Twenty-four years ago the quarterback of the Canadian Football League’s Montreal Concordes dropped back to pass, was hit as he threw and had to be removed from the field in an ambulance.

It was his third concussion that year and his second in two games. At 23 years old, he would never play again.

Today, Turner Gill has just finished his first season as coach of the Kansas Jayhawks, and the injury that ended his playing career is as big a factor as it ever was. We have learned that concussions are no more likely in the young or the old, and we are still learning about the long-term effects on the brains of the afflicted. It’s being talked about more than it ever has. Some offer solutions. Many concede there is still much to learn.

“I am always in communication with our medical staff on updates,” Gill wrote in an e-mail last month.

That staff is stationed on the lower level on the Anderson Family Football Complex. Inside Sports Medicine Director Murphy Grant’s office, weights can be heard — no, felt — seemingly crashing through the wall. The Border War’s in a few days and the team is conditioning a few rooms over to prepare for what will be a one-sided loss to Missouri. During the game, wide receiver Jonathan Wilson would get rocked by two defenders and taken off the field in a daze. Quarterback Jordan Webb would be removed from the game when a block on a Missouri interception return left him with a concussion.

A few feet from Grant’s desk is a copy of a handout the NCAA instructed its programs to give to athletes before playing this year — “CONCUSSION: A FACT SHEET FOR STUDENT-ATHLETES.” It is one of many attempts to address something that threatens the game and those who play it.

“I don’t think anybody took concussions serious”

But concussions were an issue long before NCAA policies were written and enforced.

John Novotny, a walk-on player in 1956 and the program’s first full-time academic coach, said he doesn’t remember ever seeing a doctor on the field during his playing days.

“I don’t think anybody took concussions serious,” Novotny said.

Before he graduated, James Holt led the team with 105 tackles and 10 sacks in his senior season in 2008. Against Kansas State that year, Holt had what he said was his only concussion. After making a tackle that forced a fumble and gave his opponent a concussion, he recovered the ball but didn’t realize it was in his hands until moments later.

Holt, who now plays for the San Diego Chargers and lives with Darrell Stuckey, another Charger who once played at Kansas, said the football program under Mark Mangino followed strict concussion protocol before the NCAA required a policy.

His coach certainly wanted to win, he said, but if a player couldn’t shake the symptoms of a hit, Mangino wouldn’t keep them in the game.

“We want to make sure we’re taking care of them”

Grant said he remembered returning to play shortly after sustaining his only concussion as a defensive back at Quincy College, a Division II school in Illinois. That was a little more than 10 years ago. Now, to “get your bell rung” is no longer a phrase easily dismissed.

The NCAA this year, in addition to providing mandatory fact sheets, required athletic programs to put in writing a policy outlining how concussions will be treated and when to allow athletes to return to play.

Grant, in his fifth season with Athletics, drafted Kansas’ six-page policy. One of the first steps, he said, is performing a computer-based neurocognitive baseline test and a second test measuring memory and concentration. The tests, part of the screening process for incoming athletes, are retaken when an athlete has a concussion and compared with the original results.

Whether during practice or a game, players who experience a concussion or concussion-like symptoms (such as headaches, nausea, amnesia and loss of consciousness) can expect to see the team’s head physician, Lawrence Magee, or an assistant immediately for testing.

Grant said athletes can also be sent to Lawrence neurologist Dr. Paul Morte for further testing. Morte has been in Lawrence for 16 years and has seen KU athletes for eight years.

There is no formal time frame for returning to play after a concussion. Morte said athletes should be symptom free for at least a week before resuming activity. That period becomes two weeks for severe cases, he said.

There were 16,277 total concussions reported by NCAA football programs in 2009. On average, a player with a concussion missed six days of practice and/or competition.

Return sooner, Morte said, and the risk of second-impact syndrome skyrockets.

Those with concussions immediately experience a heightened likelihood of a second concussion. If that second concussion occurs before the symptoms of the first have cleared, it can result in brain bleeding, swelling and death.

“It isn’t just a little ding, it makes its mark on the brain”

Last week, Rev. Tom Thomas and Rev. Kathy Brearly had their first Thanksgiving without their son.

Owen Thomas was 21 years old and a captain on the University of Pennsylvania’s football team when he took his own life in April. His parents called his death impulsive — they never noticed any signs of depression, nor do they recall Owen complaining of so much as a headache during his football career.

