Symptoms have unforeseeable impact away from the field
THE SANTA CLARA
May 5, 2016
Ashley Doyle’s head took a beating on a hot afternoon in the fall of 2014.
The Santa Clara defender cleared the ball with her forehead time and time again as she patrolled the sizzling rubber turf in a game against the University of San Francisco. Her head was throbbing, but she assumed it was just dehydration because of the 90 degree temperatures baking the field. The athletic trainer agreed, so Doyle played all 110 minutes in a 1-0 overtime win.
Their assessment was wrong.
Instead of her brain searching for fluids after the match ended, it was oozing them—her head bleeding from the inside out. For the next eight months, Doyle spent most of her time in the shadows on the sideline or under the darkness of the dimmed lights in the training room, living in a fog, grasping for escaped memories. She was diagnosed with a concussion, a head injury that worsened from repetitive trauma after Doyle had taken a routine header off the top of her skull the day before the USF game, a dreaded spot on the skull to take a ball flying in at full speed.
The American public has been warned about the dangers of concussions, courtesy of leading experts dishing out new research and raising the alarm. Research offers one side of the story, a side that can only share scientific data. The other side comes from the collegiate student-athletes themselves, a side with firsthand testimonials that merit attention. From unpredictable pain, recovery setbacks and distress inside the classroom, Doyle and other student-athletes alike say that it just might take everyone to suffer a concussion in order to understand the toll of a battered and bleeding brain.
“There were some girls who thought like the whole way I was feeling was mental,” Doyle said, piecing out each word with a soft and steady cadence, blue eyes lasered straight ahead. “I just think (concussions) are very misunderstood if you haven’t had one. It is a very hard thing to go through.”
Another concussion took out Doyle’s teammate Jenna Roering that same season. Roering, a sophomore from Lino Lakes, Minn. with streaky blonde hair, leaped into the air to gain control of a bouncing Nike soccer ball. She collided shoulder-to-shoulder with a teammate. Her body snapped 90 degrees as she crashed to the ground. Her head whipped against the artificial turf, rocketing rubber pellets into the air.
“When I got up, I was so dizzy and basically I was just like, ‘What just happened?’” she said. “I remember it but it was like a blur.”
Doyle watched the hit unfold and knew immediately that a concussion was clouding Roering’s mind.
“She had to come sit out next to me and she was sitting down and she’s like, ‘I’m blacking out, I’m blacking out,’” Doyle recalled.
Sofia Huerta, one of Roering’s former teammates, was just as concerned.
“I asked her what month it was,” Huerta said.
No response, just a dazed and blank face staring back.
For the next month and a half, Roering found herself off the field and in the training room. She spent her time shielding her eyes from sunlight and sleeping the consistent headaches away.
Student-athletes can suffer from a wide range of concussion symptoms, including headaches, amnesia, exhaustion or nausea.
“Every concussion is different,” said Dr. Eric Hall, a concussion researcher at Elon University in North Carolina.
The injury is an unpredictable one, according to Hall and other researchers. Think of it this way: a fractured bone is more or less universal when it comes to symptoms suffered, the physical repair needed and estimated recovery time. Symptoms normally include swelling, tenderness and overall discomfort. The bone is reset and a cast helps mend the break. Recovery typically lasts six to eight weeks.
A blow to the head offers no such standard. Symptoms include anything from moderate headaches to severe memory loss. No specific type of physical therapy can heal the injury. Recovery can take anywhere from a few days to several months.
Amanda Delfino, a softball player at Santa Clara, was plagued with a number of symptoms after a ball hit her in the temple last fall, one day after she bumped her head against a dresser drawer. The constant desire to rest her head on a pillow kept her away from the diamond. The constant glow and faint buzzing of the fluorescent lights kept her away from the classroom. The constant mental exhaustion and inability to stay focused kept her away from doing schoolwork.
“It was like having a bad migraine for five days,” she said.
Concussions occur in any given sport at any given time. Based on numbers from the 2014 NCAA concussion report, wrestling, football and ice hockey recorded the highest number of reported concussions for men.
The top three sports with the highest amount of reported concussions for females were ice hockey, field hockey and soccer.
Even 3.7 percent of male golf student-athletes and 4.6 percent of female crew student-athletes reported suffering from a concussion at least once while competing in their traditionally non-contact sport, according to the report that drew from a 20,000 sample population.
