The Concussion Crisis

by Linda Carroll

  Acclaim for The Concussion Crisis

  “Thoughtfully passionate and comprehensive. . . . Quite a devastating testament. It lays it all out and forces us to ponder how a civilized people can blithely accept an entertainment that does such damage to young men’s minds. . . . One lays The Concussion Crisis down wondering where future American gridiron gladiators will come from; surely not from families who read this book.”

  —Frank Deford, The Washington Post

  “In The Concussion Crisis, health writer Carroll and sportswriter Rosner team up to offer a jolt on the head—intellectual only—to those who’ve tended to dismiss blows to the noggin as innocuous. . . . The book is a clarion call to take full measure of the broken brains and bodies among us.”

  —The Globe and Mail of Canada

  “Important. . . . A book everyone involved with football or concerned about the sport must read.”

  —Gregg Easterbrook, ESPN.com

  “The Concussion Crisis should be required reading for parents, teachers, amateur and professional athletes, coaches, trainers, and anyone interested in the health of children and young people. . . . Linda Carroll and David Rosner have crafted a riveting look at a health crisis that is finally coming to light after decades of denial. They make a convincing case. . . . People who read this fascinating and eye-opening book will never think about concussions and head injuries in the same old way.”

  —Connie Goldsmith, R.N., New York Journal of Books

  “A very hot topic. . . . This noteworthy book issues a challenge to the ‘macho play-through-the-pain’ sports culture and urges a rethinking of safety versus spectacle.”

  —Publishers Weekly

  “A cautionary wake-up call about addressing a seemingly innocuous hit to the head with critical care. . . . A comprehensive, anecdote-laden analysis of concussive head traumas.”

  —Kirkus Reviews

  “A powerful call for action on the part of parents, coaches, and older athletes. . . . A good primer for parents whose kids play contact sports such as football.”

  —Booklist

  “This valuable book brings an important public health issue to light. Highly recommended.”

  —Library Journal

  “This book makes a convincing case for a radical shift away from [macho] attitudes, towards an understanding of concussion as a mild traumatic brain injury with potential for long-term, permanent changes in brain functioning and behaviour. . . . Anyone involved in contact sports, and many who aren’t, will find The Concussion Crisis accessible and educational. It could help prevent a lot of needless and preventable suffering.”

  —Ursula Fuchs, R.N., Winnipeg Free Press

  “The Concussion Crisis puts a human face on traumatic brain injury through real-life stories of athletes and soldiers. The authors define the problem, explain the science, and accentuate the need for prevention. This informative book sounds a much-needed alarm for medical intervention, continued research, and a reassessment of how we play sports.”

  —Michael J. Stuart, M.D., co-director of the Mayo Clinic’s Sports Medicine Center and chief medical officer of USA Hockey

  “There is no injury I worry about as a coach more than concussions, and this book shows why. It’s a must-read for athletes and their parents.”

  —Anson Dorrance, coach of the USA’s first World Cup women’s soccer champions and of UNC’s twenty-time NCAA champions

  “Carroll and Rosner tell some utterly heartbreaking stories, but their book, ultimately, offers hope by giving readers the information and resources they need to confront a public health crisis. They show us that a concussion does not have to be a life-altering event, but it can be if it is not properly recognized, respected, and treated.”

  —Michael Sokolove, author of Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sports

  “Linda Carroll and David Rosner convincingly maintain that lots of people regard concussions as a nuisance rather than as potentially life-altering brain injuries. If their book educates some of those people—particularly those of them coaching and/or parenting young athletes—then they will have performed a worthwhile service.”

  —Bill Littlefield, host of NPR’s Only a Game

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  Contents

  Introduction

  Chapter 1: Just a Bump on the Head

  Chapter 2: The Emerging Epidemic

  Chapter 3: Head Games

  Chapter 4: Sudden Impact

  Chapter 5: hrough the Cracks

  Chapter 6: Playing Defense

  Chapter 7: Anatomy of a Brain Injury

  Chapter 8: Deciphering the Damage

  Chapter 9: A Pocketful of Mumbles

  Chapter 10: Ticking Time Bombs

  Chapter 11: Seeds of Change

  Epilogue

  Appendix I: Concussion Symptoms

  Appendix II: Resources for Patients and Families

  Acknowledgments

  About the Authors

  Source Notes

  Index

  For all those whose lives have been changed by the invisible injury

  Introduction

  For more than a decade, a small cadre of scientists had been raising the alarm. Their message was simple and scary: concussions were on the rise and research was showing that these jolts to the brain were a lot more dangerous than any of us thought. While the impact of one jolt to the head tended to be transient, researchers were learning that the brain damage from concussions could not only add up, but also become permanent. And that was especially true if these “mild” traumatic brain injuries occurred in rapid succession.

  Since most of us had been brought up with the assumption that a head injury that didn’t result in a trip to the hospital could be ignored, no one was keeping count of our own—or our children’s—concussions. Moreover, since we’d been raised in a culture that celebrated hard knocks as a rite of passage, we didn’t think twice when our kids got banged around on the ballfield.