Thomas said his son was someone who pushed himself to the limit academically and athletically and cared deeply for others.

“He just enjoyed life in so many different ways,” said Thomas, who himself played football at Penn.

Brearly said she was surprised when researchers from Boston University called just hours after Owen’s death, asking if they could examine his brain for signs of damage from head injuries.

Owen’s parents consented — Thomas said he has since volunteered his brain for research — but insisted researchers would not find anything. Months later, they were told Owen’s brain showed early signs of chronic traumatic encephalopathy (CTE), a degenerative brain disease found in athletes with a history of repeated concussions.

The disease, associated with aging boxers since the 1920s, began cropping up in brain autopsies of former professional football players in recent decades. A July 2009 study written by several of the same doctors who looked at Owen Thomas’ brain looked at five former professional players whose autopsies revealed CTE. All died suddenly at middle age. Of the five, two committed suicide, one was killed in a head-on collision during a high speed police chase and one was shot in the head while cleaning his gun.

Owen’s case is the earliest known appearance of CTE. The impulsive behavior his parents believe led to his suicide is consistent with the disease’s symptoms. And while he didn’t exhibit signs of a concussion during his career, Owen’s CTE could be the result of a series of small concussions over time.

“I can’t tell if Owen is the tip of the iceberg as far as these sub-concussions are concerned or were we particularly unlucky?” Brearly asked.

Dr. Kevin Guskiewicz at the University of North Carolina has been recording head impacts for the past six seasons using accelerometers implanted inside the team’s football helmets. In that time, he has recorded about 250,000 impacts using what is called HITS (Head Impact Telemetry System) — a program now owned by the helmet company Riddell.

Surprisingly, he said, UNC’s Sports Concussion Research Program found that concussions occur at unpredictable levels of impact. Guskiewicz also found that players experience the same symptoms from concussions regardless of the force of impact.

“The big hits don’t necessarily equate to the worst clinical outcomes,” Guskiewicz said.

From years of reviewing video of injuries at the University of Kansas, Grant said he noticed many concussions occurred not when a player was hit hard, but when their head bounced off the ground after impact.

So far HITS has recorded 25 concussions at the University of North Carolina and found that the average starter in college football can expect to receive 950 hits to the head each season, give or take 100.

When one of those hits causes a concussion, Morte said, the brain smacks against the skull and can tear the fibers connected to nerve cells. The damage done to these fibers — and the contusions and blood clots in the brain that can also occur — won’t appear on a CAT scan or MRI, he said.

Morte said players often don’t report concussions. When this happens, he said, more injuries will follow with accumulative damage.

“The blows to the head are much more severe than we realized,” Morte said. “When somebody gets knocked out, it isn’t just a little ding. It makes its mark on the brain.”

“Something better be done now or they’re going to do away with the game”

Novotny and his former coach, Don Fambrough, remember when the most common injury to the head in football was a broken nose. That was when helmets were nowhere near as bulky as they are today and a face mask typically meant a single bar.

“It’s night and day,” Novotny said. “That thing weighs a ton.”

When talking about concussions, Fambrough repeatedly taps his cane on a helmet Mark Mangino signed for him years ago.

“It’s a weapon when they come together,” Fambrough said. “I can understand why that would cause an injury of some kind.”

Fambrough said he thinks today’s helmets also lead to risks players from his era would have been reluctant to attempt.

When solutions to address head injuries in the sport are discussed, helmets are often brought up. Most of the Kansas football team wears Riddell, which introduced a new model called the Revolution in 2002.

The helmet is billed by the company to be 31 percent more effective against concussions than previous models. However, Dr. Robert Cantu of Boston University told The New York Times in October that the statistic represented a comparison between brand new Revolution helmets and helmets of unknown age and condition.

The oversight of how helmets are tested for safety has also been questioned. Nearly all helmets have a label on their backsides saying they meet NOCSAE standards. NOCSAE (National Operating Committee on Standards for Athletic Equipment), is a nonprofit corporation formed in 1969 to test football helmets and its testing procedures have not changed much since the 1970s.

“Our number one goal when developing new helmet technology is not to meet a test standard but to exceed the protection standards,” Riddell’s vice president of research and development, Thad Ide, said in an e-mail.

