In the past, a "bell ringer" was thought of the same way as a cut or a sprained ankle, with no lasting side effects. Until a few years ago, the NFL's medical committee on concussions published studies that concluded players were not suffering long-term damage from head trauma incurred during athletic competition.

The lack of awareness carried over to the training rooms of every sport, and high-profile athletes such as boxer Muhammad Ali and All-Pro safety Dave Duerson were prematurely sent back into action. Years later, they essentially lost their minds.

The Centers for Disease Control and Prevention estimates that as many as 3.8 million sports- and recreation-related concussions occur each year. Out of this figure, about 235,000 persons are hospitalized and 50,000 die per annum, according to the CDC.

David Goldstein spoke to Florida legislators about devastating effects from multiple concussions.
Photo by Michael McElroy
David Goldstein spoke to Florida legislators about devastating effects from multiple concussions.
Natasha Helmick once played a game half-blind after sustaining a concussion.
Photo by Mark Graham
Natasha Helmick once played a game half-blind after sustaining a concussion.

"Ninety percent of concussions went undiagnosed," Chris Nowinski of the Boston-based Sports Legacy Institute tells Village Voice Media. "In fact, today you can talk to an athlete and ask the amount of concussions they've had and give them the actual definition, and that number will increase."

Nowinski, a former World Wrestling Entertainment pro and author of Head Games: Football's Concussion Crisis, along with noted neurosurgeon Dr. Robert Cantu, founded the Sports Legacy Institute. The foundation works with Boston University's Center for the Study of Traumatic Encephalopathy in performing postdeath pathology on brains donated by former athletes.

One of the latest specimens examined was that of Duerson, a former NFL standout who, following years of dementia and depression, fatally shot himself — in the chest so his brain would be preserved — this past February 17. Neurologists later confirmed that Duerson, who had played for three NFL teams, was afflicted with chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to the total amount of distress a brain receives during a lifetime. Because a concussed person might not always exhibit classic symptoms such as headaches and nausea, CTE can cause the brain of a 35-year-old to resemble that of an 80-year-old.

These findings have helped turn the NFL from concussion skeptic into an organization that is spreading the word that head trauma in sports can have deadly consequences. The campaign has even trickled down to the NFL-licensed Madden NFL videogames, in which a concussed player in the yet-to-be-released Madden NFL 12 cannot return to play after suffering the injury. In February, the league urged all states to pass concussion legislation in youth athletics.

For the 75 former NFL pros who sued the league in July, alleging it concealed the dangers of the injuries for decades, it's too little, too late. Football retirees such as Mark Duper, Ottis Anderson, and Raymond Clayborn claim the league was careless in its false assumptions. As of press time, the NFL planned to contest the allegations.

The proper treatment of concussions, especially in youth sports, is still a developing — and somewhat murky — science.

In 2004, Jake Snakenberg, a Denver-area high school freshman, knocked his head during a football game but assured his mother he felt ready to play again. A week later, the young fullback once again hit his head during a game. The blow was unremarkable, but Jake staggered to his feet and then collapsed. He never got back up. The next day, he was declared dead from second-impact syndrome, a swelling of the brain derived from a second concussion before the symptoms of the first have passed.

These types of injuries are exacerbated in youth athletes because the human brain doesn't metabolically or neurochemically mature until a person is in his or her early to mid-20s, according to David Hovda, professor and director of the Brain Injury Research Center at the University of California-Los Angeles. This includes the young brain of Matt Blea, who nearly died on a California football field two years ago.

On Thanksgiving Day 2009, Matt, a 16-year-old junior and starting running back for San Jose High, tried to retrieve an underthrown ball during the opening possession of the 66th annual Big Bone rivalry against Lincoln High. Despite his modest five-foot-five, 140-pound frame, Matt was the recipient of all-league honors as well as props from an opposing linebacker, who once told him: "I don't know how you ran me over, because you're so little."

As Matt jumped for the errant pass, a Lincoln High safety cleanly and legally put his shoulder into Matt's midsection. Because Matt was unable to brace himself, his head whacked San Jose City College Stadium's artificial turf.

"I knew instantly something was wrong," says his father and former San Jose High defensive coordinator Dave Blea, who stood on the sidelines. "I couldn't see his pupils. I could only see the whites of his eyes."

Out of sight of the referees, who signaled play to continue as normal, Matt crawled to the sidelines and lost consciousness. After paramedics tried unsuccessfully to revive him, Matt was rushed to Santa Clara Valley Medical Center for emergency brain surgery.

"They didn't think he was going to make it," Dave says. "They thought that he had suffered so much brain damage that he probably would have been mentally disabled."

Matt remained comatose for ten days and spent nearly a month in intensive care owing to complications from second-impact syndrome. His first concussion, suffered three weeks before on the penultimate play of a game, was not detected, even after Dave took Matt to a doctor when he told his father that his vision was blurry.

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