One in five high school athletes will sustain a sports concussion during their season. At a school like Paly, where a large part of the student body is involved in athletics, this fact can create a big problem that includes the students, their families, their teachers and the administration.

A concussion is a traumatic brain injury which causes symptoms that can last anywhere from days to years. They can be caused by a blow to the body or head that leads to the brain bumping against the skull. For this reason, concussions often occur in contact sports. Symptoms can include headaches, nausea, dizziness, sensitivity to light and noise, loss of consciousness, inability to focus and loss of memory. It is important that an athlete who has suffered a concussion does not return to their sport before the brain has fully healed. Following an initial concussion, suffering from a subsequent concussion can have severe effects ranging from worsening of original symptoms to death.

Despite the severity of the injury, some athletes are unaware they have sustained a concussion until hours, or even days, after it occurs. Maya Kandell (‘16) got a concussion this past fall when she was hit in the back of the head by another player while playing in a club soccer game.

“I didn’t really know that I had a concussion at the time,” Kandell said. “I didn’t know that anything was wrong. I played for the rest of the half [and] I did AP [Advanced Placement] US History notes in the car on the way home. It probably took until the day after that, when I failed my driving test on the first turn [because I] didn’t see any cars even though I was going into oncoming traffic, to understand [that something was wrong]. I was kind of dazed and confused for a few days.”

After the initial diagnosis, the appropriate time before returning to exercise, and eventually full contact play, depends on the athlete and the severity of the concussion.

Kandell then went into urgent care and found out that she had sustained a concussion. Despite it being her first concussion, it was an extreme case.

“My neurologist told me that it’s up to me in the end, but that she would not recommend me going back to soccer at all,” Kandell said. “If I do…it [should] be the absolute longest amount of time between the injury and me going back to playing, so certainly not this season, probably not even next season.”

Soccer is the leading cause of concussions for female athletes. However, there is always a risk for brain injury in contact sports. Avery Zenger (‘16) was concussed in a lacrosse game her freshman year when she was hit in the head with an opponent’s lacrosse stick. Since it was the end of the year, she missed the rest of school and did not take her finals. She went through physical therapy but still could not return to her previous athletics, which included club soccer and school lacrosse.

“After going through two sessions of physical therapy I would do small workouts by myself,” Zenger said. “I never really got back into my sports because my parents didn’t feel comfortable with it, and I didn’t really feel comfortable [with] it.”

For student athletes, concussions can also result in lasting academic consequences. Conner Donnelly (‘16) was concussed while wrestling his freshman year. He dropped lanes in almost all of his classes and was only able to take one class this past fall, Japanese. Although his concussion was severe, he was unaware he was injured until his symptoms became almost unbearable.

“I actually didn’t know I had a concussion until I had bad enough headaches that it was difficult to just function,” Donnelly said. “I had headaches to the point where it was hard to sleep just because the headaches were so bad…at that point I stopped wrestling and haven’t gone back, so [my concussion] pretty much ended [my] wrestling career.”

However, Donnelly, Zenger and Kandell are examples of extreme cases. Not all concussions result in having to give up sports. Owen Plambeck (‘16) did not have as long of a recovery time for his injury. He was hit in the head with a baseball going almost 90 miles per hour during batting practice, and after a trip to the emergency room was diagnosed with a concussion.

“I couldn’t exercise or run for about three weeks,” Plambeck said. “I was cleared [for full contact] four weeks after the concussion.”

Many contact sports such as football and boys’ lacrosse require the use of helmets in order to try to limit the number of head injuries. Despite this precaution, many concussions still occur. Owen Staiger (‘15) hit his head against the head of an opponent during a lacrosse game. Right away, he noticed that something was wrong.

“I knew that I didn’t feel like I could just keep running,” Staiger said. “I went out and I sat down for a little bit and then I talked to Josh [Goldstein, Paly’s old athletic trainer,] and he did some concussion tests.”

However, Staiger was not kept out of the sport for long.

“I was pretty lucky that it was only a minor concussion,” Staiger said. “I could go back into practice without severe contact for a week and then I was back playing in the next game.”

Fortunately, most coaches, especially in contact sports, seem to understand concussions and the risks involved. Staiger had a good experience when it came to his coach.

“The coaches are really worried about concussions, especially in contact sports like lacrosse and football,” Staiger said. “I’d say that they’re really conscious of concussions and preventing them, and [they] do everything they can so that we can get back and be healthy…They won’t push us unless they’re told by a professional that we can go back.”

Kandell described a similar experience with her soccer coach.

“[My coach] completely gets it,” Kandell said. “He doesn’t want me to play if I’m going to hurt myself.”

