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UPDATED 2/22/13 11 a.m.

Editor’s Note: This is the second of a two-part series looking at head concussions among Hawaii student athletes. Read part 1 looking into what schools are doing to prevent the injury.

When 21-year-old Jamie Higa got her fourth and most recent concussion in late 2011, her coach told her to man up.

Higa, then a guard on Chaminade University’s women’s basketball team, was dribbling across the court in a practice set when a spiteful teammate came from behind and “clobbered” her on purpose. Civil Beat confirmed the incident with other teammates.

The jolt caught Higa off-guard. She fell to the court, the front of her head hitting the floor and then snapping backwards — just like whiplash.

She hasn’t felt normal since.

State data show that hundreds — many suspect thousands — of student athletes suffer concussions each year. Concussions are traumatic brain injuries caused by a that can change the way the brain normally works. They can cause confusion, blurred vision, memory loss, nausea and, sometimes, unconsciousness.

Many medical experts and athletics officials in part attribute the high concussion rate to the ever-increasing competitiveness in school sports. And they say that pressure is widespread in Hawaii, which is sometimes dubbed for national recruiters.

Coaches like Higa’s often pressure student athletes into activities that put them at risk of serious concussions and long-drawn-out repercussions, experts say. But that competitive pressure comes from all directions, said Ross Oshiro, who coordinates the state Department of Education’s athletic trainers program and helped implement two of the department’s recently launched concussion initiatives.

But experts say it’s unlikely the rules of the game will be changed anytime soon. Some concussion-related policies are being adopted by schools and youth leagues, but sports are still mostly self-regulated.

Gov. Neil Abercrombie last year signed into law , requiring the DOE and to develop a concussion education program for schools statewide. The program brings together student athletes, parents, coaches and school officials to discuss concussion symptoms and management. That’s on top of the DOE’s , which was launched in 2011.

Tackle football is the leading cause of sports-related concussions among all Hawaii children — including in the zero through age 12 range, according to state Department of Health data. Tackle football accounted for more than a fourth — or 262 — of the sports-related concussions suffered by Hawaii youth treated in the hospital or ER between 2010 and 2011. Roughly 3,600 DOE high school students play football each year, according to Oshiro.

Soccer also had a high rate of concussions among hospital- or emergency-treated Hawaii students during that time period, accounting for 7.5 percent — or 74 — of the injuries.

Oshiro dismissed stereotypes that concussions only happen to boys. A girl’s neck is skinnier and can’t support the weight of a head as well as a boy’s, often making her more susceptible to injury, he said.

Girl’s judo had the highest rate of concussions in the 2011-2012 school year, followed by football, boys judo, cheerleading, boys wrestling and girls soccer, according to Oshiro.

But, as Higa’s story indicates, all sports are susceptible to concussions — “even air riflery,” Oshiro said.

Team Members: Coach Exerts Too Much Pressure on Athletes

After Higa hit her head she got up and continued practicing even though she knew something wasn’t right.

“My coach was really intense,” Higa said, adding that her coach had a three-second rule. “If you fell down, he would count to three, and if you weren’t up by then you were in trouble.”

Teammate Glacen Florita, who still plays as a point guard on the Chaminade team, agreed.

“He likes competition,” said Florita, a junior who’s suffered two less-serious concussions in the past year. “He expects a lot of physicality out of us … He keeps putting that pressure on us to be more like that.”

UPDATE Chaminade University officials declined to comment on the specific incident but did send Civil Beat a copy of the school’s concussion management policy. The policy mandates a seven-step process once a student suffers a concussion — including conducting the post-injury neurocognitive — and a six-step process once the student’s symptoms subside — including a seven-day recovery scheme — according to university spokeswoman Kapono Ryan.

“Chaminade joins with the [National Collegiate Athletic Association] and is committed to ensuring that all of our student athletes are properly protected from and treated for concussions,” Kapono wrote.

Higa drove home after practice but didn’t make it into her house, she said. (Chaminade’s concussion policy states, in bold, “Do not allow athlete to drive home.”) Her father in the middle of the night found her asleep, parked in her car on their driveway.

She didn’t remember getting home. But when Higa woke up, she felt sluggish and fatigued. She was nauseous, too, and sensitive to light and noise.

Higa had suffered at least three concussions previously, two of them while playing basketball for Kalani High School’s team.

But never before had she experienced a concussion like this one.

“It was the first time I experienced the whole array of symptoms,” she said. “It changed my life completely.”

Higa eventually decided to go to her doctor so she could get a clearance to resume playing basketball. Her visit marked the first time she had sought medical attention for a concussion. She was told to rest and seek further treatment if the symptoms didn’t go away.

They didn’t.

More than a year later, and Higa’s still doing rehabilitation exercises everyday. She drove for the first time since the incident two weeks ago.

When Higa returned to school for the 2012 spring semester, her injury took a turn for the worst. Her brain was still healing, and going to school was “overload,” she said.

“She had a hard time making sure her work was done,” said former teammate Chelsey Fontes, who quit the team in 2010 after being berated by the same coach. “I could just tell she wasn’t the same.” Fontes, now a Chaminade senior, even had to take Higa home one day because Higa felt so nauseous.

Higa requested a meeting with her coach last March, but he refused to denounce the teammate who pushed her, she said. Nor did the school’s athletic director or dean of students, who refused to take action without proof that the incident happened, according to Higa. According to Florita, the teammate that pushed Higa was later suspended — but for another, less serious incident.

Eventually, Higa consulted a Chaminade athletic trainer.

