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Utah running back Sausan Shakerin wasn't too worried when he got a headache during the Utes' fall camp. He thought it would fade away, so he ignored it and kept playing.
It wasn't until the head-throbbing pain wouldn't subside and the nausea increased that he finally talked to Utah's trainers and learned he was about to be a statistic, one of the thousands of college players diagnosed yearly with concussions.
"I'd heard all about the studies on concussions and could have cared less what happened," Shakerin said. "I didn't think they were this major. I thought it was like a twisted ankle or something that you rest and ice and it gets better."
Instead of two weeks to recover with a sprain, Shakerin needed two months. The sophomore wasn't cleared to play until recently, and he saw his first action at Iowa State, rushing five times for 24 yards.
"I was nervous since it had been two months since I hit somebody," he said. "But once I got in there, I got comfortable. The O-line was amazing and helped me. It's all good now."
Shakerin cherished those few carries more than any in the past, considering he has spent the past two months wondering if he'd ever get back on the field. Several times he'd try to return to practice or push himself hard and the concussion symptoms would hit him harder than a linebacker.
"It's frustrating because you have no idea when it hits you," he said. "One moment you are perfectly fine, then 20 minutes of running, it can hit you hard. Since it's a head injury they can't just open up your skull and say, 'OK, this is wrong.' It all depends on how fast the brain swelling comes down."
Shakerin's experience is common enough that several organizations, including the NCAA, the NFL and the American College of Sports Medicine, are teaming up to recommend new legislation and tactics to address the issue of concussions in sports.
Advocates testified on Capital Hill recently to recommend more federal legislation to address concussions.
Symptoms
At the NCAA level, concussions account for 6.1 percent of overall injuries. While the percentage might seem small, the injuries are considered serious enough to warrant more protection for athletes.
Margo Putukian, the director of athletic medicine at Princeton University who serves as a member of the NFL's Head, Neck and Spine Committee, said there is more attention being given to concussions because more evidence shows there are long-term issues related to playing with concussions.
"For a long time, athletes have played through and or hid their injuries as a sign of being tough, or because they felt these injuries were part of the game," Putukian said. "We minimized the long-term consequences of repetitive or severe injury."
The NFL has tightened its concussion policies, and this year, the NCAA instituted a rule that all injured student-athletes, including those who exhibit signs of a concussion, must be cleared by appropriate medical personnel before returning to competition.
The protocol at Utah includes immediate examinations by trainers if a player is suspected of having concussion symptoms. The player's helmet is taken from him so he can't go back onto the field.
Additional cognitive and neurological testing follow that involve testing the player against a baseline of normalcy for him. That guide is determined when an athlete first arrives on campus and is set by putting the athlete through numerous tests.
It's a much more scientific way of testing for concussions than teams had in the past, such as when Utah coach Kyle Whittingham played.
Whittingham, a former linebacker, said he was never diagnosed with a concussion but remembers having several headaches.
"Maybe that is why I am so loopy now," he said.
Despite all the increased medical information and precautions, concussions can still be hard to diagnose, Utah trainer Paul Silvestri said.
For example, Shakerin's concussion wasn't precipitated by an acute hit — he just started having headaches.
"You can have a big hit like helmet to helmet that causes a concussion, or an accumulation of smaller hits and glancing blows that add up," Silvestri said. "The biggest thing is knowing your athletes. There are so many symptoms. They can be nauseous, off balance, have headaches, blurred vision or irritability, but they aren't always obvious. You don't have to always be knocked out to have a concussion. You have to know your athlete and watch them and see what is not normal for them."
Taking action
As physicians take a more aggressive approach to treating concussions, others are taking steps to prevent them through rules and innovations.
According to NCAA statistics, the concussion injury rate for football players in 2004 was 3.4 per every 1,000 athletes, and since then, it has ranged no higher than 2.8. But ways to lower the rate continue to be explored.
Beginning in 2010, receiving teams are no longer allowed to have wedge-blocking formations of three or more players on kickoffs, a rule that was sparked by research which showed that one in five injuries that occur on kickoffs resulted in a concussion.
In July, the NFL released a study in which various types of helmets were tested against national safety standards in place to protect players against traumatic head injuries. While all 16 kinds passed, three — the Riddell Revolution, the Revolution Speed and the Schutt DNA Pro — were considered the best.
The Utes use the Riddell helmets and a version of the Schutt called the XP. Only a few players have requested to stick with their older helmets, which will be phased out, said Kelly Sharitt, Utah's equipment director. Sharitt said he has seen the costs of helmets rise from $99 to $300, thanks in part to all the technology and research that is invested into the piece of equipment, but helmets are one area in which the Utes don't cut costs.
"You can't put a cost on safety," he said. "But there is no such thing as a concussion-proof helmet, either."
Utah linebacker Jamel King learned that fact when he took a hit in fall camp.
He doesn't remember it — just the effects.
"It felt like a normal hit, then, after a while, it felt like I was almost in a dream," he said. "I was aware of what was going on but couldn't keep my memory. It was almost like I had to relearn everything. The next day, I felt sick and threw up."
King was put through the Utes' standard protocol for concussion treatment and was cleared to play after two weeks of recovery.
While no player has been more affected this season by concussions than Shakerin, he considers himself one of the lucky ones. Having a concussion was scary, he said, but he feels like he has beaten it.
"I knew what I was getting myself into when I signed up and put the pads on," he said. "I love the sport. I wouldn't change it for the world."
Fall football injuries: 2004/05 to 2008/09
Game1 Practice2 %3 Median4
Sprain 36,944 40,182 28.9 5
Strain 13,082 40,411 20 4
Contusion 20,854 20,216 15.4 2
Concussion 6,821 9,457 6.1 6
Fracture/Avulsion 5,139 5,355 3.9 12
Subluxation 2,820 6,045 3.3 5
1 — injuries during competition
2 — Injuries during practice
3 — Percentage of injuries overall
4 — Median of lost days —
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