Headaches are the most common symptom immediately after the incident, while loss of consciousness was the least common, according to a 2015 research report published in the Journal of Sports Rehabilitation.
Yet, even months and even years down the road, some concussion victims may suffer from what’s called post concussion syndrome. Highlighted by insomnia, sensitivity to light or noise, or even major memory impairment, post concussion syndrome and general concussion-like symptoms may never leave a victim’s head, according to Dr. Jonathan Cherry, a concussion researcher at Boston University’s Chronic Traumatic Encephalopathy Center. It all depends on the severity of the hit, the person’s genetics and personal history of concussions.
Doyle, following the contest against USF, took a two and half week break before returning to the field after clearing the NCAA mandated concussion tests. After playing out the remainder of the season, suffering through headache after headache, she was reevaluated.
Doyle’s updated diagnosis would change her life for the next several months. Told by her doctor that her continued play made the injury worse, the Santa Clara athletic trainers made the fateful decision to suspend her from any action on the pitch.
“My memory scores were so bad that they were like, ‘You can’t play for six months,’ Doyle recalled. “The memory was freaking me out. I was scared.”
Scientific studies are now finding that minor, repetitive blows to the head-—not just one-time, major collisions—can lead to degenerative brain diseases such as CTE, a disease that can result in memory loss, early onset dementia and depression later on in life. From rugby to wrestling, it’s not just a career in the NFL that can lead to the development of CTE, said Cherry. Heading a soccer ball practice after practice, game after game can spell trouble as well, as was the case with Doyle.
She didn’t return until the end of the fall 2015 season. During that waiting period, Doyle faced rounds of medication, medical testing and athletic trainer precaution before she was cleared to put on her red and white uniform and return to competitive play.
Flip the script for Andrew Clem, a Santa Clara senior with an infectious smile and comical personality. The rugby player had a much shorter recovery time even though he endured a hit that he can’t even remember. An opponent’s incoming knee or shoulder hammered directly into the back of his head when he was lying defenseless on the turf, knocking him unconsciousness.
He felt a damp towel over his eyes as he regained consciousness.
“He was being walked off the field and I go up to him and (I’m) like, “Hey, man, are you okay?’” recounts Andrew McCarty, Clem’s teammate, who would later be sidelined himself after suffering two blows in a two-week span.
“He’s like, ‘Yeah, I’m chillin’. I’m good. I’m fine,’” McCarty said.
Clem remembers nothing of that conversation. Looking back now, his memory of the accident is only jogged via pictures and film.
“It kind of dawned on me like 15 seconds later that I’m at the game and I just got knocked out and I just started crying,” he said. “It was more remembering how s—-y it was the first time I got a concussion, like, ‘Crap, I’m going to have, you know, like a week long recovery.’”
Fortunately for him, he was wrong.
Despite the lights-out hit that Friday night, Clem was back in the classroom on Monday morning feeling normal as ever, slightly drowsy at most.
“The relationship between the type of head injury and severity of a concussion is poorly understood and more research is needed,” said Rita Hitching, a Clinical Research Manager at Stanford University’s Concussion and Brain Performance Center.
Clem suffered a blow that knocked him unconscious. Yet, he felt fine and didn’t experience problems afterwards. By contrast, Hitching sustained a concussion when her window blinds fell down and clipped the tip of her nose a few months back. Her head itself did not receive any impact, but she still had symptoms consistent with a concussion, such as headaches that lasted several days and the sense of not feeling like herself for three to four days.
Whatever the trauma, the brain needs time to rest and heal before being put back into the game. According to experts, physical play and mental exercises should be off the table for at least the first few days to first week depending on the severity of the symptoms and recommendation from doctors.
A student-athlete’s ability to remember conversation and process information was back up to speed roughly seven days after suffering trauma to the brain, according to a 2012 article published in Physical Medicine and Rehabilitation. Fast-forward another week and the student-athlete’s reaction times along with his or her ability to remember visuals were up to par.
Modern research is also finding that some symptoms can determine the length of recovery. A 2015 report published in the Journal of Sports Rehabilitation suggested that the symptoms of amnesia, dizziness and disorientation led to lengthier recovery times–anywhere from one week to a number of months –compared to other symptoms.
