As a defensive tackle, Poly coach Larry Webster experienced full-contact practice almost every day of his 20-year playing career, usually twice a day.
It wouldn't be easy for the former Raven to adjust to coaching a football team that could soon be limited to hitting live only once or twice a week during the regular season, one of the steps being considered by a Maryland State Department of Education task force studying ways to prevent concussions in high school sports.
Still, Webster has mixed feelings about a live hitting limit, such as those already in place in the NFL and the Ivy League, which could come to Maryland public schools as early as next fall.
"I'm from the old school," Webster said, "but because of how I came up in the game, I know change has to be made because of the significant injuries that are happening. I know that all across the country, everyone wants to try to take care of the student-athlete and do what's in the best interest of the student-athlete by minimizing the chances for concussions, but there are certain elements of the game it's hard to do away with."
Officials from youth leagues to the NFL are struggling with how to balance adequate preparation for a game that is all about contact with limiting the blows to the head that can cause traumatic brain injury immediately or over time.
The Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio reported 114,540 concussions from high school football in 2010. These latest statistics include input from many Maryland high schools, according to Ned Sparks, executive director of the Maryland Public Secondary Schools Athletic Association.
While one concussion can be serious, another one on its heels can be many times worse.
"When the brain is not 100 percent recovered, it's more vulnerable," said Dr. Gerard Gioia, director of the Safe Concussion Outcome Recovery and Education Program at Children's National Medical Center in Washington, D.C. and a member of the state task force.
"The example I give is if you sprain your ankle, the first two days you don't want to walk on it that much, but some people start running or cutting before their ankle is ready. That ankle is weaker and cannot protect itself and the second injury, because of the weaker structure, can be worse and then it piles on. Then what we see is kids that have much, much more extended recovery with symptoms that last weeks or months or longer when it might have been days."
Concussion prevention has been a prime topic at all football levels in recent years as studies revealed that concussions and even sub-concussive injuries can permanently scar the brain. Reports of former NFL players suffering from early-onset dementia, as well as younger NFL veterans dealing with depression that apparently led several to commit suicide recently, have heightened awareness of the potential for permanent brain injury.
Bone-jarring tackles aren't the only hits that cause concern.
"The theory is that the more blows to the head you take whether they cross that threshold and produce a concussion or they're below the concussion level, that, at least for some people, may create a more vulnerable brain and could create more problems down the road," Gioia said, "and so the issue is how we think about managing the exposure to blows to the head also in terms of the amount of time they take the blows."
A Purdue University study of 45 Indiana high school players during the 2010 and 2011 seasons found that 17 of the players who had never had concussions showed changes in brain activity. Helmet sensors recorded that the players in the study took between 200 and 1,900 hits to the head in one season.
"For me as a lineman," South River coach Lance Clelland said, "I was pretty shocked to read that much more damage was done to the brain of linemen from all the little jabs. They basically compared it to a boxer who had been jabbed in the face his whole career as opposed to one knockout blow. That accumulated damage to the brain is far more harmful."
So far, Maryland's concussion mandate has focused on education, making sure coaches, players and parents understand the dangers of concussions, the symptoms and the need for recovery time. The Maryland State Department of Education's Policies and Programs on concussions for Public Schools and Youth Sports Programs requires an athlete who exhibits concussion symptoms be removed from a game and that he not return to competition until cleared by a doctor or an athletic trainer.
The task force, scheduled to present its recommendations in January, will study further options, such as limiting full-contact football practice to one or two days a week, following limits set last fall by the NFL and the Ivy League. The NFL limited padded, full-contact practice to 14 days during the 16-game regular season while the Ivy League set a limit of twice a week.
What happens on the NFL level tends to trickle down to the high school level.
Locally, many coaches said they would be fine with limits because they don't practice with full contact more than once a week after the season starts. Others, including Poly's Webster, would prefer it spread out over several days. He said his team only goes full speed about a half hour each day, but he feels they need that to practice the offensive and defensive strategies tailored for their next opponent.
At Westminster, coach Brad Wilson said when he started coaching more than 30 years ago, his teams practiced full contact four or five days a week. Not anymore.
"I think the game has changed," Wilson said. "We don't hit like we used to -- first, to look out for the safety of the kids and second, I don't think it's necessary. It's more teaching technique."
Wilson and most other coaches also rely on the certified athletic trainer, who is more knowledgeable about concussions.
For Gioia, athletic trainers play a key role in concussion management along with education and ImPACT, Immediate Post-Concussion Assessment and Cognitive Testing -- a computer test that provides a baseline reading of cognitive functions that can be used after a concussion to determine when an athlete is recovered enough to play.
This fall, Howard County limited the number of days of full-contact practice. Football teams can practice in full pads three days a week but can go full speed only twice.
"Most of our coaches are more restrictive than that," Howard County coordinator of athletics Mike Williams said.
"They've been following what the NFL does and some of these other groups and it just protects the kids. You can't stop all concussions," he said. "You just can't do that when there's contact and collisions, but what you can do is limit the number of concussions by the proper fitting of certified equipment, by proper teaching of tackling and blocking techniques, by how often you go live full-speed hitting and by not using drills that are no longer appropriate."