WATERLOO - The ball was in the air on the opening kick-off, and Alex Lorsung had one thing on his mind: Create a hole for the returner.

Running down field, the Waterloo West High School senior lowered his head and threw his body into an opposing player, their helmets cracking against each other.

Immediately after the hit, his balance was off when he closed his eyes. That weekend, he suffered from extreme fatigue. A week later, his head still throbbed when he tried to lift weights.

"That night was kind of hazy, (I can't remember) what I was saying to some people, or what I was talking about. It's just kind of a blur," he said.

While the symptoms are a doozy, Lorsung is better off today than athletes 10, or even five, years ago.

"I think people are a lot more cautious about concussions," said West High School head coach Doug Gee. "I think before, if you had a headache or were a little woozy, you watched him overnight, and then he was ready to go."

Shantelle Weichers, athletic trainer for Waterloo East High School, said treatment of even mild concussions, especially in youth, has become much more aggressive since she started as a trainer eight years ago. The latest research suggests that a head injury can affect the development of the brain in youth.

"They've done a lot more research on it, things are coming out and they're saying, 'Look, we can't put the kid in too soon, because if they get a hit before they recover it can make it a lot more severe,'" she said.

Research also shows people are more likely to suffer a concussion after the first one, and the effects of multiple concussions accumulate each time. The most serious possible side effect is "Second Impact Syndrome," which occurs when someone suffers another concussion before recovering from the first. Serious brain injury can result, though death is extremely rare: About 30 to 40 people have died in the past 10 years, according to the University of Pittsburgh Medical Center, a leading researcher of concussions.

Trainers for local high school football teams said they usually see one or two serious concussions per season, though they can come in waves. The East football team suffered a mysterious surge earlier this season - eight concussions in less than four weeks - which caused Weichers to meet with the athletic director and re-evaluate everything from helmet fittings to tackling technique.

The University of Pittsburgh Medical Center reports approximately 10 percent of athletes involved in contact sports, which include football, hockey and soccer, suffer a concussion each season.

The university designed computer software called ImPACT to help evaluate concussions. It's being used by schools and professional sports teams around the country, and is something local high schools and the Waterloo Black Hawks are looking into.

Currently, trainers test for memory, orientation, concentration and coordination by looking for symptoms. The software gives medical staff a more precise diagnostic tool, since they don't have a way of evaluating how much damage a player has suffered or when the brain has recovered, making it safe for them to return to the field.

Tricia Haak, athletic trainer at Waterloo West High School, said some of the most common symptoms she sees are fatigue, ear ringing, double vision, disorientation and amnesia.

"At UNI I've seen some pretty bad ones. They black out for a long time and they can't remember a darn thing. They're so tired that you can barely get them to stay awake," she said.

Most concussions are like the one Lorsung suffered recently - he didn't lose consciousness but showed other symptoms like balance problems. In fact, he didn't even report the problem - someone else on the team saw him having trouble standing and reported it to the trainer. Lorsung admits he suspected he had a concussion, but didn't tell anyone because he wanted to keep playing.

Weichers said that kind attitude is pervasive, especially in football. Combined with the fact that concussion symptoms can be subtle to begin with, diagnosis can be difficult and sometimes doesn't occur for days.

"When (a player) works really hard for a position on a team and is afraid because he knows he's going to have to sit out, a lot of kids think, 'Oh well, I'll be fine. I'll just suffer through it until it goes away,'" said Weichers, who said sometimes she finds out about injuries from parents.

Contact Jens Manuel Krogstad at (319) 291-1580 or jens.krogstad@wcfcourier.com.