Jim Greenfield sat hunched over alone in the Northeast Hamilton softball dugout pushing and pulling on a dilapidated catcher's helmet as the perspiration dripped off his forehead on a sweltering July evening. No words were spoken, but the assistant coach knew - he had to fix the helmet or the Trojets would most likely have to change their entire game plan as they got set to take on Southeast Webster-Grand in a Class 1A regional first-round clash.
Did Northeast Hamilton have another catcher's helmet? Yep, it sat just a few feet away from Greenfield as he went to work. The problem was option No. 2 fit too tightly on the head of senior catcher Jenn Willems, arguably the team's most talented player and certainly its best option behind the plate.
Willems didn't want to wear the unfamiliar helmet. She couldn't and that was final.
Jenn Willems, a 2013 Northeast Hamilton graduate, knew nothing about concussions two years ago. But two concussions on the basketball court later, she knows her life has been altered, perhaps permanently.
"They wanted me to wear the other helmet, but I just couldn't," Willems said a few weeks later as she sat at a picnic table just feet from that same dugout. "It was just too tight on my head. I couldn't do it."
The softball Gods were on Willems side that night because, luckily, Greenfield was able to fix old reliable and the four-year starter played without further complications.
You might be thinking Willems sounds overly-dramatic, perhaps even a pain in the backside, but you'd be wrong. She had a good reason - the best reason - for needing the helmet that put her at ease.
Suffering through two concussions like Willems has would make any athlete a little jumpy.
"At times even wearing the helmet I had always worn was tough, and there were times when even wearing a headband gave me a headache, but since it was my senior year I wasn't giving up catching," Willems said. "Before I got my concussions I never had headaches, but now I have them quite often. Some of the headaches aren't that bad, but when they are I always wonder why this happened to me?"
It's a question hundreds, if not thousands of athletes have asked silently.
The Centers for Disease Control and Prevention estimates that 1.6 million to 3.8 million concussions occur each year. Five to 10 percent of athletes will experience a concussion in any given sport season.
Let those figures sink in for a moment. Five to 10 percent may not seem like a lot at first blush, but consider that in 2011, the National Federation of State High School Associations said more than 7.6 million students played sports in the United States.
That's not to say that many concussions were diagnosed in prep athletics, but more awareness regarding traumatic brain injuries in athletics has become a hot-button topic in recent years. Parents want to know their children are safe when they hand them over to coaches. Those same coaches want to do everything possible to keep the children out of harm's way.
Concussions have always been prevalent in athletics, but it's only over the last decade that they've come up in discussion.
Webster City Athletics Director Bob Howard, also a Hall of Fame football coach, remembers vividly the day he received a concussion, although it wasn't diagnosed. Back when he played, in the early 1970s, going to the doctor after getting hit in the head rarely occurred.
"I had one concussion when I played," Howard said. "I was knocked out cold in the first inning of a baseball game. I woke up, went to the dugout and threw up and then caught the last four innings. Now, is that right? No, not when you look at it now, but back then we didn't know any better.
"The whole landscape has changed now and rightfully so."
In terms everyone can understand, a concussion is any kind of injury to the brain that causes a temporary change in the function of the brain. The symptoms vary; a headache is the most common variable, but blurred vision, irritability, emotional instability, difficulty with memory, amnesia, confusion - they're all common as well.
Try to imagine all of the functions of the brain. Now imagine what happens to the human body when the brain is injured.
"The brain is a Jello-O type thing," Darin Eklund, a longtime physician's assistant who specializes in sports medicine at Webster City Medical Clinic, said as he tried to explain the anatomy in simplistic terms. "It sits in your skull, but it's not nestled in there tight. There's a layer of fluid around it, so your brain essentially floats inside your skull. Anything that causes the brain to jostle inside the skull can cause damage to the brain."
Eklund estimates he sees 10 to 12 patients per year that are diagnosed with concussions. Not all, but the majority of those patients are athletes, he says.
Has the frequency of these brain injuries increased in recent years?
"Are we seeing more concussions in sports? I don't know. Probably not," Eklund said. "It's probably just a case of we're more aware of it."
No sport is immune to head-related injuries either. Football, basketball, soccer, softball, baseball, cheerleading you name the activity and it's been engulfed in the controversy. Yet one sport - football - is front and center.
The Great Football Debate
It's the 10-ton elephant in the room.
Uncomfortable shifting in chairs.
