The following is a two-part series from the LSU Manship School News Service about the dangers of concussions in high school football games in Louisiana and efforts at schools, universities, and the NFL to make the sport safer.
Chapter one: "I couldn't move my legs"
Lance Garafola lay on the turf of a high school football field wondering what had happened and where the feeling in his lower body had gone. The crowd and both sidelines fell silent as trainers rushed onto the field.
Garafola was a sophomore at St. Michael the Archangel High School in 2016 when a Loranger High player blind-sided him on an onside kick. Paramedics were brought in when Garafola said he couldn’t feel his legs, but they were hesitant to move him because of the possible severity of his injury. Silence and fear hung in the air for over an hour before they raised him onto a stretcher and Garafola threw up his thumb to let his teammates and fans know he was conscious.
He was taken to a local hospital and diagnosed with a concussion. The loss of feeling in the lower half of his body, which lasted for a little over 5 minutes, was created by the concussion and the shock from the hit to his head.
Nearly every football fan knows that concussions are a serious problem in the NFL and in college games, but less attention has been paid to the dangers facing younger athletes. Experts say high school players also face some degree of risk every time they step on the field.
The hits are not usually as hard in high school as the one that left Garafola temporarily paralyzed, but medical surveys indicate that 67,000 concussions are diagnosed nationwide among high school football players each year, with many more occurring without being evaluated.
One concern is that few high schools can afford the kinds of sophisticated safety measures that NFL and college teams now take. Garafola and others also say that many high school players are reluctant to report concussions, even when they cause problems like short-term memory loss, for fear of being sidelined for good.
Garafola, who kept playing football through his senior year, said he was diagnosed with one other concussion but probably had three or four more. “When I thought I had a concussion, I laid low because I didn’t want to go to the doctor or an expert because I didn’t want to ruin my chances of playing football,” he said.
As a result, concussions can be difficult for high school coaches—and parents--to track, and concerns about possible brain injuries are contributing to a gradual decline in the number of high school students playing football.
In 2008, 1.11 million high schoolers played football, but the total slipped to 1.006 million by the 2018-2019 school year, the lowest since 1999-2000, according to the National Federation of High Schools.
Medical researchers have evaluated the brains of former professional football players and found signs of chronic traumatic encephalopathy, or CTE, a degenerative disease caused by hard hits to the head. The disease destroys brain cells and can lead to depression, anxiety, aggression and suicidal tendencies. CTE can be diagnosed only after death when brain tissue can be removed and evaluated.
Damage can occur as early as high school when brains are not fully developed, though some experts say it might take years of repeated hits to the head in college and pro ball for the disease to become severe.
The Louisiana High School Athletic Association (LHSAA) does not keep records of concussions across all schools. Lee Sanders, the assistant executive director, said the organization requires coaches and trainers to take an annual safety course so they can tell students what a concussion is, how it feels and why they should speak up if they believe they are suffering from one.
Andy Bryson, the owner of Louisiana-Texas Gridiron Football, a website based in Denham Springs, said the LHSAA and many high schools need to do more to guarantee the safety of student athletes.
Bryson, a former high school and college assistant coach who is one of the top talent scouts in the state, said high schools in Florida, Texas, Ohio and California hire fully trained position coaches, while the assistant coaches at many Louisiana schools are teachers who help out with the football team on the side. “They might hire a teacher who knows something about Madden football and plays to be a coach,” he said.
It also can be hard for the players to tell when they have concussions, Bryson said. “You don’t actually know you have a concussion until you’re over there throwing up on the sidelines,” he said.
Nick Monica, the head football coach at Rummel High School in Metairie, said one or two of his players have mild concussions each year. The school gives all of its players a baseline mental acuity test when they make the team, and if they show signs of a concussion later, they take the test again.
Monica said some concussions occur when players hit their heads on the ground.
Dale Weiner, the former head football coach at Catholic High in Baton Rouge, said more concussions are being reported now that there is greater emphasis on safer tackling techniques.
Still, he said, “I think some guys are more prone to it because of their style of play. Some guys are more wide-open and reckless by nature.”
While the helmets used at all levels of football now provide more protection against head injuries, most high schools lack the funding to provide devices, like mouth guards that can monitor the pressure from big hits, that the pros and big colleges use. Rural and inner-city high schools have even fewer resources to combat the problem.
