The Concussion Crisis

by Linda Carroll

  Still, if concussions were taking a toll, you certainly couldn’t tell from the way the two quarterbacks were playing. Aikman and Young were at the top of their game. Through the mid-’90s, they took turns dominating the NFL: Aikman commanding the Cowboys to consecutive Super Bowl conquests in 1993 and ’94, Young rifling a record six touchdown passes in the 1995 Super Bowl to lead the 49ers to the title, and Aikman cementing a Dallas dynasty in 1996 by capturing an unprecedented third Super Bowl in four years.

  But that was all about to change, and the millions of fans who had been mesmerized by the two quarterbacks’ parallel rise would soon be stunned to watch the pair’s parallel descent as mounting concussions took a toll. In the 1997 season opener, Young suffered his third official concussion over a ten-month span. Then, midway through the season, Aikman was knocked out of a game with the seventh official concussion of his career. The following week, on the eve of a showdown between the Cowboys and 49ers, Aikman and Young joked with Steinberg that the game ought to be dubbed the “Concussion Bowl.” Steinberg was not amused.

  The time had come, he decided, to have the toughest talk an agent could have with a fiercely competitive athlete: he asked Young to think seriously about retiring. Even though Young still had several years and millions of dollars remaining in his golden left arm, Steinberg felt it was an agent’s responsibility to step in and protect the brain of a client who had earned a law degree in his spare time between NFL seasons.

  “Since no doctor can give us a precise answer, we’re playing Russian roulette with your identity, your memory, your consciousness, your ability to lead a normal life once you’re out of the sport,” Steinberg said. “We all understand that a retired player may have to live with aches and pains from old injuries when he leans over and picks up his child, but it’s another matter entirely not to be able to recognize that child.”

  Steinberg delivered the same message to Aikman. The warnings to the two quarterbacks grew increasingly urgent as Steinberg tracked the early retirements of other concussed stars. In the five years since Al Toon had been knocked out of the sport, post-concussion syndrome forced three other NFL stars to retire: fullback Merril Hoge in 1994 at age twenty-nine after his sixth concussion, quarterback Chris Miller in 1995 at age thirty after five concussions in just over a year, and quarterback Stan Humphries in 1997 at age thirty-two after four concussions in less than two years. As for Toon, he was still battling post-concussion symptoms.

  Steinberg worried that Aikman and Young might be just one hit away from post-concussion syndrome and forced retirement. He took no comfort from their ability to bounce back from multiple concussions with no apparent signs of long-lasting damage to their brains. He wanted them to walk away while they still had a choice.

  Then, in the 49ers’ third game of the 1999 season, Steinberg’s fears became a reality. In the waning seconds of the first half, Young dropped back to pass and was flattened by a blitzing defensive back. The blindside blow knocked Young backward, ramming his head into a teammate’s leg and, then, the ground. He lay on his side, motionless, curled in a crumpled heap. Team doctors, trainers, and coaches raced across the field and huddled over their unconscious star. When Young finally came to, he was helped to his feet and then he lumbered unsteadily off the field. Little did the millions of Monday Night Football viewers know, this was the last time they would ever see him play.

  Young spent the rest of the 1999 season on the sidelines, struggling to overcome the fallout from his latest concussion. For weeks, he was plagued by headaches and nausea; he felt dizzy, woozy, and fatigued. Even when the symptoms began to lift, a host of people advised him to quit: his doctors, his family, even his team. That spring, eight months after his ninth official concussion, Steve Young retired at age thirty-eight.

  At the same time as Young was wrestling with his lingering post-concussion symptoms and contemplating retirement, Aikman was having a rough time of his own. Midway through the 1999 season, Aikman suffered concussions in two consecutive games. A week after a helmet-to-helmet hit left him woozy but able to return to play, a smaller hit had a much bigger impact. That hit knocked Aikman out of the game and sidelined him for the following two. It was the first time in his career that a concussion kept him out of the starting lineup, but it wouldn’t be the last.