Besides restricting athletes’ abilities to play their sport, concussions can also take a big toll on school work. A common symptom can be the inability to concentrate for long periods of time, which inevitably extends to academics. Reading or studying can also trigger the return of other symptoms such as headaches, nausea and dizziness.

Bryce Rockwell (‘16), a volleyball player, experienced these symptoms after suffering her first concussion last spring at a tournament.

“I was out of school for a month,” Rockwell said. “I couldn’t get out of bed because I was too nauseous because my head hurt so much. I couldn’t listen to music, read, go on my phone, watch TV or anything because it would make me so nauseous. I basically just had to sit in my room and sleep, and that was it.”

Due to the severity of Rockwell’s concussion, her grades were “frozen” and she was exempted from taking second semester finals.

When Rockwell experienced a second concussion this fall, however, keeping up with her classes proved more difficult because it was the beginning of the school year and she was expected to make up all missed work.

“There was a lot of pressure to get better because it was the beginning of the year,” Rockwell said. “My grades ended up getting messed up from [my concussion]. My teachers didn’t make me do any work [while I was concussed], but I was still expected to make it up [later]. Every time I wasn’t at class I would have to make up more. But, I couldn’t make it up because even though I went to school it still hurt my head. Even when I was going to school and said I was fine, I wasn’t. I didn’t want to miss more school because it was just too much”.

This pressure to get back to her school and sport as soon as possible prompted Rockwell to return to a normal activity level despite still feeling the symptoms of her concussion.

“The second [concussion] I got on the same part of my head, playing volleyball again, and I was out for a week,” Rockwell said. “But, I went back too early and didn’t let myself heal all the way because I didn’t want to miss school…You can lie about if you feel better…it’s easy to go back and say you’re fine.”

Returning to activity before the brain is healed, however, can lead to long term complications as well as prolonging initial symptoms. After returning to school and volleyball before allowing herself to completely recover from her second concussion, Rockwell experienced noticeable differences in her ability to maintain focus while performing a mentally strenuous task.

“[My concussions] have definitely affected me,” Rockwell said. “I can’t remember things as easily… I have to think more—I’m not as quick on my feet, especially with my writing. My writing used to flow better and now it doesn’t because it takes a lot of attention and it’s hard for me to focus. If you go back too early it can damage your head even more, and I’ve definitely noticed that.”

It is possible that the consequences of Rockwell’s concussion could have been less severe if she had waited longer to go back to school and volleyball. A concussion is similar to other injuries in that returning before full recovery can worsen the injury. Attempting school work is one example of mental exertion which can aggravate symptoms of a concussion.

Plambeck was unable to complete any homework or school work soon after his injury, which resulted in academic consequences that lasted for much longer.

“I started doing light homework three weeks after the fact and make up work for probably six weeks,” Plambeck said. “I’m retaking Beginning Journalism because I got an incomplete due to the concussion.”

Kandell was also forced to drop a class because of her symptoms. She had been taking AP US History and did not think she could make up the amount of work she would ultimately miss in time to take the AP test in May. Because this had been Kandell’s only AP course, she feels that having to drop it could affect her college applications. It has been about three months from the time Kandell was injured and she still has difficulty focusing long enough to complete homework after full days of school.

“It must have been [a week after my concussion] that I dropped, [becuase] I would still have an extremely difficult time doing APUSH notes,” Kandell said. “That was my one AP class and I had to drop it…this semester I’m not taking any AP [courses] or any honors [courses]… I consider myself to be an at least somewhat high-achieving student, and so it feels really weird to not be [taking AP or honors classes]. I feel like my college applications are going to be jeopardized…I’ll put in a box ‘had a concussion, had to drop this class’ but it’s weird [that] I’m not going to have taken a single AP test by the time I’m applying to colleges, and that makes me nervous.”

Many teachers at Paly have worked with students suffering from concussions, and they have developed various methods to help them. According to students, some teachers are more accommodating than others. Some allow students to complete alternate assignments or modify assignments so that they are less strenuous. Others require that students complete all regular assignments, but give them extensions or extra time to finish them.

Plambeck described most of his teachers as accommodating and stated that he was mostly given extensions to complete the work, rather than modified assignments.

“They were pretty much all accommodating, giving me as much time as I needed until I felt like I was ready to resume work,” Plambeck said. “I didn’t do anything until I was able to do the complete assignment…I took all the tests just at a later date.”

Many teachers understand the challenges that students face when returning from a concussion, but others, especially when unfamiliar with the specifics of brain injuries, can have a more difficult time discerning what is going on with a student. Kandell encountered both types when trying to figure out her school work.

