Natasha Helmick goes up for a header during a Dallas soccer match and gets speared in the left temple by an opponent. The 14-year-old, a talented center midfielder playing in the choice Lake Highlands Girls Classic League, crumples to the ground.
She can't see anything out of her left eye. Her coach asks if she's OK. Natasha lies and says she's good to go, and the coach puts her back into the lineup. She plays the remainder of the game, even though one eye sees darkness, while floaters and sparkly objects dance in front of the other.
She plays again later that day, without full eyesight. Her vision will eventually return, but five years and four concussions later, Natasha Helmick is unable to recall much of her childhood.
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Speaking to her, you wouldn't know that Natasha, who was forced to give up an athletic scholarship to Texas State University-San Marcos, is a brain-damaged 19-year-old. "But academically," says her mother, Micky Helmick, "everything is three times harder."
While Natasha racked up more concussions, David Goldstein, a "little freshman" by his own estimation, shouldn't have even been on the soccer pitch during the January 2010 district finals for Ransom Everglades when the Miami prep school played against longtime rival Gulliver. But after an older kid was injured, David subbed in. He was playing one of the best games of his life when he collided head-to-head with an opponent he describes as "a monster from Gulliver."
Game tape shows David holding his head and swaying like a drunk. But there was no way he was going to take himself out of this match, and his coach didn't either.
It was — though David didn't understand the medical ramifications at the time — his third concussion in four years. After the game, he felt nauseated and cowed by light, stumbling to his dad's car and collapsing.
For months, the "blaring" headache persisted. "It's always there," he describes. "It's so intense, it takes over your life." Previously a devoted student, David took refuge in the school nurse's office three hours a day, closing his eyes to the painful light. He became agitated and impatient with friends. Every specialist his parents took him to was perplexed by his condition.
Across the country, people have awakened to the sometimes irreversible damage of concussions, especially in high-impact professional sports. With much of the attention focused on the National Football and National Hockey leagues, Village Voice Media — following a months-long, nationwide investigation into the consequences of concussion on youth athletes, who are larger and more aggressive than in past generations, and often play year-round — has found the following:
• The effect of a concussion on kids can be much more devastating than on adults. Doctors say that until a person is in his early to mid-20s, his brain is not fully developed and can't take the same level of trauma as an adult brain can.
• Postmortem analysis, the only surefire way to measure concussions' devastating effects, shows that repeated blows to the head might be linked with Alzheimer's, Parkinson's, ALS, and a number of other fatal diseases.
• An athlete who doesn't exhibit outward signs of a concussion (headaches, dizziness, vomiting, temporary amnesia) can still experience changes in brain activity similar to those in a player who has been clinically diagnosed with a concussion.
• Thus far in 2011, 20 state governments and the District of Columbia have signed concussion legislation that prohibits an athlete from returning to play until cleared by a licensed physician. To date, 28 states (as well as the city of Chicago) have concussion laws in place. This does not include Florida; here, legislators struck down a proposed bill that could have helped protect youth athletes.
• The ImPACT test, widely regarded as the go-to neurological exam to measure concussive blows, doesn't always accurately gauge a player's readiness to return to action. And you can cheat on it.
Meanwhile, as attorneys debate how the new concussion laws will play out, young people such as Natasha Helmick, whose memory struggles sometimes resemble those of an elderly person, continue to battle a condition that puts parents who want the best for their children in an interesting position: Would they push to have them be standouts in athletics — sometimes the key to a better future — if they realized that in some cases their kids can be harmed for life by their participation in elite sports?
For Ali Champness, it was a freak ball kicked into her face by her own goalie in practice that turned her life upside down. The 14-year-old freshman, who'd already made junior varsity at Garces Memorial, a Catholic high school in Bakersfield, California, told her parents the sting went away after a little while.
Two days later, though, on the way to a game, recalls her mother, Kim Champness, Ali complained of a headache and dizziness.
During play, the ball was kicked in the air and "brushed across the front of [Ali's] face," Kim says. "It was not a hard hit at all, but right after that, she started stuttering." Ali saw a doctor, who discovered a number of much more serious problems.
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.
"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.
"One thing that still hurts is that I always told my kids that if they suffered a concussion, I would keep them out the whole year," Matt's father says. "He passed all of his neurological tests. I guess he was misdiagnosed."
Matt suffered another setback when the surgical incision became infected, requiring another procedure to remove a piece of his skull. For the next 42 days, Matt was forced to wear a helmet and take a chemotherapy-like cocktail of antibiotics.
"I don't remember much at the hospital," says Matt, who was paralyzed on the right side of his body for more than a month. "I remember people holding me up while I tried to take my first step, but my body felt like there was nothing there, like a ghost."
