Traumatic brain injuries caused by football and other sports aren’t in the headlines anywhere near as much as five or 10 years ago.

That doesn’t mean concussions have magically disappeared, or that they aren’t still a major health concern at all levels, from youth to professional sports.

Thankfully, efforts to learn how to manage and prevent these injuries also have not ceased.

And Hawaii continues to be at the forefront of ongoing research, with the Hawaii Concussion Awareness &Management Program still going strong. It’s a team effort, with lots of work also coming from the Hawaii Athletic Trainers Association, sports doctors, and other medical professionals throughout the state — and beyond.

“There’s been a lot of great work done in Hawaii,” said Erik Swartz, chair of the department of physical therapy and kinesiology at the University of Massachusetts-Lowell. “Right when concussions started to be an increasing concern, Hawaii was at the leading edge.”

One reason is a law that made Hawaii the only state to require every school that plays sports to have at least two athletic trainers, and that at least one trainer be present at every sports event. In addition to the obvious benefits of immediate access to treatment, every injury at every event is documented — which provides valuable information for researchers.

Swartz has done extensive work in the prevention and acute care of football head and neck injuries. In 2015 he came to the first Hawaii Neuro Huddle, where trainers, doctors, educators and other interested parties discussed concussion issues. That was when he met Nathan Murata.

“We’re both Mudhens,” Murata said.

They found they have a lot more in common than the University of Toledo — where Murata taught for a while right before Swartz got a Ph.D. in applied biomechanics there.

Murata is now dean of the College of Education at the University of Hawaii. When wearing his day job hat, his biggest concern is the state and nationwide shortage of teachers. “That’s what keeps me up at night,” Murata said.

But he is also still heavily involved in concussion research (HCAMP is housed at the COE). He and Swartz are co-directors of an ongoing study called HUTT808.

The study is funded by the Gary O. Galiher Foundation. Galiher was a longtime prominent Honolulu attorney who died in a helicopter crash in 2016. His interests included supporting brain injury research and awareness.

Last year the football teams at Kalani, Roosevelt and Saint Louis wore special helmets with sensors to detect hits to the head, and were taught special practice drills that emphasize tackling without using their heads. The players are motivated to not use their heads because during the drills they don’t wear helmets.

The hope is that the players develop muscle memory that translates to non-head-tackling during the games.

“I played rugby for eight years,” Swartz said. “That was part of the inspiration for the research itself. When I tackled I didn’t use my head. We’re not trying to have helmets removed from football, we’re just trying to figure out a way where athletes and football can benefit from keeping the head out of the way.”

There isn’t a lot of hard data available yet, but “anecdotally,” Swartz said some coaches report that the drills have made the players better tacklers.

It is a three-year study that was interrupted by the pandemic, so players are still getting used to the drills.

“One of the most important things is players have to realize the helmet is to protect their skull and not their brain, and it’s not a weapon of choice for tackling,” Murata said. “We’re trying to teach that through the drills, which are very similar to rugby, that after a few weeks hopefully the mode of learning kicks in. In a game where things are moving full-speed it’s a little different. We probably are not totally going to eliminate head impacts, but hopefully we can reduce them significantly. That’s the goal.”