As I prepare to start my Junior year of college and my first season as an undergraduate Varsity Soccer Coach, I cannot help but look back on how my life has been shaped by my experience with concussions and concussion awareness. When I first started thinking about applying to colleges, playing NCAA soccer was certainly a priority of mine. However, because of the head injuries that I had suffered, I was not medically cleared by my doctors to pursue this endeavor. This development was a significant disappointment, as I had trained so hard for years hoping to one day reach this level of competition. During my first few semesters at college, I was able to play soccer recreationally, but I felt something was missing; I wanted to be involved in the highest level of collegiate soccer.
Countywide Concussion Care was created because I wanted to turn my negative experience of having suffered concussions into something positive. Going into my Spring semester last year, I remembered this choice and decided to take a similar course of action in regards to my soccer life. I interviewed with the Varsity Soccer coaching staff, and they gave me the position of undergraduate assistant coach. Working with the team has been an incredible experience, and I look forward to this upcoming season.
I have come to see first hand the power of turning a negative into a positive. Countywide Concussion Care is a prime example as is my coaching position. The lesson that I hope to spread through this post and with the Countywide Concussion Care program is a whole is that the increased awareness of the danger of concussions offers us a tremendous opportunity to do good and to make athletics safer. Rule changes across different sports such as football and soccer have been proposed and implemented, media coverage of such developments is ever-increasing, and more preventative measures are in the works. More and more research is being done to find out as many details about the real effects of concussions. We must continue these efforts in order to make athletics as safe as possible. Please contact me through this website if you are interested in working together towards achieving this goal!
Since my last post, the world of concussion awareness has continued to become more prevalent in the conscious of American and global society. FIFA, the governing body of global soccer, along with top league such as the English Premier League and the UEFA Champions League have adopted new in-game concussion protocols, and the discussion about concussions continues to develop in the world’s most popular sport. This past season in the NFL, the new rule that requires a Independent Neurological Consultant to evaluate players who are suspected of having a concussion was a positive step forward, though there is plenty of work still to be done to protect football players from concussions.
There have also been several articles written that have praised the concussion management and education work that has been done, reevaluated the effectiveness of these efforts, and proposed plans for the future. In light of the conference at Princeton that I participated in and which I wrote about in my previous post, Peter Keating wrote an article for ESPN citing Princeton Professor Uwe Reinhardt’s idea that NFL fans should have a health tax added to the price of their tickets to go towards players’ health care. Here is the link to this interesting article:
These types of innovative ideas may not be favored by all, but they do represent how major changes will likely be coming to the world of sports soon to push the bill on concussion prevention and treatment even further.
On a personal note, I have continued to work with Princeton University researcher Dr. Annegret Dettwiler-Danspeckgruber on ideas for research, policies to make Princeton University a leader in concussion management and education, and initiatives to make collegiate and youth athletics safer environments. I appeared on the award winning soccer XM radio show Over the Ball to discuss concussions in youth soccer and my work with Countywide Concussion Care, and it was a fantastic opportunity to spread my message on a national stage. The people who called in to the hosts after my interview expressed how they had learned a great deal from my story and were excited to apply their furthered knowledge of concussion awareness to their children’s youth athletic careers. As my time in college moves forward, I will continue to find opportunities to spread the word about concussion awareness and work with administrators of various institutions to foster safer spaces for youth and collegiate athletics. I cannot wait for what is next!
Last Friday, I participated in a fantastic panel titled “Concussion: Shaping the Future of Youth Sports” at Princeton University. Here is the description of the panel in the words of the its host, Dr. Annegret Dettwiler-Danspeckgruber:
“The primary goal of the panel is to discuss concussion from a public health and public policy point of view, based on the latest clinical and scientific knowledge. I view this panel as an initiative to start to bring together a group of experts who will continue to work on policy recommendations, initially in the State of New Jersey and in the future (if all goes well) nationally. The panel is co-sponsored between the Woodrow Wilson School and the Brain Injury Alliance of New Jersey.”
