EDITOR’S NOTE: This is the latest article in a series of weekly columns to be written by local high school athletic trainers. This week’s column is from Casey Riley, athletic trainer at Mercer County. These columns will deal with the inner working of athletic training. They will also deal with trends, ideas and preventative measures.

By CASEY RILEY

Mercer County Athletic Trainer

Little over a month ago, I sat next to a 17-year old girl on the bench watching my girls basketball team from Mercer County celebrate their win in the state championship game. The girl next to me was a part of that win, but not in the way she originally imagined.

She should have been a player, out with her teammates in a sweaty jersey after playing in what could very well be the biggest game of most of their lives, and instead she was in dress clothes and sitting next to me because she had just spent the year being my Athletic Training Student Aide and one of the social media rulers for the basketball team.

You see this 17-year old girl can no longer play basketball, a sport she loves, because of concussions.

Concussions: Head injuries are a HUGE topic right now. We have learned so much through research over the last few years that it can be overwhelming. There is so much information and so many angles that can be discussed in regards to concussions that myself and follow colleagues Jeremy Johnson (Boyle County AT) and Kate Storms (Danville AT) could each write an article and only touch on about half of the information that’s out there.

Because there is such a wide range of things that can be said about concussions, I want to take a different spin and tell you all about this amazing and resilient girl. Her story needs to be told as a cautionary tale of “what if” and how it can be overcome but can seriously change a high school athlete.

The girl next to me on that bench was a girl named Danielle. When I started at Mercer County three years ago, Danielle was a spunky, quirky, outgoing freshman soccer player. I came to get to know her as a generally athletic person. She played both varsity soccer and basketball, along with select/travel soccer.

Danielle had played sports pretty much her whole life. She has a passion and drive for athletics that I can’t compare to anyone I have met and was willing to sacrifice just about anything, including her body and health, for the good of her team. The latter is how I got to know her so well.

During the time I had her as an athlete she had a string of injuries, ankle sprains, hits to the face leading to almost knocking out teeth, shoulder problems and head injuries. While dealing with her other injuries, I learned the extent of her concussions: over the course of years playing sports (mostly soccer), Danielle suffered from multiple concussions. Studies have shown multiple head injuries can actually can lead to other injuries since balance and other bodily systems can be affected by a head injury, which made her seemingly clumsiness make a little more sense.

In two years of athletics at the high school level, Danielle suffered from two documented concussions leading to a total of 4 documented concussions, with at least one additional head injury that she never saw a doctor for. Number four lead to the end of her athletic career as she knew it.

Her last concussion happened during a soccer game warmup in mid-October 2015 when she got hit by a kicked ball straight to the back of the head and neck. During this time she was even wearing a “concussion helmet,” a soft padded helmet that is legal in most all sports, but it still wasn’t enough to protect her. No helmet, even football ones can be absolute protection from a concussion since it can’t stop the brain from bouncing around in the skull, which causes damage and bruising to the brain.

In this particular case Danielle was actually transported to the local hospital via ambulance due to spine pain. Thankfully X-rays cleared her of any spinal issues, but she was once again diagnosed with a concussion. They performed a CT scan in the emergency room, which was also clear, but she had symptoms of a concussion: these included severe headache, dizziness, sensitivity to light and sound and mood swings.

It is extremely important to understand that a scan can NOT rule out a concussion. MRIs or CT scans are routinely done when a person reports to the ER for a suspected concussion but only a small percentage will have an abnormal scan. A scan only shows a concussion if there is a bleed, and bleeds are uncommon. So just because a person has a clean scan does NOT mean they are concussion free. It just means they don’t have the complication of having a bleed which can be life threatening.

As Danielle laid on the hospital gurney in complete darkness waiting for X-rays and scans, her parents and I discussed her future in athletics. There isn’t a magic number of concussion to disqualify an athlete from participation; it is decided case by case, athlete by athlete and many factors come to play.

In her case we decided that Danielle should see a specialist, a neurologist who would decide her fate in athletics and monitor her care of this concussion. Danielle saw the specialist less than a week later and it was decided at the time that she was done with soccer for a year but that she could return to basketball once her symptoms from this concussion resolved.

However that was an uphill battle. Danielle suffered from debilitating headaches, which caused her to mostly want to sit in a darkened room and sleep most days away, and she consumed a lot of ibuprofen. One of the biggest things to understand about Danielle is she was 100 percent a social butterfly: the sports she played and her friends are who she is and she really struggled with not being able to do those things she loved. School was a struggle because the light, sound, and trying to concentrate would just make the headaches worse.

