Scoring Prep Grid Injuries

It was a Friday night high school pressure moment. The Oilers, the Huntington Beach High School football team, were behind, 7-0, in the second quarter of last month’s first-round California Interscholastic Federation playoff game against Servite High of Anaheim.

In the huddle, 16-year-old Oiler quarterback Eric Pettinato, 5-foot-11 and 165 pounds, called for a pass play in which a tailback would be in motion before the snap, then run downfield to catch the ball and score.

As Pettinato dropped back to pick out his target, a blocked 220-pound Servite defender rolled into Pettinato’s left leg.

Moment of Injury

The quarterback’s foot caught in the turf and his knee folded beneath him so severely that the referee would later say both foot and knee momentarily touched the ground, even though Pettinato was still under the impression he was upright.

In a split second, the boy was writhing on the turf; X-rays would find he had severely torn four knee ligaments. That major injury put Eric Pettinato on the long national list of teen-agers injured in high school football.

The good news on those statistics is that fatality and major head and spinal injury rates have apparently declined in the last decade. But medical experts agree that far too little still is known about precise injury rates and risk factors. Coaches and trainers are better educated about injury risks than they used to be, these experts say, but teen-agers are still being unnecessarily hurt and even killed in the game.

Nationally, the situation would appear to have taken a significant turn for the worse last year: 11 high school players were killed, compared with four for each of the two preceding years. However, Fred Mueller, a football injury expert at the University of North Carolina, said preliminary totals from the 1987 high school season indicate the death toll has dropped back to about four--though several players remain in comas after severe head injuries.

Playing and Driving

“I think 1986 may just have been an off year,” Mueller said. “I don’t think high school football is unacceptably dangerous. I think the incidence of severe injury is less than one per 100,000 participants. It remains safer (to be playing in a high school game) than driving to or from the field.”

Other experts said, however, that the lack of a national standard definition of an injury and the absence of a unified national statistics-gathering mechanism still make football injury rates something of a vast unknown.

To try to formulate a better understanding of the situation, the National Athletic Trainers Assn. last year organized a reporting system in which 105 high schools report all of their injuries based on standardized criteria. The figures are then subjected to statistical extrapolation to obtain national totals.

John Powell, a UC San Diego researcher who heads the project, said the registry estimated 54,000 serious injuries last year out a total of more than 636,000 and that 14,380 injured players would require surgeries--9,933 of which would be knee operations.

Figures for 1987 are to be released next month and Powell declined to identify trends. But he said that high school football as a sport is so vast--with an estimated 747,000 varsity players in almost 15,600 programs nationwide--that tracking injury trends is difficult.

“It is very hard to get a handle on it,” Powell said. “Attempts to make national projections have been very superficial.”

Dr. Walton Curl, head of the research committee of the American Orthopedic Society for Sports Medicine, said he believes high school football still exacts too great an injury toll. Curl, of the Hughston Orthopedic Clinic in Columbus, Ga., maintained that improved conditioning techniques and better field safety maintenance could cut injury rates by 20%.

Contributing Factors

Improper warm-up techniques and playing while injured also contribute to the rates, Curl said. He and other experts also agreed that the sometimes extreme differences in the size of high school players introduces an element of risk not present on college or professional levels, where players are more evenly matched.

The kinetics of a 120-pound high school running back colliding with a 300-pound tackle make it inevitable that high school football injuries have the potential to be extremely serious, Curl said. “This is a problem that’s not very easy to control,” he said.

Like most boys his age, Eric Pettinato had given little thought to being seriously hurt--until he was. Like any starting high school quarterback, he said, he dreamed about playing college or professional ball. Now, he is most concerned about whether he can play at Huntington next year and whether his knee injury will rule out an application to his first-choice college, the U.S. Naval Academy.

It had happened so fast that Huntington Beach coach George Pasco, who was watching where Pettinato’s pass went, wasn’t aware anything was wrong until he saw players of both teams gathered around the fallen quarterback. It was just the kind of injury Pasco said he pays a lot of attention to trying to prevent.

Each player is required to participate in a mandatory lower-body weight-training program to keep knees and ankles and strong as possible, Pasco said, and attention is paid to neck and shoulder musculature as a means of preventing cervical spine injury and its high risk of permanent paralysis.

Now back in school on crutches and about 25 pounds lighter after a weeklong hospital stay after surgery, Pettinato sat on a couch in Pasco’s office a few days ago. His injury formed a large bulge under the knee of his sweat pants, a protective brace used in place of a cast and several wrappings of elastic bandaging.

“I don’t know how to explain it,” Pettinato said of the split second in which his ligaments were torn. “I could feel it happening. It was like my knee exploded. I didn’t want to let go of it because I thought that my leg was going to fall apart.”