Getting football coaches to discuss concussions isn't easy. Finding players, particularly high school males, that have suffered the injury to talk about it in detail is even tougher.
According to the American Association of Neurological Surgeons, there were 46,948 head injuries sustained in football that were treated in U.S. hospital emergency rooms in 2009.
In this day and age of ESPN, where bone-jarring hits on the gridiron are replayed over and over again, football coaches are forced to defend their sport seemingly on a daily basis.
Yes, football players are most prone to concussions for various reasons. It's a contact sport and participation numbers dwarf those of its contemporaries.
"It is the bell cow of sports in the United States," Howard, who will begin his 37th year of coaching high school football next week, said. "It's an easy target, and the defending football part is tricky because whatever a football coach says is going to come off as us defending the sport. But I'll say this: I've seen a lot more concussions off school property than I have on school property."
"More kids play football now than ever before and that's probably raising the number of concussions," Eklund surmised.
In his nearly four decades roaming the sidelines, Howard says his players have suffered very few concussions. He could remember only two that were diagnosed in 27 years at Sigourney-Keota, and only one of his players has ever been knocked unconscious on the field. That occurred last fall when WCHS sophomore wingback Cal Zahn was sideswiped by Humboldt linebacker Brady Ross as he broke free near midfield. The unexpected collision sent Zahn straight to the turf; he laid face down for several minutes before being helped off the field and eventually into a nearby ambulance.
It was Zahn's second concussion. He missed the remainder of the season and Howard doesn't expect Zahn to return to the football team this fall.
"Cal's not going to play this year," Howard said. "I talked to his parents the day after. I told them that if you can't feel comfortable with him playing football anymore, I'll support that 100 percent. You shouldn't live in fear of watching your son play football after he's already had a couple (concussions)."
The Zahn family declined an interview request for this story.
Howard accepts the fact that football simply isn't for everybody. Hitting and being hit don't appeal to every high school athlete, but he isn't in the camp that feels the possibility of a concussion is reason alone to not participate.
"If a parent is going to say I don't want my son to play football because they might get a concussion, that's pretty hard to argue with," Howard said. "But my comeback to that would be well, I guess that's fine as long as they're never out on an ATV, a four-wheeler, a snowmobile, they don't go water skiing, and they probably don't want to play basketball, wrestle, play soccer or softball or baseball.
"I understand what the parents are going through; it's a hard choice. But I think if your child doesn't have a history (of concussions), then I think the benefits outweigh the risk. That makes me sound pretty mercenary and makes me sound like a coach, but I guess that's what I am."
Eklund echoed Howard's sentiments.
"If (parents) are not letting their kids play football but they're letting them ride motorcycles or do other risky behaviors, then there's just a misunderstanding of what the risks in football really are," he said.
Girls Get Concussions Too
Various studies on the subject conclude that girls have higher concussion rates than boys, particularly in sports such as basketball and soccer.
Willems is all too familiar with that theory. Before Valentine's Day, 2012, she admits she knew next to nothing on the subject. Playing sports was what she did; the risks were the furthest thing from her mind.
And then her skull bounced off the basketball floor on that cold winter night in Burnside and, essentially, her life was altered, perhaps forever.
"A girl was going in for a shot she missed and I went in for the rebound," Willems said. "But she pretty much knocked me to the ground and I hit my head on the ground. At first everything was black I couldn't see anything. I didn't even know who was touching me."
"That one really scared a lot of people because you could hear it when she hit the floor," Bret Schutt, the Northeast Hamilton girls' basketball coach at the time, said. "But at the time we didn't know enough about concussions, so we didn't know how bad it was."
Willems actually went back into the game a few minutes later and made two free throws down the stretch to get the Trojets into overtime.
"She said she felt pretty good, so she went back in and played really well," Schutt said. "Looking back on it that was the wrong thing to do.
"People say that basketball isn't as physical a sport as football, but I am probably willing to bet there are more concussions that are undiagnosed in basketball than football. I think it's because we look at basketball as a non-contact sport, but it's becoming more and more physical year after year."
Willems' significant pain didn't occur until the next day. It lasted for two months.
"I'd get headaches, I'd get light-headed when I stood up, especially in the morning, and I couldn't even handle loud noises," she said. "That's when I knew it was pretty serious."
Willems saw her chiropractor, her family doctor and was eventually shipped off to a neurologist for further tests. She spent most of February, all of April and part of May trying to shake the cobwebs.
"When I started exercising and running again, it just sounded like there was a pounding in my head all the time," she said.
