The Concussion Conversation

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Four players.

Four concussions.

One tough season.

It never crossed my mind that Id have a season with four concussions, said Damian Elder, head coach of the women’s volleyball team at Mercer University. I think in three prior seasons we had two concussions. You expect one a season but four concussions are unheard of.

Not anymore.

Not for the Mercer Bear’s volleyball team of Macon, Georgia, which became hyper-vigilant about these traumatic brain injuries after more than one-third of its players suffered concussions during the 2015 season.

We erred on the side of caution, said Elder, who is adamant that everyone in the volleyball community understand the dangers posed by these injuries and the protocols to follow when a player has a concussion. If a player got hit near the chest, shoulder, or head, I was like, Youre out.

Volleyball talked to other coaches, players, and concussion experts nationwide who share Elder’s concerns about these brain-changing injuries.

Although volleyball has a low incident rate of concussionsabout 455 annually by collegiate playersthese forceful blows that cause the brain to bounce around in the skull can have severe consequences in the short and long term.

When [concussions] occur, they can indeed have serious ramifications, said Dr. William Briner, chair of USA Volleyball’s Sports Medicine and Performance Commission, and they may be harder for female athletes to recover from. So it’s important to recognize them.

Veteran high school volleyball coach Liz Bohl agreed. Concussions are very serious and should be treated as serious injuries, said the varsity coach at Bloomer High School in Wisconsin. [Coaches] have a responsibility to be aware of these injuries. Were talking about someone’s brain.

Those risks struck a personal and worrisome cord with the members of Mercer’s coaching staff, who racked their brains to find out why their players suffered an unprecedented number of concussions this season.

I asked if we had one drill that was more dangerous than another, said Amos Mansfield, Mercer’s director of sports medicine. Did we run two lines of players spiking and killing the ball? Did players have to dodge other balls while they were playing?

Elder said nonone of his players had suffered concussions during practice drills.

And none [of the concussions] came from the ground or running into a player, pole, or table, said Elder, who didnt want to identify his injured players for privacy reasons. All were caused by ball contact to the head.

The first concussion happened during a match on August 29 when an outside hitter went up for a block and the ball smacked into her head.

She almost immediately had significant symptoms, Elder said. She was nauseous and threw up.

The next day, another Mercer player suffered a concussion. This time, the ball ricocheted into the libero’s head after a dig. She’s our second best player, and she gets injured in the very next match, Elder said.

But Mercer’s rash of bad luck wasnt over yet.

In September, the team’s setter suffered a concussion when she went for a dig during a scrimmage and the ball nailed her in the head.

The Bears now had three starters with concussionsand they were only three weeks into the season. It was like [concussions] were picking off people crucial to our success, Elder said.

The concussion curse struck Elder’s team one more time. During a practice in October, a ball drilled one of the middles in the head as she went for a block.

By the fourth concussion, it was clear to me [which injuries] might turn into a concussion, Elder said. The way a player lands, their head movement and mannerisms. Im definitely more educated [about concussions] and aware of the moments that they may happen.

Has that increased concussion awareness changed his coaching philosophy?

Im not going to change the way I practice, but Im definitely going to be absolutely aware of every single ball that hits a player’s chin, shoulder, or head, said Elder, whose team finished the season 10-19. Even with a glancing blow, Im going to stop practice and make sure our athletic trainer goes through the [concussion] checklist.

The last thing I want to happen is for a player who may have a concussion to go through the rest of practice and put themselves at risk.

Elder said his players also have a heightened understanding of concussions and are more willing to self-report a possible head injury.

By our fourth concussion, everyone on the team was comfortable with someone who got hit saying: I dont want to take a chance and taking themselves out of a match. Concussion awareness, however, starts early for all athletes at Mercernot just those in the increasingly fast-paced sport of volleyball, where balls are hit with tremendous force and intensity, players dive on the floor, and teammates often collide.

At the beginning of every season, this Division I school requires all varsity athletes to take a baseline concussion test that measures their verbal and visual memory, processing speed, and reaction time.

If a player suffers a blow to the heador the coaches or staff notices any signs of a concussionthe athlete is:
1. immediately removed from play;
2. evaluated by a trainer or medical professional; and
3. removed from play for the day if the concussion is confirmed.

Our policy is that athletes [with concussions] see a physician within 24 hours of the incident, said Mercer Director of Medicine Mansfield. We also talk to the players and their roommates about concussion signs and symptoms.

When players are symptom-free, they can start the return-to-play protocols. But Mansfield and his staff never rush athletes with concussions to get back in the game.