“You gotta have money to get that concussion stuff down right,” said Lamontah Curry, who had several concussions while playing wide receiver for Pensacola High School in Florida.
Louisiana high schools get some help from Tulane University’s sports science department, which puts on an annual seminar about concussions for high school athletes in various sports.
“They kept showing football players mostly who would get concussions in games and then later on down the line they would have really traumatic injuries,” said Caleigh Foto, a kinesiology major at LSU who went to the seminar when she was in high school.
“I thought it was really beneficial every year that we did it because normally you just think you hit your head and it’s going to heal just like a bruise,” she said.
A study from the Institute of Medicine, a non-profit group formed by the National Academy of Sciences, found that concussion symptoms last for two weeks in most patients while more than 20 percent of people can experience symptoms for months or years.
Nick deBouchel, a construction management major at LSU, has had his share of concussions. He was a linebacker at Oak Ridge High School in Conroe, Texas whose job was to pursue and tackle the ballcarrier every play.
“Concussions are no joke,” he said. “You kind of forget where you are for a little bit. Once you realize what’s happening, you involuntarily tear up because your body doesn’t know what’s happening. I’ve had one where I woke up and everything was blood red as if someone put a red filter over my eyes.”
He mentioned memory loss as one of the main symptoms from his concussions. Short-term memory loss is usually more common in the first few concussions but can become worse after repeated hits.
“My worst one was when I was a senior,” deBouchel said. “After getting hit, I apparently played the rest of the game, and then I started crying once everything set in. I had to ask my teammate who we were playing and what the score was. Amnesia definitely happens if it’s bad enough.”
Garafola said he hid some of his concussions so he could keep playing football.
He thinks the concussions are why he struggles with depression and not feeling like himself on occasion. He also worries that the injuries could permanently affect him.
Jessica Speziale and Henry Weldon contributed to this story.
Chapter two: “You kill the head, you kill the body.”
Back when Eric Hill played linebacker for LSU and in the NFL, every tackler had the same mindset: “You kill the head, you kill the body.”
Hill, who retired from football in 2000, remembers coaches at every level telling him to use his helmet as a weapon. That created a greater risk of concussions for both players. But the NFL was like “the wild, wild West” then, he said, with few safety rules, and concussions seemed like “a phantom injury” since few people were aware of the serious effects.
If a player got his bell rung, he had ammonia packs in his sock to sniff and keep playing.
“You could just grab one, and ‘all right, I’m good,’” Hill said. “That’s how we did it.”
Hill played 11 seasons in the NFL, mostly for the Cardinals in St. Louis and Phoenix. He also was a captain of LSU’s SEC Championship team in 1998. He had seven documented concussions in the NFL, but he suspects he might have had up to 100 throughout his career.
One sticks out in his mind. His team was facing the New York Giants when he scooped up a fumble. Another player came in and hit him on the side of the head. He dropped the ball and then instinctively headed back to the huddle.
“To this day, they were saying it was, like, three plays where I had no idea what I was doing,” Hill said.
The concerns about concussions surfaced after the first case of chronic traumatic encephalopathy (CTE) was found in 2005 in the brain of Mike Webster, a former center for the Pittsburgh Steelers, and they have since prompted efforts to make tackling–and football itself--safer at every level, from youth and high-school leagues on up through college and the pros.
As more brains of deceased NFL players were examined, nearly all came back with the same result: CTE. Many of the players suffered from severe mood swings, and some committed suicide. Former New England Patriots tight end Aaron Hernandez was convicted of murder and, at 27, hung himself in his jail cell in 2017. Researchers determined that he had one of the most severe cases of CTE for someone his age.
At first, the NFL shunned doctors who discovered the disease and refused to admit there was a connection between playing football and long-term effects like dementia, Alzheimer’s disease or brain trauma.
Hill sees these brain issues among colleagues with whom he played. He knows some who need handlers to help manage their days.
“To see friends that are hurting, that’s tough sometimes because you easily know that could be you,” he said.
Players received pamphlets before the 2007 season about a concussion protocol, but the plan was not very detailed. The pamphlets stated that research had not shown that having one or two concussions led to permanent problems. Two years earlier, an NFL committee had found that returning to play after a concussion did not involve a significant risk of another injury in the same game.
