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.
"After that first concussion, he went through all of the necessary neurological tests, but he might not have been as forthright with some of the lingering symptoms," Scott Collie said. "During that game (against New England), he was active and took a couple more hits. With each one, the doctors would bring him off the sideline and check him out. He seemed fine."
The fact that coaches and doctors rely on athletes in helping them diagnose a concussion is an inherent problem.
"You're depending on the player to inform you about the symptoms," Morris said. "Sometimes there are outward signs, and those are obvious. But more often, it's the unseen symptoms, and you have to rely on the athletes to tell you those."
In the case of the New England game, doctors opted to remove Austin Collie from the game anyway. He missed several more weeks, which allowed him to recover from all concussion symptoms, as well as the other injuries.
Austin Collie was outstanding in his return with two touchdown catches for the Colts against the Jacksonville Jaguars on Dec. 19. Late in the second quarter, however, he was hit by a Jaguar linebacker's forearm and chest as he reached out to catch a pass. He fell forward onto the turf, motionless. (see video at www.youtube.com/watch?v=11FlX104gk4)
The family of the promising young player, who recently became a father, has had mixed reactions to the second concussion, Scott Collie said.
"Mom is ready to get on a plane and discuss with management that he needs to stop playing for now," he said. "His grandmas were saying he needs to do something else."
Scott Collie wants more information. As people tell him that having one concussion makes a person more susceptible to future concussions, he isn't sure the freakish hit his son sustained will happen again.
"You never want to see your son hurt," he said. "You never want to see a player hurt. But you do start thinking in the long term that it might be time to shut it down and let the thing rest. From the player/coach perspective, it's rare to see lightening strike twice. Two violent, clean hits. You don't see it happening on a regular basis to the same player."
Since that interview with Scott Collie, Austin Collie was benched for the remainder of the season.
While coaches like McGeary continue to struggle with the issue, he is grateful that there is more information and attention to the injuries.
"Everyone's awareness is heightened, in every area of the game," he said. From teaching players not to lead with their heads or helmets on tackles to the innovations in helmets to the dissemination of medical information, McGeary said it all helps coaches deal with a dangerous and delicate subject.
Dr. Colby Hansen of the University of Utah Physical and Rehabilitation Medicine, says the issue is multifaceted.
"Part of the responsibility comes on how the media and fans really eat up that kind of contact. That's the stuff that gets glorified," Hansen said. "There needs to be a culture change how football players are playing the game."
This year, the NFL recorded a record number of players suffering concussions, a phenomenon experts say is due to the league's heavy emphasis on the issue.
"It's a serious thing," McGeary said. "We always want to err on the side of being too cautious. … I would probably use the three strikes and you're out rule. But I guess it depends on the situation."
Contributing: Marjorie Cortez