No matter how much padding you put in a helmet, the brain is still going to slam into the inside of the skull in football.

No matter how careful the players are, elbows and knees are still going to crash into players’ heads in soccer. More often than not, these types of hits to the head aren’t taken seriously in sports.

Unfortunately for the athletes, however, the risk of playing might be higher than anyone had ever thought.

In a recent study by neuroscientist Kevin Guskiewic for National Geographic, six years’ worth of impact data on hits to the head of football players at the University of North Carolina was analyzed. For one defensive lineman in particular, 417 hits to the head with a g-force of 10 or more occurred over the course of one season, with two of those hits resulting in a concussion. Anywhere from 10g to 50g of force is enough to cause a brain injury.

Dr. Ann Mckee made huge strides in understanding the scope and lasting effects from repeated shots to the head of football players. Her work in diagnosing chronic traumatic encephalopathy (CTE) in 76 of 79 brains of former NFL players ultimately influenced the NFL and the NCAA to change their policies on concussions.

Dr. Bennet Omalu, Mckee’s predecessor in diagnosing CTE among NFL players, said the degenerative state of the players’ brains resembled those of Alzheimer’s patients. Omalu suggested CTE in these cases was caused by repeated trauma to the head, including concussions.

Kari Gage, head athletic trainer at Central, said 10 to 15 concussions a year is average for Central across all athletic teams. While this number may seem high, Gage said concussions are handled with extreme care, especially after the NCAA amended its concussion protocol in 2010.

“We take it very seriously. We do a lot of baseline testing before they even step on the field and do a very in-depth type of assessment before they return to play,” Gage said.

Central’s new return-to-play guideline states: “The student-athlete should be asymptomatic for one week. Once asymptomatic for a week and post-exertion assessments are within normal baseline limits, return to play should follow a medically supervised stepwise process — a graduated return-to-play protocol may begin.”

Gage said a few students, after suffering multiple concussions, would take a month to be clear of symptoms. In these extreme circumstances, the training staff is forced to remove these athletes from playing for the remainder of their college careers.

“We’ve probably disqualified anywhere from two to four students from playing,” Gage said. “They might have had some from high school and then came here and got another one. A lot of times, the red flags are how long it takes them to recover.”

Dr. Jack Horsley is the director of medical services at Central and team physician. Horsley evaluates every player who suffers an injury. He’s the last to clear a student to return to play.

“People are becoming much more aware, more aware they need to be careful in recovering,” Horsley said. Concussions “have definitely decreased since the NCAA and NFL paid more attention.”

In one instance, Horsley treated a female soccer player who had suffered eight concussions before deciding to call it quits.

“She decided to attend a less expensive school after high school, needed to slow down,” Horsley said. “She couldn’t think as fast as she used to.”

Central alumnus John Kitna started his career in the NFL in 1996, back when the concussion policy was much more relaxed.

“Concussions were just a part of the game, kind of this unknown thing,” Kitna said. “If you played the game you probably had them at some point.”

Kitna said that doctors were checking on concussions after players had them, and players were allowed to re-enter games.

“There just wasn’t enough information back then,” Kitna said. “Your head would hurt, so you were cognitive, but you never really considered it a concussion. [The league is] overprotective of it and I understand it.”

Kitna has suffered six concussions.

“I haven’t noticed anything to this point for me,” Kitna said. “I haven’t had a teammate I know develop anything serious yet. Nowadays, [people] try to attribute anything to concussions.”

Some athletes are not as fortunate as Kitna. Brandon Purcell, Central club soccer defensive back, has experienced six or seven concussions throughout his life since he started playing soccer in kindergarten.

Purcell’s latest concussion happened just four weeks ago in the NIRSA Region VI Men’s Northwest Soccer Tournament

“I was feeling all loopy, so one of the other players told me to step out,” Purcell said. “The trainer came over and immediately did a concussion protocol. I ended up losing feeling in my legs. I was out for two or three weeks, no class, no work. I’m not sure when I’ll play again.”

In addition to loss of feeling in his legs, Purcell had migraines for weeks and trouble sleeping. He has just now been able to return to class.

Purcell said that he and his teammates had never really taken concussions seriously before. He said that he and many other players wouldn’t tell anyone they’ve had a concussion in fear of losing playing time.

“I was annoyed at the time. It’s regional tournament and I wanted to keep playing,” Purcell said. “Sometimes doctors say no, and sometimes people don’t want to admit they have them.”

Horsley said even NCAA players don’t report concussions or head injuries because they know they’ll be out for at least a week. Horsley said he didn’t think there was a single concussion this year in Centrals’ football season.

Central free safety Anthony Beaver said he never had a concussion while playing, though he has had his “bell rung” a few times. He said he knew of players on the team who would hide concussions from coaches and training staff.

“You’ll just keep going and try to get through practice or through the game as best as you can,” Beaver said. “You just don’t want the coaches or the trainers to take you out. If they take you out you lose your playing time.

Players coming into Central are required to sign a concussion protocol, saying they will report any instances immediately. But Beaver said he and his teammates know what it means to have a concussion, and their internal pressure to succeed sometimes overrides their own safety.

Gage agreed with Horsley that the biggest challenge for them as a training staff is getting players to take head injuries seriously and to report them. Gage also said it’s getting harder for players to hide it, since both the coaches and staff are getting better at recognizing symptoms.

“I actually teach all of our coaches CPR training and first aid and in that, I go over concussions and return to play,” Gage said. “I basically just say, ‘This is what we look for and this is how it is and you can’t argue with it.’ And they’ve been very good about it. I think they understand the severity of it.”

Beaver agreed the coaches take it seriously and he never had an instance where he felt pressure from them to play through any injuries.

“As a player, if it felt like it wasn’t going to affect my playing and being on the field when I came back from a concussion, I would feel comfortable talking to someone,” Beaver said. “Nobody wants to stand on the sideline during games.”