But the NFL no longer holds these views, and it is spending $100 million on medical research and efforts to improve equipment. The NFL and the NCAA also created a targeting penalty to try to stamp out the head-hunting that was common in Hill’s day.
If a player lowers his head to initiate contact with his helmet against another player’s head, he is now ejected from a game. The penalty makes players aware of how to hit without causing head injuries.
The NFL has hired biomedical engineers to study how to make helmets safer. Many colleges, including Tulane University, now use mouthguards that track the force a player takes with each hit.
Trainers monitor hit levels during practice and games. If the levels reach a certain peak, a trainer will pull a player aside and assess him. Tulane defensive lineman Noah Seiden, who just completed his sophomore season, recalls how a trainer pulled him out of practice to be evaluated after a hard hit. He said he would not have realized how hard the hit was had the mouthpiece not picked up a high force.
Seiden said he has had three documented concussions: in sixth grade, his senior year in high school and his freshman year in college.
“The first helmet that I had when I got that first concussion was just like a brick,” he said. “It was hard padding and didn’t really help me that much.”
Each Tulane player uses three helmets to keep them from wearing down as fast. Trainers check the air pressure in the helmets to assure that they sit correctly and can limit the severity of a hit.
LSU, Hill’s alma mater, also continues to experiment with new safety measures. It uses sensors in its helmets to determine the gravitational and rotational forces from a hit.
Hill said he probably had more concussions in practice than in games. LSU also has cut back on violent practices to reduce the hits players absorb.
“We were the lead school to eliminate two-a-day practices because of our research,” said Jack Marucci, LSU’s director of athletic training for football.
Starting with youth and high school leagues, athletes need to recognize symptoms of concussions, which may include confusion, balance issues and blurred vision. Concussions can be scaled from level 1 to level 3, with level 3 being the most severe, and taking enough time to recover is imperative.
“Take it slow and get evaluated as soon as possible,” Marucci said. “Follow the protocol to return to play.”
“Every athlete is different, so there is not a set amount of days,” he added. “It can vary from four days to 21 days.”
Often, football players aren’t even aware they have a concussion, said David Daniels, who played at Millikin University and Valparaiso University. Like Hill, Daniels said he had probably played with multiple concussions in his career.
“Even though I got hit a lot, I never checked to see if I got a concussion or not,” Daniels said.
Mark Dalecki, an assistant professor at the LSU School of Kinesiology, said most athletes are eager to get back on the field, but they need to wait to be cleared by a medical professional.
Dalecki said short and long-term impairments might not stem from one big concussion but from a combination of tiny hits over time. Concussions as a youth also place a player at a higher risk for dementia or other ailments.
Hill, now enjoying the game from his couch instead of the field, sees how “the kids” are hitting differently and appreciates how the coaches are teaching them to avoid injuries.
“You still get big, fast, strong men that are running into each other, so that’s a lot of energy, so that’s gonna be violent,” he said. But the violence is not quite the same as when he played “because the intent is different,” he added.
Carolina Panthers linebacker Luke Kuechly felt that his health should take precedence over the game. He retired last year due to concussions sustained during his playing career.
Hill said Kuechly could make that decision because he was financially stable, whereas players in earlier times were not as well off.
Noah Seiden’s mom Kathy remembers the first time her son got a concussion, in sixth grade.
“It was the first time I ever thought, ‘Oh my gosh, this could potentially be dangerous,’” she said. “Because they were so little at the time.”
She has been impressed with the way her son’s coaches and trainers at Tulane work toward keeping safety a top priority. She still prays for her son before every game. But, she said,
“When your kid is so smart about it and handling it well...you got to let him go.”
Hill is glad that more people are talking about the dangers of concussions. He said that breaks down the “gladiator shield” that he and his teammates had to maintain during their time.
Many parents, including some former NFL players, are concerned about having their sons play football. But for anyone who has a passion for football like he did, Hill thinks, the benefits still outweigh the risks.
“Every time you go out on the field, you take a risk,” Hill said. “You have to make sure that risk is worth it.”
Hunter M. McCann, Keith A. Fell Jr. and Anthony J. Mocklin contributed to this story.