Nate Haugh remembers almost everything about that tackle last September.
The hit broke the other guy's chin strap, sending him to the sideline, and left Haugh feeling fine at first. Then, some dizziness and people telling him his eyes looked strange. Finally, his coach pulled him from the game, followed by an ambulance ride from the field at Indian Creek High School (Trafalgar, Ind.) to a hospital in nearby Indianapolis.
Haugh, then a junior lineman at Milan (Ind.) High School, had sustained a concussion.
It wasn't catastrophic -- Haugh was home two days later and back on the football field within three weeks -- but that didn't mean he was done thinking about head injuries. He recalled a similar injury from his sophomore year that went untreated. Before returning to the field, Haugh bought a helmet that claims to reduce the risk of concussions.
"You need two things to have a concussion," said Dr. Daniel E. Kraft, a specialist in concussion management at the Indianapolis-based Methodist Sports Medicine. "You have to have an injury, a force to the head. The second part of the equation is that you have to have a symptom of some kind headaches, blurred vision, amnesia . [It] doesn't matter if it's only one of [the symptoms]; you have a concussion."
The National Athletic Trainers' Association says between 43,000 and 67,000 concussions occur among high school football players each year, with research suggesting the number might be greater since symptoms often go unreported. A recent NATA study also showed high school players are much more at risk for concussions than collegians are, due to the level of physical development and improper technique.
Yet awareness remains lacking, according to many across the high school football landscape. For every player like Haugh, there are thousands of players, parents, coaches and even medical personnel underplaying these jarring hits -- often based on a lack of knowledge.
Still, there are those on the other side who might not believe all concussions can be eliminated but feel it's an issue worth fighting through prevention, diagnosis and treatment.
Haugh is one of the now many focused on prevention.
But really, it started years earlier, when former Harvard quarterback Vin Ferrara set out to make a helmet that fights what he and his company refer to as a "silent epidemic."
"I feel like one concussive episode is too many," Ferrara said.
With his focus solely on helmets, Ferrara founded Xenith, and created, tested and launched the X1 -- which ditched the typical in-helmet padding for shock absorbers that, as Ferrara puts it, work like an airbag in a car, reducing the speed with which the head moves on every hit. The X1 debuted in fall 2007, on a test run. This fall will be the first in which sales are open to the public.
But, does it work?
Time will tell, although the technology has received a strong response. Robert Cantu, chief of neurosurgery service and director of sports medicine at Emerson Hospital in Concord, Mass., and co-director of the Neurologic Sports Injury Center at Brigham and Women's Hospital in Boston, has called the helmet "perhaps the greatest new head protection system to emerge in the last 30 years."
Player feedback also has been positive, albeit in a small sample size (65 players ages 14 to 24 were polled after fall 2008). Haugh seems satisfied.
"I can go back and forth, back and forth, and hit somebody with that helmet, and it feels so much better than a regular helmet," Haugh said. "It takes a big blow for you. When you're on the sidelines and you hear everybody say, 'Man, my head hurts from hitting somebody,' I'm like, 'Well, mine [doesn't].'"
Still, the X1 has its skeptics, most of whom point to a need for more data and the price tag ($350).
Xenith is not alone when it comes to helmet innovation. Riddell's newest model, the Revolution Speed, will see its first full season this fall. Riddell took some of the first steps in concussion prevention eight years ago when it introduced the Revolution helmet. That helmet reduces concussion risk by 31 percent, according to a 2006 University of Pittsburgh Medical Center study. Schutt and Adams also makes helmets designed for concussion prevention. (In addition, Schutt developed its Brain-Pad mouth guard to fight concussions.)
However, no helmet manufacturer believes equipment to be the cure-all.
Proper tackling technique -- keeping the head up and avoiding helmet-to-helmet collisions -- is the other element of prevention. According to everyone from coaches to athletic trainers to Ferrara, this must be taught at all levels, stressed to coaches and players alike.