  Before he could complete a single pass the following season, Aikman was gang-tackled hard and knocked out of the Cowboys’ opener—and their next two games—by his ninth official concussion. While recovering, he reached out to Young. Though Aikman acknowledged that their talks had an air of “the blind leading the blind because no one knows what the long-term effects are,” at least the two could compare notes on their shared experiences. They talked about how it took lighter and lighter hits to cause a concussion and how it took longer and longer for the symptoms to lift. They talked about how those short-term post-concussion symptoms—and the even scarier specter of permanent brain damage—might figure into a player’s decision of when to retire.

  When Aikman returned to play, the quarterback who once made everything look so easy was now struggling as the Cowboys plummeted in the standings. Then, in the first quarter of a late-season game, just as Aikman flicked a pass, a linebacker dove into him at full speed and slammed him to the ground. Aikman’s head bounced off the unforgiving artificial turf, denting the whole left side of his helmet. He was done for the game, for the season, perhaps forever.

  It would take three weeks for the headaches and dizziness to subside. It would take much longer for Aikman to finally accept the reality of his situation and the advice of his family, friends, and teammates. The following spring, four months after his tenth official concussion, Aikman tearfully announced his retirement at age thirty-four.

  Just like that, Troy Aikman and Steve Young, two of the greatest quarterbacks in NFL history, had been forced from the sport within ten months of one another.

  For so long, posters of Aikman and Young had papered the bedroom walls of the countless kids who idolized them. Now, whenever Steinberg looked around his office and paused to take in the life-size cutouts of his two biggest clients, he couldn’t help but lament how they had ironically become “the two poster boys” for a burgeoning concussion crisis.

  At least Steinberg could take consolation knowing that the pair would no longer be poster boys for playing through concussions and that their symptoms seemed to have abated with no apparent aftereffects. Their retirements would benefit not only their own long-term health, but also that of all the kids who looked up to them.

  “There are millions of young kids out there taking as their model the athlete who plays with nine concussions, who goes back into the game after he’s had a concussion,” Steinberg said at the time in a nationally televised interview. “And I’m scared that we’re going to have a group of high school athletes, collegian athletes, and professional athletes who end up having real impairment.”

  • • •

  Leigh Steinberg wasn’t the only one worried about college and high school athletes. As the string of professional retirements played out in the headlines and highlight reels, medical researchers started to wonder about the impact of multiple concussions on younger—more vulnerable—brains. Because concussions had always been dismissed as dings or bumps on the head, no one had bothered to scientifically study their aftermath. Now that it was becoming clear that concussions could produce real damage to the brain, team physicians and athletic trainers needed answers.

  For Kevin Guskiewicz, the issue had taken on a particular immediacy in the ’90s. As director of the University of North Carolina’s education program for certified athletic trainers, he was now constantly fielding questions on concussions. While years of study had taught him how long an athlete with a twisted ankle should be sidelined, there were no data on how long a concussed player needed to rest. These days the questions were increasingly coming from the players themselves, and Guskiewicz would sometimes lie awake at night troubled by his inability to sup
ply a concrete answer.

  Early in his career, while working as an assistant trainer for the Pittsburgh Steelers, he had become friends with the team’s starting fullback, Merril Hoge. Several years later, when Hoge called to chat, Guskiewicz was taken aback: the former Steeler didn’t sound like himself. Guskiewicz was sure it was due to the post-concussion syndrome that had forced Hoge to retire from the NFL.

  Guskiewicz didn’t want the same thing to happen to any of the athletes in his care. The only way to protect them, he reasoned, was to get more information—to scientifically investigate the impact of repeated concussions in college football. So in 1999 he gathered a group of leading brain experts and sports medicine specialists, and together they set up a large-scale study that would track concussions in nearly three thousand players from twenty-five colleges over the next three seasons. At the beginning of each season, athletes would take neuropsychological exams that could then be used as a comparison to tests taken after a concussion. The groundbreaking findings mirrored what had been seen anecdotally in the pro players: the more concussions a college player sustained, the more vulnerable he was to another one. College players with three or more concussions were three times more likely to sustain a new concussion than those with no history of head injury. What’s more, multiple concussions led to longer recovery times.