After weeks of her struggling we started discussing homebound schooling so Danielle could stay home and do work at her own pace. As one last ditch effort her parents finally had to take one weekend where she wasn’t allowed to go anywhere or really do anything besides rest to hopefully get the headaches to subside, which helped enough that she did not have to go on homebound.

Finally after almost eight weeks of symptoms and struggles Danielle finally felt good enough and got the all clear from the doctor to return to basketball. Unfortunately her return would last less than a week.

During a half court scrimmage at basketball practice, Danielle took a glancing blow to the temple from a teammate’s elbow. This was one of those hits that to most people wouldn’t have been that big of deal. It may have given someone a headache and maybe even other concussion symptoms but for Danielle this brought back a rush of all her symptoms — sensitivity to light and sound, dizziness and an overwhelming headache. This blow would cause her to have symptoms for months, and she still struggles with headaches on occasion still over a year later.

She also returned to the neurologist who disqualified her from all contact sports. She is only allowed to now run track or cross country and can possibly play tennis.

As a sophomore who thought she had at least two more years of playing the sports she loved with some of her best friends, Danielle’s world was turned upside down. While most people would think being told your sports career is over wouldn’t be that big of a deal, to a 16-year old who has played and lived sports her whole life, this news was shocking and terrifying. She not only struggled with constant headaches that at times were absolutely debilitating, she also had issues with mood swings and depression.

To some high school athletes, athletics is their life. They have spent and devoted so much time and effort to working and honing their skills for a certain sport, they have no idea what to do when it’s over. And Danielle was one of those athletes.
I mentioned before her passion and love of the sports she played — well, that passion and love slowly became resentment and hate. She couldn’t stand to be around the soccer team, she loved that basketball team but we could see the hurt she went through watching them play a sport she could never play again without risking her life.

Her parents, coaches and myself continued to try to keep her involved and active in sports because it was when she was the happiest, but it was like watching someone go through the stages of grief, all the way from denial and the 100 conversations about why she couldn’t play to acceptance.

Thankfully, finally, after watching for months that bubbly, quirky girl I knew disappear, she slowly accepted that she would never play the sports she loved and she found love in the things she could do.

Most people don’t realize the lasting effects concussions can have and it doesn’t take multiple ones to cause that effect. Yes, Danielle has had many but for some it only takes one to completely change their life. If you keep up with current sports news you know that CTE and concussions are a big topic for former NFL players. We are finding that blows to the head cause many issues from mood swings, depression, to continuous symptoms like headaches and dizziness that can affect a person’s day-to-day life, and we still don’t know the exact extent of these issues.

Even as soon as a couple months ago, Danielle asked me if she could play basketball next year, because most people don’t understand why she is still out and why she can’t play, so she gets asked by former teammates and classmates why she isn’t playing or when she’ll return. They don’t do it to be mean but the fact is they just don’t know.

The truth is, with Danielle each concussion has presented with symptoms just a little worse than the last and we have no way of knowing if they next one would be the one that makes her have total and complete disastrous results. She could lose all ability to maintain memories, she can lose function in arms and legs since the brain controls all that, the list goes on and on. The risk for a 17 year old is just too great.

And despite the fact that she has accepted she will never play contact sports again, there is still a part of her that gets hurt each time someone asks when she’ll be back.

Thankfully, Danielle has found joy in working and learning with me. She worked football with me and then helped out with the basketball team, and she will get a state ring for her efforts. No, it’s not how she imagined it would happen, but when I wasn’t at a game or practice she was my eyes and ears and the team depended on her. She was just as important as any other player and the team was successful partial because of her.

She also has joined the track team this year so she at least can say she’s an athlete again.

Overall the takeaway I want you to have from Danielle’s story are two things. One, you never know a person’s story or what they have gone through, and two, concussions can no longer just be a causal issue.

Coaches and parents need to get away from the old mentality that he just got “his bell rung.” We still don’t understand a lot about concussions and the long term effects they have on athletes, especially high school and younger athletes.

We all must be proactive and advocates for our children in that if they take a blow to the head or face, or even a jolt to their body that causes a whiplash-type motion and they complain of a headache or other symptom such as dizziness or problems concentrating, we need to take them seriously.

While I’m not glad Danielle has had so many problems and still has some pretty bad headaches, I’m happy and proud to call her my student and to be able to share her story. She has fought hard to overcome so many issues someone so young should never have to encounter, and while they may seem minor to some they are huge character blocks for her. I am over the moon proud of her and her continuous journey.