Student-athletes at Iowa’s three state universities suffered twice as many concussions in practice as they did in games or competitions in 2011-2012, according to a Gazette review.

Concussions are more likely during games, but student-athletes spend more time in practice, so the numbers are higher in those sessions, said Dr. Andy Peterson, director of the University of Iowa’s sports concussion clinic.

“You just have more exposure in practice,” he said.

UNI’s Braden Lehman (from left), Ben Wallace, Griffin Gaeta, Breion Creer and Spencer Hicks run plays during football practice at the UNI-Dome on Wednesday in Cedar Falls. Concussions are more likely in games, but because athletes spend more time in practice, a larger number happen in those sessions. (Liz Martin/The Gazette)

Universities across the country are taking steps to limit that exposure. The Ivy League recently restricted contact in lacrosse practices, and University of Louisville basketball players who have had a concussion wear headgear during practice to prevent fresh damage.

Some of these changes could come to Iowa — if research shows they keep athletes safer, trainers and team physicians said.

Concussions, which can cause physical and functional damage to the brain, are a top concern in college and professional sports — especially football.

Thousands of former NFL players are suing the league, saying the NFL is responsible for the long-term care of athletes suffering from dementia, Alzheimer’s and other diseases that may be linked to brain injury.

Wally Hilgenberg, a UI All-American who played 16 seasons in the NFL, died in 2008 of amyotrophic lateral sclerosis, or Lou Gehrig’s disease, which his family believes was caused by repetitive concussions.

By the numbers

The UI, Iowa State University and the University of Northern Iowa reported 64 concussions in 2011-2012 for all sports combined, according to data obtained through an Open Records request. Of total concussions, 43 were in practice and 21 in competition.

The UI had four times as many concussions in practice as in games, with 22 and five respectively. UNI student-athletes had 11 concussions in practice and five in games. Only ISU had more concussions in competitions than in practices, with 11 and 10 respectively.

Football caused 20, or about one-third, of all concussions at Iowa’s state schools last year. Wrestling came in second with 11 concussions, eight of which happened at ISU. Concussions also occurred in gymnastics, soccer, field hockey, rowing, volleyball, track and other sports at the three schools.

It’s hard to tell how concussions at Iowa universities compare with other schools because the National Collegiate Athletic Association doesn’t require colleges and universities to report sport injuries, including concussions.

Up to 10 percent of NCAA member institutions voluntarily report injury data to the NCAA Injury Surveillance Program, which is managed by the Datalys Center for Sports Injury Research and Prevention. Datalys provides regular reports to the NCAA Competitive Safeguard and Medical Aspects of Sports committee, which uses the data to make policy and rule recommendations.

“They’re actually using that data to make informed decisions,” said Tom Dompier, Datalys president.

The NCAA’s recent rule change starting football kickoffs at the 35 yard line rather than the 30 yard line resulted from Datalys data showing more injuries occurred during kickoffs than in other phases of the game, Dompier said.

ISU is the only public university in Iowa that reports injury numbers to the NCAA. The UI used to send stats to Datalys, but now reports to the Big Ten Conference instead. The Big Ten and Ivy League have a new collaboration to study head injuries.

Iowa’s state schools all have concussion-management plans, as mandated by the NCAA since 2010. The plans explain how each school diagnoses concussions and what steps must be followed before an athlete can return to play.

“I think we do a pretty good job making sure people are fully recovered before they come back,” Peterson said.

Peterson leads a UI concussion clinic every Monday for student-athletes with fresh concussions and those who have ongoing concussion care. The clinic had 11 athletes scheduled Oct. 29, four of which were new football concussions, he said.

The tougher question is what to do with student-athletes who have had multiple concussions, Peterson said.

“We still don’t know how many concussions is too many,” he said.

The UI, ISU and UNI require student-athletes to take preseason tests on balance, coordination and cognitive functions. If the student-athlete gets a concussion during the season, doctors and trainers can compare baseline tests with behaviors after the injury.

The UI requires “complete physical and cognitive rest” until a student-athlete is symptom-free for 24 hours. Student-athletes must be back at their baseline tests before they can resume practice, and then only gradually.

“It wasn’t easy,” said Devyn Marble, a UI junior basketball player, about sitting out two weeks last year for a concussion.

After Marble collided with Matt Gatens in practice, Marble had a headache and failed several concussion tests. When he returned, Marble had no-contact practices before going back to normal play.

“It’s a good policy, even though I was struggling with it,” Marble said. “You have to put your safety first. They care enough about me not to let me keep playing.”

What causes concussions?

Concussions result when the brain becomes mobile inside the skull because of a blow to the head, particularly one that causes the head to rotate or be violently shaken, said David Moser, a University of Iowa neuropsychologist and psychiatry professor.

While structural damage can occur, concussions cause functional damage by disturbing the brain’s metabolic balance. Chemical messengers called neurotransmitters are released indiscriminately, which causes potassium to leave brain cells as calcium rushes in.

“The cells then go into a highly active state, which requires a lot of fuel — glucose — as they attempt to restore the potassium-calcium balance,” Moser said.

A brain with a concussion gets less blood flow, which means less glucose. This supply-and-demand problem leaves the cells dysfunctional and vulnerable, Moser said. Physical and mental rest is required to minimize the demand on brain cells while they recover from concussion.