Since the Maine Legislature passed a concussion law in 2012, high school administrators, coaches and athletes have become more educated about head injuries and more vigilant in treating them. But experts say there’s still much to be learned about concussions, which accounted for nearly a quarter of reported high school injuries nationally in the 2014-15 school year.

“If you follow what’s happening with the science of concussions, it’s amazing how much energy and resources are going into trying to figure this out,” said Dr. Paul Berkner, the director of the Maine Concussion Management Initiative at Colby College in Waterville. “We are just beginning to understand the impact of hitting your head. And it’s going to take us another five to 10 years to understand what’s going on at a cellular level.”

All 50 states plus the District of Columbia have implemented concussion laws in the last six years. Maine’s law, much like the others, requires schools to have a concussion management team to not only diagnose and treat the injury, but determine when it’s appropriate for a student to return to the classroom and playing field.

Other steps are being taken both on and off the field in the Maine. Thornton Academy, the reigning Class A football state champion, has purchased specially cushioned helmets for some of its players in hopes of reducing the number and severity of head injuries. Meanwhile, a Maine group is embarking on a federally funded study of concussions among high school athletes.

Dr. William Heinz, a Portland orthopedist who specializes in concussions and is the chairman of the Sports Medicine Advisory Committee for the National Federation of State High School Associations, said many states have struggled to come up with effective concussion protocols. The importance of having the laws, he said, “is more about education than anything else, educating parents, coaches, educators, administrators and students that we have to be careful.”

Mark White, the Presque Isle High athletic director, agreed.

“I think we’re much more diligent now,” he said. “We are very sensitive now to any injury above the shoulders, and rightfully so. We’re a lot more concerned about the impact it may have on the student more than the athlete. I think it forces us to be better caretakers of peoples’ children.”

Possibly because of that, more concussions are being diagnosed. Dr. Dawn Comstock, a Colorado School of Public Health associate professor who is regarded as one of the nation’s top experts on sports injuries, has tracked high school injuries since the 2005-06 school year through the High School Sports-Related Injury Surveillance (RIO) Study.

The original study included 100 schools across the nation and focused on nine core sports, with athletic trainers providing information on the injuries suffered by high school students, the circumstances of the injuries and the recovery time. The study has expanded to include 24 sports and any school that wants to be included.

Comstock found that the diagnosis of concussions has increased dramatically since the first law was passed by Washington state in 2009.

In the study’s first year, 2005-06, concussions accounted for 9 percent of reported injuries. In 2009-10, the numbers increased to 13.9 percent. Then the rate jumped to 20 percent in 2010-11.

The rate of concussions nationally for the 2014-15 school year was 24.5 percent.

“Does that mean more kids are actually sustaining the injury?” asked Comstock. “I don’t think so. What it likely means is we are doing a much better job of identifying kids who are sustaining concussions now.

“In 2007, we know kids sustained concussions. But maybe they honestly didn’t know they had suffered a concussion or didn’t realize it was a serious enough injury to be reported. And that still happens today. But today it would be difficult to find a high school athlete, or coach, or parent of a high school athlete, who could not recite at least some of the symptoms of concussions. Virtually everyone understands it’s not just a dinger, not just getting your bell rung. It’s a concussion. It’s a brain injury to be taken seriously.”

Comstock said perhaps trainers and coaches are simply being more careful these days.

“That’s not a bad thing,” she said. “High school sports are supposed to be fun. I’d rather have a kid who really doesn’t have a concussion be pulled out to be safe rather than have a kid who does have a concussion stay in.”

TAKEN SERIOUSLY IN MAINE

Maine has long been on the leading edge of concussion study and treatment. It was one of the first states to embrace the ImPACT test, a computerized neurocognitive exam used to establish a baseline score that must be matched before a student who has been diagnosed with a concussion can return to play.

The Maine Concussion Management Initiative is about to launch another ambitious study. According to Berkner, it has received a federal grant from the Health Resources and Services Administration to track concussions in Maine.