To the surprise of the physicians, Matt eventually recovered. Soon the high school graduate will attend De Anza College in Cupertino, California, to study for a career in physical therapy, a profession he never considered before his injury. His first choice was to become a paramedic, but he's been told that's impossible — his right eye remains half-blind.
Dr. Mark Ashley — cofounder, president, and CEO of the Centre for Neuro Skills, whose clinics in Bakersfield, California, and Irving, Texas, specialize in traumatic brain injury rehabilitation — is helping Ali Champness recover from a number of serious health issues spawned by the not-too-dramatic hits from a soccer ball in January.
Ali, on Ashley's advice, sat out the rest of the soccer season. Two months later, she joined the school's swim team. But three weeks in, Ali called her mom from a competitive meet in a panic. "Mom, you need to get me to a doctor," Kim Champness remembers her daughter saying.
At Ashley's center, an MRI and CAT scan revealed bleeding in Ali's brain. A cardiologist found that the initial concussion had deregulated Ali's autonomic nervous system. For months, whenever Ali jogged on the treadmill, her heartbeat soared high enough to trigger cardiac arrest or stroke. She still goes to rehab three hours a day.
One of Ashley's most severe cases, treated at his center's Texas facility in 2006, was a 13-year-old football player from the Seattle suburbs named Zackery Lystedt, called "Ray Ray" for his idol, rampaging linebacker Ray Lewis.
In the second quarter of a game, Zack fell after an unremarkable tackle and hit the back of his head, although the injury escaped the notice of his father in the stands. "I thought he had gotten the wind knocked out of him," Victor Lystedt recalls.
Zack played every down for the rest of the game, even forcing a fumble and sprinting to a 32-yard return. But when his dad met him after the game, Zack began stumbling and muttering, "My head hurts really bad."
He collapsed onto the field. His left eye suddenly "blew out" and turned an inky black, the result of blood swelling in his skull. Then he convulsed into dozens of strokes. Says Victor, who witnessed the spectacle, helpless and confused: "My boy was dying on a football field." His son would survive, but his serious health problems continue.
Concussive episodes in youths have led school districts en masse to adopt new procedures for dealing with blows to the head. The most popular is the ImPACT test. A simple computer program designed by a pair of Pittsburgh doctors in the early '90s, the exam finds an athlete's "baseline" — his mental aptitude and quickness of reflexes when he's not suffering concussive symptoms — which can be used later in a comparative test to see if a collision has caused a lag.
But the test has hit real-world snags. The first is its price: At packages costing roughly $600 per school for the first year, ImPACT is deemed too expensive for some districts. And even when they spring for the program, few schools can afford to pay a specialist to administer it. That duty tends to fall on coaches or trainers, who are often unqualified to conduct the test. As shown in a litigious case in the suburbs of New York City, the results can be tragic.
In 2008, Ryne Dougherty, a 16-year-old high school linebacker in Essex County, New Jersey, sat out three weeks following a concussion. But after taking an ImPACT test, he was cleared to play. During his first game back, he suffered a brain hemorrhage and slipped into a coma. Ryne died within a week.
But Ryne's ImPACT results were ominously low, the family has claimed in a lawsuit against the school district. Additionally, according to the test results, Ryne reported feeling "foggy," but he was still cleared to play.
"Fogginess is the lead predictor of lasting head trauma," says Beth Baldinger, the attorney representing Ryne's family in a suit against the district. "[The trainer] ignored the test results in front of her. This case screams ignorance."
Michele Chemidlin, the trainer who administered the test, ignored phone messages and an email requesting comment for this story. She claimed to Sports Illustrated that Ryne's test was interrupted by a "disruptive" teammate, which made the results "invalid." But Baldinger claims the trainer retracted that story in a recent deposition.
"She testified that she never even bothered to see Ryne's test results," says the attorney. "It was one of the most brutal depositions I've ever been involved in. She left the room crying several times."
Kenneth Podell, a Detroit neuropsychologist and one of the creators of ImPACT, declined to comment specifically on Dougherty's case. But he says that "in ideal circumstances," the test should be administered not by a trainer but by a medical professional.
"It's better than nothing," UCLA's Hovda says of ImPACT. "I don't mean any disrespect, but neuropsychological tests, which require responses and performance from individuals, are always going to have problems because there's always going to be variances."
One of those variances is that an athlete can cheat the system. In April, Indianapolis Colts quarterback Peyton Manning flippantly admitted he intentionally performs poorly on baseline exams. When and if he takes postconcussion tests, the results won't look as bad, which means he (or anyone else who employs a similar baseline-test strategy) might be able to return to play immediately. NFL Commissioner Roger Goodell later fessed up that concussion-test cheating is an issue the league needs to address.
