The tackling technique we teach doesn't use the head at all," Thorn said. "They're tackling through their thigh pads, with the shoulder and either roll or wrap either drive for five depending on the style."

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Many youth leagues also are adopting the Heads Up program. It's an NFL-sponsored effort for the league's youth program, USA Football, to teach concussion awareness and correct helmet fitting. It also promotes teaching players about going into the tackle, the hit, with their shoulder, rather than their head.

Some high school programs are taking a similar approach.

"Since my return to coaching three years ago, we've taken the head, yeah, striking with the head, out of it," said Dave Morton, head coach at Laguna Creek High School. "All shoulder, lot of shoulder. Fundamental technique from the shoulder down, rolling, grabbing the hips, dragging the legs. When we roll our hips, the head automatically comes up. So the head's up, hips in, heads up."

Morton has personal experience with a player who suffered a serious brain injury in a game. It was a gut check.

"I'm the dad of a concussed high school player. My son barely dodged brain surgery and I spent my days in neuro ICU. So I know as a parent what it's like," Morton said. "So my days as a football coach/dad, I didn't separate the two very well and first thing my son said to me in the ER was, 'dad, I tried, I didn't quit.' And that makes me sound like a barbarian. Sometimes as coaches and dads is we say things and want things, but the reality of it comes back to haunt us."

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Other safety measures

Those who govern prep football want to cut down on the possibility of injuries, concussions and otherwise. One of the ways is to limit full contact in practice.

Starting Jan. 1, 2015, California Assembly Bill 2127 takes effect. It mandates that California high school and middle school football practices cannot exceed two, 90-minute full contact sessions in a week.

CIF currently regulates prep program practices to no more than 18 hours a week and no more than four hours a day.

Some parents want to know if they can buy their athlete a safer helmet or a mouth sensor to detect head injury. Some prep programs have these measures, which Broomand, the youth concussion specialist, feels may have some benefits but also limitations, considering the culture of the game.

"I don't know that there's a way to make the sport safer other than education and awareness, teaching coaches what to look for and athletes know when to speak up and their teammates," she said.

Playing smart and maybe more safely ultimately falls on the shoulder pads of those on the field. That may be the most difficult adjustment to make.

"I try to remember so when I go to hit, I hit lower so I don't injure myself or the other (player)," Romainia said. "For me, I'm not gonna change my game because I'm not afraid of anything. I'm gonna go out there and play, but I'm gonna do everything when I hit, I'm gonna be aware, protect myself."

"For game night, we still want to play," Coach Morton said. "My biggest thing is I don't want to over-emphasize the new thing so much to where my boys it's analysis paralysis. Start thinking too much between your ears your feet stop working and you hesitate and take a bigger risk of being injured as opposed to playing. So we want to play. Do our thinking and reps during practice and then Friday nights, go out and play."

Thorn pointed out that just knowing about concussions and how to maybe reduce their incidence can have an extended effect.

"The cool thing is that carries over to all the other sports they do. That is the real benefit of teaching concussions in football because we're teaching parents and kids what happens, why it happens and how they can prevent it from happening, in general, regardless of what they're doing."

Additional information

- Centers for Disease Control and Prevention: Traumatic Brain Injury Prevention and Control in High School Sports

- Review of studies on repetitive brain injuries in sports

- Junior Seau diagnosed with brain disease cause by head hits

- MindGame / Sacramento Valley Concussion Care Consortium

- USA Football Heads Up program

- Wells Fargo Play it Safe Concussion Care program

- NFL concussion lawsuit settlement

- California Interscholastic Federation concussion policies

- California Interscholastic Federation football rules

- National Federation of State High School Assocations - football

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