Natasha Helmick goes up for a header during a 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 okay, but Natasha lies and says she's good to go. The coach puts her back into the lineup and 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 later that day, too, still without full eyesight. Her vision will eventually return, but five years and four concussions later, she's unable to recall much of her childhood.
Speaking to her now, 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. "Academically," says her mother, Micky Helmick, "everything is three times harder."
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, reporting by Village Voice Media, which publishes the Observer, has revealed even more dire consequences for youth athletes, who are bigger and more aggressive than in past generations and often play year-round.
The effects of a concussion can be more devastating for young people; 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 may be linked with Alzheimer's, Parkinson's, ALS and a number of other fatal diseases. And even a young 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, making the challenge of managing head injuries even more difficult for trainers and coaches, who are often part-time and under-trained.
Twenty state governments and the District of Columbia have signed concussion legislation this year alone, prohibiting athletes from returning to play until cleared by a licensed physician. But 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.
Meanwhile, as attorneys debate how the new concussion laws will play out, kids like 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 have pushed them be standouts in athletics if they realized that in some cases, their kids could 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, Ali complained of a headache and dizziness.
The ball had only "brushed across the front of [Ali's] face," says her mother, Kim Champness. "It was not a hard hit at all, but right after that, she started stuttering."
Ali saw a doctor, who discovered a number of serious problems. In the past, a "bell ringer" was considered no different from a cut or a sprained ankle: part of the game. 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 athletes were prematurely sent back into action. Years later, it became obvious that many of them were losing 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 are hospitalized and 50,000 die, according to the CDC.
"Ninety percent of concussions went undiagnosed," Chris Nowinski, of the Boston-based Sports Legacy Institute, says. "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, founded the Sports Legacy Institute with neurosurgeon Dr. Robert Cantu. The foundation works with Boston University's Center for the Study of Traumatic Encephalopathy in performing post-death pathology on brains donated by former athletes.
One of the latest specimens examined was that of former Chicago Bear Dave Duerson, who earlier this year, following years of dementia and depression, shot himself to death in the chest so his brain would be preserved. Neurologists later confirmed that Duerson had been 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 may not always exhibit classic symptoms such as headaches and nausea, CTE is, in essence, an invisible killer that can cause the brain of a 35-year-old to resemble that of an 80-year-old.
The findings have forced the NFL to shelve its concussion skepticism. In February, the league urged all states to pass concussion legislation in youth athletics. But 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 are claiming that the league was careless in its false assumptions. (The NFL plans to contest the allegations.)
The proper treatment of concussions, especially in youth sports, is still a developing — and somewhat murky — science.
Dr. Mark Ashley is co-founder, president and CEO of the Centre for Neuro Skills, whose clinics in Bakersfield and Irving, Texas, specialize in traumatic brain injury rehabilitation. He's currently helping Ali Champness recover from a number of serious health issues spawned by the not-too-dramatic hit from a soccer ball in January.
Champness, based 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 the Centre's Texas facility in 2006, was a 13-year-old football player from the Seattle suburbs named Zackery Lystedt. In the second quarter of a game, Zack fell backwards 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," recalls Victor Lystedt.
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 started 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. And 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 to the present day.
Spurred by stories like Zack's, school districts en masse are adopting 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 1990s, 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.
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. He 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 told Sports Illustrated that Ryne's test was interrupted by a "disruptive" teammate, which made the results "invalid." But Baldinger claims that the trainer retracted that story in a recent deposition.
"It's better than nothing," says UCLA researcher David Hovda about 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."
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 may 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 Florida state Senator Dennis Jones, a working chiropractor who, in May, helped to kill a state concussion law. "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 in Washington. 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 after Natasha Helmick, was signed by Governor Rick Perry in June after the Senate passed the bill by a 31-0 margin. And, beginning on January 1, 2012, Colorado's Jake Snakenberg Act will require every coach in youth athletics to complete an online concussion recognition course.
Florida, however, recoiled from its own version of concussion safety because Jones was miffed that the language did not include chiropractors among "medical professionals."
As more and more states enact concussion laws, medical professionals, athletic trainers and school administrators are wondering if these laws are actually going to help prevent a condition that's inherently difficult to detect.
"I think the law comes up a little short," says Saint Louis University head athletic trainer Anthony Breitbach about Missouri's Interscholastic Youth Sports Brain Injury Prevention Act, "because a lot of these symptoms are subtle and can be easily concealed by the athlete if he or she wants to play." Additionally, Breitbach estimates that since only half of the state's schools can afford to employ an athletic trainer (which echoes a nationwide trend), a lot of concussions will continue to go undiagnosed, even with the new law in place.
In Arizona, on the strength of Governor Jan Brewer's signature on House Bill 1521, the Mayo Clinic is offering free, online-based concussion tests to more than 100,000 high school athletes. In June, the Mayo Clinic issued a press release stating that 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 2011-2012 school year starting with football.