“What she said really stuck with me,” Higa said. “She said, ‘This is your brain — you can’t live without it.’” That’s when Higa decided she would quit the team.

Doctors would later tell Higa she damaged both the front and back of her brain. And the trauma, they said, was especially severe because her body wasn’t expecting it.

According to Higa, it took months of worsening symptoms and a series of incompetent doctors to convince her family to send her in September 2012 to the for two weeks of treatment. She met with five specialists, including a neuropsychologist, exertion therapist and optometrist.

The concussion, according to Higa, damaged her — the system responsible for balance. The damage made it difficult to be in crowded places. It also affected her mood.

Some of the most debilitating symptoms involved her eyes. She was diagnosed with — rapid, involuntary eye movement — which made it difficult for her eyes to track objects. She also had .

Higa still wears prism glasses to help control the nystagmus. And she still has a hard time reading.

She also developed depression last November — a symptom she in part attributed to some narcotics she was prescribed for dizziness. She’s since gotten rid of the depression but still has bouts of mood swings.

Experts: Players Shouldn’t Just ‘Shake it Off’

Higa should’ve sat down after falling to the ground. Concussions are multiplicative: a person who suffers one concussion is to sustain a second one. And experts say subsequent concussions — especially if they occur before the first ones heal — can .

But Higa resumed playing for fear of being harassed by her coach, she said.

Other teammates told Civil Beat similar stories about the coach.

“He just thinks that we should just suck it up all the time,” former teammate Fontes said. “He really needs to educate himself on the injuries. He’s not a doctor — he doesn’t know what’s going on.”

Fontes said she quit the team after the coach yelled at her — and called her profanities — when she stopped to fix a contact after a teammate accidentally poked her eye during practice.

Fontes suggested that Chaminade mandate concussion education sessions for both student athletes and coaches.

Elzy Kaina, a nurse at the Rehabilitation Hospital of the Pacific, said the age-old tendency to brush off a concussion is exactly what should be avoided.

“A lot of it has to do with that whole mindset of ‘get back in the game,’” said Kaina, who also serves on the state’s . “Little do they understand that it (concussions) can be a very severe problem. They shouldn’t take it lightly.”

Cathy Todd, whose 16-year-old daughter suffered a debilitating concussion while cheerleading for Punahou in 2011, said she thinks the heightened competitiveness largely contributes to high youth concussion rates.

“It’s so competitive that they forget when to stop,” she said.

The nonprofit arm of i9 Sports — a national youth sports franchise — last year surveyed 300 former football players whose children now play the sport. Almost half said there’s too much hype over concussions.

And 90 percent of the dads who suffered or believed they suffered a football-related concussion still want their kids to play tackle football, according to the survey.

“I think, culturally, a lot of times they just shake it off — you know, it’s not a big deal,” said Roger Dequina, who owns and directs . “But that’s not the correct approach to have. It’s a lot better to err on the side of being too cautious.”

“It’s the ‘play hard, play to win,’ mentality,” Kaina said, pointing out that many high school athletes strive for sports scholarships. “Hawaii’s very football-centric.”

Advocates say competitive pressure is slowly trickling down to younger and younger athletes. Oshiro said the state is working on promoting concussion awareness among youth sports organizations.

Caesar Ursic, medical director of trauma services at Queen’s Medical Center, said it’s critical that concussion awareness programs include younger athletes — especially because their brains are still developing and more susceptible to serious concussions.

“Any child of any age is susceptible to a brain injury. Nobody’s immune,” Ursic said. “It’s not responsible to focus just on high school.”

i9 Sports launched its concussion policy in 2011. Parents have to read through and initial waiver forms. The organization also enforces the “when in doubt, sit it out” rule.

And the last March — the result of recommendations put forward by an AYSO Concussion Task Force.

Advocates Call for Game Changers

Linda Rosen, chief of the DOH’s Emergency Medical Services and Injury Prevention Systems branch, stressed the importance of proactive preventative measures, including adjusting how the sports are played.

“For me, the next step is to start to look at the nature of some of the activities and whether they could be changed to be less risky,” Rosen said, pointing to rules, penalties and age requirements.

For example, the National Federation of State High School Associations this year allowed at cheerleading competitions. The Hawaii State Cheerleading Judges Association adopted the changes, too. Until recently, Hawaii cheerleaders were expected to do harder and harder stunts, Todd said.

“Is it so critical to win that you keep making the girls do harder and harder things?” Todd asked.

But for the large part, it’s up to how officials choose to run the game, according to Oshiro.

Queen’s Ursic said game changes are unlikely. Community outreach and education should take precedence over policy, he said.

“The more we value something, than probably the less willing we are to let go of it or allow someone to come in from the outside and change the way you look at this,” he said.

The DOE’s Athletics Administrator Raymond Fujino did point out that the state is constantly on the lookout for new equipment and products, including a new type of helmet that will be presented to the department at the end of the school year.

In general, helmets have raised concerns dover their limited ability to protect a brain from a concussion. The helmets that high school football players wear are designed to prevent skull fractures — not concussions, Oshiro said.

“[I]t would be fair to say that people have a false sense of security,” Rosen said.

Still, helmets reduce the likelihood of brain injuries by 88 percent, according to Kaina.

Higa is now working with Oshiro to develop a concussion awareness nonprofit geared toward student athletes. But she suspects efforts to change how games are played would be met with a lot of resistance — especially from the athletes, who “think they’re invincible.”

Higa doesn’t play basketball anymore and doubts she’ll ever return to the sport — at least not competitively.

“I lost my identity,” she said. “My whole world was flipped upside down.”