The program will be offered this year to 50 Maine high schools – with the hopes of enrolling every high school in the state – along with 20 Massachusetts high schools. Last year, the MCMI gathered concussion data from 12 Maine high schools and 12 New England colleges in a pilot version of the program. MCMI will offer services and training to the high schools in the program, which will track who suffered a concussion, and when and how it happened.

Called the HIT (Head Injury Tracker) program, it “will provide real data where head injuries are in Maine and how they occurred,” said Berkner. “Our goal is to get as many schools as want to be enrolled.”

Berkner said this is a long-term project. “It will take time to get the schools going and collect the data,” he said.

Like the ImPACT test and the concussion laws, the HIT program will be another piece in the study of concussions.

Others include the Heads-Up Football programs sponsored by the NFL and USA Football, which teaches the correct techniques for tackling and blocking. High school coaches in Maine must take the NFHS online concussion course. The Maine Principals’ Association established practice guidelines for football this fall, limiting the number of days a team can have full-contact practices during the season, and limiting that full contact to 30 minutes.

The Maine Department of Education has a web page devoted to the concussion policy, with resources for parents, students, coaches, teachers, administrators and even health-care providers.

RIGHT EQUIPMENT CAN HELP

Equipment is also a crucial ingredient, especially in football and especially helmets.

Thornton Academy purchased 10 Riddell SpeedFlex helmets this year after receiving a positive review from senior quarterback Austin McCrum, who was given one late last season.

“I have nothing bad to say about it,” said McCrum. “It’s a little heavier but it’s worth the trade. I remember a game in the playoffs against Scarborough. I took a big hit. I was running and there was a collision and I was stunned by the hit. But my head itself, nothing hurt. That’s when I said, ‘This is a pretty cool helmet.’ ”

The SpeedFlex helmet offers more flexibility in the crown of the helmet, the facemask and the facemask clips to absorb more shock.

They are expensive, about $400, but the school invested in more. “They’re good,” said Thornton Coach Kevin Kezal. “Obviously there’s no such thing as a concussion-proof helmet, but when you look at the studies, you want to put the best products you can on your kids.”

The Trojans gave the helmets to upperclassmen in high-impact positions: linebackers, linemen and skill-position players.

School officials across the state are always looking to get the safest equipment. “We put a lot of thought into our football helmets, same as lacrosse and ice hockey,” said Mel Craig, the athletic director at Deering High in Portland. “But there’s a lot more to concussion management than just helmets.”

Heinz said he hopes athletes don’t get a false sense of security when they wear a top-rated helmet. “We still don’t have helmets or devices that can lessen the concussion rate,” he said.

McCrum knows that. “I’m not really trying to take too many hits,” he said.

Regardless, concussions will happen. Tony Giordano, the athletic trainer at Thornton Academy, said he treated about seven in football last year compared to 17 the year before. “And in any given year, we see between 30 and 50 across the board, in all sports,” he said.

Andy Helstrom, the athletic trainer at Presque Isle – which does not offer football – said he probably treats 15 athletes for concussions over the school year. “That’s just a rough estimate,” he said. “We don’t have football, but we do have ice hockey. Still, I see more in soccer than I do in hockey.”

Football is played at Leavitt High in Turner. Athletic trainer David Enos said he treats about 10 concussions each fall. “And the majority of them are non-football,” he said.

That follows national trends. Football may be the most visible sport when it comes to concussions because of the focus on the NFL, but soccer – especially girls’ soccer – also has a high rate.

In fact, girls’ soccer had the highest concussion rate (17.2) in the initial HS Rio report. And in the latest RIO report, girls’ soccer had a higher concussion rate (34.5 percent) than football (25.2).

“This is not just a football problem,” said Comstock. “Over the last 10 years, I have literally captured concussions in every sport – swimming, cross country, track and field. We need all young athletes, all young coaches and all parents to be aware of that.”

And that’s why state laws are important. Comstock, Heinz and Berkner agree they are not perfect, but they offer guidance and help for anyone who has questions.

“No one can feign ignorance at this point,” said Berkner. “And that’s great.”