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SHERIDAN, Wyo. (AP) — When an athlete breaks a bone, sprains a joint or tears a ligament, the damage is easily identified by bruising, swelling and obvious pain.
Brain injuries are different — they're mostly invisible. Because of this, for many years, concussions were essentially "out of sight, out of mind." If an athlete could still run, jump and throw, coaches often allowed players with possible head trauma to return to the field too soon, putting their short- and long-term health on the line.
Not anymore.
Sheridan County coaches are part of a national movement to curtail concussions and make sports safer for athletes from the youngest children up to the professional ranks. Through certifications and training, teaching proper techniques and using high-quality equipment, local coaches hope to reduce head injuries amongst athletes and ensure that, when players return to the field, they do so healthy.
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Even as recently as 10 to 15 years ago, coaches usually did not receive education on prevention, identification and procedures for head injuries. Administrators at organizations like the Wyoming High School Activities Association have worked to change this.
Although Sheridan High School employs a full-time athletic trainer and the school's student-athletes take tests to determine a cognitive baseline in the case of a concussion, the WHSAA still mandates coaches take training on head injuries.
As a result, girls soccer head coach Mallery Marshall said coaches are very aware of the dangers of brain trauma.
"We as coaches try to be really on top of it," she said. "We receive a lot of training in our certifications that deal specifically with concussions and head trauma, and warning signs and recognizing when an athlete potentially has a concussion."
Marshall said training focuses on pulling athletes off the field for medical attention as soon as possible. Then, coaches need a basic understanding of how long an athlete should stay off the field before returning.
"The worst concussions are received after (an athlete) didn't really recover from an initial one," she pointed out. "After a concussion, it's just so imperative the athletes get the time off to fully recover before they're getting back on the field and risking getting a secondary one."
Coaches in Little Guy Football, a local league for fifth- and sixth-graders, take similar training, according to Richard Wright. The executive director for the Sheridan Recreation District said coaches learn about tackling and concussions through the National Alliance for Youth Sports.
Officials in the league also treat potential head injuries differently than they would have several decades ago. Wright said the motto is simple: "If in doubt, send them out." In other words, if a kid might be hurt, referees send the player off the field for medical evaluation. Rocky Mountain Ambulance has emergency medical technicians at Little Guy football games.
"We want to make the game safer for the kids who are participating," Wright said.
The National Sheridan Intercollegiate Rodeo Association does not make Sheridan College rodeo coach Mark Gilkerson take training.
However, the college has partnered with the Orthopaedic & Spine Center of the Rockies to make sure a trainer is present at all rodeos and other athletic events. Also, SC athletes take baseline testing.
Even still, Gilkerson says coaches closely monitor the athletes' health.
"We pay attention to that every practice," he said of head injuries. "That's one thing we're always concerned about."
Having accrued several concussions over the years himself courtesy of bull riding, Gilkerson is aware of concussion symptoms and protocols. If an athlete is knocked unconscious or sustains a potential head injury, the coach makes sure that individual sees a trainer or doctor.
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Training for dealing with concussions certainly has its merits, but cutting down on the actual number of concussions sustained within certain sports takes wholesale changes.
This is where technique comes in, and no sport needed an overhaul on fundamentals more than football. Watch any "big hit" video on YouTube and you'll notice players tackling with their head down — called "spearing" — and hitting the opponent in the head and neck area with the crown of the helmet.
In order to establish a different style of tackling at all levels, Wright knows good habits must be established from a young age.
"We really need to change the poor tackling habits from over the years with the helmet down," Wright said. "We cannot teach those, and when we see them, we need to correct them right away."
Coaches from Little Guy Football all the way to the NFL are teaching rugby-style tackling with a different "strike zone." The new strike zone emphasizes hitting from the shoulders down, avoiding the head.
