For many, it's somewhat of a silent epidemic that is turning into a loud problem.
High school athletes are suffering brain injuries at alarming rates, and the research is staggering.
According to the Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control, the number of brain injuries in teenagers is between 1.6 to 3.8 million per year.
That's far too many, say local coaches and athletes.
"It's not worth the risk anymore, with all the stuff that's coming out with the long-term effects with having multiple concussions," St. Francis High football Coach Jim Bonds said. "When you have one, you're a lot more susceptible to having another."
Research behind the concussions has provided other distressing information.
A 2005 study by the Michigan State University Kalamazoo Center for Medical Studies showed that the highest number of sport-related concussions have been reported in football.
Most recently, a 2012 study in Michigan discovered that student-athletes are at risk of neurocognitive deficits that may last for more than a year, and concluded that eliminating tackle football for players under 16 is recommended to reducing concussions.
A majority of the studies have focused on football, including one by the University of Michigan that investigated the cumulative number of head impacts and their associated acceleration burden in 95 high school football players across four seasons of play. Using the Head Impact Telemetry System (HITS) — software installed in helmets that recorded the frequency and severity of impact to a player received during games and practices — the investigation revealed athletes received 101,994 impacts across 190 practice sessions and 50 games.
The number of impacts per 14-week season varied by playing position and starting status, with the average player sustaining 652 impacts. Linemen had the highest number of impacts per season (868), followed by tight ends, running backs, and linebackers (619); then quarterbacks (467) receivers, cornerbacks, and safeties (372).
Local administrators, coaches, trainers, parents, and doctors are trying to tackle the delicate and difficult subject.
Even California legislators have become involved. Legislation that would require high school coaches to receive training in concussions was sent Monday to Gov. Jerry Brown. Assembly Bill 1451 cleared its final hurdle Monday in the Assembly, which voted 65-0 to move the bill to Brown.
The measure would require high school coaches to receive training every two years on recognizing the signs of concussions.
"People are a lot more cautious," said first-year Glendale Coach John Tuttle, a former standout at San Marino High who admitted that concussions were not discussed during his playing days in the 1990s. "It's not worth the risk."
Football is often violent and concussions have been a part of the fabric of the sport for decades. Only recently have concussions become a national issue, brought on by the news of suicides of prominent NFL players who sustained years of brain trauma.
"It was never anything we discussed back when I played," said Hoover Coach Andrew Policky, who graduated from Arcadia High in 1998. "I could remember a time when I got my bell rung. I didn't even think to go over to the trainer. Nowadays, there is protocol in place."
As a player, Policky shrugged off headaches and injuries to become a stalwart wide receiver. As a coach who will enter his second year at the helm of Hoover's program, he would still like his players to play through minor injuries. But Policky won't take a chance on letting a player fight through concussion issues, even when a player tries to prove his toughness to a coach and his teammates.
Long-term brain trauma is not worth the risk, he said.
"Nobody knows their body more so than themselves," Policky said. "At the same time, it's our responsibility to look out for the responsibility and safety, especially in a sport like football when everybody wants to measure your toughness. You have to fight against that as a coach and do the right thing."
Bonds, Tuttle and Flintridge Prep Coach Antonio Harrison all concurred.