Some will jump up and down, their excitement uncontainable. Others will quiet themselves, their lips moving in silent prayer. And then, on football fields across Southwest Ohio and Northern Kentucky, the whistle will blow and the games will begin. There will be winners and losers and an occasional head-rattling hit.

In the stands, after each of these hits, mothers and fathers will hope their son gets up for the next play, same as it ever was.

But now, because of the rising awareness of the dangers of football head injuries, parents will also worry about how their child will feel 10, 20, 30 or 40 years from tonight because of these hits and the concussions they sometimes cause.

Car accidents are the leading cause of concussions for people aged 15 to 19.

Sports are the second-leading cause. Half of those happen in football.

For years, Laura Moore of College Hill told her son Sean he couldn’t play. As he got older, the parental calculus of risk vs. reward shifted. “He has been playing since seventh grade and I do worry about head injuries,” Moore said. “My husband and I decided that the benefits of playing on a team would be good for him.”

While automobile safety and driving are closely regulated by federal agencies and state laws, no firm rules govern safety standards for football equipment — something medical experts say would be impossible.

“It’s an easy snap judgment to say there should be legislation and laws and regulation of the industry,” said Dawn Comstock director of research at the Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital at Ohio State University. “But we don’t have the science for evidence-based legislation.”

So, with no hard and fast rules and many variables such as the position a teen plays, schools do the best they can, follow guidelines and work with equipment companies.

At Walnut Hills High School in Cincinnati, all 120 boys on the school’s teams are wearing new helmets this fall, the highest-rated available.

“This wasn’t a football decision or a sports decision, it’s about the child,” said Walnut Principal Jeffrey Brokamp. “It was a moral and ethical decision.”

Young people are particularly vulnerable to brain injuries, and to the possibility of lasting effects. The Centers for Disease Control and Prevention says “younger persons are at increased risk for traumatic brain injuries with increased severity and prolonged recovery.” The CDC uses the terms “traumatic brain injury” and concussion interchangeably.

The CDC also says that multiple concussions, when not managed promptly and properly, may cause permanent brain damage.

Since the early 1990s, the National Federation of State High School Associations, which suggests rule changes that the Ohio High School Athletic Association chooses to follow for football, has been adopting rules specifically trying to limit brain injuries and codifying concussion treatments.

In the last few years however, as the public has become more aware of the science, the concussion issue developed a sense of urgency.

Schools are looking for better equipment, changing the way the game is coached and played, and trying to change the culture of a sport that celebrates hitting hard and the toughness to bounce up from those hits.

What happens to the brain to cause a concussion

The human brain is protected from everyday bumps by the cerebrospinal fluid it floats in.

A concussion happens when a blow to the head or a severe whipping motion causes the brain to bang against the inner wall of the skull.

Imagine a car accelerating rapidly and then the driver slamming on the brakes. The purse or briefcase flying off the seat into the dashboard is what happens to the brain during a concussion.

The Mayo Clinic describes what can happen next. The trauma, it says, “causes the brain cells to become depolarized and fire all their neurotransmitters at once in an abrupt cascade, flooding the brain with chemicals… and deadening receptors in the brain that are associated with learning and memory.”

This can result in immediate disorientation, amnesia, headache, and sometimes, but not typically, loss of consciousness.

For teenage boys, no sport is more likely to cause a concussion than football.

The American Association of Neurological Surgeons says “reasonable estimates show that between 4 and 20 percent of college and high school football players will sustain a brain injury over the course of one season.

Comstock, at Ohio State, studied concussions for the three school years beginning in 2008, 2009 and 2010 and broke down high school sports to their most basic levels, defining an “athletic exposure” as any one practice or game in which a student participates.

In high school football games, the concussion rate was 22.9 per 10,000 athletic exposures.

Teasing that number out, if all 1.1 million kids playing high school football in this country played tonight — and they will not — more than 2,500 would suffer concussions.

All levels of sport generate worries

The statistics have become big news. This summer, more than 2,000 former NFL players filed a lawsuit accusing the league of concealing information linking football-related injuries and brain damage. The NFL denies the claims.

Some former players, including Junior Seau and Dave Duerson, committed suicide in recent years. Their families suggested their despair was the byproduct of old football injuries to their brains. Both shot themselves in the chest, preserving their brains for study. Seau’s autopsy found no evidence of brain trauma.

Former quarterback Kurt Warner said he was frightened by the idea of his own children playing football. Tom Brady Sr., said that knowing what he knows now, he would be hesitant if deciding again to let his son play.

Local parents share the same concerns. Penny McDaniel of Pleasant Ridge grew up in Texas as part of a football family.

She always said no when her son Parker asked to play, but relented now that he is in high school at Walnut Hills. She was comforted by the school’s commitment to safety.

“Safety issues are first and foremost in our minds. The new state-of-the-art helmets are a good first step” along with other measures, McDaniel said.

This was why Brokamp decided his school needed to buy new helmets.

The highest-ranked for concussion protection, by an independent researcher, was a helmet called the Riddell 360. The problem was a list price of $375.99 per helmet.

Brokamp could not ask the district for more money, and he would not take from other existing school budgets, so he worked with Riddell to get the lowest price possible, and then he bought all new helmets.

He is still working to find the money, and is asking boosters and local companies to help out.

“I could not have some boys on the team with the new helmet and some boys on the team not,” Brokamp said.

And the coaching staff was working to move past the culture that has long been a part of football. Head Coach George Kontsis — like nearly all high school coaches — was emphasizing proper technique and reminding players that he did not want them to hide injuries or blows to the head. “Do not prove to me how tough you are. I know you are tough,” Kontsis said. “Show me how smart you are.”

Barry Borman, the athletic director at Moeller High School, said he does not hear from parents regarding their concerns because concussion awareness is already a part of the culture at Moeller.

“I believe that is because we have been proactive in this area,” Borman said. “Our trainer, Craig (Lindsey), and our medical staff have done an outstanding job in taking every precaution for our athletes.”

At Campbell County High School in Alexandria, the athletic department hears from moms and dads.

“The concussion issues are a big deal to parents, I know our coaches have heard about it,” said AD Stephen Hensley

The coaches of the Camels get training on concussion awareness. They teach proper tackling techniques and talk about safety during every practice.

“It wasn’t a huge discussion when I played, you just played,” said Hensley, 46. “This is better.”

Comstock believes empirical data will lead the way to improved safety.

She examined injury data over the past 20 years and saw that overall injuries have gone down because of better equipment, rule changes, and improved facilities. But the number of reported concussions have increased.

This, she thinks is good news. “It’s scary epidemiologically, but the numbers represent a positive thing,” Comstock said. “Awareness is way up.”

Comstock is often asked: Should I let my son play football?

She tells them she got into her research because she wants sports to be safe and believes they can be. Still, all sports come with an inherent risk. Finally, she says the dangers of inactivity surpass the dangers of playing.