Cherry believes that every concussion sufferer should be sure to take the safety first approach.
“See a doctor,” he said. “Take time off. You want to fully recover completely from any sort of concussion before you go back and start playing again.”
Returning to his seat in the classroom worked for Clem following his collision on the rugby field. For others, the classroom was just another nightmare atmosphere during the long road building back to full strength.
Doyle struggled daily to recall conversations with friends and professors that she had just had a few hours before during the days and months following her diagnosis. Eventually, she was forced to medically withdraw from class.
“The teacher would be talking and looking at me and it was, like, going in one ear and out the other,” she said. “I was like, I don’t want to be in class cause I’m scared I’m going to get called on and I have no idea what the teacher’s saying.”
Despite her anxiety, Doyle was calmed by supportive professors, a sentiment echoed by a number of Santa Clara student-athletes who were also recovering from concussions.
Austin Hooper, a former tight end on the Stanford University football team, had a different experience.
He remembers sitting isolated in the locker room, staring directly into the white light flashed in front of his pupils by the athletic trainer on Halloween night 2015. His teammates stormed the field in celebration after their opponents’ potential game-winning field goal sailed wide, but his only focus was taking deep breathes to calm the pounding inside of his skull.
For 57 minutes of game time that night, Hooper collided heads like a ram during a one-on-one battle with a defensive lineman who had a 50-pound cushion on the Stanford junior. Pain enveloping his brain on the sidelines, hands squeezed against his red and white helmet to prevent any further rattling inside his skull, Hooper was pulled from the contest by the training staff.
He struggled to cope with the subsequent treatment he received when he returned to campus.
“No one really understands a concussion,” said Hooper. “I feel like everyone should get one until they get their head f—ed up, they vomit, they can’t do anything and they’re like, ‘Wow, this is a significant injury.’”
Expected to return to the classroom two days after his Saturday night concussion, Hooper cut class on his own to sleep.
“(Professors) say, ‘Oh, here’s an athlete that’s trying to find a way to have another excuse why he can’t be at my class and do my assignments on time,” he said. “Like, ‘No, dude, my brain is bleeding. I can’t pay attention right now.’”
Cognitive rest, or performing little to no mental exercise, is crucial in healing the brain and getting student-athletes back up to speed on the field and in the classroom as quickly as possible, according to Hall, the lead author of a 2015 report published in the Clinical Journal of Sports Medicine. Based on the findings, student-athletes are encouraged to treat their return to the classroom similarly to the way they treat their return to the field. They should take enough time – anywhere from a few days to two weeks as specified by a medically knowledgeable individual – to rest and sleep before gradually and incrementally intensifying their workload as the days go by.
Student-athletes often face bouts of depression during those immediate days and weeks following their injury, according to a 2012 report in Physical Medicine and Rehabilitation, because of the added stress that comes along with completing outstanding school work or not being physically surrounded by loved ones for comfort and support.
The Emotional Toll
Physically and mentally, student-athletes report that returning to the field and returning to the classroom can be straining. Emotionally, the inability to play the sport they love can cut even deeper.
Feeling up to speed and ready to hit the diamond after recovering from the bruised temple that had sidelined her a couple weeks earlier, Delfino was still not cleared by the athletic training staff. Left to sit at the end of the bench in the dugout, trapped behind the protective fencing, she watched as her teammates played without her.
“I couldn’t even put on my own uniform,” she recalls. “I wasn’t allowed to because I wasn’t allowed to be on the field. That’s probably the hardest part.”
Out on the rugby field, Clem’s teammate, McCarty, felt a similar bout of torment. Shut down for the season after suffering two concussions in a two-week span, he was left to find something else to do with his new free time.
“It was tough,” he remembers. “I live with the guys who are on the team so they’re going out to practice and they’re going to games and stuff like that. I was just left kind of like twiddling my thumbs.”
It’s the waiting game of recovery that most student-athletes struggle to cope with, not to mention the few, if any, physical therapy exercises that one can do to repair a bruised brain. Roering remembers watching her fellow injured teammates repair strained muscles in the bone-numbing waters of ice baths or under the soothing heat of electric blankets. Her physical therapy: sleep.
“It was kind of tough seeing your teammates work really hard to try and get better and there was nothing you could do,” she said. “It really sucks.”
