The Concussion Crisis

by Linda Carroll

  Brain Injury Association of America

  1608 Spring Hill Road, Suite 110

  Vienna, VA 22182

  Phone: 800-444-6443

  Website: www.biausa.org

  The nation’s oldest and largest brain injury organization offers education, research, and advocacy for individuals with brain injury, their families and friends, and healthcare professionals. The BIAA offers a nationwide network of more than forty chartered state affiliates and hundreds of local chapters and support groups. Its National Directory of Brain Injury Services offers a comprehensive online directory of TBI providers.

  CDC’s National Center for Injury Prevention & Control

  4770 Buford Highway, NE

  Mail Stop F-63

  Atlanta, GA 30341

  Phone: 800-232-4636 (800-CDC-INFO)

  Website: www.cdc.gov/injury

  This CDC website provides comprehensive information on brain injury in general and concussion in particular. Access its “Concussion and Mild TBI” homepage directly through www.cdc.gov/concussion. The homepage offers links to separate sections on sports concussions and on clinical diagnosis and management, as well as links to tools and resources for downloading and mail-ordering educational materials. There are links to download its “Heads Up on Concussion” toolkits, a series of free guides, and other educational materials for coaches, parents, athletes, and healthcare professionals that provide information on preventing, recognizing, and responding to concussions. They include “Heads Up: Concussion in Youth Sports,” “Heads Up: Concussion in High School Sports,” “Heads Up to Schools: Know Your Concussion ABCs,” and “Heads Up: Brain Injury in Your Practice.”

  National Library of Medicine’s Medline Plus

  Website: www.nlm.nih.gov/medlineplus

  This government site provides comprehensive information and links. Type “concussion” into the search engine for the latest news and a host of external links.

  Traumatic Brain Injury National Data and Statistical Center

  Website: www.tbindsc.org

  For information on the sixteen federally funded centers that provide comprehensive systems of TBI care and rehabilitation, click on the “TBIMS CENTERS” homepage link or go directly to the address www.tbindsc.org/Centers.aspx.

  Acknowledgments

  In the five years since we first stumbled upon this hidden epidemic and realized how little was known about it, we’ve had to rely on countless people to help us comprehend the impact of the invisible injury and to bring an emerging public health crisis out of the shadows.

  First and foremost, we’d like to thank all the TBI sufferers who’ve courageously shared the stories of their struggles to overcome an injury that most prefer to keep private. Chief among them are those you’ve met in these pages: Dave Showalter, Willie Baun, Melissa Inzitari, Katrina Majewski, Brian Radke, Chari Abb, Anne Forrest, Mike Zacchea, Mark Lenkiewicz, and Angelica Kruth. We’d also like to thank their family members for opening lives and hearts to us: Whitey and Becky Baun, Nova Radke, Diane Lenkiewicz, Doreen Kruth, Eleanor Perfetto, Jovita Bollig, and Chari Stoesser, among others. We owe a debt of gratitude to all those whose stories have played out in the media—from the teenage athletes struck by second-impact syndrome to the professional stars who’ve battled post-concussion syndrome and early-onset dementia. Thanks to all who have shared their compelling stories in an effort to help and to inspire the countless TBI survivors who suffer in silence.

  We’d like to acknowledge all the doctors who have devoted their careers to treating patients with brain injuries and who graciously took time out of their tight schedules to talk with us. Among them, we’d especially like to thank Bob Cantu and Mark Lovell—pioneers in the diagnosis and treatment of concussions. Other clinicians who were generous with their time, insight, and experience include Jill Brooks, Richard Saunders, Robert Harbaugh, Mark Sementilli, Tom Thompson, Wayne Gordon, Tamar Martin, James Hill, Warren Lux, Joe Maroon, and Barry Jordan.

  Without the help of the scientists who took many hours of their time to explain very complicated research to us, we wouldn’t have been able to describe what goes on in the brains of TBI sufferers. Dave Hovda and Doug Smith welcomed us into their state-of-the-art labs and were always available to patiently explain difficult concepts, occasionally many times over. We also relied on many other researchers to help us put the emerging science in perspective: Ann McKee, Bob Stern, Bennet Omalu, Julian Bailes, Kevin Guskiewicz, Fred Mueller, John Povlishock, Ed Hall, Jon Lifshitz, Michael Lipton.