Complicating head-trauma detection is a recently released Purdue University study that concludes that youth athletes who aren't clinically diagnosed with a concussion are still experiencing fundamental brain changes that might be detrimental.
For two seasons, three Purdue professors tracked every practice and game hit sustained by 21 Lafayette Jefferson High School (Indiana) football players. "That's when we started to see that about half of the kids had some level of easily measurable neurophysiological change without any concussion whatsoever," says Purdue's Eric Nauman.
"What we think is probably happening is that since these kids don't have any symptoms, nobody ever takes them out of the game or makes them sit. They probably keep racking up more and more hits, and it tends to affect more and more of the brain."
Nauman and his colleagues are looking for funding so they can study soccer players, wrestlers, and participants in activities that aren't usually thought of as dangerous. "Anecdotally, the cheerleaders at Purdue had almost as many concussions as the football players," Nauman says.
"No bill is better than a bad bill," says state Sen. Dennis Jones, a working chiropractor who helped kill a concussion law in Florida this past May. "As chiropractors, we've been treating head injuries since 1931. The symptoms of a concussion are not that difficult to diagnose."
Florida is one of the only states to balk at concussion legislation for youth athletes, a nationwide trend that started in 2009 when Washington gave a thumbsup to the Zackery Lystedt Law. A prototype for dozens to come, the act requires any athlete under 18 who suffers a suspected concussion to receive written consent from a medical professional before returning to play. There is no similar federal law.
In Texas, Natasha's Law, named for former soccer player Natasha Helmick, was signed by Gov. Rick Perry in June after the Senate passed the bill by a 31-0 margin. Beginning January 1, 2012, Colorado's Jake Snakenberg Act will take the Lystedt Law one step further by requiring every coach in youth athletics to complete an online concussion recognition course.
Florida, however, recoiled from its own version of concussion safety because Jones, a Republican from Seminole, was miffed that the language did not include chiropractors among "medical professionals."
On the Senate floor, Jones argued that standard MRIs can be used to detect concussions, which is a fallacy. Jones filed an amendment to include chiropractors, but the House refused to vote on the amended bill.
David Goldstein, the Miami high school soccer player, testified in favor of the bill in Tallahassee. After suffering three concussions, David had been told by doctors to "wait it out, never play soccer again, and good luck." It wasn't until he visited the University of Miami — one of the nation's top medical centers for head trauma in student athletes — that David's injury wasn't treated as some unfathomable affliction. The doctors slowly worked him back to the point where he could return to soccer wearing a rugby helmet. Now 16, he's a starter on varsity.
Last year, David organized a raffle at school and wrote letters asking for cash until he had raised $35,000, which will be donated to the Miami-Dade school district. It will pay for three to four years of concussion tests for every public school in the county.
As more states enact concussion laws, medical professionals, athletic trainers, and school administrators are wondering if these laws will help prevent a condition that's inherently difficult to detect.
In Arizona, on the strength of Gov. Jan Brewer's signature on House Bill 1521, the Mayo Clinic offers free online concussion tests to more than 100,000 high school athletes. In June, the Mayo Clinic issued a news release stating the Arizona Interscholastic Association had endorsed the baseline test, which was not true and caused an AIA attorney to threaten legal action. The two have since made up and are partnering to test all Arizona contact athletes during the 2011-12 school year, beginning with football.
Steve Hogen, athletic director of Mesa Public Schools, had concerns with Arizona's law even before it passed. According to him, if he and his cohorts hadn't been vocal about the bill's language (which was consequently amended), the law would have placed an impossible load on them.
"It put the burden on us that we had to make sure that all Pop Warner football kids were tested. That's impossible. We can't do that," Hogen says. "What if an out-of-state group had come in and they didn't have this concussion testing? We wouldn't have had the resources to check."
Because a legal precedent has yet to be established on these new laws, attorneys are divided on how potential lawsuits will play out in a courtroom.
Steven Pachman is a Philadelphia-based lawyer who has advised numerous academic institutions and athletic entities about concussion litigation. Though Pachman declines to comment about specific clients, a records search shows he defended La Salle University in a lawsuit filed by the family of a former player. Preston Plevretes claimed he had received severe brain damage because the school's nurse and a team trainer inserted him back into play too soon following a concussion. (La Salle settled out of court for $7.5 million.)
Pachman explains he receives a call every week from advice-seeking youths and high school sports organizations. "What I'm hearing from the defense perspective — 'We don't have a plan' and 'An athletic trainer is too expensive' — frightens me," he says.
