The Hidden Injury: State rules provide foundation for growth in athletes' safety

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Two years ago, the Illinois High School Association and state Legislature overhauled the landscape of prep sports with a single move.

The passage of House Bill 200 mandated that athletes suspected of suffering a concussion not only be removed from action, but not return until cleared by a licensed physician.

“The IHSA went from nothing to a very good system,” Newman High School Athletic Director and football coach Mike Papoccia said.

As of a month ago, 38 states – plus the District of Columbia and the city of Chicago – had adopted youth concussion laws.

The law adopted in Illinois requires each school board to adopt a concussion policy that complies with IHSA guidelines.

The missing element? The criteria by which athletes are cleared to return to action.

Dr. Michael DeFranco, an orthopaedic surgeon and sports medicine specialist at CGH Medical Center, has worked hard with others to establish that criteria.

“Concussions are not an issue we want to be reactive about,” DeFranco said. “It’s something we want to be proactive about. We believe that the medical care begins before any season starts.”

DeFranco has worked the past 7 months to establish the Sports Concussion Program for CGH. It closely follows a template in place for years at Newman Central Catholic High School. Newman teacher and coach Andy Accardi and Dr. Joseph Welty, a family practice physician at KSB Hospital, have shepherded that program.

DeFranco views Welty as a comrade, not competition.

“I would never look at it that way,” he said. “The way I see it, we’re in this together.”

The two physicians offer a preseason physical examination, which gives athletes a baseline cognitive exam to compare to a re-test if there are concerns they’ve suffered a concussion.

If a concussion is diagnosed, there are specific benchmarks an athlete must meet to draw closer to returning to the playing field or court.

Fall short of one of those benchmarks, and it’s 24 hours of rest and back to the preceding phase.

Injuries don’t just take place under the lights on Friday nights. That’s why DeFranco is establishing a representative at each area school who will reach out to his team if a concussion is suspected.

“You don’t need a medical school background to understand what to do about a concussion or a basic sports injury,” DeFranco said.

Newman set the gold standard in the Sauk Valley long before DeFranco’s arrival to the area last fall, but he’s taking it to the streets.

He’s conducted seminars for athletes, parents and coaches, and sat down with as many athletic directors and coaches as he could.

DeFranco is saddened that it’s taken a lawsuit from numerous former players against the NFL for people to realize the potential long-term effects of concussions.

“It’s a little bit sad that it had to come to that – that some people had to die,” DeFranco said. “You can turn on an NFL game any week of the season, and concussions are missed all the time.

“And they have probably the highest number of medical professionals per athlete of any sport in the world. If it’s happening on that level, what’s happening on the high school level, where they might not even have an athletic trainer?”

In a perfect world, every school would have an athletic trainer at every sports event. Instead, just 42 percent of high schools have one, according to the National Athletic Trainers Association.

“If we could just get everyone to do something,” Welty said.

The new CGH program will have its opening night with the start of the fall prep sports season. But DeFranco is quite happy watching from the sidelines.

“I think who’s really going to shine is the athletes,” DeFranco said.

Steps necessary to return to play
From the CGH Sports Concussion Program Playbook

1. Athlete experiences no symptoms of a concussion
2. Physical exam, including balance and strength testing, is normal
3. SAC tests scores are normal or equivalent to the pre-injury/preseason score
4. Successful (with no symptoms) completion of 5 phases of physical activity:
Phase 1: Light aerobic, low-impact exercise, such as walking
Phase 2: Sport-specific, non-contact activity (i.e. strength training)
Phase 3: Non-contact training drills
Phase 4: Full contact in practice
Phase 5: Return to competition

* – If the athlete experiences symptoms in any phase, they must rest 24 hours and restart the preceding phase.