Keith Johnson, Deseret News
PROVO — Steven Thomas couldn't find relief from the pain in his head. He couldn't shake the fatigue or the nausea that seemed to accompany it each day.
Which is why, when BYU head athletic trainer Kevin Morris discussed the possibility of giving up football, Thomas understood the rationale.
That understanding didn't make the decision any easier.
The 21-year-old was living his childhood dream to play football for BYU when he suffered two consecutive concussions. A few days after Morris explained the risks associated with continuing to play, Thomas reluctantly agreed that as much as he loved the game, it wasn't worth the risks.
Physicians interviewed by the Deseret News say repeated concussions require an abundance of caution in their treatment and the deciding if or when a player should return to play. The issue has even been the subject of congressional hearings as medical science has learned more about the long-term effects of traumatic brain injuries.
As the National Football League and organizations governing high school sports have established formal protocols in recent years, the NCAA has left most of the responsibility for concussion management to the colleges.
NCAA guidelines require schools to establish concussion "management plans." Players who show symptoms of a concussion may not return to practice or play on that day. The student-athlete must then be evaluated before rejoining the team.
After Thomas' concussion this past season, he met daily with Morris and the medical staff. He realized in talking to doctors that he'd had several minor concussions as a young football player. They went undiagnosed because he didn't lose consciousness and had no lingering problems. Still, he tried not to let his love for the game cloud his judgment.
"I didn't want to be stupid about it," said Thomas. "But football was everything (to me). I'd been playing since I was 8 years old. I love being out on the field. I liked to hit people."
Morris said he has only had to tell a handful of athletes in 20 years that they should consider giving up sports.
"I think it's very difficult for them to come to that decision on their own," Morris said. "They love the game. They don't want to let other people down. They don't want to give up on goals. All you can do, when you think it's to that point, is give them as much information as possible."
Experts say the best course of treatment for a concussion is physical and cognitive rest. Absent baseline cognitive tests prior to an athletic season, athletic trainers and physicians largely rely on athletes to tell them how they're feeling.
Lone Peak High School coach Tony McGeary, who has coached football for 22 years, says trying to decide if a player actually has a concussion can be tricky.
"It's a tough call to make," McGeary said. "When a kid gets hit and he's dazed a little bit, is it a concussion? Or do we jump to concussion?"
That's something Scott Collie wonders. His second-oldest son, Austin Collie, had a successful career with BYU and then was drafted to play for Indianapolis. Collie had become one of all-pro quarterback Peyton Manning's favorite receivers in his rookie season.
This fall, however, he had several nagging injuries, including a heel bruise and a torn ligament in his thumb, which were affecting his play. Then in a game against Philadelphia he suffered the first concussion of his career. (see video at www.youtube.com/watch?v=hbIZCfZwzHU)
"It's been extremely frustrating for Austin," said his father. "All season long he wasn't feeling 100 percent. The (concussion) was kind of an icing on the cake."
Austin Collie actually returned to the field against New England two weeks after the hit in Philadelphia, but coaches removed him mid-game.