Football produces the highest rate of sports-related concussions in interscholastic sports.

And the only recent deaths of high-profile Hawaii sports figures in team sports known or believed to be largely concussion-related — those of Punahou, USC and NFL star Mosi Tatupu and University of Hawaii assistant coach, nine-year NFL veteran and sports agent John Wilbur — have been of retired football players.

Players are leaving the game at younger ages because of concussions. A prime example is Aofaga Wily, a three-time All-State high school running back who retired from football after playing two games at UH as a freshman, due to concussions.

But statistics show many concussions in other sports.

“Concussions are no respecter of what sport you play,” Hawaii-Hilo athletic director Patrick Guillen said. “At my previous school we had indoor baseball practice and a ball went off a wall, hit a player in the head, and he was out three weeks with a concussion.”

A higher rate of concussions of females is reported than of males in comparable sports.

At UH-Manoa, even when including the 13 from football — by far, the most in any sport — more were reported and diagnosed for females (27) than males (18) in data collected since August 2017.

Statistics tracked since 2010 by the Hawaii Concussion Awareness Management Program (HCAMP) show that in all but one contact or collision sport in which significant numbers of both genders compete, female high school athletes were reported to have a higher-rate of concussions diagnosed than males. The one sport in which boys have a higher rate is wrestling. (Baseball and softball are considered comparable, and among the five contact sports where girls have the higher rate of reported concussions.)

Research is inconclusive as to why there is a higher rate of concussion in most female sports. But some players and medical professionals say males have been less likely to report concussions because of societal expectations.

“Obviously we didn’t want to report them,” said Rich Miano, who estimates he had between 10 and 15 concussions from the time he played football at Kaiser High School, then at UH and during an 11-year NFL career, mostly during the 1980s. “A lot of it was ignorance, masculinity, wanting to keep our job, all those things. You expected to get dizzy when you ran into someone at full speed. I remember multiple times officials and referees telling me, ‘38, keep your head up.’ Because we used our heads. Getting your head involved in tackling, it’s frowned upon now, it can result in ejections, and worse.”

In all sports for both genders, however, under-reporting of injuries including concussions remains a challenge.

“Yes, they don’t even want to miss one game,” said Dr. Jill Inouye, the head physician for UH sports, who also works at the Manoa campus student health clinic. “So it is still a problem. The majority are worried they’re not going to play. In some cases, even if they get handouts and information about symptoms they don’t really think it’s a concussion.”

Inouye makes a presentation about concussions to coaches of all sports at an annual meeting.

“I tell them the signs and symptoms,” she said.

UH and the state’s three Division II colleges all follow NCAA guidelines regarding concussion awareness, diagnosis and treatment.

School records show 70 concussions were incurred by UH football players since 2010 (that includes 14 players with more than one). In 2010 there were five compared to the 13 since 2017; those numbers are tied for the least and most per year in the time frame.

That doesn’t mean just five concussions occured in 2010. They are now more likely to be reported and diagnosed than they were in the past.

“For the football coaches, I can tell you for sure, they understand the severity,” Inouye said. “They never question it. If they think one of their guys is acting strange they’ll let us know.”

Still, many athletes have been raised with a “shake-it-off” ethos that contradicts reporting injuries of any kind.

“Athletes don’t want to report because they don’t want to lose playing time,” HCAMP manager Troy Furutani said. “They don’t want to let their coach down. They don’t want to let their parents down. And also there’s that mentality that they need to just tough it out.”

Concussions Statistics by Honolulu Star-Advertiser on Scribd