  By the fall of 2003, when the study was published in the Journal of the American Medical Association, concussion research had begun to take off. Other researchers found a similar connection between repeated concussions and a heightened risk for future ones. An alarming finding came from a study that looked at both college and high school football: players with a history of concussion were six times more likely to sustain a future concussion than those with no previous head injuries. Even more disturbing were the studies showing that scores on tests of memory and mental agility dropped when athletes sustained multiple concussions.

  The football studies echoed what scientists had been learning from concussed animals. Experiments in rats over the previous decade had provided insight into what happened not only after a single concussion but also after multiple ones. Researchers found that concussed rats experienced a burst of chemical changes in their brains. Those changes made the rats more vulnerable to severe, and sometimes irreversible, damage if there was another injury. For young rats, even one concussion could be enough to impair the rodents’ future ability to learn. The studies also showed that rats needed seven to ten days to recover from a mild concussion.

  Some of that emerging research found its way into new and existing guidelines for concussion management. The ominous findings pushed experts to make the return-to-play recommendations more conservative. Still, among the nearly twenty sets of published guidelines, there was no consensus on how to grade the severity of concussions and how to determine when it was safe to return to play. That disparity stemmed from the lack of any solid science on the impact of concussions on human beings. As a leading animal researcher was quick to point out to one of the guideline authors, you can’t assume that people’s brains will respond the same as rats’.

  Flawed as they were, the guidelines at least offered doctors, trainers, and coaches throughout the nation advice on how to handle an exploding epidemic. The numbers were staggering. Well over a million boys were playing high school football—and studies showed that an alarming number of them were experiencing concussions. In fact, one study found that almost half of them were sustaining concussions, with over a third suffering more than one.

  It wasn’t surprising that a sport marked by crashing helmets and crunching tackles would produce nearly two-thirds of all concussions among high school boys. What was surprising was the plethora of concussions beyond the gridiron among younger kids. Once researchers started looking at the broader picture of youth sports from peewee leagues through high school, they were startled by how pervasive the problem had become. With so many younger children playing soccer and basketball in youth leagues, those two sports combined to produce nearly as many concussions as football among kids between the ages of five and eighteen.

  As if that wasn’t eye-opening enough, concussions were striking more females than males in soccer and basketball, the two most popular sports in which both sexes participated in equal numbers. High school girls were sustaining more than three times as many concussions as boys on the basketball court. They were sustaining almost 50 percent more concussions than boys on the soccer field, with a rate of injury second only to football among all high school sports. On the college level, women were experiencing 60 percent more concussions than their male counterparts in basketball and 30 percent more in soccer. More remarkably, women playing soccer were suffering concussions at a higher rate than men playing football.

  No one had figured out why females appeared to be more vulnerable, but there were theories: their necks weren’t as strong as those of male athletes; their brain chemistry and hormones were different, too. Several factors compounded the problem for women and girls. Some concussion symptoms, such as impaired memory, appear to be more severe and long-lasting in girls than boys. Concussions are more likely to be missed in girls than boys, thanks to the popular misconception that girls don’t play as hard as boys. Even when concussions are noticed in girls, symptoms are more likely to be minimized because people assume the macho subculture doesn’t extend to girls’ sports.

  Those people haven’t met Jamie Carey.

  • • •

  The day Jamie Carey showed up for her first basketball practice at Stanford University, coach Tara VanDerveer took her aside and handed her a bright yellow jersey. Then VanDerveer gathered the rest of the women on the team, all clad in Stanford’s cardinal red, and explained why Carey alone would be wearing yellow every day. “We’re going to have a strict rule in our practices: nobody touches Jamie,” VanDerveer announced. “And this yellow jersey is to remind you of that.”