  But as it turned out, some of the most frightening research was in children—especially those playing contact sports. Kids’ brains, scientists learned, were exquisitely sensitive to repeated jolting. Concussions, if they weren’t managed properly, could derail a kid’s life. Thinking could be slowed, attention dulled, judgment impaired, memory muddled. Those changes could make school impossible and send a kid on a downward spiral.

  Unfortunately, studies had also shown that many parents were unaware of the dangers facing their children. A 2010 survey found that just 8 percent of parents felt they had a good background on the dangers of repeat concussions. More than a third said they knew virtually nothing about concussion risks, while fully half said they didn’t even know whether their children’s school had a policy detailing when a student-athlete could return to play after a concussion.

  Other studies showed that this was a particularly bad time for parents to be ignorant about the dangers of concussions. A silent epidemic of these unseen brain injuries among kids had been exploding right under our noses. And nowhere was that more true than on the nation’s playing fields. In just ten years, visits to the emergency room for concussions among eight- to thirteen-year-olds had doubled, while visits among fourteen- to nineteen-year-olds had more than tripled, a 2010 study showed. And that was just the tip of the iceberg, experts warned, since it didn’t include all the kids who were seen by their family doctors
or had never even told anyone about their symptoms. It was clear that the public had to be warned and educated about the danger of injuries that had long been dismissed as “dings” and “bumps on the head.”

  The Concussion Crisis lays out the history of how we came to underestimate the damage resulting from jolts to the head and how scientists, over the last couple of decades, began to recognize that there was an emerging silent epidemic of brain injuries, especially in sports. While nobody knows exactly how many concussions occur, estimates by the Centers for Disease Control and Prevention range anywhere from 1.6 million to 3.8 million sports-related brain injuries in the United States annually. Those CDC estimates don’t include concussions from accidents such as playground falls and bicycle collisions. Whatever the actual number of concussions is, one thing researchers do know is that nearly a quarter of a million new patients turn up each year with long-term deficits resulting from these so-called mild traumatic brain injures.

  In the following pages, you will see how the epidemic was able to explode unseen into a major public health crisis. It was partly because of the invisible nature of the injury: we didn’t understand how people could develop life-altering deficits as the result of something that didn’t even show up on a brain scan. Making matters worse was the macho attitude threading throughout our culture: we figured that anyone who complained about issues related to simple bumps on the head was either a sissy or a malingerer.

  Nothing can convey the menace of concussions more clearly than the heartrending stories of people whose lives have been irrevocably changed by these seemingly minor injuries. In the pages that follow, you’ll read about individuals like the twelve-year-old boy who was so disoriented after a concussion that he couldn’t even recognize familiar faces for almost a year, the college football player who had to drop out after a series of concussions made schoolwork impossible, the Ph.D. economist whose career was ended after her thinking was muddled by a jolt in a fender bender.

  Until very recently, many people, including doctors, thought of concussions as “a different animal” from severe traumatic brain injuries. But as you read the stories of people who survived horrific car wrecks and wartime bomb blasts, you’ll be struck by how similar their symptoms are to those experienced by people whose lives have been derailed by repeated concussions.

  Only in the past few years has science begun to explain why that is so. This book will take you into the labs where cutting-edge research is showing why concussions are such serious injuries. You’ll meet the scientists who discovered how multiple concussions could add up and leave the same kind of damage as a single severe brain injury.

  While all this new science is scary, even more frightening is emerging evidence that concussion damage can remain hidden for years only to show up later as early-onset dementia. You’ll learn how scientists discovered that repeated blows absorbed by boxers set many of them up for neurodegenerative disease and how a small band of researchers recognized that the boxing paradigm could also be applied to football. What drove these researchers was a need to explain the haunting stories of National Football League players who slipped into early-onset dementia before they even hit middle age. The latest research shows that a single moderate to severe brain injury can result in changes that increase a person’s risk of dementia, while multiple jolts to the head can have the same impact.

  Although better testing and treatments may someday help reduce the scourge of concussion damage, what is needed today is for Americans to learn about the true nature of this invisible injury—and to understand its severity and potential to upend a life.

  Chapter 1

  Just a Bump on the Head

  Concussions caught up with Dave Showalter before he could play a single down of college football.

  A big, burly kid whose passion for the sport seemed wound as tightly through his DNA as his large brown eyes and fine chestnut hair, Showalter was playing tackle football almost from the time he could walk. While he impatiently waited to grow old enough to join a team, he made do roughhousing at home with his two big brothers. The three would shove the furniture against the walls and position the couch as a goalpost, turning the living room into a playing field for games of “knee football.” Their objective wasn’t so much to score touchdowns as to rough each other up in the process; casualties of the games often included their mother’s bric-a-brac as well as their own heads.

  When he reached fourth grade, Showalter finally got his chance to strap on the shoulder pads, pull on a helmet, and play for real. He was grateful that his parents had chosen to send him to a Catholic school that, unlike the neighboring public schools in central Pennsylvania, allowed kids as young as nine to play tackle football.

