Concussion expert sees adolescents at higher risk

Tim Froberg
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MENASHA - Lee Evans had just taken a big hit while scoring a touchdown for the Wisconsin Badgers in the 2000 Sun Bowl and was being evaluated along the sideline.

It didn’t take long for Dr. Greg Landry — the Badgers’ team physician — to determine the big-play receiver had a concussion.

Michigan running back Chris Evans, center left, is hit from both sides by Illinois defensive back Stanley Green, front left, and defensive lineman Carroll Phillips, center right, in the first quarter of an NCAA college football game at Michigan Stadium in Ann Arbor, Mich., Saturday, Oct. 22, 2016. Evans suffered a concussion from the play and left the game.

“I asked him who had just scored a touchdown,” said Landry. “He didn’t know.”

That proved to be one of the quickest medical diagnoses that Landry made in his 31 years as team physician for the University of Wisconsin Athletic Department.

Concussions are not always that easy to pinpoint and remain a complex and controversial subject in the field of sports medicine. Concussion numbers in sports have climbed steadily over the past two decades and there is a growing concern at all levels.

“There’s been a lot of interest in concussions and people are more aware of them, but it’s not always that easy to spot them,” said Landry on Wednesday night in a presentation on managing sports-related concussions at the University of Wisconsin-Fox Valley. “There are some players who unless they say something, it takes us awhile to figure out if they are impaired. And sometimes, athletes don’t know they’re impaired.

“Take (former Badgers and San Francisco 49ers linebacker) Chris Borland. It was said that he’d had 30 or more concussions before he retired. In all honestly, he may have not known he was impaired every single time. Blows to the head are so common in sports that sometimes athletes don’t know when they’re impaired.

“That’s why teammates, coaches and everyone on the sidelines needs to be aware of the symptoms of a concussion and what to watch for.”

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According to Landry, a blank stare, a dazed look, disorientation, memory loss or a delayed response to a question are initial signs that an athlete has been concussed.

Landry served as team physician for the Wisconsin football team from 1984 to 2009 and also worked 21 years in the same capacity with the Badgers hockey teams until 2015. He currently practices part time in pediatrics and is a professor of pediatrics at the UW schools of Medicine and Public Health. He has lectured on concussion risk and treatment through his career. His presentation Wednesday was sponsored by the UW alumni association.

Dr. Greg Landry

One of the most interesting things Landry said during the 90-minute presentation was that adolescents appear to be more prone to sports-related concussions than college-aged and pre-teen athletes.

“There’s something about the adolescent brain that just doesn’t do as well with concussions compared to adults and pre-adolescents,” said Landry. “We don’t know why.”

Kimberly athletic director Ryan McGinnis was surprised to hear of Landry’s findings that teen athletes were more vulnerable to concussions.

“That’s very interesting. I had not heard that,” said McGinnis. “It’s disconcerting. I guess I would want to know the reason why and hopefully we can find that out. If the why is understood, then we could take more steps to try and make it a little safer.

“(Concussions) are something we take extremely seriously. We’ve taken a lot of precautions and steps to ensure not only the best preventative methods that we can, but also the best steps for the recovery process.”

Landry added that studies show girls are more likely than boys to get a concussion in high-school-aged sports.

“For some reason, girls are more vulnerable and their recovery rate has been longer,” Landry said. “And that’s another situation where we don’t know why. We’ve learned a great deal about concussions in recent years, but we still have a lot to learn.”

While concussions are often linked to contact sports such as football and hockey, there has been a spike in concussions in other activities.

“The concussion rates in soccer are quite high, especially girls’ soccer where the numbers are much higher than in boys’ soccer,” said Landry. “There’s a fair number of them in wrestling, where you have situations where wrestlers are hitting head to head or head to mat.”

Some say that because of head-related injuries, tackle football is doomed and will eventually be stopped. Landry, who played college football at Butler University and is the son of a football coach, doesn’t see that happening.

“I don’t think so,” said Landry. “But I do think that football needs to change. The problem is that the American football helmet is so well-made that for the last 10 or 15 years, players have used it as a weapon.

“You still see a lot of head-to-head, head-to-body contact. I think if you enforce the rules, it can really make a difference. Spearing was outlawed in 1976 and yet referees don’t always enforce it. At the college level, they’ve introduced targeting, which is basically when a guy launches his head into another player. It’s a 15-yard penalty and an automatic disqualification, and they’re calling it.

“A guy like Chris Borland. He’s a smart guy and he’s as tough as nails, but his style of play was exactly the problem — head-first.”

Landry said the Heads Up Football program in youth football, an NFL-funded program which guides coaches how to teach safer and proper tackling techniques, is a step in the right direction.

As for the safety of youth football and other youth sports, Landry doesn’t feel they present a high risk.

“Concussions are relatively uncommon at the youth level,” said Landry. “Little kids don’t generate the force that big kids do. There are some, but not nearly as many as the high school and college level. Everything has risks. Riding a bike may have higher risks than football, yet we choose to allow our kids to ride bicycles.”

Some feel that upgrading helmets might solve the problem and there has been talk of concussion-proof helmets, but Landry isn’t sold on the concept.

“I don’t think you can rely on helmet technology to protect the brain,” he said. “Concussions occur because of acceleration-deceleration of a head in space. Concussions are not about how hard you have been hit, but how quickly your head moves in space. So it doesn’t matter what helmet you have on. If your head gets jerked quickly and suddenly, you’re likely to get a concussion.

“There are a lot of people who would like to make money off this scare, if you will. There are a lot of helmet companies who think their product is the best and therefore the athlete will be less likely to get concussed. One of my colleagues in Madison, Tim McGuine, did a study of high schools in our area and it showed that it didn’t matter what kind of helmet you wore. In fact, it didn’t even matter how old the helmet was.”

A hot topic in sports medicine is the link of repeated head blows to chronic traumatic encephalopathy (CTE), a progressive, degenerative disease that affects the brains of those who have had traumatic brain issues such as concussions.

“It’s kind of scary, because we don’t know yet who is at risk,” Landry said. “It’s been in the news because some former NFL players have had it, but there are thousands of former NFL players who don’t have it. Why do some get it, and some don’t? That’s what we’re trying to find out.”

Tim Froberg: 920-993-1000, ext. 423, or; on Twitter @twfroberg

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