February 9, 2025
Not long after Mark and Lindsey Stinson’s oldest son began playing football, he suffered a concussion. Xavier, now a tight end at Truman State University, sat out the rest of his third-grade season.
“He was a quarterback, and, you know, we always thought concussions came from these huge hits,” Mark Stinson said. “Didn’t really think the kids were big enough to do that, but he had a run one time when he ran into kind of a huddle of linemen, and somewhere in there he hit his head. He came out kind of rubbing his helmet.”
After that, the couple held their two younger sons from playing tackle football until seventh grade. The Stinsons’ middle son, Isaac, is a senior wide receiver at Hallsville High School. He’s never been diagnosed with a concussion, but Lindsey still worries.
“As a mother, you’re sitting there kind of sick the whole time, just hoping no one gets hurt,” she said. “I really enjoy it, (and) I’m never going to tell them no, but you do sit there with that little pit in your stomach the whole time.”
It’s no secret that football players have a high risk of suffering concussions. Head injuries in the sport are receiving national attention — especially at the pro and collegiate levels — and people are searching for solutions, including padded helmet covers, clinical trials to more easily diagnose nervous system traumas and concussion screening apps.
While knowledge about brain injuries in football and their long-term effects — including neurodegenerative diseases like CTE — is increasing, researchers are still trying to understand the full extent of damage that hits to the head can cause in young athletes.
Research is also increasingly focusing on much smaller head impacts, known as subconcussive hits.
“A lot of the research is showing that that is probably what’s leading up to concussions, and they matter,” said Stefanie West, the director of sports medicine at PEAK Sport & Spine Physical Therapy in Columbia. “That is also why we don’t want to send athletes back into (the) sport before their concussion is completely cleared, because of all those small hits that they’re going to get.”
PEAK provides athletic trainers for 24 high schools in Missouri, including Hickman, Battle and Rock Bridge in Columbia, as well as Hallsville. West has worked at PEAK for 21 years; she served as the athletic trainer at Hickman High School for 18 years and now covers several high school football teams.
“We always joke around that people say, ‘Well, what would they have to change to get rid of so many concussions in football?'” West said. “You’d have to change the game.”
Spotting concussions
If you’re a high school football player in Missouri, you’ve likely signed a consent form to play the sport. A player who shows signs of having a head injury should be pulled out of the game and evaluated by a coach, athletic trainer or physician for concussion symptoms and monitored for the next 24 hours by a parent or guardian. Return-to-play requirements then depend on medical clearance; at the very least, a player can’t go back to playing the same day.
Missouri law requires basic concussion protocols, and the Missouri State High School Activities Association sets the rules for high schools in the state and collects head injury information through annual surveys.
Last school year, MSHSAA surveyed 589 high schools and combined schools — a total of 247,135 students.
Schools are required to track head injury instances on MSHSAA’s website throughout the year, and the organization makes this information available to the public, MSHSAA’s Executive Director Jennifer Rukstad said in an emailed statement. Rukstad did not agree to be interviewed for this story.
According to MSHSAA’s 2023-24 Interscholastic Youth Sports Acute Brain Injury Report, 2,697 males and 1,282 females were held out of athletic practices and contests due to suspected head injuries. Sideline cheerleading and girls soccer were the only sports that saw concussion increases from the 2022-23 school year.
Of the 20,929 students who participated in 11-man football last year, 1,269 were diagnosed with head injuries. In the 2022-23 academic year, 1,280 football players were diagnosed with head injuries.
Football had the highest concussion rate at 7.23, significantly higher than soccer at a rate of 5.91 and sideline cheerleading at 5.33.
While many high school football teams in Mid-Missouri have designated athletic trainers to spot head injuries in addition to coaches, depending on where a player goes to school, there might or might not be a trainer who regularly attends both practices and games.
There is a difference in accessibility for rural versus non-rural school districts. MSHSAA’s own protocol acknowledges that “not all school districts have medical personnel available to cover every practice and competition.”
Of school districts that don’t have athletic trainers regularly attending practices and games, Rukstad said in an email, “Our coaches should be able to recognize the signs and symptoms.”
At Hallsville, the football team’s athletic trainer also covers several area schools and sports. The team’s trainer comes to games every Friday night but only attends practice sporadically, Isaac Stinson said.
If the team’s trainer is unavailable, players can be sent to PEAK for evaluation, said Kari Yeagy, Hallsville’s director of communications.
In contrast, at Rock Bridge High School, athletic trainer Phil Threatt attends every practice.
