Con­cus­sion aware­ness grow­ing in grav­ity sports

Mind-set chang­ing to: “You are a bad ath­lete when you keep com­pet­ing with a con­cus­sion”

The Denver Post - - SPORTS - By Ja­son Blevins

It was just a tap on the back of the hel­met from a buddy. But it sent freeski­ing su­per­star Justin Dorey tum­bling, once again, into dark­ness.

“Each time the re­cov­ery time would dou­ble,” said Dorey, whose ca­reer of podi­ums was earned de­spite count­less crashes and at least a dozen con­cus­sions that even­tu­ally left him hud­dling in a dark room, all but in­ca­pac­i­tated. “It’s ridicu­lous how small of an im­pact it takes to take me out for a year and a half.”

The is­sue of con­cus­sions is front and cen­ter in the world of sports, thanks largely to well-pub­li­cized con­cus­sion man­age­ment pro­to­cols that have been es­tab­lished as an out­growth of a tragic his­tory of trau­matic brain in­juries among pro­fes­sional foot­ball play­ers. But for win­ter sports ath­letes — who of­ten lack the sup­port of a league or even a team — the is­sue of con­cus­sions is only now emerg­ing from the shad­ows. It’s not un­com­mon for a win­ter ath­lete to dis­re­gard re­port­ing hits to the head as he or she pushes to the podium. They fear get­ting side­lined in a dis­ci­pline where fleet­ing suc­cess re­wards very few.

It hap­pens all the time, said Dorey, who re­cently re­tired from pro­fes­sional ski­ing af­ter tak­ing more than 18 months to re­cover from a slam to his head he suf­fered jump­ing off a rope swing into a lake.

“If you hit your head be­fore the X Games, you are not telling any­body be­cause they will take you out. Maybe it is a mi­nor hit and you’ll prob­a­bly be fine,” said Dorey, 28. “But if it is more se­ri­ous than you think and you hit your head again, it gets bad quick. A cou­ple times I hit my head and didn’t tell any­body be­cause I didn’t want them to stop me from ski­ing.”

While the re­search re­gard­ing brain in­juries is still in its in­fancy, it has been es­tab­lished that re­peated blows can lead to chronic trau­matic en­cephalopa­thy (CTE), a pro­gres­sive, de­gen­er­a­tive dis­ease that has been linked to a litany of life-chang­ing symp­toms such as mem­ory loss, im­paired judg­ment, in­som­nia, de­men­tia and de­pres­sion so deep it pushed some re­tired foot­ball play­ers, such as Ju­nior Seau, to take their own lives.

Dave Mirra, the BMX leg­end whose jour­ney to 24 X Games medals in­cluded many con­cus­sions, died of a self-in­flicted gun­shot at age 41 last Fe­bru­ary. Neu­ropatholo-

gists found CTE in Mirra’s brain, mak­ing him the first ac­tion sports ath­lete to be di­ag­nosed with the neu­rode­gen­er­a­tive dis­ease. It’s un­likely he will be the last among grav­ity sport ath­letes who have long and silently en­dured con­cus­sions as a cost of ad­mis­sion.

“Ath­letes are not talk­ing about this like we should,” said moun­tain biker Amanda Batty, who has more than 30 doc­u­mented con­cus­sions in her ca­reer as a pro­fes­sional ath­lete. “We won’t be hon­est about the dis­con­nect be­tween want­ing some­thing so bad and liv­ing long enough to get it. Ac­ci­dents hap­pen. That doesn’t mean you are a bad ath­lete. You are a bad ath­lete when you keep com­pet­ing with a con­cus­sion.”

Suf­fer­ing in si­lence

Dr. Jon Li­eff, a Bos­ton-based neu­ropsy­chi­a­trist who has stud­ied thou­sands of pa­tients with brain in­juries for 40 years, said while re­search out­side ma­jor pro­fes­sional sports is lack­ing, there is sub­stan­tial ev­i­dence that cu­mu­la­tive im­pacts to the head will prove detri­men­tal to some peo­ple but not nec­es­sar­ily all peo­ple, “not even a ma­jor­ity of peo­ple.”

“Twenty per­cent of peo­ple who play foot­ball for three, four years will suf­fer de­creases in cog­ni­tive abil­ity. But which 20 per­cent? No one can tell,” he said. “If you hit your head one way and I hit my head the ex­act same way, you could be fine and I could suf­fer mem­ory loss for the rest of my life and there’s no way to de­ter­mine what makes you more re­silient than me. There is a lot we don’t know.”

A 10-year study by the In­ter­na­tional Fed­er­a­tion of Ski­ing, the gov­ern­ing body of ski­ing and snow­board­ing, doc­u­mented 320 con­cus­sions suf­fered by FIS ath­letes be­tween 2006 and 2016, or roughly 10 per­cent of all the in­juries counted among the FIS dis­ci­plines of World Cup alpine ski­ing, freestyle ski­ing, snow­board­ing and ski jump­ing. Per­haps most dis­con­cert­ing in the FIS In­jury Sur­veil­lance Sys­tem re­port was that 51 of the 355 head in­juries suf­fered by train­ing or com­pet­ing FIS skiers and snow­board­ers in that decade did not sideline the ath­lete for any time. But, 82 of the 355 head in­juries took ath­letes out of com­mis­sion for more than a month.