  Carey’s reputation for fearlessness and recklessness on the court clearly had preceded her. Short even for a guard at five foot six, she compensated for her lack of size with a fierce competitiveness: diving headlong for loose balls, hurtling into crowds of jostling elbows, planting herself solidly against charging opponents.

  That scrappy style made Carey the nation’s 1999 High School Player of the Year as a senior in Thornton, Colorado. But it also had a dangerous downside: a history of concussions dating back to seventh grade when an opposing player rammed into Carey and sent her crashing to the floor headfirst.

  At Stanford, six years and seven concussions later, Carey reluctantly pulled on the yellow jersey that spotlighted her vulnerability. She hated the idea that she needed the yellow jersey as armor to protect her from other players. Unfortunately, it wasn’t enough to protect her from herself.

  Carey was wearing it during a preseason practice her sophomore year when she dove for a ball, slid across the floor, and banged her head on a teammate’s shin. She tried to dismiss the incident as just another bump on the head, but this time the symptoms were debilitating and persistent. She was so dizzy and disoriented that she couldn’t walk up stairs. She had so much trouble following her professors’ lectures that she stopped going to class. She would start a sentence and forget how to finish it.

  Now even Carey realized there was something seriously wrong. A neurological evaluation the following week confirmed it. Doctors concluded that Carey’s brain had already sustained significant damage and that she’d be risking her health if she continued to play. As soon as Stanford officials received the medical report, they called Carey in and told her she was being dropped from the team.

  At an emotional press conference four days later, Jamie Carey, in a quivering voice, stunned the roomful of reporters by announcing that concussions were forcing her to retire from college basketball. When asked if she could imagine herself returning to play someday should her condition improve, Carey paused and let out a sigh. “Trust me, I asked the doctors many questions like that,” she replied. “I kind of
got an explanation that everyone with their brain starts out on a full tank. Or like in a video game, you start out with so many lives that you can give. You can give those lives and give those lives and, with each hit, it’s fine. Nothing happens. Your brain isn’t affected. But, you can’t get those lives back. So once you’ve used them and you get another hit, it’s going to start affecting your brain. And that’s where I’m at. I don’t have any hits left.”

  The ones she’d already taken had derailed not only the athletic career of the Pac-10 Conference Freshman of the Year, but also the academic dreams of a former high school valedictorian. Unable to do quantitative work anymore, Carey had to change her major from computer science to sociology. That allowed her to take courses with essay-based exams, which were easier to complete now that she was coping with cognitive deficits and memory problems.

  For much of the next year, Carey laid off physical activity, and her head started to clear. Emboldened, she began playing pickup games. With no yellow jersey to protect her, she found herself trading elbows with men in daily playground games that were rougher than the Stanford women’s scrimmages. There were no concussions and, to her surprise, not even a headache.

  Her hoop dreams thus revived, Carey resolved to fight her way back to NCAA competition. She petitioned Stanford for reinstatement to the team she once led. University officials turned her down flat, saying the risks to her brain were simply too great.

  Characteristically undaunted, Carey sought a second opinion at the University of Texas. After extensive testing showed that many of her symptoms had abated, specialists there cleared her to play again and she transferred to Texas. But with brain injury experts still debating the long-term impact of multiple concussions, the university’s decision sparked controversy. Things got so heated that the team physician for women’s sports at Texas, Dr. Mark Chassay, felt compelled to defend the university’s stance at a press conference. He cited a recent journal article that had concluded there wasn’t enough scientific evidence yet to prove concussion damage could add up over the course of an athlete’s career. Then he turned his attention to the media storm over the recent rash of premature retirements in pro sports due to concussions: over the past few years, post-concussion syndrome had claimed the careers of Football Hall of Famers Troy Aikman and Steve Young as well as Hockey Hall of Famer Pat LaFontaine. “In football and hockey, there have been some articles that scare people,” Chassay told the reporters, “but those probably are repetitive injuries while the players are not symptom-free.”