  We all owe a debt of gratitude to those who struggled early on to educate the public about the dangers of concussions. In particular, we’d like to thank Leigh Steinberg for sharing the story of his drive to change football’s concussion culture and for providing insights on the evolution of concussion awareness. We’d also like to thank Chris Nowinski for providing us with an inside look at the crusade he’s led to force safety reforms in football as well as other contact sports.

  We’d like to acknowledge our fellow journalists for writing the first draft of history on this emerging story. We are particularly indebted to Alan Schwarz for the relentless reporting that put concussions on the front page of The New York Times and helped raise the nation’s awareness about this growing public health crisis.

  This book could not have happened without Jane Dystel, literary agent extraordinaire. Jane believed in the project right from the start, and whenever the going got tough and we got discouraged, she was always there to remind us that this was an important issue that needed to be written about. She tenaciously sought a publishing house that would agree and, eventually, found just the right home for the book.

  We couldn’t have anticipated the enthusiasm with which Simon & Schuster embraced the project, from its publisher on down. We were heartened by Jonathan Karp’s suggestion that this book could change the way America looks at concussions. We are indebted to our editor, Roger Labrie, for helping mold the manuscript. He saw what needed to be pruned and where we needed reorganization to make the book’s message more powerful. His guidance made our manuscript into a much better book.

  We are fortunate to have friends who were willing to read multiple drafts and to offer specific suggestions for improvement. We’re especially grateful to Peggy Loper, Michael Keller, and Diane Nafis, the one person who may have read the manuscript more times than we did. Thanks, as always, to Dale Maharidge for the wisdom of his experience—starting with the warning that writing a book is “like climbing a ten-thousand-foot wall of ice, carving one new handhold at a time”—and the encouraging advice on how to scale that ice cliff.

  Finally, we’d like to thank our families for living with this project for the past five years—especially Mariela, who only rarely complained that Mommy was often too busy working on the book to come out and play.

  About the Authors

  Linda Carroll is a nationally respected health writer with an expertise in brain science. Over the past two decades she has covered a wide range of health topics for prominent publications, including msnbc.com, Newsday, and The New York Times. As a contract writer for msnbc for the past fifteen years, she has written investigative stories, news features, and the women’s health column. She has also written investigative pieces for Health and SmartMoney.

  David Rosner is a longtime journalist with extensive experience covering sports and health. While on staff at Newsday, he won national awards for sports writing and investigative reporting. In addition to writing for national magazines, he has co-authored a hockey history book and helped create an award-winning website serving athletes with disabilities. He developed brain injury expertise as managing editor of Neurology Now, the official patients’ magazine of the American Academy of Neurology.

  Source Notes

  Introduction

  Parents’ concussion knowledge: Survey data came from 2010 University of Michigan report titled “C. S. Mott Children’s Hospital National Poll on Children’s Health.”

  Hospit
alization statistics: Data came from Lisa L. Bakhos et al., “Emergency Department Visits for Concussion in Young Child Athletes,” Pediatrics 126:e550–56, 2010.

  Concussion incidence: CDC estimates for sports-related concussions came from Jean A. Langlois et al., “The Epidemiology and Impact of Traumatic Brain Injury,” Journal of Head Trauma Rehabilitation 21:375–78, 2006.

  Long-term deficits: Statistic came from David F. Meaney and Douglas H. Smith, “Biomechanics of Concussion,” Clinics in Sports Medicine 30:33–48, 2011.

  Chapter 1: Just a Bump on the Head

  Dave Showalter’s story: Narrative based on interviews with Dave Showalter and Jill Brooks, Ph.D.

  Chapter 2: The Emerging Epidemic

  Concussion incidence: CDC estimates for sports-related concussions came from Jean A. Langlois et al., “The Epidemiology and Impact of Traumatic Brain Injury,” Journal of Head Trauma Rehabilitation 21:375–78, 2006.

  Participation statistic: Estimate by the National Council of Youth Sports came from its 2008 market research membership study titled “Report on Trends and Participation in Organized Youth Sports.”

  Cantu guidelines: Narrative based on interviews with Robert Cantu, M.D. Details on his guidelines came from Robert C. Cantu, “Guidelines for Return to Contact Sports after a Cerebral Concussion,” Physician and Sports Medicine 14:75–83, 1986.