"As far as warding [concussions] off, the biggest thing is teaching the game properly so that the technique does not allow itself to have concussions," said Mike Kirschner, coach at Ben Davis High School in Indianapolis.
Reduction, not elimination, is the key word when it comes to concussions.
"I think [technique is] going to solve half the problem," said Kevin Guskiewicz, an athletic trainer and researcher at the University of North Carolina Injury Prevention Research Center, and chair of UNC's Department of Exercise and Sport Science.
Said Mark Stead, an athletic trainer at Cardinal Ritter High School and Methodist Sports Medicine in Indianapolis: "Even using great technique, there's still going to be [concussions]."
Just ask Haugh and Milan coach Ryan Langferman, both of whom insist his concussion was not because of a mistake by the player. It just happened, they say.
When concussions do happen, management becomes key -- identification of symptoms, followed by diagnosis and then treatment. Proper measures must be taken so the player doesn't return to action prematurely.
Innovation is playing a part here, too, as many schools now are using electronic software to track these injuries. Through programs such as ImPACT, players take a preseason "baseline" test, which measures brain function. Then, if concussion symptoms are reported, another test is taken to determine the injury's effects on the brain. Whereas terms such as "mild," "moderate" and "severe" once existed with by-the-book rest periods (e.g., one week for a mild concussion), these tests are taken and retaken -- under varying circumstances, such as at rest or with exertion on a treadmill -- until the results normalize and symptoms disappear.
Doctors and athletic trainers, however, say electronic testing can't stand alone, as results must be combined with subjective analysis (i.e., observation of symptoms) before a final decision is made.
"I'm a fan of [ImPACT-type testing], if it's one piece of the puzzle," Guskiewicz said.
What's more important, Guskiewicz said, is simply having access to a certified athletic trainer -- something only 42 percent of U.S. schools can claim, according to NATA. "You need to have educators in place," Guskiewicz said.
The reason many schools are missing athletic trainers is funding, according to Guskiewicz.
"Schools typically employ a full-time nurse," Guskiewicz said. "And that nurse plays a very important role in the school. But if you look at the overall risk, and think about the students in a high school who are most at risk for injury and illness, clearly your contact athletes are at the greatest risk."
With not everyone aware of the danger, education becomes essential in prevention and treatment.
"When someone has an ACL injury, everybody knows about it and everybody knows what that is," said Indiana Sports Concussion Network coordinator Kirsten Bondy. "With a concussion, it's kind of a hush-hush injury."
Part of that is the vagueness of the symptoms, a wide-ranging list that includes such things as "feeling sluggish" and "feeling foggy or groggy." Another is the lack of severity in these symptoms, which might lead a player to believe he is not hurt. The delayed nature of the symptoms also might make identifying concussions more difficult.
And then there's denial, as the tough-it-out nature of football often lends itself to a player fighting through all sorts of pain and injuries, including concussions.
"We know that happens, and there's not much we can do other than try and help them understand that it doesn't do them any good to do that," said Kraft, the Methodist Sports Medicine specialist and Ben Davis High School's team physician. "The only way we can do that is by educating them."
Guskiewicz is among those attempting this, as he recently spent months traveling and spreading the word. In North Carolina, he said, recent deaths provide harrowing examples. Elsewhere, too, have been deadly or nearly deadly concussion-related situations. To prove his point, Guskiewicz often will use the newspaper headlines announcing these tragedies.
Sometimes knowledge spreads organically, as was the case in Milan, where freshman Cory Hunter's career ended because of a life-threatening brain injury sustained on the football field.
This made Langferman take notice and, eventually, Haugh. Now, the latest in high-tech helmets has been introduced to the small-town Indiana school -- one more step in the battle against a potentially devastating, but relatively common, football affliction.
Can the fight against concussions be won completely? Some say no. Others, like Ferrara, disagree, saying, "I think it's important to have the goal of eliminating the issue, because that's what will keep you innovating, keep you driving for continued improvement."
Patrick Dorsey is a high school sports reporter for The Indianapolis Star.