“A lot of my teachers were really great, [but] some were kind of stubborn,” Kandell said. “I think that it’s very hard when you have a brain injury for somebody to see [what is going on]. I think it is really hard for some teachers to understand that I can’t do something… In the last few months I was still participating in class, so I think it was really hard for some teachers to understand, ‘okay she can do this but she can’t do homework, or she can’t take tests.’”

Justyn Cheung (‘16), who got a concussion playing water polo, also experienced different policies between his teachers and consequently his workload was not significantly diminished while he was concussed.

“I had the guidelines that said I could only do an hour of school work a night,” Cheung said. “Even though I had the guidelines, teachers had different interpretations of it—some thought, ‘oh, I can only give you an hour of homework per night,’ as opposed to a cumaliative whole of one hour of homework per night. It varied between the different teachers, and overall I think I had the same amount of work.”

With teachers’ varying methods for handling concussions, it is easy for students to experience a workload that is not less than normal. Consequently, many student athletes suffering from concussions are held to an academic standard that can be too rigorous for their neurological well being.

“The teachers were really nice, but if you get a concussion you get behind really fast,” Cheung said. “So, if you don’t make up the school work, it’s really hard to get back up to where you were. Most of the teachers gave me more time on the stuff, which doesn’t necessarily help if you’re having trouble recollecting things. They tried to be accommodating in the best way that they could, but overall it was still difficult.”

The administration can also play a key role in handling concussions. If a concussion is severe enough to limit academic work, a student and their family can talk to the guidance counselor in order to figure out a way to still fulfill class requirements while also taking care of themselves. Ultimately the decisions regarding coursework are left up to the student and their teachers, but the guidance staff can help a student decide if it is necessary to drop a class or switch into a lower lane in order to maintain a course load that is manageable.

Kandell met with Susan Shultz, the junior guidance counselor, in order to figure out an academic plan that was adequate.

“[Shultz] really wanted things to work for me,” Kandell said. “My grades got frozen after a certain point…before then my teachers were pretty understanding. I don’t have to make up entire classes, [but] I have to make up a few assignments for English and some other classes because the teachers didn’t want me to not do anything for that period, and not make up anything that I missed.”

Shultz described how the guidance department currently deals with concussions, and explained that most of the action is decided on a case by case basis.

“[Students] usually start out by coming in with a doctor’s note that confirms they actually have a concussion,” Shultz said. “Then we have a concussion protocol form that we ask them to take back to their doctors, because it’s pretty specific about what accommodations they need given their specific concussion. Then, once we get that information back with parent consent, we actually give that to the teachers.”

As someone who has repeatedly dealt with students with concussions, Shultz finds that more often than not the student’s teachers are very flexible. However, if certain teachers are less helpful, a lot of the responsibility falls on the students to report what is happening in order to make the situation better.

“It can be pretty difficult [to manage a concussion]—and it is stressful,” Shultz said. “I’d like to hope that the teachers are following the accommodations and the students are getting the support they need. If a doctor is saying that the student should only have this much work…we have to go with that. But, we need someone to tell us if teachers aren’t being accommodating.”

Although a concussion can have serious detrimental effects regarding athletics and academics, Kandell and Zenger both agreed that the experience has been beneficial in some ways. Kandell has had an opportunity to explore more of her interests outside of school and sports, especially art because it does not seem to require the same amount or type of brain power that other activities do. She also has gained a new perspective on the pressure that students put on themselves to perform well, especially when trying to become the best college applicant possible.

“I was so caught up in the craziness of junior year and the college rat race, [so] getting a concussion and having to step back from that actually really put things into perspective for me in some ways,” Kandell said.

Like Kandell, Zenger has taken up new hobbies since her injury. She has been taking guitar lessons which she really enjoys, and she has also found a new subject that interests her: neurology.

“I realized that I have a really strong passion for neurology now and I want to study neurology in college,” Zenger said. “That was one of the best things that came out of [my concussion].”

Zenger and Kandell have found silver linings to their injuries, which otherwise affected their lives, both athletic and academic, in dramatic ways. Concussions are unlike other sports related injuries because there is a potential for irreversible, long term brain damage which can result in changes in IQ scores and even personality traits. It is important that athletes understand symptoms and the potential consequences of attempting to play through them or returning to play too early. The athletic community has taken tremendous strides in the past couple of decades to make sports safer for athletes, especially for children and adolescents, but much of the developed preventative and recovery methods rely on the cooperation of those affected and those around them. While the athletic and academic communities make further progress, athletes, coaches and teachers will have to work together to promote a healthy environment for healing.