TUSCALOOSA | It was just like any other drill. The running back would receive a handoff from the quarterback, then try to break the tackle of a linebacker 3 yards ahead while staying between tackling dummies spaced a few yards apart.
The drill would be over when one of the players was on the ground.
It was the Oklahoma drill — a drill known for its bone-breaking, mouth guard-swallowing, ruthless helmet-to-helmet hits — designed to see how players respond to contact. It is a drill rarely used by college and NFL teams these days, a drill deemed by Dr. Jeri Zemke, a certified athletic trainer and clinical coordinator at the University of Alabama's athletic trainer education program, as “the dumbest drill known to man.”
It is the drill that gave American Christian Academy sophomore running back Austen Akins a concussion.
“My head was hurting doing the drill,” Akins said. “I kept doing it because I thought it would go away, and I didn't want to look weak with my friends watching. But I guess it was a bigger deal than I thought, because when we took a water break I wasn't feeling good and passed out.
“My friends said that I was delirious. I didn't completely lose consciousness, but I came back in the hospital room wondering why I was here. My mom was in shock and scared. They scanned my head and said I had a concussion.”
Akins in one of an estimated 43,000 to 67,000 players annually to sustain a concussion while playing high school football. The actual number of concussions per year may reach 100,000, since players hide injuries in order to play, according to an October 2010 Purdue University and Indiana University study published in the Journal of Neurotrauma. The risk of a concussion in football is three to six times higher in players who have had a previous concussion, according to a University of South Carolina neurology department study.
Head trauma has become an increasingly serious issue heading into the 2011 season. It's something that players, coaches and medical personnel will need to keep an eye on with preseason practice starting next week for most area high schools.
A concussion is not a bruise to the brain caused by hitting a hard surface. The injury takes place when the head either accelerates quickly then is stopped, or is spun and the brain becomes untethered. The brain floats in the skull surrounded by cerebrospinal fluid, which cushions the brain inside the skull. In most cases, the person who suffers a concussion doesn't lose consciousness.
Nausea, dizziness, memory loss, ringing ears, prolonged headache, confusion and inability to follow a pattern can occur after a concussion. Even after one concussion, a brain scan can reveal injury to the brain. Zemke said that if a player suffers three or four concussions, he should quit playing.
In many cases, however, players continue to play even after they experience a series of concussions.
Akins' former teammate, junior wide receiver and running back Miller Greene, sustained two concussions while at ACA. He quit after the second one, during spring practice in May. Greene's first concussion came during practice last August. A safety hit him as Greene ran with his head down.
“It was bad technique,” Greene said. “I ducked (my head) too low. I lost consciousness for a few seconds and walked towards the bleachers. I went to the hospital and found out I had a concussion. It was just unlucky.”
Greene's second concussion came in practice nine months later when he lined up at receiver and three defenders delivered a powerful blow.
“I was in a trance,” Greene said. “I stayed on the ground for a few seconds. I knew I was hurt. The trainer came over and asked to check me out. I went to the hospital and was told I had another concussion.
“Since I have a history of getting knocked in the head, I'm not going to play anymore. I still have headaches every now and then.”
Trent Lesley, an incoming freshman at the University of Alabama, suffered four concussions while playing free safety at Tuscaloosa County High School. Lesley's first concussion came in eighth grade, when he tackled a player while leading with his helmet. But it was his sophomore year when the concussions piled up.
“I lowered my head and got knocked woozy,” Lesley said. “I didn't want to come out. I didn't want to look like a baby, and I didn't want someone to take my spot (on the field). I was dizzy and couldn't see straight for a while, but I wanted to keep playing.”
The next week's game was something Lesley would like to forget. Since he hadn't recovered from the previous concussion, the results were disastrous. He said he was blind-sided by a receiver, and that's all he remembers.
His next memory is sitting in a wheelchair at the hospital.
“It felt like nothing,” Lesley said. “They said I played two more downs, but I can't remember anything. I think my mom drove me to the hospital, I just don't know.”
For eight weeks, he couldn't attend school.
“I had continuous headaches,” Lesley said. “I couldn't see straight or balance. All I wanted to do was sleep. I made good grades my whole life, but I made a 27 on my history test. I couldn't think.”
