It was the fourth quarter in a little league football playoff game between the Lindenhurst Bulldogs and Massapequa Chiefs. The year was 2000, and Rich McDonald sat on the sideline.
“I remember diving for the ball on the ground," McDonald said, "and as I did, someone else jumped and hit me in the head.”
At 8 years old, McDonald suffered his first concussion.
Sports injuries, second only to vehicle crashes in concussion causes for people ages 15 to 24, according to the Centers for Disease Control, is a little-known topic in the medical world. To bridge the gap between researchers and medical professionals, the University of Florida and Florida State University are collaborating to offer a community-based research effort.
The collaboration, called Health IMPACTS, enlists primary care practices in Gainesville, Jacksonville, Orlando and Tallahassee to collect information related to youth concussion management and health risks.
McDonald, a 20-year-old UF civil engineering senior, is a member of the UF men's rugby football club and has suffered three concussions in his life. He never sought medical attention.
He attributes his lack of professional medical assistance to three things.
First, his father, also an athlete, grew up in the era during which it was noble, and even expected, to "shake off" a head injury. McDonald said he was raised with this type of attitude.
Second, concussion laws related to youth athletes did not exist in Florida when McDonald played on his pee-wee football team.
Above all, McDonald feared he would be pulled from the game.
"It’s just in my nature to really want to play and to be out there with my teammates,” McDonald said.
He said he felt disoriented the first time he experienced a concussion, but he asked to keep playing in the game. His coaches refused because it was late in the fourth quarter.
According to the CDC, young athletes like McDonald are more susceptible to concussions because of ongoing neurocognitive development that occurs during youth.
A program to track concussion rates
Russell Bauer, lead UF researcher of Health IMPACTS, said that since the program's inception, researchers have found an astounding lack of public knowledge on concussions.
"We just evaluated a young man last week who is a freshman in high school and plays football," Bauer said. "He thought a concussion was essentially identical to a wrist or ankle sprain."
Since last August, Health IMPACTS has increased concussion awareness in the medical community and among the nearly 1,000 families who have participated, Bauer said.
In a case like McDonald's in which concussive-like symptoms have gone untreated by medical professionals, Bauer said adolescents run a higher than normal risk of developing neurodegenerative diseases later in life.
Young athletes with untreated concussions can suffer potentially fatal injury, Bauer said. He said that young athletes have developing nervous systems that don't mature until the later teen years, and the damage can cause arrested learning.
Arrested learning can cause problems with memory and concentration, Bauer said. Data shows adolescents heal more slowly than adults with similar trauma.
Staying silent to keep playing
Between 1.6 million and 3.8 million sports-related concussions occur each year, according to The American Journal of Sports Medicine. This includes those with sports-related concussions who choose to not receive medical care.
McDonald said he, like many athletes, didn't report his concussive-like symptoms because he didn't want to lose playing time.
Because new regulations for the rugby club require an automatic two-week game play suspension of players who suffer concussions, McDonald said he decided to continue playing after he blacked out for a few seconds from a major hit and suffer the consequences.
“There have been times when I don’t remember stuff from the game,” McDonald said. “I get hit, and I know I hit my head, and I wake up two to three seconds later, and the next day things will be kind of fuzzy, but I don’t tell anyone that because, like I said, I don’t want to miss out on that time.”
Despite the wealth of information about the possible consequences of suffering concussions and failing to receive treatment, McDonald said it doesn't change the way he plays rugby.
“With everything that’s been coming out, it’s definitely something to be taken more seriously,” McDonald said. “But, if you ask any professional athlete, they have the same mindset. Nothing is going to keep them from playing.”
Waiting for clearance
Lauren Krasner, head athletic trainer at Eastside High School in Gainesville, said proper hitting and falling patterns and techniques can greatly decrease the risk of concussions in a game.
When officials believe students are experiencing a concussion, Krasner said, the first priority is to pull the student from the game immediately and to be assessed.
"We do the SCAT2, we do the impact, and I get with our team physicians for the high school and we wait until those numbers go back to baseline," Krasner said.
Students are completely banned from activity, Krasner said, and are discouraged from doing anything that may raise their blood pressures or heart rates.
"That means practice. That means P.E.," Krasner said. "That also means they can't go home and do yard work."
This kind of shutdown, Krasner said, takes the collaboration of the coaches, athletic directors, teachers and parents to ensure a student gets the necessary rest.
Krasner said returning to game play and practice after a concussion is a measured process. The process, following a six-day monitoring of a student's baseline test levels, can take weeks. According to high school regulations, students cannot play until cleared by a physician trained in concussion management.
Concussion research has received attention because of many high-profile cases in the past few years. Krasner said this kind of research can change the future of sports.
"There's not as much known about concussions as there could be because it's such an individual basis," Krasner said. "I think they're going to widen our knowledge of concussion management and see if what we're doing really is a good way."
Free testing available
Once a group of fully trained physicians, like the ones in the Health IMPACTS program, is established, Bauer said the program can provide more meaningful research and data about concussions and long-term effects.
"This is not only an activity we are engaging in now, but a model for collaboration that is sustainable in the future," Bauer wrote in an email.
In the meantime, UF will offer free baseline concussion testing for children ages 9 to 18 Saturday, Feb. 2 from noon to 4 p.m. at 2401 SW Archer Road.