High School Sports

After a concussion, it’s unclear when — or if — high school athletes should return to action

Lee’s Summit North’s Mychal Shaw was slow to get up Friday after being hit in the game against Blue Springs High. He played the remainder of the game. He is continuing his football career despite a concussion a year ago.
Lee’s Summit North’s Mychal Shaw was slow to get up Friday after being hit in the game against Blue Springs High. He played the remainder of the game. He is continuing his football career despite a concussion a year ago. The Kansas City Star

It’s 6:35 on a cool October morning, still nearly an hour before sunrise, when Mychal Shaw emerges from his bedroom, pulls a Lee’s Summit North shirt over his head and joins his family in the kitchen for a morning prayer. At his mother’s request, he locks hands with his father and younger brother.

A hallway chandelier supplies a beam of light as Mychal bows his head. The glimmer shines on his mother, Ryana, who commences a prayer that has become the family’s weekly precursor — and security blanket — to Mychal’s high school football game days.

“Please,” Ryana begins. “We pray that You keep him safe in his football game tonight and let the angels watch over him.”

A brief pause. A deep inhale.

“Don’t let anything happen to my baby.”

A year ago, Mychal suffered a concussion in a game that rendered him temporarily unable to walk or speak. Subsequent memory loss forced him to drop two high school classes. Extreme sensitivity to light and sound prevented him from attending his team’s games, even as a spectator.

This season, though, he’s back on the field, a senior for the Broncos.

Mychal isn’t alone in his plight. Nearly 1,500 high school football players in Missouri suffered concussions in 2012, and the majority of them returned to action within two weeks, according to the Missouri State High School Activities Association.

The attention given to concussions has never been more intense. It has prompted coaches, parents, schools, legislatures — everyone — to be hypersensitive to head injuries and their symptoms. A step in the right direction.

But it’s the next step — the aftermath of the initial diagnosis — that still lacks a precise medical standard.

When is a high school player ready to return to the football field after suffering head trauma?

“I think we all worry about sending a kid back out there too soon. Any doctor who says otherwise is lying,” said Greg Canty, director of the Center for Sports Medicine at Children’s Mercy Hospital in Kansas City.

“You like to practice medicine based on evidence that’s supported with medical studies. We don’t have that here. As a result, there are no concrete answers.”


There were 17 deaths across all levels of football in 2013, according to figures gathered annually by the National Center for Catastrophic Sport Injury Research.

All 17 were high school athletes.

Two high school football players from the Kansas City area have collapsed on the field and died in the past four years — Spring Hill senior Nathan Stiles in 2010 and Shawnee Mission West senior Andre Maloney in 2013. A third, James McGinnis of Olathe East, suffered a serious head injury during a game Sept. 12 and remains hospitalized at a care facility in Nebraska.

Those incidents helped trigger local awareness about the perils of high school football. But while that recognition has focused primarily on spotting an initial brain injury, doctors who spoke with The Star are even more concerned with “second-impact syndrome” — an often fatal condition that occurs when a player suffers a second concussion before the previous one has healed.

“It’s like playing Russian roulette,” Canty said. “Once you have the symptoms, the brain is more fragile. If it takes a second hit or second blow, that could cause the brain to react and not be able to regulate itself, and that can result in potentially catastrophic injury.”

During a time in which professional and college football players are bigger than ever, it’s adolescents who are most susceptible to second-impact syndrome because their brains are still in the maturation process, says Brett Osborn, a neurosurgeon who has studied concussions in sports.

High school athletes suffer concussions at nearly twice the rate of college players, the Institute of Medicine and National Research Council determined last October.

But they receive inconsistent treatment plans for those potentially life-threatening injuries.

Brian Mahaffey, who wrote an article about concussions in the journal Missouri Medicine last year, advises that high school athletes should be symptom-free for seven days before returning to the practice field. An athlete of middle-school age should wait 10 days after all symptoms have subsided, he said.

Osborn, on the other hand, recommends that a child sit out at least six weeks after suffering a concussion, even if it’s mild.

State law isn’t so cautious.

Legislatures in Missouri and Kansas enacted laws in 2011 that require high school athletes to have signed clearance from a doctor before returning to the field. Under the Missouri law, a player must be removed from competition for only 24 hours before evaluation. Kansas has no such timetable.