When Threatt started out, there weren’t full-time athletic trainers at high schools in Columbia. Ten years ago, only 42 percent of secondary schools in the U.S. had access to athletic trainers, according to the Journal of Athletic Training. While many schools still lack such access, that number has increased to 56 percent as of 2023.
West said that most athletic trainers are “pretty fluent” in concussion care and rehabilitation.
In an initial evaluation for a perceived head injury, PEAK trainers check a player’s orientation, mental awareness and memory, vision, balance and other physical symptoms: Do you have a headache? Are you dizzy? Are you sick to your stomach? Are your ears ringing? These are a few indicators that something is wrong, West said.
“Recognizing the concussion is the easy part,” Threatt said. “It’s ruling out the concussion where the nuance comes in, and it’s hard.”
While head injuries are receiving more attention in high school football today, that wasn’t always the case.
“How we treated them 10-15 years ago compared to now is vastly different,” West said.
Long-lasting impact
Jacob Biddle played through several years of high school football with concussions. He’s had seven that he knows of, some of them back-to-back — like the summer before his sophomore year when he had three in a row. Around that time, he was diagnosed with post-concussion syndrome.
Biddle has always liked football; as a kid he wanted to play, but his mother didn’t let him.
“It just seemed like the most fun to play and the easiest way to take your aggression out on the field,” he said. “I was always a kid who did better when I had an outlet like that, so when I finally got to start playing my freshman year, I fought the whole time to keep playing.”
Biddle, who graduated from Battle High School in 2015, has struggled with health issues in the years since.
In his senior year season, Biddle took a big helmet-to-helmet hit after running into a linebacker.
“I was like, leaning on the sideline, my center was holding me up,” he said.
He sat out for a quarter, but then went back into the game.
In the second half of the next week’s game, he got knocked out again and woke up in the hospital. That was his fifth concussion.
“I mean, the coaching staff was great, they were friends,” Biddle said. “They were coaches, but they weren’t — they cared more about winning than individuals.”
Justin Conyers, who coached Biddle when he was a student at Battle, said his main priority is player safety. Conyers has worked as a football coach for 21 years and is currently the head coach at Hickman.
“That’s one of the things that I’ve always taken pride in, is making sure all of our kids are safe,” Conyers said. “And it’s much more than the wins and the losses in the game. Those things are going to come and go, but you want to make sure that your kids are always taken care of and their well-being is, as a football coach, your number one thing at heart.”
In addition to constant headaches, depression and a stutter that lasted around six months, Biddle gave himself ulcers from taking too much ibuprofen “to try to get through the school day and stuff.”
He also started passing out.
In his junior year of high school, Biddle said he was diagnosed with postural orthostatic tachycardia syndrome and was told to continue playing. Falling down became a routine part of his life — like football. It wasn’t until after high school that Biddle learned he had an abnormal EEG test showing brain activity conducive to seizures.
“Everybody just kind of got used to it. I was just the kid who fell down. I always got back up, and I would just try to avoid the ‘You’re not playing again,'” Biddle said. “There was nobody there to stop me from hurting myself in the future.”
Biddle still deals with seizures. In 2020, he once had 36 in a week. Two of his seven concussions were the result of falling and hitting his head during seizures. Now he takes medication to manage them and works as an assistant physical therapist at PEAK’s Moberly clinic.
Though his life is different than he thought it would be, Biddle said he enjoys getting to help people recover from injuries. He said he wouldn’t be here without his wife, who encouraged Biddle to get a second opinion on his POTS diagnosis.
“I tied myself up into being an athlete, and I wanted to go into the Marine Corps, bad,” he said. “And I lost that opportunity, too, and became suicidal.”
Biddle was constantly trying to get back to playing football. The sport was everything to him in high school — he never wanted to miss a game.
“It’s hard to convince a high school kid to look into the future, but I lost a lot of opportunities,” he said. “I’m happy with where I’m at, but life (is) completely different than what I thought it was going to be because of the choices I made when I was 15 to 18.”
Changing technology
When Mark Stinson played football as a high school senior in the late 1990s, there were no athletic trainers on the field watching for concussions. At the time, people weren’t focused on head hits in the sport.
“I remember times when someone got hurt pretty bad and we had to find someone in the stands that was a medical professional (to) come down,” he said. “It was a different environment back then.”
The Stinsons both grew up in Brookfield, a small town where football was a big piece of the community. Lindsey Stinson’s father also coached her brother to play beginning when he was in second grade — the sport has always been a part of her life.