Steve Hogen, athletic director of Mesa Public Schools, had concerns with Arizona's law even before it passed. If he and his cohorts hadn't been vocal about the bill's language (which was consequently amended), he says, 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. He defended La Salle University in a lawsuit filed by the family of a former player, Preston Plevretes, who claimed that he'd 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 that he receives a call each week from advice-seeking youth and high school sports organizations, and "what I'm hearing from the defense perspective — 'We don't have a plan' and 'An athletic trainer is too expensive' — frightens me," Pachman says.
"The youth sports might suffer the most because of their lack of resources. ... A town of 80 people, like the one from Hoosiers, may not even think about potential litigation until something tragic happens," Pachman says.
Before she became an old woman at age 14, Kayla Meyer had three passions. She rode horses on her family's farm. She was a huge reader. "Supernatural monsters kind of thing," explains the gregarious Minnesotan when asked what books she likes, "or old kind of sword-fighting stuff is basically what I read."
And, like seemingly every other man, woman and child in the iced-over town of New Prague, 45 miles south of Minneapolis, Kayla played hockey.
In early 2009, then age 13, she was skating in a club game when a collision took her legs out from under her and she fell, hitting the back of her head. Kayla told the coach she was fine and played the rest of the game.
When she went to the nurse with a headache the next day, the nurse gave her aspirin. When her headache persisted, a doctor administered a run-of-the-mill CAT scan, which does not detect concussions. Nothing looked amiss, so she was cleared to return to the ice.
"I've been skating since I was four, at the pond near my house," explains Kayla. "It would've just felt weird not to play hockey."
Ten months later, at a high school team practice, Kayla was doing a drill she calls "mountain climbers," a sort of butt-in-the-air pushup on skates. Exhausted, her arms slipped, and her forehead smacked the ice. The rest of the team skated to the locker room, unaware that she lay crumpled in pain. It wasn't until the next team found her in the rink that Kayla's mom, Mandy Meyer, received a frantic call to come to the arena.
Kayla's head hurt so badly in the next couple of weeks that her bewildered parents called a plumber to check for carbon monoxide leaks in their house. Her coach's solution, according to Mom: "Put a helmet on her. Let her skate through it."
Meyer's head was too sensitive for her to even bear wearing a helmet. She hasn't played hockey since. A year and a half since that second concussion, she remains hobbled by excruciating headaches and a crippling intolerance to noise.
Kayla's ordeal illustrates a debate that's currently occurring in the medical community: How long should a concussed youth sit out before returning to athletic activities?
"Some people said ten days, others said three months," says Dr. William Jones, a staff physician at the Memorial Hermann Sports Medicine Institute in Houston, Texas, about a medical conference that he recently attended. Meanwhile, Ashley sits somewhere in the middle. "We really need to be thinking seriously about waiting at least 30 days until a person with a concussion returns to play."
It's all leading toward games that may be significantly altered in the future. Arizona has considered eliminating kickoffs from high-school football because of the dangers inherent when players collide with each other at top speeds. And while 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. This season, each varsity player for Houston-area football powerhouse Katy High School will don the pricey and brand-new Riddell Revolution Speed helmet, which costs anywhere from $236 to $1,030. The previous version, the Riddell Revolution, helped decrease concussions by more than 300 percent, according to Katy head athletic trainer Justin Landers.
Katy's football staff has the money to use ImPACT testing and state-of-the-art helmets. However, one thing Landers and his coaching staff can't control is the win-hungry culture of Texas high school football.
From early June to mid-July, with the hot Texas sun overhead, Katy players run sprints on an outdoor practice field and hit the weight room during a five-week summer fitness program. Around this time every year, several parents — who are desperate for their freshman enrollees to gain a competitive advantage — will call Landers to ask his advice on what type of helmet they should buy for their sons. Landers, the son of a helmet salesman, is freaked that these kids will go out on some random field with ill-fitting equipment and hurt themselves.
Landers is another athletic trainer who believes that the state's recently passed concussion legislation has its shortcomings and that "the judgment call on whether to pull a kid from play won't make the decision any easier," he says. "We would look foolish if we were to send a kid to the doctor and he didn't end up having a concussion. That would be a waste of time and money."
Four years ago, Landers told a varsity football player who had suffered a staggering three concussions in five months to go to the doctor toward the end of the regular season. The athlete, a key contributor to the Tigers' playoff push, was deemed unfit to continue playing football.
Though Landers realizes that the doctor's decision was probably the right call, he still feels like he screwed up.
"I still feel badly," says Landers through teary eyes, as if the incident had just happened yesterday, "because he'll never get to experience what it's like to play in a Texas [high school football] playoff game."
As 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 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, the 16-year-old, like his older sister, 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," says Micky, who adds that an incident that she and her daughter witnessed at the Texas state Capitol has contributed to her fears.
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, while 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 engaged in idle chitchat with the group, they noticed that 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.'"