Panelists included NFL Hall of Famer Harry Carson, Peter Keating (writer for ESPN and actor in “League of Denial”, Barbara Geiger-Parker (President and CEO of the Brain Injury Alliance of New Jersey and a Chairperson on the United States Brain Injury Alliance), Columbia University Assistant Professor of Neurology James Noble, world-renowned economist Uwe Reinhardt, and Dr. Dettwiler-Danspeckgruber (a leader in the field of concussion research).
I learned an incredible amount from the panelists, and I am sure the same would be said by all the members sitting in the packed auditorium. There were a few points in particular that stuck with me. One was that concussion education needs to reach young age groups (i.e. 7-8 year olds) so that as they are entering sports they can have concussion awareness instilled into their newly forming sports world. A second point is that there are still so many unknowns when it comes to concussions, and it is essential that more scientific research is funded to eliminate this ambiguity. Lastly, every person involved in youth athletics including parents, researchers, coaches, clinicians, educators athletic trainers, athletic directors, and referees are responsible for making sure that youth athletes in the present and future are protected. It takes a total team effort to make sure kids are properly educated, diagnosed, and rehabilitated in the proper manner. I also had the honor of participating in the discussion as a representative of Countywide Concussion Care and the voice of a youth athlete who has suffered concussions. My contribution was well received by both the panelists and the audience, and it was a true honor to play a part in such an amazing event.
Another noteworthy event that I took part in recently was the Miami Project to Cure Paralysis Great Sports Legends Dinner on September 29th. The Miami Project has backed Countywide Concussion Care since its inception, providing resources, hosting events, being a voice for the safety of youth athletes, and countless other essential contributions via the Project’s Kidz Neuroscience Center. The work that Marc and Nick Buoniconti have done for countless injured people truly is inspirational. Their annual fundraiser in New York City was an incredible event. Legends such as Warren Sapp and Grant Hill were honored and mingled with the crowd. There was a tangible sense of hope for a future in which spinal cord injuries are the thing of the past. In the midst of his incredibly touching speech about being a quadriplegic and how he will one day get out of his chair, Marc praised the work that the Project has done to combat concussions. That Marc would go out of his way to praise the efforts of the Kidz Neuroscience Center and Countywide Concussion meant so much to myself and Dr. Gillian Hotz, the administrator of Countywide Concussion Care for Miami-Dade County, who was also in attendance.
I hope to continue to participate in events like these and to spread the message of concussion awareness and protection. This past week has reminded me of how much progress has been made in terms of combating the issue of concussions and how much more work there is left to be done. Everyone out there who is reading this has a role to play in protecting youth athletes from concussions. Let’s get to it.
I write this blog having finished my second semester at Princeton in the Spring and my first summer as a counselor at Camp Androscoggin. Both experiences were fantastic opportunities to take on new responsibilities, make lasting friendships, and grow into a more mature person. As a player for the Princeton Men’s Club Soccer team and as a soccer coach at Camp Andro, each day I gained an even greater appreciation for the way that concussion awareness has spread in recent times. Both my classmates with whom I played and the young campers I coached protect their heads and have an understanding of the symptoms of concussions that was not part of the youth sports culture even just a few years ago. This goes to show me that this country has become a safer place for kids to participate in and receive the many benefits of sports.
I want to continue to increase the awareness of concussions in this country. In order to do that, I am searching for schools and county boards across the country to adopt the guidelines of Countywide Concussion Care. As I mentioned in my last post, Countywide Concussion Care is now a licensed entity. This program lays out a comprehensive plan to bring concussion education and management county by county. Dr. Gillian Hotz, one of the top concussion specialists in the country and the administrator for the ImPACT Testing component of Countywide Concussion Care, believes that this program is one of a kind. I urge the readers to please spread the word about this program and to find high schools and county boards interested in having an effective concussion management and education program for their county. Each county that uses Countywide Concussion Care is another one that can take comfort in knowing that its youth athletes are better protected from concussions.