15-Inch Incision

He didn’t remember whether the pass was completed or that Huntington Beach eventually lost, 31-7. His 15-inch incision begins several inches below the knee, zigzags across the knee cap and continues well into the thigh. His doctors tell him he will be out of action at least nine months but that he may be able to play next season.

Because he was in good physical condition before the injury and because teens recover comparatively quickly from injuries, Pettinato was able to resume an upper-body weight-lifting program a few days ago. Surrounded by curious and amused teammates, he was embarrassed that bench-pressing only 115 pounds quickly tired him.

It is expected to be just a temporary problem. Barring unforeseen complications, he will regain his weight and his knee will heal. Orthopedic surgeons questioned by The Times agreed that modern surgical techniques make it likely that Pettinato will be able to play competitive football again and his knee will remain healthy for several decades--without succumbing to premature arthritis caused by a permanently loosened joint.

Pettinato is far more fortunate than Richard Ruiz, 15, a former member of the football team at California High School in Whittier. Ruiz returned to school this fall in a wheelchair after sustaining a serious neck fracture last season that has left him a quadriplegic.

While community support for Ruiz has been substantial, Herman Travers, California High’s athletic director, declined to discuss strength-training programs there because a negligence suit has been filed by Ruiz’s family. “It’s really a sensitive matter,” Travers said.

Ruiz is the last California high school player to be entered into the grim tabulations kept by the National Football Head and Neck Injury Registry, a University of Pennsylvania Sports Medicine Center project that has monitored the most serious and fatal football injuries at the college and high school levels since 1976.

Pettinato and Ruiz, in a sense, represent two extremes of the injury controversy.

Pettinato typifies the type of problem that can probably never be completely eliminated from a rough contact sport. According to sports medicine researchers, Pettinato’s injury might have been avoided since he was wearing conventional football shoes while recent studies suggest that the soccer-style shoe--with shorter cleats and a cleat pattern less likely to stick in the grass--can prevent many knee and ankle injuries.

Equipment, Game Rules

Ruiz’s case, however, represents a type of injury sports medicine experts contend has not received adequate study, which could focus on how equipment or game rules might be changed to reduce injury and death rates.

In the last decade, changes in helmet design and game rules banning “spearing,” the use of the head as a battering ram while tackling, have substantially reduced head-injury deaths, spinal fractures and quadriplegia.

But Dr. Joseph Torg, who heads the head- and neck-injury registry, said that even the beneficial changes that have occurred are insufficient and that there is not enough genuine concern with reducing catastrophic head-injury rates, in particular, on a national level.

“The big problem is there is no real good data surrounding the circumstances of each injury,” he said. “The problem is really, in effect, that no one is studying it. No one is interested enough to deal with this problem.

“Nobody really cares. It’s still, ‘Play ball. So the kid has a brain hemorrhage. So what?’ A lot of lip service is paid (to reducing the most serious head injuries), but no concerted effort is made to finance a scientifically designed study. In general, nobody gives a ------. That’s the way it is.”

High school football head-injury deaths in 1986, according to still-unpublished data gathered by Torg’s project, rose to five from three a year earlier, but were down from six in 1984. Incidents in which players were rendered permanently quadriplegic were down to five from seven in 1985. There were four cases in 1984.

An Apparent Trend

Torg said the figures have sometimes been confusing. In 1980, for instance, there appeared to have been a significant increase in quadriplegia and head-injury deaths, but it turned out the apparent trend was explained by more widespread use of sophisticated X-ray scanners at hospitals--a change that permitted greater precision in diagnosis.

To Dr. Clarence Shields, the Inglewood orthopedic surgeon who is team surgeon for the Los Angeles Rams and two Inglewood high schools, inconsistencies in statistics on high school injuries mean it is difficult to know exactly what problems may exist.

Like many orthopedic experts, Shields questions the value of a trend that has established itself in football at all levels in recent years--knee braces worn by healthy players who believe the braces will prevent injury. Repeated studies, said Shields and Curl, have established that no convincing evidence that braces keep athletes from being hurt--and, in fact, two studies imply injury rates may actually be higher in players who wear braces.

Policy Statement

The American Academy of Orthopedic Surgeons recently issued a policy statement urging that the braces not be used. Shields said he believes the purchases of the braces--which cost about $150 per player--may divert funds at hard-pressed schools, making money unavailable for better field maintenance and the purchase of safer soccer-style shoes. Both of those factors, Shields said, can directly influence knee injury rates.

Shields favors changes in helmet design. A soft outer surface, he said, would make it far more difficult to inflict injury by a butt of the head--intentional or not. But by and large injuries in high school football are likely to remain a part of the game, he said.

“The sport is a contact sport,” said Shields. “There is certainly a risk of injury but high school football is just part of the American way of life.

“At the high school level, one of its purposes is for the camaraderie that (the players) get. I think it’s part of high school life for males.”