“What we’re learning about head injuries is very significant the last few years, and we’re reacting differently to them,” said Staley High School coach Fred Bouchard. “We have to always be in tune with what the doctors and trainers are telling us about when a kid is ready.”

The danger is that a player who has suffered a concussion immediately becomes more likely to suffer another one. A person who has had three concussions, for example, is nearly four times as likely to suffer a concussion as the average person, Mahaffey said.

As a result, he suggests to some patients they quit football. But determining that proper stopping point is often guesswork.

“Can you have one concussion that causes permanent damage? You most certainly can,” Mahaffey said. “But I’ve also treated patients with 10 to 12 concussions who are asymptomatic almost immediately.

“That’s why it’s a hard question to answer. There’s no science that tells us how many concussions is too many.”


For Barb Kunz, one concussion was enough.

In the opening month of the 2013 high school football season, her son Alex took a helmet-to-helmet hit during an Olathe South practice. He was knocked backward but never lost consciousness.

A day later, Alex was having trouble comprehending basic concepts in his math class. He remembers walking to the cafeteria for lunch feeling confused.

Then it became obvious that something wasn’t right.

As he sat down for lunch, he shook his two milk cartons — as he did every day. But this time, he had opened the cartons before shaking them. Milk sprayed everywhere.

“It took me a good half second before I realized I was showering myself with milk,” he said. “I was soaked.”

Alex left school 20 minutes later to see a doctor, who diagnosed him with a concussion. His mother, Barb, reacted quickly.

She forbade him from ever taking the field again.

“I worried about the potential of Alex being that one-in-a-million kid whose prior injury might contribute to a future injury that would be much more debilitating,” Barb said. “So we made a family decision that it was one and done.”

Not just for Alex. His brother Andy was also pulled from the Olathe South team.

When Alex suffered the concussion last year, Barb and her husband, Ed, asked their sons to watch a CNN special on the potentially life-altering effects of repeated concussions. Then they informed Alex and Andy that they would be quitting football.

Barb’s biggest concern, she said, was allowing Alex to play while he was still experiencing the lingering effects of the initial injury.

“The best way to ensure he doesn’t come back too early,” Barb said, “is to not let him come back at all.”

The CNN report included one local subject.

On Oct. 29, 2010, Spring Hill senior Nathan Stiles died hours after collapsing on the field during a football game against Osawatomie.

Deputy Johnson County coroner Michael Handler said Stiles died from the “rebleed” of an undetected subdural hematoma, most likely suffered in a game several weeks earlier.

Second-impact syndrome.

Boston University later determined Stiles had the youngest reported case of chronic traumatic encephalopathy, more commonly known as CTE, a progressive and degenerative disease that’s currently diagnosed only after death.

Four years after Stiles died, his father, Ron, says Nathan wouldn’t have returned to the field had the family known the initial concussion wasn’t yet healed.

But a CT scan revealed nothing. And so he played in a game only three weeks later — with a doctor’s permission.

“We need a better way to diagnose concussions, first of all,” Canty said. “There’s no one test that is going to show everything you need to know. There’s a lot of research that needs to be done still.”


On the first play of his 2014 season, Liberty High School junior Josh Watson sniffed out a Lee’s Summit West running play. He sprinted toward the line of scrimmage, where he met tailback Ryan Williams.

Bang.

The ensuing hit — between two players shorter than six feet and less than 185 pounds — was jarring enough to send Watson to the turf. He remained there for a few moments before needing a trainer’s assistance to walk to the sideline.

Watson begged the team’s trainers to return the game, but they thought he displayed symptoms of a concussion. That spelled the end of his playing time in the season opener.

“That decision is out of my hands. It’s not me making the call,” said Liberty coach Chad Frigon. “And that’s a good thing. As a coach, I want to win and put him back in the game. But we take the emotion out of it.”

The process of rejoining the team — which Watson did the following Wednesday, after it was determined he did not have a concussion — has new guidelines.

Several area high schools in Missouri and Kansas, as well as a handful of middle schools, have implemented ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) into their football programs. The players take the computerized assessment before the season — when they’re concussion-free — to establish a baseline score.

If a player is later thought to have had some sort of head injury, he takes the test again and the scores are compared.