We know athletes dont want to sit out, Mansfield said. But concussions are injuries that take time to heal. If we dont give players time to heal, theyre likely to have more concussions and more severe issues.

Some volleyball players who have a history of concussions now include protective headgear in their safety protocols.

Players like Wisconsin high school junior Krystina Seibel, who has suffered three concussions in basketball and one in volleyball since eighth grade. Krystina said the headgear gives her an added sense of security.

Before I had this [headgear], I was hesitant; I was scared that Id get another concussion, said the 5’7″ Bloomer High School libero and setter. But this made me feel safer. I wasnt scared anymore. It gave me the feeling of having an extra cushion on my head.

Krystina and her parents readily admit the Gamebreaker headgear wont prevent the scrappy multi-sport athlete from having another concussion.

But it helps absorb the impact, said Kevin Seibel, Krystina’s father.

Bohl, who is Krystina’s high school coach, supports the junior’s decision to wear the headgear. She also understands the lightweight helmet wont stop her player from suffering another traumatic blow to the brain.

But it makes her feel safer, Bohl said. She’s a player who sacrifices her body for sports, and this [headgear] was a good fit for her. She wasnt so hyper-aware of the possibility of getting another concussion.

The NCAA, however, doesnt allow players to wear protective headgear.

There is no evidence that this use of such headgear actually prevents concussions, said NCAA spokesman Christopher Radford. Furthermore, there is some evidence to suggest that when allowed to wear headgear, athletes will become more aggressive in their play, which actually increases their risk of injury.

He added: There are no available safety standards to guide the manufacturing and performance of helmets that may be used in the sport of volleyball. This is an additional impediment to their adoption.

The NAIA doesnt allow volleyball players to wear headgear, either.

USA Volleyball says players can wear a foam helmet or headgear, but that decision comes with a warning.

The wearing of this type of protective gear does not guarantee to prevent injury, said Margie Mara, senior director of USA Volleyball.

Mike Juels, founder and CEO of Gamebreaker headgear, however, defends his product and its use in volleyball.

Our headgear doesnt prevent concussions, Mike Juels said. No one can make that claim. It would be misleading.

But we believe our product is reducing the risk and severity of [concussions]. And weve never had anyone wearing our headgear while playing volleyball say theyve suffered a concussion.

Mercer’s head coach has already developed a strategy for next season to reduce the number of concussions among his players and protect them from the dangers posed by these injuries.

Im never going to allow any [player that gets hit] near the head to go unchecked or unnoticed, Elder said.

He encourages other volleyball coaches at the high school and collegiate levels to follow his lead.

I hope coaches lean toward care firstinstead of play first, he said. I also hope everyone from administrators down understands that concussions are serious and they shouldnt test the theory [with concussions] that nothing is wrong.

We need to take concussions seriously.

What is a concussion?

A concussion is a traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.

>> Source: Centers for Disease Control and prevention

Concussion Protocols

Coaches who suspect a player has a concussion should take the following steps.

1. Remove the athlete from play.

2. Ensure the player is evaluated by an appropriate health-care professional. If the player isnt sent for immediate medical attention, a responsible adult must continually observe the athlete. Never leave a player with a suspected concussion alone.

3. Inform the player’s parents or guardians about the possible concussion and give them information about the injury.

4. Keep the player out of play the day of the injury and until a health-care professional with experience in evaluating concussions says the athlete is symptom-free and can start the return-to-play protocols.

Concussion Signs Observed by Coaches/Trainers

Cant recall events prior to or after a hit or fall
Appears dazed or stunned
Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows mood, behavior, or personality changes

Concussion Symptoms Reported by Players

Headache or pressure in head
Nausea or vomiting
Balance problems, dizziness, or double/blurry vision
Bothered by light or noise
Feeling sluggish, hazy, foggy, or groggy
Confusion or concentration or memory problems
Just not feeling right or feeling down

Concussion Advice For Players

Know the symptoms.
Self-report any signs.
Dont keep playing. Youre not doing your team any favors, and youre putting your health at risk.
Watch out for your teammates. Players who see a teammate struggling should immediately alert a coach or trainer.

For Parents

Learn the symptoms.
Take these injuries seriously.
Have any signs of concussion immediately evaluated by a trainer or doctor.
Dont let children talk you out of seeking help. It’s not uncommon for children to say theyre fineeven when they arent.

For Coaches

Learn to recognize the signs of a concussion.
Remove athletes from play if they show signs of a concussion.
Give athletes time to rest and recover.
Pay attention to the physical and emotional side of the athlete’s recovery. Concussions can be stressful for athletes. Their grades can fall, and they might need additional academic support.

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