The best piece of advice that doctors and researchers give to those who have suffered a concussion: rest. Rushing back from a head injury only increases the likelihood of prolonging recovery time, further developing CTE or even suffering an injury to another part of the body.
Student-athletes that have suffered a concussion are almost twice as likely to suffer an injury to their lower limbs during the one year time table following their initial brain injury, whether that come in the form of an ankle sprain, broken leg or torn knee ligament, based on the findings from a 2015 report in Medicine and Science in Sports and Exercise. The reason: the brain’s ability to synchronize movement could still be in repair.
Cherry said that most student-athletes can and do return to a normal and healthy state of mind weeks and months after the accident without any adverse effects. Further along down the road however, student-athletes may run into trouble.
Readjusting for the Future
Those that catch minor blows to the head are more or less able to recover fully without combating agony in the long-term. However, people that sustain severe hits are not so lucky, according to Cherry. There have been documented examples of severe concussion victims suffering from prolonged impairment and neurobiological problems, such as fatigue, dizziness, anxiety and irritability, years and years since the original hit that rumbled their mind.
Although Cherry admits that the evidence for long-term consequences is still not entirely conclusive across the board and that much is to be researched, many student-athletes are paying attention and even putting serious thought into reconsidering their athletic futures.
Carlo Eikani, a soccer student-athlete at Saint Mary’s College, gave himself an ultimatum after the first day of practice during his senior season. Playing in a 6-on-6 scrimmage, competing against freshmen doing their best to catch the eye of the head coach, the senior was blindsided by a shot that blasted into the back right side of his head. Dropped to the grass, Eikani held his body steady in a crouching position as what felt like the pounding of drums rang throughout his skull. He was sidelined for two and half weeks and made a promise to himself and his future, one more concussion and he’d hang his cleats up for good.
If the possibility of an NFL career weren’t on the table for Stanford’s Hooper, his future would admittedly be different as well.
“I would ride out my time, get my education and then happily be done but there’s an opportunity in it for me to make some money, so why not?” he said.
Doyle and Roering admit that a cautious mentality has crept into the depth of their minds now when they rise up to make a challenge with an opponent or jump into the air to clear a ball.
“It’s something that I need to, like, get better on for myself playing soccer, but it’s very scary knowing that you could get hit too hard and it just takes one second and you could be out for two months,” Roering said.
These injuries are even challenging student-athletes to think about the future when they teach their kids the fundamentals of sports. Eikani and McCarty are adamant that their children will never strap on a helmet and shoulder pads to play football. Clem will only let his children play football or rugby beginning in high school at the earliest. On the other side of the debate, Hooper believes in the intangible benefits of contact sports, such as perseverance and hard work that can mold children into adults.
“That’s the thing, people don’t want their kids playing football at a very young age but it also puts them at a disservice when they try to put them with kids who are 15 and 16 and already have seven years of experience,” he said. “That’s how kids get injured.”
Hitching, the Clinical Research Manager at Stanford’s Concussion and Brain Performance Center, believes in a balanced approach. With rising obesity rates for young children, sports are a necessary part of life to keep people of all ages fit and healthy.
“Concussions are an injury, and for most people, the injury will heal and no residual symptoms will remain,” she said. “Concussions are an issue of concern but provided you get the appropriate care, it doesn’t mean you should stay away from sport completely.”
Jerry Smith, who begins his thirtieth year as the head coach for the women’s soccer program at Santa Clara in the fall, has witnessed the culture of managing concussions advance dramatically. He remembers the days when concussions were swept under the rug because coaches were fearful of babying the injury and developing “soft” athletes. All that has changed. Smith and his coaching staff have reduced the amount of heading and high-contact drills in practice and if any player takes a knock, they are immediately sent to see an athletic trainer to follow through with the concussion protocol.
Smith admitted there were times in the past when he wondered if he was being overly cautious. But he has come to believe that there’s no such thing as going to far when it comes to player safety.
He even seriously questioned if Doyle would return and wear her No. 3 jersey for the Broncos again.
She has. Now, gearing up for her redshirt senior campaign, Doyle is excited to be back playing the sport she loves. But the fear of another concussion always lingers in the back of her mind.
“I think there’s always a part of me that’s going to be scared,” she said.
Contact Brendan Weber at firstname.lastname@example.org or call (408) 554-4852.