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Taking Care of the Boys

During an ordinary Saturday-night high-school football game last fall, Scarborough High School quarterback Kyle Heine came within a scalpel's stroke of living in a wheelchair.

After being sacked by the Kashmere defense, Heine, then a junior, struggled to his feet. A referee's whistle had blown the play dead. But a Kashmere defender swooped in late and, using the crown of his helmet (a highly illegal maneuver called spearing) crushed the quarterback into the ground. The play drew a penalty for unsportsmanlike conduct.

"Hell, can I still walk?" Heine asked himself as he stood up from the bone-jarring tackle. After wobbling around for a few moments, several teammates helped lay Heine back down.

While on the turf, Heine told the attending physician, Barton J. Kendrick, about the severe pain in his neck. After a brief examination, the doctor opted to walk Heine off the field -- a medical mistake if serious neck injury is suspected.

In fact, Heine's neck had been broken. In Heine's opinion, it's a minor miracle that he escaped paralysis -- Kendrick's on-field exam was flawed in a number of aspects.

"One, when he pulled me up," says Heine. "Two, when he walked me off. Three, when he sat me down on the bench -- my head was just sitting there, swaying. Four when they laid me down. And then five, whenever they pulled the helmet off."

Kendrick later told the Chronicle that Heine didn't exhibit the signs typical of neck injury. In the doctor's opinion, the standard preventative back-board -- used to immobilize, then carry players off the field -- was not needed.

Kendrick did not respond last week to phone calls from the Press.
Fortunately, after surgery and a three-month convalescence, Heine more than walked again. Last spring, as catcher for Scarborough's baseball team, he got an honorable mention in the 20-4A all-district selection.

Other young athletes around the country haven't been as lucky. Last year in the United States at least four high-school football players suffered permanent damage to the cervical cord. They were paralyzed. Another three incurred serious brain damage. Ten died, either directly or indirectly, from playing high-school football. Hundreds of thousands sustained injuries serious enough to remove them from part -- or all -- of a game.

Football is a sport with professional heroes named Hacksaw, Ironhead, Moose and Doctor Death. Liability labels on football helmets warn players not to illegally "butt, ram or spear" opponents, but it is widely believed that many elementary and high-school coaches continue to teach such tactics.

Heine blames no one for his injury. Nevertheless, the alleged mishandling of the incident raises questions about the safety of high-school football in the Houston Independent School District.

All the major public school districts around Houston -- Spring Branch, Alief, Katy, Klein, Alvin, Aldine, Galena Park, Deer Park, Cypress-Fairbanks, Clear Creek and Pasadena -- have placed a certified athletic trainer at each of their high-school campuses. Spring Branch and Alvin employ two at each.

The majority of Texas's big-city districts -- Austin, San Antonio, El Paso and Corpus Christi Ñ maintain at least one trainer at each high school. Only Dallas ISD and HISD do not.

For its 21 high schools, HISD has six full-time trainers: Six trainers for 10,000 athletes, of whom 4,000 play football. One of the six is always present during HISD home football games -- a trainer was present on the night of Heine's injury. However, no HISD trainers travel with the teams or attend practices.

No trainer could have diagnosed Heine's broken neck. No trainer could have overruled a doctorÕs decision. But many sports physicians say a campus-based trainer would have known the boy better, may have had a sense of his sincerity, his predilections for melodrama, his propensity to feign his way through pain.

"When you have your own trainer at your own school, it'd be more of a personal thing," says Heine. "You'd be close if something happened. You would think more about the person."

Ron Cunningham, a representative of the North Carolina-based National Athletic Trainers Association (NATA), agrees: "Athletic trainers often know more than the physician does, and I'm talking about right there on the playing field."

If Heine's injury had occurred at an HISD practice -- where 60 percent of sports-related injuries take place -- there would have been no medically savvy personnel on hand.

"There's an immediate need for someone to go out there and see to the injury," says Cunningham.

Heine's injury raises another issue regarding the need for on-site athletic trainers: long-term rehabilitation. Heine has undergone all of 30 minutes of rehab since the injury. Because his neck no longer hurts, Heine believes that his recovery is complete. He continues to play catcher for Scarborough's baseball team, and his coaches regard him as one of the area's top college prospects.  

Though his athletic future appears rosy, no medical expert informed Heine about the possibility of future risk. A certified trainer would have known that a blue-chip athlete ought to undergo rehab -- that he ought to increase his neck's range of motion and strengthen the surrounding muscles.

"The athletic trainer would be the conduit through [which] the physician [reaches] this young man," says the NATA's Cunningham. "If an athletic trainer feels that there is a student that he needs to be consulted about, he's going to pick up the phone."