Brain re­searchers are learn­ing more about the lin­ger­ing con­se­quences of a life­time of head trau­mas. That re­search is fu­el­ing a grow­ing aware­ness among ac­tion sports ath­letes that a brain “bruise” needs the same amount of at­ten­tion, rest and re­cov­ery as any other in­jury.

“The pen­du­lum has swung from one ex­treme to the other,” said Melinda Roal­stad, the for­mer med­i­cal di­rec­tor for the U.S. Ski & Snow­board As­so­ci­a­tion who helped es­tab­lish con­cus­sion pro- to­col pro­ce­dures for FIS, pro­tec­tive pro­cesses that mir­ror those used in foot­ball, base­ball, hockey and soc­cer, for in­stance.

The key to con­cus­sion man­age­ment — treat­ment for brain trauma as well as re­duc­ing the in­ci­dence and sever­ity of con­cus­sions — is “ed­u­ca­tion, ed­u­ca­tion, ed­u­ca­tion,” said Roal­stad, who is see­ing more pa­tients at the Think Head First con­cus­sion clinic she started in 2010 in Park City, Utah, largely be­cause of that grow­ing recog­ni­tion of the need for proper care af­ter a blow to the head.

Batty has be­come some­what of an ex­pert on con­cus­sions, hav­ing ar­rived at that des­ig­na­tion by en­dur­ing sev­eral con­cus­sions a year in the past decade. In her late teens and early 20s she la­bored to earn a liv­ing from snow­board­ing, and re­peated head in­juries nearly killed her.

“There is a pe­riod of my early 20s that I re­ally don’t re­mem­ber,” she said. “That’s my nor­mal, but it is not nor­mal. It’s so (messed) up.”

For the past decade, her life has been a scary nav­i­ga­tion of post­con­cus­sion syn­drome, a maze of headaches, dizzi­ness, mem­ory loss and un­cer­tainty. In March 2009, she slammed her head so hard while snow­board­ing her brain be­gan bleed­ing. She spent six weeks in a hospi­tal. In 2012, fight­ing to es­tab­lish her­self on the pro down­hill moun­tain bik­ing cir­cuit, she crashed and col­lapsed her lungs, an in­jury that masked yet an­other con­cus­sion from the slam. The brain dam­age was pil­ing up.

“I had just had these se­ries of con­cus­sions that I never took se­ri­ously,” she said. “I was so hun­gry and so hell-bent. I was young. I was stupid. Con­cus­sion re­search wasn’t re­ally a thing back then.”

Batty wants more dis­cus­sion about con­cus­sions among all stake­hold­ers in grav­ity sports. She wants federations, gov­ern­ments, spon­sors, par­ents and coaches at the ta­ble. But the move­ment has to start with the ath­letes, she said. She’s help­ing lead the charge, look­ing to in­flu­ence aware­ness of brain safety among the next gen­er­a­tion of up-and-com­ing ac­tion sports ath­letes.

“Hav­ing re­cov­er­ing con­cussed ath­letes talk with kids and get­ting the coaches on board to talk about it in a pos­i­tive way and then giv­ing them a sys­tem that is sim­ple to fol­low, that’s an im­por­tant part of the aware­ness process,” Roal­stad said.

It’s up to ath­letes

Ath­letes, Batty said, need to step up and not just model proper head pro­tec­tion but vis­i­bly step away from com­pe­ti­tion af­ter a head in­jury. The whole “shake it off, bro” men­tal­ity has to stop, she said.

“Un­til ath­letes do their job to pro­tect them­selves, federations and gov­ern­ments can’t do their jobs,” she said. “It’s a mul­ti­prong ap­proach.”

Dorey is step­ping up, telling his story to en­cour­age kids not to just wear a hel­met but rec­og­nize that a brain in­jury needs rest, like any other in­jury.

As a teenager, Dorey would lose mem­ory of a crash that left him con­cussed. The following few hours would evap­o­rate as well. The next day, he would usu­ally feel OK. The more re­cent con­cus­sions, how­ever, re­sulted in lin­ger­ing im­pacts that pro­gres­sively wors­ened, though the hits weren’t par­tic­u­larly hard.

“The stu­pid­est, small­est im­pacts,” he said.

The head tap from a pal. An in­nocu­ous fall on the slope. But the blows would leave him de­bil­i­tated. He would hide in a dark­ened room for a week, then two weeks, then a month, then a year.

Now, 18 months af­ter his last hit to the head, Dorey still gets headaches every day. They worsen if he ex­er­cises. He’s study­ing busi­ness in col­lege in Van­cou­ver and hasn’t no­ticed any cog­ni­tive de­cline, but the headaches are crush­ing.