Player safety is a significant focus for the family. Lindsey runs Lindsey Stinson Personal Training, a “boutique gym” in Hallsville where young athletes can take speed, agility and flexibility training courses.
“I think people are more educated now; they watch for (concussions) a lot more,” she said. “A high school football game is not worth this kid having a brain injury.”
Threatt, who has 30 years of experience as a certified athletic trainer, attributes improvements in concussion management to better technology, coaching techniques and protocols.
“Back in the late ’80s, when I first started doing this, if you weren’t knocked unconscious, it wasn’t considered a concussion,” Threatt said. “Even if you did lose consciousness, it was not unheard of to get back and play the same event. If you could remember where you are, who you were, what the score was (and) could balance without wobbling too much, we let athletes go back and play.”
In addition to heightened awareness of head injuries, improved helmets and less emphasis on full contact hitting during practices, Threatt said a concussion screening app has been particularly helpful in identifying head injuries.
Using the app Sway, students can take a test measuring their balance, memory, reaction time, impulse control and other concussion symptoms in about 10 minutes. Working with 156 football players at Rock Bridge, the app has been a “game-changer” for Threatt.
Clay Galloway, a PEAK athletic trainer in his second year working at Battle High School, said the Sway app has helped trainers streamline care. He said he’s also noticed more self-reporting of concussions.
“Before, kids have kind of tried to hold off, not come and talk to us whenever they took a hit and they got dizzy — it kind of scares them, but they know that they’re going to miss some time,” Galloway said. “I think we’ve kind of gotten past that hump.”
Galloway had two concussions in high school from playing football and wrestling; his injuries led him to pursue athletic training. In his view, taking time to teach proper technique and not “breezing through it” is key to minimizing injuries in football.
Conyers also emphasized the importance of minimizing full contact at practices.
“The kids are not experiencing (nearly) as much contact as they used to even, you know, 20 years ago,” he said. “It was rough back then; there was a lot of contact. It’s just not that way anymore.”
A new addition to the landscape of football injury prevention is Guardian Caps — padded helmet covers designed to reduce head impacts, which have been popularized by the NFL.
Columbia Public Schools doesn’t provide the caps, but they can be used at a program and/or individual level, district athletic director David Egan said. Both Rock Bridge and Hickman’s football teams use Guardian Caps, Threatt and Conyers said. Battle players do not use the caps, Galloway said.
But West doesn’t believe any piece of equipment can stop someone from getting a concussion, and she worries that Guardian Caps give players a false sense of security.
“I think it’s a gimmick,” she said. “Until you can tether your brain so it’s not bouncing around, when you’re running full speed and you hit a 300-pound guy and stop, the Guardian Cap isn’t gonna stop that brain from bouncing when you hit the ground or them.”
Emotional hits
One lasting component of concussions in football is their emotional impact. West said concussions are hard to deal with emotionally because the injury is, for the most part, invisible.
“I don’t care if you’re the biggest, toughest lineman on the football team or the cheerleader, there’s going to be some emotional issues with it,” West said. “Their identity is wrapped up in that (activity), and you pluck them out of that kind of cold turkey and you’re not going to practice, you’re not hanging out with friends, you’re not at the team dinner with them — that affects them on a mental level.”
Concussions get in the way of students’ ability to function in school, let alone socially and interpersonally, said neurologist and leading CTE researcher Robert Stern.
Daryl Fields, a neurologist and researcher at the University of Pittsburgh, said individuals process stress in very different ways, and it can be especially difficult to pick up on signs of brain damage in young adults because they can mirror other common issues.
“When you look at kids, the things that tell you that they’re under stress or they have a less than ideal home life (are) often changes in grades, it’s headache patterns, it’s lack or disinterest in activities — so, early signs of depression,” Fields said.
Fields said young athletes need to have a health care provider on the sidelines who “doesn’t have a horse in the race of winning the game.” It’s important that individuals are aware of concussion likelihood, he said, and student safety should be prioritized.
“We need to have standardized ways of observing kids and pulling them out if they’re at risk,” Fields said. “Educating is probably the best way, making sure that the families understand the risk that they’re taking.”
But even knowing the risk doesn’t mean kids, or their parents, will walk away from the game they love.
At Hallsville, Isaac Stinson’s favorite thing about football is being part of a team.
“I just like the game,” he said. “Just playing and having fun with all my teammates I’ve been friends with for as long as I can remember. Just going out there and trying to win games.”
The work of the Missouri News Network is written by Missouri School of Journalism students and editors for publication by Missouri Press Association member newspapers.