Roger Riedau, HISD's director of athletic business, initially thought Heine had undergone "extensive rehabilitation." When informed that Heine had in fact undergone virtually none, Riedau cited the district's policy that medical permission must be obtained before an injured student can return to the playing field.

"We would not have let him play baseball without that release," contends Riedau.

Even after obtaining that release, some athletes might need ongoing rehab, especially if they are to return to a contact sport like football. The training rooms in HISD's three football stadiums are well-stocked with the necessary equipment, but lacking is an authority who makes sure the student sticks to the program. In HISD, with no on-site athletic trainers, that responsibility falls on the coaches.

Transporting an athlete to a stadium training room doesn't exactly coincide with a coaches' ideal practice schedule. Hence, the temptation to shrug off complaints of aches and pains.

"In a lot of cases, you have coaches who don't want to believe athletes are serious, and want them to have that old 'Tough It Out' routine," explains Louis Ray, assistant athletic trainer at the University of Houston. Ray maintains that ignoring injury often results in more serious, permanent damage. For that reason, he contends, the UH athletic scholarship procedure includes an examination of the knees -- the body parts most commonly injured in football.

Asked whether HISD's dearth of trainers produces more physically impaired athletes than other districts, Ray claimed to have no official statistics. But, he added, "I'm pretty sure it is, in many cases."

Determining the ongoing effects of football injuries is difficult. A 1989 NFL Players Association study showed that over 66 percent of professional football players retiring after 1970 had some form of debilitating injury. Mark Popovich, the Ball State University professor who conducted the research, said percentages are high for college athletes as well.

"The closest statistic I could find was about one-third coming out of colleges go into professional football with injuries," says Popovich. "They're picking up injuries left and right. It's a major health problem."

As far as Popovich knows, no longitudinal studies have been conducted on the long-term physical repercussions of football on players whose careers ended at high-school graduation. But University of North Carolina professor Fred Mueller, who conducted a national survey of catastrophic injuries in high-school football, says, "A lot of these things may not show up even in their high-school years. They may show up five or ten years later."

The most comprehensive national survey of high-school injuries was completed by the NATA in 1987. It estimated that 37 percent of high-school football players were injured during the season, and over 500,000 injuries required an athlete to miss playing time.

HISD's Riedau believes that football coaches can cope with most of these problems. "All of our coaches have gone through some kind of first-aid treatment," he says. "They've been told how to handle emergencies and who to call about not moving a kid if certain injuries take place"

Maurice McGowan, head coach of Jack Yates High School, disagrees: "They train some of the coaches. But still, we're not trainers. That's not our forte."

In Texas, trainers must be certified by the state's Advisory Board of Athletic Trainers. The requirements include a four-year degree that includes anatomy and athletic training courses, and a three-year, 1,800-hour university apprenticeship. Trainers must then pass a three-part certification exam.

High-school coaches appear to want athletic trainers. "We've asked for [trainers] for years," McGowan says. "[But] once they tell you you can't have any, it's not in the budget, why keep asking? This is HISD."

Logan Wood, an HISD trainer, claims that with the help of volunteering orthopedic surgeons, he and the other five trainers have no problem taking care of the district's athletes. "You have to look at the record and see how many fatalities, etcetera, etcetera, and in that regard, the record looks good."

According to Logan, no HISD player has ever died on the football field. But solely focusing on catastrophic injuries might mean overlooking the misery -- and cost -- of the hundreds and perhaps thousands of smaller, less severe injuries.  

Over the past few years, HISD's student insurance premium, which the district matches, has increased from $10 to $25 per season. Riedau says since August 1992, HISD's sports insurer, Dallas-based Sports Insurance Services, has processed claims totalling $369,702.72, most of which involve football-related injuries.

Those are just the injuries that resulted in visits to doctors and hospitals. HISD officials are unsure of the number of football players injured each year. While Riedau claims only the trainers keep the totals, Wood says he only records an injury if the coach brought the athlete into the training room and if that athlete completed the required accident form.

Applying the NATA's 37 percent injury rate to all HISD football players would mean that approximately 1,500 boys per season would be hurt seriously enough to miss part of a game.

While none of the experts claim additional athletic trainers would eliminate contact-sport-related injuries, most say a set standard should be set for responsible athletics. Among possible provisions: educating coaches and players, emphasizing the need to tend to injuries.

"I think an athletic trainer could prevent a lot of injuries by being on-site, making decisions whether a kid plays -- not the coach -- and rehabilitating injuries," says Mueller. "Injury rates go up when you have an athletic trainer, but that's because they are more conscious of injuries that are happening there."

Adds Riedau, "To say you're going to put a trainer in every school and that's all they're going to do, it would not be economically feasible. Not at this stage of the game.


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