During the 2009 season 19.3 percent of football injuries in the United States were concussions.

As athletes get bigger and faster collisions produce more energy, which can lead to an increase in injuries.

While these injuries could lead to broken bones and torn ligaments, the injuries that concern coaches, administrators and members of the medical community the most are concussions — mild traumatic brain injuries that interfere with normal brain function.

“The worst case scenario is that they can be fatal,” said Wes Richardson, the head athletic trainer and industrial rehab coordinator at Bone &Joint Rehab Services in Florence.

Richardson, who provides his services as an athletic trainer at high school games at Russellville, Belgreen and Tharptown, said the number of concussions has not increased over the years, but the understanding of the dangers of concussions is better understood.

He said the Alabama High School Athletic Association’s new concussion management program is a proactive way for the state to educate people on the seriousness of concussions and the best way to deal with the injury.

“There is a greater awareness of concussions among coaches, players and officials,” Richardson said. “At the same time I still see concussions not being taken as serious. That is what the AHSAA is trying to do.”

During the past decade new research has been done to uncover the immediate effects of concussions and the long-term effects of the injury. Two frightening possibilities exist with concussions.

Second Impact Syndrome causes death or devastating brain damage when a second injury occurs before the first injury is completely healed. Possible long-term effects include dementia and depression.

“Second Impact Syndrome can increase swelling and cause another injury to worsen that, if not fatal, can be career or season ending,” Richardson said.

Another problem with multiple concussions is the possible development of Chronic Traumatic Encephalopathy, which is a degenerative disease of the brain found in athletes with a history of repetitive brain trauma.

Michael C. Koester, MD is the chair of the National Federation of High School Associations Sports Medicine Advisory Committee, which oversees medical issues in high school athletics across the country.

Koester’s research shows the problem with concussions is not limited to football.

While 19.3 percent of all football injuries in 2009 were concussions, there were likely at least 100,000 concussions in high school athletes every year.

Girls basketball had the fourth highest total of concussions while boys basketball was sixth and softball was seventh.

Koester’s committee approved the following rule change for the 2010-2011 seasons: “Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional.”

The AHSAA’s response to this rule was its concussion management program, which can be found on its Web site. Koester designed the education course and part of that information was used in this story.

Richardson said that is a great step in helping educate people about concussions.

“It is hard to convince athletes,” Richardson said because many young athletes feel invincible. “It is important for parents and athletes to be aware of the dangers of concussions and to take them seriously.”

Richardson said attitudes about concussions have changed, but there is still a lot of information to learn. He said many coaches realize the severity of the injury and the old days were players played if they could walk are over.

“Thankfully most coaches take care of players and don’t have the win-at-all-costs mentality,” Richardson said. “They love their players and want to take care of them.”