YouTube Video

Video from Boston University

Helmet manufacturers test their own helmets during production and there is no independent force to oversee these tests. During the tests a helmet is mounted on a synthetic head model and dropped on a foam rubber pad from different locations and varying temperatures.

Holt said he sticks with the original model and even said since his high school introduced the Revolution helmet two years ago, it has actually seen a spike in concussions.

Not all place blame squarely on the helmet. Guskiewicz said he has been impressed with improvements in helmet technology. However, he said he wasn’t sure the answer to concussions is in the helmet.

“The problem is we sort of want our cake and eat it too,” Guskiewicz said.

He said helmets were designed to prevent catastrophic head injuries, such as skull fractures, and not necessarily concussions. Instead, he said the issue is better addressed by focusing on style of play and the game’s rules.

In 1976 the NCAA eliminated the head and face as a primary and initial contact area for blocking and tackling. In 2005 the NCAA changed rules to address “spearing” and head-down contact. A ban on hitting opponents with the crown of one’s helmet was also introduced shortly thereafter. After the 2005 rules changes, reported concussions decreased slightly. The NCAA’s Injury Surveillance Program reported that in 2004, 3.4 out of every 1,000 football players suffered a concussion. That dropped to 2.4 per 1,000 in 2005 and has ranged no higher than 2.8 in the last three seasons.

The National Football League gained attention in October when it began fining and threatening suspension for helmet-to-helmet contact. Holt, who is in his second season with San Diego, said the measures won’t prevent what is “just part of the game.”

“It’s like telling a boxer not to hit someone in the head because they’re going to not be able to walk later on in their life,” he said. “It’s just not going to happen.”

Holt said he was always taught to lead with his nose, keeping his head up as he tackled. Sometimes, however, he said helmet-to-helmet contact is inevitable. To him, it’s just how the game is.

“I just don’t see how it’s becoming such a shock to people that there’s all these concussions and stuff messing up these players’ lives,” Holt said.

Fambrough is conflicted. He said the sport is getting out of hand. Maybe kickoffs should be erased. Maybe it’s the equipment. Fambrough is afraid if something isn’t done soon, the sport that treated him so well may be done away with altogether.

Yet at the same time, the sport’s becoming hard to watch for the old coach as officials, with pressure to crack down on crunching hits, throw more penalty flags than Fambrough recalls ever seeing.

“They’ve got to stop calling all of these damn penalties,” he said. “The games last way too long and people get bored.”

Holt thinks penalties, fines and suspensions will only hurt defenses. He said defensive players don’t know what to do in the NFL when one misstep might cost them tens of thousands of dollars.

“I’m waiting for them to put a belt around their waists and we’ll just start playing flag football,” Holt said.

“If reported incidents are on the rise, that’s a good thing”

On Thanksgiving morning, Kathy Brearly dressed her son’s grave with Christmas decorations as she talked to him. Anything for a little comfort while getting used to having someone so alive in her life one day and gone the next.

She said she checked in on a family that also lost a loved one to suicide. Since Owen’s death, Brearly has contacted parents of suicide victims, many who once suffered from concussions. She was amazed to discover the level of misunderstanding even some physicians had about CTE and its effects. She recently received an e-mail from a woman whose husband killed himself shortly after being discharged from the hospital that treated his concussion. The couple had received no instructions to look for suicidal tendencies or other side effects.

“How can that happen?” she asked. “It’s just amazing to me.”

What’s difficult to deny, though, is the heightened level of discourse about concussions in football. We may have only scratched the surface of what can be known about the injury and its lasting effects, but we’re looking at an issue once dismissed as someone being “punch drunk.”

“At the beginning of the season the announcers would talk about having your bell rung,” Thomas said. “They don’t use those terms anymore.”

Everyone interviewed said awareness of the issue is higher than any other time in the sports.

Guskiewicz warned against interpreting the increased attention as signaling an increase in concussions over previous years. Instead, with more awareness come more diagnoses. With a better knowledge of symptoms and effects come more effective response plans. And with more dialogue comes more disclosure from players who may have previously stayed on the field with fatal consequences as a real possibility.

“If the reported incidents of concussions is on the rise then that’s actually a good thing,” Guskiewicz said. “The word ‘reported’ there is a key word.”

— Edited by Tim Dwyer