Old-school tackling involved trying to get the helmet in front of a ball carrier, essentially using the head and shoulder to lead on every tackle. Instead, rugby-style tackling teaches players, basically, to wrap with the arms, squeeze and fall — using the shoulders, not the head. The differences seem small, but rugby-style tackle allows players to quickly take down the ball carrier with minimal trauma to the head.
Soccer, meanwhile, results in plenty of head injuries. The Sports Concussion Institute reported the sport has the most common risk of concussion in females at a 50 percent chance.
Marshall and her staff work to train the athletes on how to avoid concussions when heading the ball. The girls are taught to go up and meet the ball halfway, not let it ricochet off them. Coaches teach the team to attack the ball while engaging the core and back, which relieves stress on the head and neck. Repetition is important to strengthen muscles and perfect technique.
Rodeo doesn't have this luxury. In terms of actual coaching, there isn't a whole lot Gilkerson can do. In a sport as unpredictable as rodeo, no two animals and no two rides are the same. So the coach said he talks to his athletes about how to dismount and fall properly — avoiding landing on the head, if possible.
"But when you're rodeoing, a lot happens that you have no control over," he said. "So, no, there is no real training we can do."
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The right equipment can save lives and prevent concussions, and new rules and technology mean athletes have more access to high-quality gear than ever before.
In rodeo, the National Intercollegiate Rodeo Association mandates bull riders wear helmets and all roughstock participants wear protective vests at all practices and events, moves that prevent concussions and, in the most extreme cases, death.
Even the best technique to correctly head a soccer ball can't prevent all injuries. Soccer players routinely sustain trauma on the pitch in any number of ways, and head-to-head collisions on contested headers commonly result in concussions.
In part for these reasons, many soccer players worldwide have taken to wearing thick, protective headbands. Marshall said last year's SHS varsity squad featured three players who wore the equipment. Cheyenne Central's entire starting 11, the coach added, wore headgear.
FIFA, international soccer's governing body, determined these headbands provide very little benefit in head-to-ball impacts, but they do provide "measurable benefit" in subconcussive head-to-head impacts.
Little Guy Football has made a conscious effort to improve its equipment. Every helmet issued to youth football players this season was purchased within the last three years. The life cycle used to be five to seven years, Wright said, but now the Rec. District emphasizes new, state-of-the-art equipment.
This desire doesn't come cheap. The Rec. District spent more than $8,000 on helmets alone in 2015, but the safety of the players take precedence over any cost issues.
"The technology in helmets have come a long way," Wright said. "Some of them actually have sensors in them. Some of them have kevlar in them. We tell parents if they want to go out and buy their own. we'll look at (the helmet) for fitting and make sure it fits the kid right."
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General attitudes toward concussions have significantly changed, even in the last 10 years. Head trauma is taken as seriously now as other, more visible injuries, like broken bones or sprained ankles.
"I don't remember ever hearing about concussions as a high school athlete or college athlete, for that matter," Marshall said. "I don't remember anyone talking about it with us or doing any baseline testing."
Even in macho sports like football and rodeo, awareness is at an all-time high.
Years ago, after one particularly bad concussion left Gilkerson with terrible headaches, blurred vision and the full gamut of symptoms, he did what was expected — he cowboy'd up and entered the next weekend's rodeo. But now there are measures to try to prevent this sort of danger.
"There are rules that have come into place because of awareness from other sports and injuries in rodeo, too," he said. "So we're slowly evolving, maybe not as fast as some of the other sports because it's kind of hard to change the traditions that we've grown up with, growing up in the West and being a cowboy."
Even with local coaches committed to keeping athletes safe as possible, each coach pointed out trauma in contact sports is unavoidable. Football will still involve huge collisions. Soccer players will still knock their heads together in mid-air. Bull riders will still be awkwardly thrown off 2,000-pound beasts.
With the proper training and good equipment, however, the future could mean fewer damaged brains and shortened lives.
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Information from: The Sheridan (Wyo.) Press, http://www.thesheridanpress.com/
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