Willems was eventually cleared by doctors to play softball, yet she spent her junior season at shortstop instead of catching.
"My doctors and coaches decided it would be a bad idea to catch because I couldn't handle the helmet being on my head," she said.
Eventually the lingering symptoms subsided and Willems was able to return to a sense of normalcy. But when basketball came around it was back to square one; on Dec. 7, 2012, at a game in Tripoli, Willems again took a shot to the head and those same feelings returned.
"I was going for a rebound again and this time a girl hit me with her elbow right on my temple," Willems said. "I had a headache right away.
"The actual hit wasn't as bad, but (assistant coach Jeff Meyer) came out and said I wasn't playing the rest of the game."
"We watched the game film time and time again we never saw her get hit; it was almost like a glancing blow, but she must have got hit just right," Schutt said.
Willems missed the remainder of the pre-Christmas schedule and didn't return to practice until late December. She returned to the lineup in January, but whether it was physical or psychological, Schutt said Willems' aggressiveness lessened.
"She was never the same player after that (second concussion)," he said. "I don't want to say it was the concussion, but I think sometimes after they get that second one, it's pretty scary for a kid. She was a lot more cautious, which was good for her in the long term."
On the outside, Willems was ready to play. But, now, she says the lingering effects never went away.
"When I went back to practice the headaches were still really bad the running gave me that thumping in my head," she said. "It got better, but it never really stopped."
With two concussions under her belt, Willems is aware of the fact that she's at a higher risk for another concussion than other athletes. Still, playing sports is what she's always done and that's not likely to change.
"(Doctors) have told me that if I got one more I had to be done with sports," she said. "But I wouldn't go back and change anything. I love basketball and I wouldn't have wanted to give that up."
Other Sports Are Vulnerable Too
Drive down the streets of any community on a summer day and you'll see an endless stream of children riding bikes. Competitive cycling has become quite popular as well, and in Iowa RAGBRAI is one of the summer's most popular events.
At least one study says riding a bike is more dangerous than playing football.
According to the American Association of Neurological Surgeons, cycling accidents played a role in approximately 86,000 of the 447,000 sports-related head injuries treated in emergency rooms in 2009.
Cycling was also the leading cause of sports-related head injuries in children under 14 years of age, causing 40,272 injuries nearly double the number related to football (21,878).
A soccer player heading the ball has an estimated impact speed of 70 mph, and it's a regular occurrence to see three, four or five players all jump at the same time in attempt to head the ball in their favor. Those scrums sometimes end with players on the ground after knocking heads.
"It can be a real scary deal," WCHS boys' soccer coach Craig Signorin admitted. "There really isn't a completely safe place on the field as far as contact goes. So, yeah, it's something I think about, but it's not something I bring up year round."
In his three years in charge of the Lynx program, Signorin says only one of his charges developed a serious concussion and he didn't return to the field the remainder of the season.
"He didn't even know it happened until he got home. He didn't remember the trip home and that scared the heck out of me," Signorin said. "But, for the most part, I'm worried about more injuries than concussions. There are a lot of other injuries in soccer that you see more often."
Wrestlers are also prone to situations where concussions can occur, although Lynx head coach Ted Larson says he's never had an athlete that developed a serious head injury while on the mat.
"I'm not going to say we haven't had one, but there's nothing that sticks out to me," Larson said. "But anytime you're talking about the head, it's nothing to mess with."
The old-school philosophy of sucking it up and getting back on the mat is no longer prevalent, Larson says.
"If somebody is running a half (nelson) or a chicken wing, there's someplace to go. You either go to your back or you don't and there's some pain," Larson said. "But that's a whole different deal than getting a head against a head or a head against a knee, stuff like that. I've seen kids get knocked out, I have, and if that ever happens you're done until you're cleared by a doctor."
BreAnn VanDeer, a 2005 WCHS graduate who owns an undergraduate degree in athletic training and a master's degree in exercise science, serves as a trainer for the sports teams at Fort Dodge Senior High School. While she admits that the highest number of concussions she sees are on the football field, she's also dealt with plenty of head injuries off the gridiron.
"Football is where you're going to see the most concussions because it's a contact sport," she said. "But I've also seen them in girls' basketball, I've seen them in volleyball where girls dive for balls and hit their head on the gym floor. In softball I see quite a few where girls either run into the fence or collide with another player. I've seen them in soccer getting hit in the head by a ball. I've seen them in wrestling but all of those (sports) get overshadowed because of football."