The fourth concussion was the turning point for the parents of Alfonso Castro.

The Rio Americano High School senior loved football, relished the hitting, cherished the team bonding. An offensive guard and linebacker at an undersized 5-foot-9 and 175 pounds, Castro was good enough to earn all-league honors as a junior.

But Castro suffered a concussion while making a tackle in the Raiders' second game of the season against Woodland High. It was his fourth concussion – his third in football – and at the urging of his worried parents, he reluctantly agreed to put away his helmet and not return to the sport.

In January, a new California law takes effect that requires the parents of student athletes to sign a concussion-awareness form before their children can play sports.

Assembly Bill 25 also puts into law an existing requirement by the California Interscholastic Federation, which oversees high school sports, that student athletes who have sustained concussions must obtain medical clearance before returning to play.

It is one of a number of changes that high school sports teams are adopting that stem from increased awareness of the dangers that head injuries pose in a sport where adolescents are getting bigger, stronger and faster while their brains are still developing.

The concussion issue has come into sharper focus in the past two years in large part because of a sea change in the NFL, where the deaths of a number of former players from dementia-related complications – including former 49ers star and Rocklin resident Forrest Blue, who died in July – and lawsuits filed by dozens of ex-players have generated headlines.

After years of denying any conclusive link between concussions and long-term brain impairment, the NFL reversed its position last year and moved to warn players about the dangers of head trauma, limit physical contact in practices and escalate penalties for certain types of hits.

"There's definitely more awareness because of everything going on with the NFL," said Christian Mahaffey, Castro's coach at Rio Americano. "What happens with them eventually drips down our way."

CIF officials saw a need for better concussion care during an eye-opening seminar several years ago in South Lake Tahoe.

"They showed a tape of this kid playing who got hit in the head during a game a week earlier," said Sac-Joaquin Section assistant commissioner John Williams. "He goes down, then dies. We're looking at each other and saying, 'Wow! This is serious stuff.' "

Starting last year, the CIF changed its rules to allow game officials to remove players suspected of a concussion from a game. Such players are not allowed to play again until they have written clearance from a licensed health care provider.

For area schools, the concern has led to tougher rules, more educational materials, and a broader awareness among coaches, some of whom have changed the way they teach the fundamentals of tackling and hitting.

It has led some schools, including Del Oro and Jesuit, to start using neuro-cognitive testing of their athletes to better evaluate when it's safe to return to play after a concussion.

"There are some who think there is this hysteria about concussions – that we're being overly cautious," said Jesuit Athletic Director Chris Fahey. "But with student athletes who have such a bright future, it's better to be safe than sorry."

Injury 'part of the game'

"The old-school way was when you got your bell rung, you sucked it up and went back in and played," said Rosemont High football coach Rick Wanlin, 38, a middle linebacker as a prep. "I'm sure I played with a concussion or two. You figured you had to be tough, that you should play through anything."

Despite the changes, the headlines remain alarming:

• Emergency room visits by children and adolescents for brain injuries jumped 60 percent over an eight-year period, according to a report last month by the Centers for Disease Control and Prevention. Football ranks at the top for head injuries among high school males; soccer among females.

• Last month, a 16-year-old New York high school football player died from a cerebral hemorrhage shortly after he collapsed on the field during a game. Ridge Barden was the 13th high school player to die from a brain injury sustained on a football field since 2005 and the third this year.

• According to the Sports Concussion Institute in Los Angeles, between 1.6 million and 3.8 million sports-related concussions occur each year in the United States, most often in organized high school sports.

Concussions remain a part of local high school sports, especially football. In a contact sport where players sometimes launch themselves like missiles and bodies are flying everywhere, taking blows on the helmet can be unavoidable.

In addition to Castro, Mahaffey says he had four other Rio Americano players miss time this season because of concussions. Fahey said six Jesuit football players were diagnosed with concussions. Rosemont lost two players to season-ending concussions.

"Our coaches are always pushing for safety," said Jalen Cope-Fitzpatrick, a senior tight end-defensive end at Whitney High in Rocklin. "But injuries are part of the game, especially when you are wearing helmets."

Although he didn't suffer a concussion, Cope-Fitzpatrick was removed late in an Oct. 20 win over El Camino High after a jarring helmet-to-helmet collision with a defender. For precautionary reasons, Whitney's team doctor wouldn't allow him to return to the game.

"I wanted to go back in; I have only so many games left at Whitney," said Cope-Fitzpatrick, who is 6-foot-5, 235 pounds and plans to play football next year at USC. "But I can understand why the doctor was worried."

Ex-49er suffers effects

Visger, 53, said he is plagued by short-term memory loss, seizures and anger management issues related to chronic traumatic encephalopathy or CTE, a degenerative brain disease caused by repeated trauma to the head.

The condition, once associated with boxers, is the subject of an extensive research project at the Boston University School of Medicine. Researchers have found the disease in the brains of more than 50 deceased pro, college and high school athletes, including 14 NFL players.

A former star at Stagg High School in Stockton whose history of head injuries dates back to his youth football days, Visger said he has had nine brain surgeries and has a shunt that drains to his abdomen the fluid that builds up because of scar tissue on his brain.

"I'm the poster child for what can go wrong," said Visger. "I'm conflicted. I don't want to see football disappear. Yet I'm not certain if the human body really was meant to play football. It's like running as hard as you can into a wall."

Visger is among the ex-players challenging the NFL over its treatment of injured veterans, and is also pushing for rule and equipment changes he argues would improve player safety. Among his suggestions for players at all age levels:

• Add padding on artificial-turf fields to help mute the impact of player collisions.

• Limit teams to full pads in practice one day a week.

• Have players use a two-point stance to better avoid helmet-to-helmet contact.

Concussion care stressed

The next piece could be base-line testing, a computerized program that measures reaction time, attention and memory. Athletes are given the test, which takes 20 to 25 minutes, at the start of their season; those suspected of having suffered a concussion are then re-evaluated.

Jesuit is in the first year of testing most of its athletes through the ImPACT Concussion Program, which cost $750.

"We've already had six football players and a soccer kid we pulled out of action then had them tested and it turned out they had concussions," Fahey said.

Stanley Herring, a physician and co-director of the Seattle Sports Concussion Program, applauds area coaches and officials for being proactive.

Herring was among those who helped push through Washington state's Zackery Lystedt law, named for a youth football player who, after getting injured, was put back into a game and suffered a traumatic brain injury; it's become a template for other state laws, including California's.

"While we're trying to figure out the science of this, no one argues that one of the safest things you can do to prevent long-term consequences of concussions is to get completely well before returning to play," said Herring, also the team doctor for the Seahawks and the Mariners.

One of the focuses of his research, Herring said, is whether some people are more at risk for concussions than others: "If you ask me to prognosticate," he said, "I think we'll eventually find that contact sports is too dangerous for certain individuals."

Castro isn't sure if he is one of them.

He says he feels great – no headaches, dizzy spells or memory loss – and continues to run and lift weights.

"We made a good decision," said Margarita Castro, Alfonso's mother. "We didn't want to see him have bigger problems in the future."

She said she already has told Alfonso's younger brother, a 14-year-old who also loves football, that he is on a short leash.

"One concussion and it's no more football for him," she said.

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