  Already weighing well over a hundred pounds, he was so big that by league rules his helmet had to be marked with a black X and he wasn’t allowed to carry the ball or to play glamour positions such as quarterback and running back. An offensive lineman by default, he quickly learned to make the most of his size. At the center of all the crashing and crunching on the line of scrimmage, he would often thrust headfirst into opposing linemen with reckless abandon.

  By the time he reached high school, Showalter seemed an indestructible force at six foot four and 260 pounds, his imposing size amplifying the sense of invincibility that naturally comes with youth. All of that allowed him to shake off his concussions as if they were common colds. He played through headaches and nausea and a strange metallic taste that exploded in his mouth after hard helmet-to-helmet hits. He kept quiet about the scary symptoms for fear that telling anyone—his coaches, his trainers, even his parents—might cost him playing time; and besides, having been weaned on football’s just-rub-dirt-on-it ethos since fourth grade, he could shrug off each jarring hit as “just getting my bell rung.”

  It wasn’t until the summer before his junior year that a concussion symptom finally brought Showalter up short. He’d be walking around the house and suddenly his vision would fade to black. The blackouts would last several seconds, and though he never lost consciousness, he’d have to grab on to something solid to steady himself. He didn’t understand what was happening, and he was frightened that it meant something had gone seriously wrong with his brain. He suspected that the blackouts were related to a concussion he had sustained during summer football camp when he was kneed in the head and briefly knocked unconscious. As much as he loved the game, he decided to give it up and concentrate on other sports.

  That resolve lasted barely a season. One afternoon before basketball practice, his old football coach strode into the locker room looking for Showalter. The coach dropped a plastic shopping bag full of recruiting letters on the bench where Showalter was suiting up and said, “I was going to throw these away, but it’s a federal offense to mess with your mail. This is something you need to think about, something you could be missing out on.” Showalter pulled out a handful of unopened envelopes and saw return addresses from some of college football’s powerhouses—Notre Dame, Nebraska, Penn State. As he ripped open the envelopes and started reading, Showalter for the first time realized that he might be able to parlay one more season of high school football into a college scholarship. The more he mulled it over, the less he could think of any reason not to return to the gridiron, especially since his concussion symptoms had completely disappeared.

  His comeback seemed perfect. Showalter was playing better than ever, his team was rolling through the season undefeated, and his head felt fine. Even when he took a hard helmet-to-helmet hit late in the season, he just shook it off and kept playing until his team scored a touchdown. Only after he returned to the sideline did anyone notice something was wrong. The trainer glanced down the bench and saw that Showalter seemed dazed, just staring up at the stars beyond the Friday night lights. After taking a closer look, the trainer determined that Showalter was dizzy and disoriented enough to be pulled from the game. During halftime, Showalter tried to argue his way back onto the field, uncharacteristically crying, y
elling, and even cursing at the trainer. This time the concussion was so bad that the trainer sidelined Showalter not only for the rest of that game, but also for most of the next week’s practices. By the following Friday night’s game, Showalter had convinced the trainer that he’d recovered enough to return to action.

  As his team moved through the state playoffs, racking up two victories before losing in the quarterfinals, Showalter came more into focus for college recruiters. Now they could see firsthand that not only was he big, at six foot five and 280 pounds, but he was also quick and agile. They recognized raw potential that could be shaped by weightlifting and the right coaching. They could see that this kid had the brawn to excel in major-college football, the brains to shine in the classroom, and the determination to make all those dreams come true. By the time Showalter chose which athletic scholarship would be his ticket out of the depressed railroad town of Altoona, his concussion symptoms were a distant memory and his prospects seemingly boundless.

  At Rutgers University, the coaches had big plans for their rough, uncut gem. They would “redshirt” him as a freshman, sitting him out of games through the 1998 season so he’d start his playing career as a sophomore with all four years of eligibility remaining. That gave them a year to sculpt his maturing body through long, grueling hours in the weight room and to teach him blocking techniques that relied more on using his hands than his helmet. He began his sophomore year, an inch taller and forty pounds stronger, as the backup offensive tackle to a senior bound for National Football League stardom.

  Then, just a month into his first season on the Scarlet Knights roster, while Showalter was warming up for a game he wasn’t even scheduled to play in, his life was upended in a split, and stunning, second. Since it was just pregame warm-ups, he hadn’t bothered to buckle his chinstrap or to put in his mouthpiece, and he certainly wasn’t expecting his own teammate to crash into him with enough force to knock him to his knees. He knew he was in trouble right after the helmet-to-helmet hit flooded his mouth with that familiar and frightening metallic taste. Although teammates later told him he spent the game on the sideline charting plays as usual, he remembers nothing until halftime, when he asked for Advil to quiet a searing headache. After that, he doesn’t remember anything—not the second half of the loss to Wake Forest, not the plane ride home to New Jersey from North Carolina, not even a minute of practice the next day.