Chronic traumatic encephalopathy, the degenerative brain disease linked to repeated blows to the head, has been found posthumously in a 29-year-old former soccer player, the strongest indication yet that the condition is not limited to athletes who played sports known for violent collisions, like football and boxing.
Researchers at Boston University and the VA Boston Healthcare System, who have diagnosed scores of cases of C.T.E., said the player, Patrick Grange of Albuquerque, was the first named soccer player found to have C.T.E. On a four-point scale of severity, his disease was considered Stage 2.
Soccer is a physical game but rarely a violent one. Players sometimes collide or fall to the ground, but the most repeated blows to the head may come from the act of heading an airborne ball — to redirect it purposely — in games and practices.
Grange, who died in April 2012 after being found to have amyotrophic lateral sclerosis, was especially proud of his ability to head the ball, said his parents, Mike and Michele. They recalled him as a 3-year-old, endlessly tossing a soccer ball into the air and heading it into a net, a skill that he continued to practice and display in college and in top-level amateur and semiprofessional leagues in his quest to play Major League Soccer.
Grange sustained a few memorable concussions, his parents said — falling hard as a toddler, being knocked unconscious in a high school game and once receiving 17 stitches in his head after an on-field collision in college.
“He had very extensive frontal lobe damage,” said Dr. Ann McKee, the neuropathologist who performed the brain examination on Grange. “We have seen other athletes in their 20s with this level of pathology, but they’ve usually been football players.”
The damage to Grange’s brain, McKee said, corresponded to the part of the head that Grange would have used for headers. But she cautioned against broad conclusions.
“We can’t say for certain that heading the ball caused his condition in this case,” McKee said. “But it is noteworthy that he was a frequent header of the ball, and he did develop this disease. I’m not sure we can take it any further than that.”
C.T.E. is believed to be caused by repetitive hits to the head — even subconcussive ones barely noted. Once considered unique to boxers, it has been diagnosed over the past decade in dozens of deceased football players and several hockey players. In December, it was found for the first time in a baseball player. Symptoms can include depression, memory loss, impulse control disorders and, eventually, progressive dementia, scientists said.
Boston University researchers also found a severe case of C.T.E. in a 77-year-old former rugby player from Australia, Barry Taylor, who was known by his nickname, Tizza. A hard-charging sort, he played competitive rugby for 19 years, including 235 games for Manly Rugby Union, an Australian professional team near Sydney.
While brain research involving rugby players is still in its infancy — partly because of the sport’s general lack of popularity in the United States, where much of the research occurs — Taylor’s condition may come as little surprise. Though rugby players do not wear helmets, their games, like those of American football, are filled with collisions, many involving the head.
Taylor’s family noticed increasing cognitive problems when he was in his 50s. Within a decade, Taylor had severe dementia. He died in April.
“At one point, I took him for a walk, and I was getting a lot of monosyllabic answers,” said Taylor’s son, Steven. “I said, ‘What’s your name, mate?’ He looked at me and just shrugged his shoulders. That’s the point he got to. He didn’t even know who he was.”
McKee found Taylor’s brain to be extraordinarily shriveled and deteriorated. His disease was diagnosed as severe Stage 4 C.T.E.
“It was, in a lot of ways, a very classic case — the tearing of the septum pellucidum and lining of the ventricles, and atrophy of the central structures of the brain,” McKee said.
“And then, microscopically, he had this tremendous buildup of abnormal tau,” she added, referring to a symptomatic protein, “and no evidence of any other disorder. It was a pure C.T.E. case.”
The diagnosis came as something of a relief to Taylor’s family, including his daughter, Jennifer, and his son. But the regret is that the illness could have been avoided.
“Both of us after talked about it and had this great relief,” Steven Taylor said. “It is not genetic. But there was a great deal of sadness, knowing it was preventable. It was a great waste, a great shame, knowing that the last 20 years did not have to be like this.”