Before concussion laws came into vogue, the parents of Zackery Lystedt of Seattle filed suit on their son's behalf. Airlifted to a Seattle emergency room on life support, Zackery had the top of his head completely removed by surgeons. He wasn't supposed to regain consciousness.
The milestones that have come since then have been both miraculous and frustratingly slow. Nine months later, Zackery resumed speaking. By 13 months, he moved his left arm. After 20 months, he could once again eat. Now, five years later, 18-year-old Zack can walk a few steps with a cane. "You get a little bit back, you want a little bit more," Victor Lystedt says of his son's progress. "You never get satisfied, because you had it all before."
Zack's parents, whose lives have been completely altered as they have cared full-time for their son, sued the school district for allowing him to play through his injury. The district settled, and one of its lawyers shrugged off the payout as a "business decision."
That still offends his father. "Shame on those lawyers," Victor says. "They can all rot in Hell as far as I'm concerned. There's nothing 'business' about my kid."
Born and raised in Santa Ana, California, Karoline "Kari" Krumpholz was destined for water polo greatness. Her father, Kurt Krumpholz, a three-time All-American selection in men's water polo, was inducted into UCLA's hall of fame in 2008, the same year that Kari's brother J.W. won an Olympic silver medal with the U.S. water polo team.
As a sophomore at Foothill High School, Kari and her water polo team won the 2007 California Southern Section Division I championship. Following a star-studded career that included numerous athletic honors, she accepted a scholarship to UCLA.
During a UCLA practice in February, Kari was defending "one of the strongest girls on the team" when she was clocked between the eyes by her teammate's elbow. Kari thought her nose was broken, but upon further examination, a student trainer said she was fine. As a precaution, the trainer made her skip the rest of practice.
However, Kari wasn't doing so well the next day. "I went to class and I knew something was wrong. I couldn't focus and I felt out of my body. I am a really good student, so for that to happen, I knew something wasn't right."
That day, a doctor diagnosed her with a concussion. Five months later, after nearly daily visits to various UCLA physicians as well as Orange County's Migraine & Headache Center, she's still experiencing symptoms.
To Kari's knowledge, this is the first concussion she has received. "But since I've been having so many problems, one doctor said that it's possible that I had undiagnosed concussions in the past," she says.
If and when her symptoms clear, Kari, a sophomore majoring in psychology, sounds doubtful she'll return to the water.
"It would be scary for me to play again because my brain is really important to me and I have plans for graduate school," she says. "Once I am cleared, I'm going to have to really examine if I'm willing to take that risk."
For those who decide to stick it out, they might be playing a game that could be significantly altered in the future. Arizona, for example, has considered eliminating kickoffs from high school football because of the dangers inherent when players collide with one another at top speeds.
Other organizations are relying on updated helmet technologies to try to prevent concussions. Although it's impossible to completely prevent head trauma in football, helmet manufacturer Riddell has, in the past 20 years, redesigned and released several types of helmets.
While parents, coaches, and athletes try to find the proper balance between athletic participation and long-term health, Natasha Helmick, who's studying at Texas State University to be an athletic trainer, is still experiencing depression and focus issues.
Natasha says she still hasn't moved past the disappointment of that day when Texas State decided to pull her athletic scholarship. "My doctor told me that I should never play a contact sport again in my life. He said, 'Don't even go out and shoot with friends. That's how endangered your head is.'"
Natasha's 16-year-old brother Zachary plays club select soccer and has "moved up the soccer ladder faster than Natasha did," says their mother Micky. This summer, Zachary participated in the U.S. Youth Soccer Olympic Development Program. If he keeps performing well, he could be handpicked from a pool of athletes to represent the country in national and international competition. However, like his older sister, he has suffered multiple concussions. Micky, mindful of her son's dream as well as his long-term health, says it will be a "difficult decision" to pull Zachary from soccer if he receives another head injury.
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"He's aggressive out there. He plays a lot like [Natasha]. It's very scary for me," Micky says.
After Natasha's initial testimony in front of the House of Representatives in Austin, she and her parents sat in a rotunda with former football players Robert Jones and N.D. Kalu. Jones won three Super Bowl rings as a linebacker with the Dallas Cowboys, and Kalu played ball at Rice University before embarking on a 12-year career with the Philadelphia Eagles, Washington Redskins, and Houston Texans.
As the Helmicks chitchatted with the men, they noticed something just wasn't right mentally with these hulking athletes who had suffered countless concussions during their playing careers.
"When we left there for the day," Micky says, "Natasha turned to me and said, 'Mom, I could really tell. I hope I'm not that way when I'm their age.'"