It all started with a routine blitz.
With his defense backed up against its own goal line, Salisbury High’s middle linebacker Jeffrey Burton went on a called blitz. Once the ball was snapped, Burton sprinted toward East Rowan’s backfield. Seconds later he was airborne. An offensive lineman went low and chop-blocked Burton. He landed on his head.
At first everything seemed normal. After all, Burton racked up some nice stats during the game — 11 tackles and three sacks. But all he remembers of the game are anecdotes from teammates and game film.
Burton had a concussion. Initial signs ranged from mumbling his words to miscalling plays.
“It was one of those things where you could just talk to him and knew things weren’t right,” said Salisbury High Athletic Director Dale Snyder.
Burton played most of the game, but was held out for a small period near the end as a precaution.
Lauren Teodorovici, a Novant Health athletic trainer, instructed Burton to receive a more formal evaluation the following day, which he also doesn’t remember.
When he returned to school, concussion symptoms began to show up in the classroom.
“In most of my classes I would just stare off and look outside,” Burton said. “It was hard for me to focus.”
Burton was held out of athletic activities for several weeks. After receiving treatment, he’s now back to being the school’s starting middle linebacker and an all-star student. However, Burton and his parents have decided that one more concussion would mean leaving football permanently and focusing on wrestling, his other sport of choice.
Burton’s story may be a sign of the increased attention to concussions, but it also shows the added requirements, both through state law and the high school athletic association, to have athletic trainers at every game and practice.
When Salisbury High head coach Ryan Crowder began coaching football around 2000, medical requirements were minimal.
“We only had to have someone certified in basic first aid and CPR,” Crowder said. “It was usually a school employee. You just didn’t have any actual medical staff during practice or on the sideline during games or anything.”
Now, 14 years later, the presence of medical personnel is greatly increased. Athletic trainers are at every practice and game for Rowan County high schools. Emergency medical technicians also dot the sidelines on game day.
Novant Health, which owns Rowan Medical Center and several clinics in Salisbury, provides trainers to every school for free. A news release from Novant estimated the cost of all of the company’s services to area high schools at $300,000.
Some schools, such as South Rowan, have a certified athletic trainer on staff. Novant’s personnel serve as a liaison between Novant and the school, said Alex Hogue, who is an athletic trainer with Novant.
Dr. Harrison Latimer, who specializes in orthopedic surgery and sports medicine with Novant’s Pinnacle Orthopedics, said the tight-knit nature of athletic trainers’ relationships with schools allows injuries to be more quickly and accurately diagnosed. For example, some football players may be more tolerant of pain than others, Latimer said.
Other changes to care for local students include a computer test, which students take with Novant at the beginning of each football season and again if a concussion is suspected.
A part of the test includes words that spell out a color, but the letters are shaded with a different color, said Jon Plummer, who works as an athletic trainer with Novant. As an example, Plummer said the word green might be colored red.
“If there is a problem, you don’t expect to have the same levels and scores as the pre-concussion test,” Plummer said.
Athletic trainers and emergency medical technicians have been a common sight at high school football games for years, but the N.C. High School Athletic Association and state law actually make their presence mandatory.
The Gfeller-Waller Concussion Act, passed in 2011 with overwhelming support from state legislators, required N.C. public high schools and middle schools to remove students from play if suspected of having a concussion. it also required athletes to be cleared by a medical professional before returning to play.
The NCHSAA took similar steps to address concussions and athlete injuries before the concussion act’s passage, but the law may provide a new emphasis on the issue. Some of the items in the concussion act took state board of education guidelines and made laws.
Regardless, Davis Whitfield, the head of the NCHSAA, said he’s noticed a significant effect resulting from both actions.
“It used to be that when you felt woozy, you just had your bell rung,” Whitfield said. “I think there’s now more serious attention being paid to the issue of concussions. It brings attention to and raises the level of awareness.”
Concussions haven’t been completely eliminated from football. Because of the nature of the sport, other injuries haven’t either. Latimer says his clinic — Pinnacle Orthopedic Associates — sees about three student athletes per week with concussion-like symptoms.
Just this football season alone, athletic trainer Elizabeth Nottingham, assigned to South Rowan High, said she has witnessed four concussions. Most of the concussions have come in practice, Nottingham said. Though none have been as serious as Burton’s.
“A lot of the time they are quite wobbly and you can tell that they’re not quite sure what happened,” Nottingham said. “This year, all of them have been able to talk and tell us what happened.”
In practice, concussions are only a part of athletic trainers’ duties.
Nottingham said her attention is mostly on taping players, placing water coolers and injury ice, and stretching the players before games. She said cramps are the common injury during early parts of the season. Overall, ankle and knee injuries are most common during football games, she said.
Certain players still push to return to play after injuries, but Nottingham says the culture is quickly changing. Both coaches and players are focusing more on preventing severe injuries, she said.
“I’ve noticed this year with my guys that they will say they were just hit and have a headache or just that they don’t feel quite right,” she said. “I think there’s still those players that want to get right back into the game out there, but the word is getting out about how serious injuries are. Kids are taking it more seriously.”
Snyder said he even asked about injuries when interviewing coaching candidates for Salisbury High School’s football program.
“When we were interviewing a few years ago for a new football coach, one of the questions was who determines whether a player goes back in after getting injured,” he said. “And, 100 percent of the answers were that it’s the doctor’s call.”
Like technology, Whitfield said he expects football equipment and injury regulations to improve, but the greatest reduction in injuries comes from practicing proper form when tackling or blocking. He said focusing proper techniques at younger ages could lead to fewer injuries in high school and higher levels of competition.
“I think concussions will always be a part of the game in some shape or form, but we can do more in terms of taking the head out of the game,” Whitfield said. “I think that’s where the biggest emphasis needs to be — concentrating on the proper techniques of blocking and tackling.”
Though he is the head of N.C. high school athletics, Whitfield ranked the state at or near the top in terms of precautionary injury measures.
“I think we have been a leader well before injuries issues came into the national spotlight,” he said. “That’s not to say we’ve got it right. We have to continue to look at how we can improve.”
But the future of athletics isn’t just about a proper procedure in returning from injuries, Snyder said.
“Brain activity and head injuries can affect children for the rest of their life,” he said. “It’s not just about that next play. It’s a far more serious thing than one game or one play.”
Contact reporter Josh Bergeron at 704-797-4246