  Second-impact syndrome discovery: Narrative based on interviews with Richard Saunders, M.D., and Robert Harbaugh, M.D. Details on their findings came from Richard L. Saunders and Robert E. Harbaugh, “The Second Impact in Catastrophic Contact-Sports Head Trauma,” Journal of the American Medical Association 252:538–39, 1984. Works cited for influencing their research include the seminal textbook describing catastrophic injuries, Richard C. Schneider, Head and Neck Injuries in Football: Mechanisms, Treatment, and Prevention (Baltimore: Williams & Wilkins, 1973); and an animal study, Robert A. Moody et al., “An Evaluation of Decompression in Experimental Head Injury,” Journal of Neurosurgery 29:586–90, 1968.

  Enzo Montemurro’s story: Frederick Mueller, Ph.D., director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina–Chapel Hill, and the public affairs office at Dartmouth College helped identify the Cornell student who succumbed to second-impact syndrome. Details on the injury and its aftermath came from articles reported by the Associated Press and several newspapers. Particularly helpful were stories on his treatment (“Gridder Remains Critical; Doctor Explains Condition,” Cornell Daily Sun, October 27, 1981) and his death (“Cornell Gridder Dies of Injuries,” Ithaca Journal, October 30, 1981).

  Second-impact deaths: Invaluable assistance in identifying college and high school athletes killed by second-impact syndrome was provided by Frederick Mueller. Details on the deaths of the high school football players cited came from their local newspapers. Particularly helpful were articles on Billy Rideout (“Football Player, 17, Dies after Injury,” New York Times, November 10, 1986) and on Freddy Mendoza (“Prep Player Dies After Collapsing,” Los Angeles Times, October 8, 1991).

  Second-impact syndrome statistics: The CDC provided the number of known second-impact deaths in a report titled “Sports-Related Recurrent Brain Injuries—United States” in its Morbidity and Mortality Weekly Report of March 14, 1997.

  Brandon Schultz’s story: Narrative constructed from “Playing Hard,” PBS NewsHour with Jim Lehrer, January 26, 2000, along with information from the law firm that represented Schultz in his landmark suit, Nelson Langer Engle.

  Steinberg-Aikman-Young concussion awakening: Interviews with Leigh Steinberg formed the basis of the narrative. His quote on role models came from “Playing Hard,” PBS NewsHour with Jim Lehrer, January 26, 2000. Background on the multiple concussions leading to the retirements of Troy Aikman and Steve Young came from various periodicals. Details on Young’s retirement came from Dave Kindred, “In the End, Young Had No Choice,” Sporting News, June 19, 2000. Details on the concussion that hospitalized Aikman came from “A Common N.F.L. Question: How Many Fingers Do You See?” New York Times, January 26, 1994. The Concussion Bowl reference came from Mark Starr, “Arms Like Lead! Hit ’Em in the Head!” Newsweek, December 1, 1997. Details on Aikman’s conversations with Young came from “Giants Want Aikman Stopped but Conscious,” New York Times, October 13, 2000. Background on Al Toon’s post-concussion syndrome and retirement came from multiple New York Times news stories.

  Guskiewicz research: Narrative based on interviews with Kevin Guskiewicz, Ph.D. Description of his findings came from Kevin M. Guskiewicz et al., “Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study,” Journal of the American Medical Association 290:2549–55, 2003, and Michael McCrea et al., “Acute Effects and Recovery Time Following Concussions in Collegiate Football Players: The NCAA Concussion Study,” Journal of the American Medical Association 290:2556–63, 2003.

  Studies illuminating dangers of multiple concussions: Details of the college and high school football study showing that risk of concussion goes up with each head jolt came from Eric D. Zemper, “Two-Year Prospective Study of Relative Risk of a Second Cerebral Concussion,” American Journal of Physical Medicine & Rehabilitation 82:653–59, 2003. Information on the link between cognitive deficits and multiple concussions came from Michael W. Collins et al., “Relationship between Concussion and Neuropsychological Performance in College Football Players,” Journal of the American Medical Association 282:964–70, 1999, and Grant L. Iverson et al., “Cumulative Effects of Concussion in Amateur Athletes,” Brain Injury 18:433–43, 2004.

