Concern over teen concussions grows in Sonoma County

Dylan Mathias' first experience with a head injury came when he was 10 years old and the tree branch he was hanging from snapped, sending the boy hurtling to the ground. He fractured his skull. A few years later, his mother was understandably concerned when Mathias lobbied to play football at Analy High.

"But he's good," said his mother, Kelley McNeal. "And he loves it."

So he played. Last year, as a junior, Mathias was shaken up twice on the field. The first time was, by all accounts, minor. He came out of a play dazed; there was no official diagnosis. The second time was more severe. Dylan was diagnosed with a concussion, an injury that sidelined the wide receiver/linebacker for three games.

"It was definitely a struggle making these decisions," McNeal said. "In my head I'm thinking, &‘Is it OK? Should we let him keep playing?' It was an internal struggle."

McNeal is not alone in her confusion and anxiety. Throughout Sonoma County, and pretty much wherever high school football is played, families are reconsidering their commitment to the sport. They have been bombarded with media reports of rampant dementia among former NFL players, not to mention the suicides of prominent players like Junior Seau and Dave Duerson.

While the commentary has focused mostly on the NFL and the lawsuits filed by more than 2,000 former players, deep concern has spread to the high school level, where 1.1 million students across the country play the game.

Certainly, there is research to justify those concerns. Studies in the past decade have shown that sports are second only to motor vehicle accidents as the leading cause of brain injury among people 15 to 24 years old; that 47 percent of all high school athletic concussions happen on the football field (just under 64,000 each year); that anywhere between 50 and 90 percent of concussions at this level go undiagnosed.

Though the science of concussions remains a bit murky, one thing is clear: High schoolers seem to be particularly vulnerable. Their brains are still rapidly developing, especially the frontal lobes, increasing the potential harm of head injuries. And fostered by loyalty to teammates and an ingrained tough-guy culture, high school athletes are notoriously unreliable in reporting symptoms.

Asked if she trusts her son to inform her of a head injury, Kelley McNeal answered bluntly: "No. He wants to get back in that game."

High school-age players seem to be at greater risk than younger youth-football players, too, because they hit with more force. Jim Hanson, president of North Bay Youth Football and Cheer — the local equivalent of Pop Warner football — said before this season that his organization hasn't seen a diagnosed concussion in five years.

It is the high schoolers who play at the intersection of youthful exuberance and grown-up muscle. It's a dangerous intersection.

With that in mind, Gov. Jerry Brown signed Assembly Bill 25 last October, making California the 31st state to pass legislation ordering specific handling of high school concussions in all sports. (Since then, seven other states have joined the charge, and others have pending legislation.) AB 25, which took effect Jan. 1, requires same-day removal of any athlete suspected of sustaining a concussion, prohibits the athlete's return without written clearance from a health-care provider and mandates that parents or guardians annually sign forms with information on the subject.

One problem with head injuries, though, is that there is no simple diagnosis. Concussions are caused by the brain slapping against the inside of the skull, but they have no obvious biological markers. The classic image is a football player out cold on the turf, but fewer than 5 percent of concussed high school athletes report loss of consciousness.

"There's no blood test you can do. There's no scan you can do," said Dr. Robert Nied, a physician at Kaiser Permanente's Santa Rosa Medical Center who specializes in family medicine and sports medicine.

Instead, diagnosing a concussion involves a complex interplay of physical observation, tests of balance and cognition, and self-reported symptoms.

One approach riding a wave of momentum is baseline testing. Several competing computer models exist, each involving healthy athletes taking online, rapid-fire quizzes that test memory, concentration and problem solving. If a player is suspected of suffering a concussion, retests can help determine his level of impairment.

"The nice thing is, it's objective data," said Dr. Ty Affleck, who heads Santa Rosa Sports and Family Medicine. "It looks at the visual side of the brain and measures reaction time and distractibility. If all of that's working, you've got a pretty good idea that you're looking at a healthy brain."