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Saturday, May 20, 2000

Sports world is divided
on how to address the
dangers of concussions

Hawaii trainers practice
extra caution when athletes
suffer head injuries

By Jaymes Song
Star-Bulletin

NOTE: This is the local sidebar to
an article that ran in today's Editorial Section by
James C. McKinley Jr. of the New York Times

WHEN it comes to concussions, trainers and physicians in Hawaii take a conservative approach when dealing with young athletes.

"Later on in life, the effects can be devastating," said Eric Okasaki, head athletic trainer at the University of Hawaii.

The number of prep or college athletes in Hawaii who have suffered concussions is uncertain, because injury statistics are not recorded by any group or organization. The Hawaii High School Athletic Association (HHSAA) said each school is responsible for keeping its own statistics.

Trainers say they see a few concussions at their schools each year and believe they are inevitable.

"It doesn't matter what skill or size of the athlete, they're gonna happen," said Cindy Clivio, president of the Hawaii Athletic Trainer's Association.

Not surprisingly, football players appear to have more concussions than other athletes, said Clivio, a trainer at Kamehameha Schools for the past 14 years.

However, more and more concussions are occurring in soccer as the game becomes more physical and aggressive, she said.

Concussions can happen in any sport, but it would be a "fluke" in noncontact sports, like swimming, riflery and tennis, she said.

Once a concussion is diagnosed and treated, the next task is deciding when the athlete can return to his or her sport. There is no standard guideline. The decision is based purely on the judgment of a school's trainer or medical personnel, said Thomas Yoshida, spokesman for the HHSAA.

In general, however, student athletes are not allowed to return to practice or a game until all symptoms are completely gone. High schools have to be more careful than the college or professional ranks because there are no team physicians, Clivio said.

"We tend to be conservative," she said. "We take no chances with kids."

If a player suffers two concussions in a season, even if they are mild, he or she would need to have a release signed by a physician to return to the sport, she said.

Clivio said most high schools grade the severity of a concussion on a scale of 1 to 3, although there are several other scales.

The most minor, a "Grade One," would include being dazed or other temporary symptoms. A severe concussion, a "Grade Three," would require hospitalization, with the athlete having been unconscious for several minutes.

Dr. Andrew Nichols, UH team physician and associate professor in the UH's John A. Burns School of Medicine, doesn't bother with grades, preferring to look at "the whole picture," including symptoms -- dizziness, headaches, nausea, blurred vision -- and the player's history of head injuries.

He has seen "quite a few" concussions at the UH, but the "great majority are minor."

UH athletes must have "absolutely no symptoms" and be "completely rested" before returning to any activity, Nichols said. Gradually, they would be allowed to participate in light exercise the first few days before being exposed to more rigorous activities, such as lifting weights.

"It's not, 'OK, you're back,' " he said.

Sometimes, trainers and physicians decide to keep the player out for a week or the entire season, which may not be popular with fans, coaches and even the injured player.

But they say being safe and "appropriately conservative" is better than having the athlete deal with the consequences later on.

"They're kids or young adults we're dealing with," Okasaki said. "We don't want to see something that occurred in our management that will affect them 10-15 years down the line."