“Computerized tests can offer a false confidence,” Canty said. “A player passes the test and he’s often determined to be fine. Many times we need more and better evidence to support that determination.”

Frigon says Liberty follows guidelines from the Missouri State High School Activities Association, which helped shape the state’s 2011 law. The association suggests that athletes follow a seven-step return-to-play form and recommends spending at least one day at each step. But that’s not written into law.

When Kansas enacted its state law in 2011 — requiring a doctor’s clearance to return to play — Ron Stiles warned the the Kansas State High School Activities Association not to advertise it as a lifesaving plan.

“They’re telling people they’re safe if they follow this procedure and that’s not necessarily true,” Stiles said. “That’s exactly what Spring Hill already had in line. That’s exactly what we did with Nathan. He was cleared to play.”

His case isn’t unusual. Mahaffey said he has diagnosed high school players with concussions after they were cleared by other doctors.

Mychal Shaw, the Lee’s Summit North senior, was cleared to play five days after taking his helmet-to-helmet hit in a game against Lee’s Summit West. A neurologist initially diagnosed him with a migraine, his father said.

He missed five months.

More than a year later, he still has memory problems.

A second doctor informed Mychal that the brunt of his post-concussion complications were likely caused from the hits he suffered after his first one. He continued to play after the probable concussive blow — though he doesn’t remember the last half of the game.

“A lot of guys want to hide it because they want to protect their pride,” Mychal said. “I’m a victim of that. I did that.”


Over the winter break last year, Mychal and his parents were watching an ESPN special on head injuries in football. It sparked a conversation.

Mychal paused the TV and told his parents he was determined to play football again. He didn’t want a concussion to end his career.

He still hoped to attract the eyes of college scouts in his senior season so he could realize his dream of playing Division I football — where the players are bigger, faster, stronger.

“To be honest, I didn’t really want him to play because of what happened to him,” said his father, Michael. “As a parent, to see what I saw him go through — to have a healthy 17-year-old son turn to 90 overnight — that’s really scary. I wanted to say to hell with football.

“But at the same time, I wanted him to be happy. I wanted him to pursue his goals in life.”

Michael and Ryana, Mychal’s mom, arrive early for every Lee’s Summit North football game. They sit as close to the field as possible — “in case we need to rush down there,” Ryana said.

Mychal was officially cleared to play in February. The Shaws are confident in his doctor’s expertise, but Ryana has read the story of Nathan Stiles. He, too, was deemed ready to play.

Mychal spent time rehabbing with a personal strength coach. He says he hopes to deliver more big hits than he receives.

Among a pack of teammates, he takes the field every Friday night to blaring music. As the team heads to its sideline, Mychal jogs to the opposite end zone, takes a knee and bows his head.

One final prayer.

“I don’t want to play scared,” Mychal said. “So I just want to take a moment before the game and get rid of my nerves.

“After that, it’s on.”

To reach Sam McDowell, call 816-234-4869 or send email to smcdowell@kcstar.com. Twitter: @SamMcDowell11.

MISSOURI STATE HIGH SCHOOL ACTIVITIES ASSOCIATION RETURN-TO-PLAY FORM

The Missouri State High School Activities Association requires an athlete to have signed clearance from a doctor before returning to the field. It also suggests athletes who have been concussed to follow a seven-step process before returning to the field. It advises spending at least one day at each step.

1. Complete cognitive rest. This may include staying home from school or limiting school hours for several days.

2. Return to school full time.

3. Light exercise. This step cannot begin until the athlete is no longer having concussion symptoms and is cleared by a physician for further activity. At this point, the athlete may begin walking or riding an exercise bike. No weightlifting.

4. Running in the gym or on the field. No helmet or other equipment.

5. Non-contact training drills in full equipment. Weight training can begin.

6. Full contact practice or training.

7. Play in game.

HIGH SCHOOL FOOTBALL FATALITIES

The numbers include both direct and indirect fatalities. A direct fatality is classified as one that results directly from participation in football. An indirect fatality is one caused by systemic failure as a result of exertion while participating in a football activity.

2013: 17

2012: 9

2011: 13

2010: 11

2009: 16

2008: 14

2007: 9

2006: 13

2005: 10

2004: 11

2003: 7

2002: 9

2001: 18

2000: 14

Source: National Center for Catastrophic Sport Injury Research

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