  Incidence of sports concussions: Statistics on high school football came from Wayne Langburt et al., “Incidence of Concussion in High School Football Players of Ohio and Pennsylvania,” Journal of Child Neurology 16:83–85, 2001. Statistics comparing college and high school basketball, soccer, and football came from Luke M. Gessell et al., “Concussions among United States High School and Collegiate Athletes,” Journal of Athletic Training 42:495–503, 2007.

  Jamie Carey’s story: Narrative constructed from multiple newspaper stories, including “The Science of Hard Knocks,” Chronicle of Higher Education, June 15, 2007; “Concussions Knock Out Stanford Star’s Dream,” San Jose Mercury News, November 8, 2000; “Concussion Aside, Jamie Carey Tries to Resume Career at Texas,” Dallas Morning News, July 26, 2002; “Texas Women’s Hoops Transfer Brings Issue of Concussions to Forefront,” Kansas City Star, August 24, 2002; “Concussions Are Just Part of Game for Longhorns’ Carey,” New York Times, April 6, 2003; and “Her Courage Is Untouchable,” Hartford Courant, May 20, 2005. NBA-WNBA concussion rates came from John R. Deitch et al., “Injury Risk in Professional Basketball Players: A Comparison of Women’s National Basketball Association and National Basketball Association Athletes,” American Journal of Sports Medicine 34:1077–83, 2006.

  Zack Lystedt’s story: Narrative constructed from published and televised reports. Most helpful was “Knocking Heads,” Dan Rather Reports, HDNet, March 3, 2009. Some details of the injury and its aftermath were drawn from newspaper stories, notably “Special Report: The Dangers of Adolescents Playing Football with Concussions,” Seattle Times, November 4, 2008. Research showing that athletes returned to play too soon came from Ellen E. Yard and R. Dawn Comstock, “Compliance with Return to Play Guidelines Following Concussion in U.S. High School Athletes, 2005–2008,” Brain Injury 23:888–98, 2009.

  Chapter 3: Head Games

  The Bauns’ story: Narrative based on interviews with Willie, Whitey, and Becky Baun. Background came from Christopher Nowinski, Head Games: Football’s Concussion Crisis (East Bridgewater, Mass.: Drummond, 2007).

  NFL violence: Details on Fox commercial, TNT ad, and ESPN highlights came from “Scorecard,” Sports Illustrated, October 16, 1995, and “NFL Is Playing Head Games,” New York Post, September 6, 1995. Vince Lombardi’s philosophy came from multiple sources, notably David Maraniss, When Pride Still Mattered: A L
ife of Vince Lombardi (New York: Simon & Schuster, 1999).

  Physics of football hits: Player size analysis based on several sources. Most helpful were two studies that used large databases of NFL players—“Heavy Pressure: NFL Players Struggle with Weight Game,” Palm Beach Post, October 29, 2006, and “Supersized in the NFL: Many Ex-Players Dying Young,” Scripps Howard News Service, January 31, 2006. Statistics on force of hits came from Brian Vestag, “Football Brain Injuries Draw Increased Scrutiny,” Journal of the American Medical Association 287:437–39, 2002, and Tim Layden, “The Big Hit,” Sports Illustrated, July 30, 2007. Statistics on force of concussive hits in NFL study came from Elliot J. Pellman et al., “Concussion in Professional Football: Reconstruction of Game Impacts and Injuries,” Neurosurgery 53:799–814, 2003.

  Steinberg’s advocacy: Interviews with Leigh Steinberg provided the details on his awakening in the wake of Aikman’s rookie concussion and his subsequent crusade for safety reforms.

  NFL concussion data: The widely used per-game average was based on the league’s released statistics for number of reported concussions per season.

  Wayne Chrebet’s story: Narrative of concussion controversy based on multiple news stories in The New York Times and the New York Daily News. Quotes came from “Jets’ Chrebet Sustains Another Concussion,” New York Times, November 6, 2003, and “Concussion and Its Aftereffects End Season for Jets’ Chrebet,” New York Times, November 13, 2003.

  Elliot Pellman controversy: Background on the formation of the NFL’s MTBI Committee came from Elliot J. Pellman, “Background on the National Football League’s Research on Concussion in the National Football League,” Neurosurgery 53:797–98, 2003. Background on Pellman’s chairmanship came from Peter Keating, “Doctor Yes,” ESPN The Magazine, October 28, 2006.