The findings are part of an updated version of the 2012 documentary “Head Games,” by the filmmaker Steve James. The updated film, titled “Head Games: The Global Concussion Crisis,” will debut Thursday at NYU Langone Medical Center.
Dr. Erin Bigler, a professor of psychology and neuroscience and the director of the Magnetic Resonance Imaging Research Facility at Brigham Young, said he was not surprised to learn that C.T.E. was found in a soccer player.
“The brain is a very delicate organ, and it probably can withstand some injury, but the whole issue of repeated injury is a very different circumstance,” he said. “When it’s moving, it’s moving with its 200 billion brain cells. And those cells are being, in some way, mechanically deformed, some more than others, which gives you an appreciation of what’s going on with these collisions.”
Bigler said he would not recommend that players, especially young ones, routinely head the ball. The brain is not fully developed until about age 25, he said, making it more susceptible to injury.
Some youth soccer organizations have warned against practicing heading until players reach a certain age, usually between 10 and 14. Some scientists believe those ages are somewhat arbitrary, but they understand that parents want to know whether their children should be allowed to head soccer balls.
“The cold, hard reality is that the data don’t exist to address that question,” said Dr. Michael L. Lipton, a neuroscientist and neuroradiologist at Yeshiva University’s Albert Einstein College of Medicine, who studies the effects of heading. “We’re really in very much uncharted territory. So what should I do with my kid? That basically becomes the kind of risk-benefit assessment we have to make all the time in life.”
Last year, the journal Radiology published results of a study by Lipton and others of 39 amateur adult soccer players, with a median age of 31, who had played soccer since childhood. It concluded that “heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance.”
Lipton said Wednesday that there was probably a reasonable threshold below which heading might cause few problems.
“Above some level, heading is probably not good for anyone,” he said.
After the 2002 death of Jeff Astle, 59, a longtime player in England’s top league who showed dementia-like symptoms in his final years, a coroner determined that heading the ball probably led to the damage found in his brain. The term C.T.E. was not in wide use at the time, but scientists believe Astle probably had it.
Grange was a lifelong soccer player who starred in high school and played collegiately at Illinois-Chicago and New Mexico. He played for the Chicago franchise of the Premier Development League, a proving ground for future professional players, and in a couple of semiprofessional leagues. He coached and played at an indoor soccer complex in Albuquerque, his hometown.
Grange was 27 when he was found to have A.L.S., a degenerative disease of the nervous system that is sometimes referred to as Lou Gehrig’s disease. Most people with A.L.S. are deep into middle age or older, with the average age of 55 at diagnosis, according to the ALS Association.
Grange’s symptoms began with a sore calf. He soon struggled to walk, and the A.L.S. diagnosis followed. Grange had to use a wheelchair within six months. Paralysis soon made him unable to feed himself. He died 17 months after the A.L.S. diagnosis.
McKee believes that the damage to Grange’s brain was at the core of his A.L.S.
“We think the precipitating factor in his case was most likely the trauma,” McKee said. “First of all, he was absurdly young when he developed this disease. And he had considerable evidence of this trauma-induced tauopathy, or C.T.E.”
In hindsight, Grange’s family said that he showed symptoms of C.T.E. beginning in high school. He struggled to balance a checkbook. He did not understand the repercussions of failing classes. He once left for Seattle to try out for a soccer team and returned to find he had been fired from his job waiting tables because he never asked for time off. Grange fought depression in the years leading to his diagnosis, his parents said.
When he died, the Granges received a call from Boston University, requesting his brain. Learning that their son had C.T.E. was painful, but it brought some semblance of relief and peace. Like the doctors, they cannot be sure that their son’s death was precipitated by soccer, but they wish they would have discouraged his habit of heading the ball.
“Every park you go by, kids are playing soccer,” Michele Grange said. “And they’re doing headers. And that really bothers me. When I see the little kids playing soccer, even my grandson, for one thing it reminds me of better days. But on the other, it makes you think of the consequences. And I hope that these kids and their parents are going to see to it that they take care of their heads.”