Youth Sports Concussions: A 10-Year Look at San Rafael High
Concussions remain one of the most common injuries in youth sports. They’re also one of the most misunderstood. Football has roughly double the concussion rate of the next most prevalent sport, soccer, especially girls’ soccer. But sports concussions aren’t limited to contact sports.
Most concussions result from collisions, head-to-head contact, ball-to-head impact, or falls. In order of prevalence, they’re also common in water polo, lacrosse, basketball, cheer, volleyball, and mountain biking. All of these sports are offered at San Rafael High.
Ten years ago, I spoke with San Rafael High School’s Athletic Director, Tim Galli, about the steps they were taking to protect student athletes. Even then, SRHS was on the cutting edge of concussion prevention and management. Since 2014, each athlete had completed the King-Devick baseline neurological test which could be compared against if a concussion was suspected. The school was also part of a pilot program, the first in the San Francisco Bay Area to test concussion-monitoring technology in real time.
A decade later, I went back to see what’s changed. I spoke with the Athletic Director and head coach of the football team, Casey Sully, and with Ysa Morris, the athletic trainer contracted through Marin Health. What I found is a program that hasn’t just kept pace with advances in concussion science. It’s doing something few high schools in California offer at all: $0 next-day concussion telehealth, even for athletes on Medicaid or who may be uninsured.
Smarter Helmet Technology, Tracking Every Hit
Since the 2014 pilot program, San Rafael High School has moved from sensors worn in a headband or skull cap to helmets with integrated impact-monitoring technology. In the last three years, the school began outfitting its linebackers and running backs with Axiom helmets. These helmets have impact-sensing plates on the front, back, and sides. They aren’t inexpensive, but they are worth it. Each one is coded to track the individual player. A significant impact triggers an immediate alert to pull that player out. Every week, Coach Sully receives a report showing the location and degree of impact for each practice and game. He uses that data to adjust practice and game play for student safety. The district purchases 10 of these helmets per year. Axiom verifies and replaces them as needed annually.
The team has also added Guardian Caps, padded shells worn over the helmet. Coach Sully notes that these have a minimal cushioning effect on impact force. But because they’re loosely attached to the helmet, they can slide on contact. That slide reduces some of the shear and rotational forces that can lead to more severe concussions. Guardian Caps are currently mandatory at practice and optional during games.
A New Approach to Sideline Testing
The King-Devick test, a quick eye-tracking screen we highlighted in 2016, is no longer part of San Rafael High’s protocol. In its place, the athletic training staff now uses the SCAT6 (Sport Concussion Assessment Tool, 6th Edition). It assesses cognitive function and balance. Staff also use VOMS (Vestibular/Ocular Motor Screening), which evaluates how eye movement affects symptoms. Together, these tools are a more comprehensive, current standard for evaluating a possible concussion on the sideline. They provide a clearer indicator of concussion severity.
SRHS has recently partnered with Headquarters Health (HQH), a provider of both baseline testing and telehealth concussion care within 24-48 hours. Going forward, sideline testing will be compared against a preseason baseline assessment logged in the HQH platform. That gives the athletic trainer and clinician another comparison point when evaluating a suspected concussion.
A First for Marin County: Concussion-Specific Insurance
San Rafael High School is going above and beyond. Thanks to its Boosters, the school now provides concussion-specific insurance coverage for every student-athlete in the school. The coverage comes through the HeadStrong Concussion Insurance Program. It was developed by Dissinger Reed, a division of HUB International, and Mutual of Omaha serves as the insurance carrier and claims processor. It’s secondary insurance, but it becomes primary if the injured student doesn’t have other coverage. There are no restrictions on which doctors a family can see. No referral is required to access the $25,000 in coverage.
A family may prefer to see their own pediatrician, but appointments aren’t always easy to get quickly. With a suspected concussion, a student can instead get a telehealth visit with an HQH concussion specialist the next day, even on weekends or holiday breaks. Headquarters then provides concussion-focused evaluation and follow-up care by their interdisciplinary team of concussion specialists. This type of timely targeted care has been shown to reduce the chance of long-term symptoms by 50% and speed up recovery by 25% (Leddy et al, 2021).
Getting Back to School and Back to Play, the Right Way
San Rafael High’s return protocol follows California Interscholastic Federation (CIF) guidelines. It’s built around two tracks that run in parallel: return to learn and return to play.
After a suspected concussion and a sideline evaluation by athletic trainer Ysa Morris, an appointment is scheduled as soon as possible with a concussion specialist, who makes an official diagnosis. Once diagnosed and documented as a concussion, any needed classroom accommodations are made. Then the athlete can start both the return to learn and return to play process. Return to play generally begins once return to learn is complete. From there it’s a minimum 7-day, 8-step process, where the athletic trainer oversees progression. It starts with light aerobic exercise and goes all the way up to practice. Another medical visit is needed for state-mandated clearance to move on to the last few steps, which carry risk of head impact. This way, athletes not only are safe from the risk of Second Impact Syndrome, but also get back to the sport they love in a speedy manner..
Before any injury as well as post-recovery, trainer Ysa Morris also incorporates neck-strengthening exercises. Recent research points to this as an effective way to reduce concussion risk and severity, since a stronger neck can measurably lessen the acceleration force on the head during an impact.(Elliott, J., Heron, N., Versteegh, T. et al., 2021)
Why This Matters for Families
What’s changed since 2016 isn’t just the technology. It’s the coordination. Concussion care at San Rafael High School now connects coaching, athletic training, treatment, and insurance coverage into a single, streamlined process, from the moment of impact through a documented return to school and sport. An unmanaged concussion, or an early return to play, can lead to long-term cognitive and emotional symptoms. Parents can rest easier knowing their children are well taken care of at San Rafael High.
If your student athlete has experienced a head injury, in football or any other sport, Balance Chiropractic and True Brain Concussion Center can help. We provide hands-on treatment as well as nutritional and lifestyle guidance to speed recovery alongside your physician’s recommendations. Schedule a no-commitment conversation to talk through symptoms and next steps.
