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Concussions And Repercussions, Part One: Return To Play

David Martin Davies
Christopher Muniz is examined by Dr. Rudy Navarro for a possible concussion.

Football is about hitting and being hit, so it’s expected that players will suffer some injuries. But what happens when high school football players receive injuries that they don’t recover from, particularly brain injuries?

Credit David Martin Davies
Christopher Muniz and his mother sit in the waiting room at a sports clinic after he was hit in the head playing football

On an early Saturday morning at a weekly sports-injury clinic, after the Friday night lights of high school football, the waiting room at Christus Santa Rosa hospital in Alamo Heights is already full.
Most of the young athletes are hobbling in on bandaged legs or have an arm in a sling, but not 15-year old Christopher Muniz.  He sits quietly next to his mother and his injury is invisible.

“I was on kick-off return and we were running up towards each other and we hit head to head contact,” he says.

Muniz is a freshman at Lanier High School. That day they were playing against the freshman squad from Central Catholic.

“I just felt a little bit dazed and went back to the huddle. That’s when the ref took me out,” Muniz explains.

The referee made the call that Muniz needed to ride the bench the rest of the game. And he needed to see a doctor before he could return to the team for contact practice.

Christopher’s mother Vanessa Muniz was in the stands at the game and she saw the big hit.

“Yeah, he’s big. But the other guy was bigger. I get scared every time he’s on the field,” she says.

Credit David Martin Davies

She’s been scared for the last ten years, watching her son play little league football and up. He’s had at least one concussion before.

“My concern is for him is to not to have a concussion without me knowing because if they put him into play next week and he had a concussion, then he can get worse,” she says.

Mom is worried about “second impact syndrome.” It’s a concussion on top of previous unhealed concussions and the results are often fatal or can leave an individual severely disabled. Young people are particularly vulnerable.

Concerns about second impact syndrome is what spurred the Texas legislature in 2011 to pass sweeping reforms requiring high school athletes who take a hit to the head to obtain medical clearance before they can return to play.

The "return to play" law was widely praised, but now many are asking if the law goes far enough.

“All I have to do is get a paper signed," explains Will Danes, director of the Brain Injury Association of America - Texas Division.

"The players [are] going in to get their paper signed. They’re not going in to assess their condition. They’re not concerned about their health. They are going in to get a form signed so they can go back to play – because of pressure from coaches – and their teammates, and because they want to play. They love the sport,” Danes says.

Muniz is playing center for Lanier's 9th grade team and lines up against Jefferson.

Danes says the Texas “return to play” law doesn't include penalties for coaches, school officials and medical workers that don’t follow the law.

It doesn't require a minimum or standard level of medical resources for games or practices. And it should require more education for players and parents about brain injury.

At the sports clinic, Muniz is seen by Doctor Rudy Navarro, a primary care physician and professor in the Department of Family and Community Medicine at UT-Medicine.  

“A concussion by definition is a functional injury of the brain. It’s where the brain resets – gets slowed down. I use the analogy of a computer that has a virus.  It doesn’t run as fast. It’s not going to load the programs as quickly,” says Navarro.

Since there are no visible wounds, Dr. Navarro must hunt for signs of a concussion by looking for evidence that Muniz’s brain is “slowed down.”

Credit David Martin Davies
Muniz goes to the water station during the game against Jefferson

“Right there, close your eyes - hands on your hips –feet together and stand just like that ok?" he tells Muniz.

Muniz is a little wobbly but he’s keeping his balance. He’s asked to perform some mental exercises.

“I’m going to give you some things to remember – just say back to me – Car – Ball – Tree –Flag- Shoe…”

The Centers for Disease Control estimates nearly 200,000 kids and teens are treated in emergency rooms every year for sports-related concussions.
However, at the end of the examination Dr. Navarro tells Muniz that he appears to be not one of them.

“I can’t say you definitely had a concussion. You had a hit to the head – and it was a bad one. In these cases, I don’t put concussion down because I can’t tell you that you definitely have a concussion. But it’s possible that you still do. It’s just – it’s really kind of hiding under there,” he says to Muniz.

So he recommends some precautions.

“What I’m going to do is rest you over the weekend," he tells Muniz. "Take it easy... quiet – resting – easy foods – and then go from there.”

Credit David Martin Davies
Muniz takes a breather before going back in the game at Lanier

Dr. Navarro tells Muniz to ease back into football over the next few days. He needs to self-monitor for headaches, upset stomach, problems with motor control.

A week and a half later, Muniz is back in the game. He’s playing center for the Lanier Voks against the Jefferson Mustangs.

And as he snaps the ball and throws a block – there is the question about his rising risk of severe brain injury. Each hit to the head makes him more vulnerable to a concussion. Is this just part of football? Or can more be done to protect Muniz and the over one million high school football players in the United States?

David Martin Davies can be reached at dmdavies@tpr.org and on Twitter at @DavidMartinDavi