Lesley's head trauma didn't end there. During the last game of the season, he hit a fullback with his head down, using improper technique, and sustained his fourth concussion.
“I didn't know what was going on, but it was my last game of my senior year,” Lesley said.” I couldn't come out, you know.”
Now, Lesley sees a neurologist every three to four months for a checkup. He has to take prescription painkillers to make the headaches go away. Since his most recent concussion, he's had two MRIs and three CT scans.
“It doesn't scare me, but it bothers me,” Lesley said. “It bothers me that if I have a car wreck or somehow get hit in the head again that I could turn into a vegetable. That's what bothers me.
“I'm going to play flag football from now on.”
One concussion can lead to another, according to Zemke.
“There is a neurochemical response that takes place when the brain receives a concussion,” Zemke said. “If the patient returns to play before the neurochemicals are absorbed by the body, it will take longer to recover, and it takes less of a hit to cause another concussion. A concussion is actually a traumatic brain injury. The brain is like a yolk inside an egg.
“Teenagers who participate in higher-risk sports suffer greater injury than their (adult) counterpart. Teenagers' bones aren't as strong, and the brain isn't fully developed. The risk is at a greater rate than their adult counterpart.”
John Causey, the first-year head coach at ACA, said the Oklahoma drill is a safe one that teaches fundamentals.
“Safety is our first concern,” Causey said. “No championship ring trumps safety. Our trainer is going to meet with the parents and players on safety sometime soon.
“I've had a least four concussions playing football, probably more that weren't recorded. Players need to know whether they are fuzzy or have a concussion. I ask them if they are injured or if they are hurt. They know the difference. If I remotely think it isn't safe for a kid to play, I won't put him back in.”
The Alabama High School Athletic Association requires coaches and referees to take an online concussion class before they are able to step foot on the field. In addition, they must earn a CPR certificate, which has to be renewed every two years.
Last year, the AHSAA modified its rule on concussions. Before 2010, if the head coach deemed the player was able, he could send the player back in the game. Now, the player must be evaluated by a physician before he can play again.
While Zemke likes the new rule, she still thinks there is room to improve.
“Just because you're a physician doesn't mean you're up-to-date on concussion treatment,” Zemke said. “The rule says any physician, so an OB/GYN could, technically, treat the player. I would hope the physician would know their limits, but they (AHSAA) need to get some of the kinks worked out.”
Chris Hilliker, head coach at Paul W. Bryant High, had two players sustain concussions last season when he was coaching at Hale County High. Hilliker said he puts concussion safety posters on the bulletin board in the locker room.
“We talk about safety on day one,” Hilliker said. “We talk about better tackling methods and keeping your head up when you go in for a tackle. I think the game is safer since there is better equipment.”
Tuscaloosa County High and Sipsey Valley High each had two players sustain concussions last season. Anthony Truelove, a trainer for Paul W. Bryant, believes the game may be getting more dangerous.
“Athletes weren't as fast and as big 10 years ago,” Truelove said. “Now you have 280-pound guys on the field. Some of it is just the luck of the draw on whether you get a concussion or not.”
Northside High didn't have a player sustain a concussion last season. John Montgomery, Northside's coach, credits last summer's strength and conditioning program.
“Kids do more work in the summer,” Montgomery said. “We try to prevent (concussions) by teaching them to get their heads and eyes up. We instill that in them. We tell them that if their head or neck hurts, to report that right away. If they are hurt, they can't play or practice until they're cleared. There's no foolproof method to prevent injuries, but we try.”
Zemke doesn't believe the game is getting more dangerous. In fact, she thinks the equipment is much better – when it properly fits the player.
“No NFL team goes out with improper equipment, and they still have some concussions,” Zemke said. “The equipment is safer, but the problem you have is when players use their heads like a battering ram. They feel invincible, so they use their heads as a weapon. It's like they have a false sense of security. They don't realize that the slobber-knocker of a hit they give actually hurts themselves.
“If teams spent more time teaching fundamentals, injuries would go down. But the kids want the big hit. They like it when the crowd oohs and aahs when they collide with another player. If Nick Saban can win a national championship without doing the Oklahoma drill, other teams can too. The long-term effects of concussions occur younger than we think.”