“Not be­ing able to be an ath­lete in the fu­ture is go­ing to be a re­ally big chal­lenge for me,” he said. “I’ve de­fined my­self as an ath­lete for my whole life.”

He wants the next gen­er­a­tion of win­ter ath­letes to know more about con­cus­sions. Specif­i­cally that each one of those blows piles upon the pre­vi­ous.

“Just know what you are get­ting your­self into, and if you do get a con­cus­sion, treat it se­ri­ously be­cause it’s re­ally im­por­tant to fully re­cover,” he said.

Dorey knows that’s eas­ier said than done. For young ath­letes scram­bling for ex­po­sure in an in­dus­try teem­ing with ea­ger com­peti­tors, there’s a lot of rea­sons to hide a head in­jury. Es­pe­cially when coaches and team doc­tors fol­low strict, of­ten legally reg­u­lated pro­to­cols when it comes to a head blow.

Dr. Moin Salah, a doc­tor who watches over ath­letes at the Dew Tour, which stopped in Breck­en­ridge for its ninth show in early De­cem­ber, said aware­ness of head trauma and its cu­mu­la­tive im­pacts is grow­ing. It’s a cul­tural shift that is re­ject­ing the pre­vi­ous no­tion that no one drops from an event be­cause of headaches.

“Be­fore, it was about keep­ing it quiet and push­ing through,” Salah said. “That’s chang­ing. As soon as you say, ‘Hey, we want to get you to a po­si­tion where you are per­form­ing at the high­est level and you are go­ing to be much more suc­cess­ful if you take care of this in­jury,’ then they will be much more re­cep­tive to the feed­back and buy in to it.”

Even as a vo­cal ad­vo­cate for brain safety, Batty was strug­gling to pro­tect her­self from her­self as re­cently as last spring. Af­ter a year of dili­gent train­ing and a lengthy re­cov­ery from in­jury, she was count­ing on a come­back at the World Cup down­hill moun­tain bik­ing race at the Mon­tSainte-Anne re­sort out­side Que­bec City last spring. That was the race that would reignite her bik­ing ca­reer, which had el­e­vated her as one of the na­tion’s top down­hill rac­ers, renowned for her ag­gres­sive style and speed.

On her third prac­tice run, she tum­bled down a rock face. It wasn’t a big crash, she said, but at the bot­tom of the course she felt her vi­sion blur­ring and synapses slow­ing. She tried to ig­nore the tell­tale signs of her con­cus­sion.

“I was not walk­ing into that clinic,” she said. “That’s the dis­par­ity of an ath­lete’s de­sire to win. I had trained so hard for this race. This was my race.”

She called a friend. He no­ticed her slur­ring her words. He per­suaded her to get checked out. At the clinic, the doc­tor quickly noted her di­lated pupils and slurred words. But she aced the mem­ory exam be­cause she had mem­o­rized the test. The doc­tor pulled her from the com­pe­ti­tion.

“It broke my heart, but that shows the dis­so­nance from what I want and what’s ul­ti­mately good for my brain,” she said. “I’m still so sad that I self-re­ported, but that’s a small part of me. On the other hand, I’m so glad that the sys­tem works when you self-re­port. But ath­letes won’t start self-re­port­ing un­til federations stop treat­ing their ath­letes like a re­place­able com­mod­ity.”

Justin Dorey crashed dur­ing the ski­ing su­per­pipe fi­nals at the 2012 Win­ter X Games in As­pen. Dorey, now 28 and re­cently re­tired from pro­fes­sional ski­ing, gets headaches every day. And they worsen if he ex­er­cises. “Not be­ing able to be an ath­lete in the fu­ture is go­ing to be a re­ally big chal­lenge for me,” he says. AAron On­tiveroz, Den­ver Post file

Justin Dorey crashes dur­ing the ski su­per­pipe fi­nals at the 2014 Win­ter X Games in As­pen. “Just know what you are get­ting your­self into, and if you do get a con­cus­sion, treat it se­ri­ously be­cause it’s re­ally im­por­tant to fully re­cover,” he says. Ma­hala Gay­lord, Den­ver Post file

Dave Mirra, the BMX leg­end whose road to 24 X Games medals in­cluded many con­cus­sions, died of a self-in­flicted gun­shot at age 41 last Fe­bru­ary. Ed­ward A. Or­nelas, San An­to­nio Ex­press-News

Daniel Petty, Den­ver Post file

Justin Dorey, now 28 and re­cently re­tired from pro­fes­sional ski­ing, catches big air while com­pet­ing in ski su­per­pipe at the 2012 Win­ter X Games at But­ter­milk Moun­tain in As­pen. As a teenager, Dorey would lose mem­ory of a crash that left him con­cussed. The next day, he would usu­ally feel OK. But his more re­cent con­cus­sions re­sulted in lin­ger­ing im­pacts that pro­gres­sively wors­ened, though the hits weren’t par­tic­u­larly hard.

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