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 Kari's brother, J.W., won an Olympic silver medal with the U.S. water polo team.
As a sophomore at Foothill High School in Orange County, Krumpholz 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 at UCLA.
During a UCLA practice in February, Krumpholz was defending "one of the strongest girls on the team" when she got clocked between the eyes by her teammate's elbow. She 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, Krumpholz wasn't doing so well the next day. "I went to class and I knew something was wrong," she recalls. "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, between nearly daily visits to various UCLA physicians, as well as Orange County's Migraine & Headache Center, she's still experiencing symptoms.
To Krumpholz's knowledge, this was the first concussion she'd suffered. "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, Krumpholz, a sophomore majoring in psychology, sounds doubtful that 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."
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 conducted a nationwide investigation into the consequences of concussion on youth athletes. We found the following:
• The effect of a concussion on kids can be much more devastating than on adults. Doctors say that until a person reaches 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 sure way to measure the effects of concussions, shows that repeated blows to the head may be linked with Alzheimer's, Parkinson's, ALS and a number of other fatal diseases.
• An athlete who doesn't exhibit headaches, dizziness, vomiting, temporary amnesia or other outward signs of concussions still can experience changes in brain activity similar to those in a player who has been clinically diagnosed with a concussion.
• 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.
• 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 have concussion laws in place. (California, however, does not.)
As attorneys debate how the new concussion laws will play out, parents are struggling with a growing awareness that if they push their children to be standouts in athletics — sometimes the key to a better future — the cost might be irreversible damage.
Is the risk worth it?
The answer is "no" for NFL Hall of Fame quarterback Troy Aikman. The former UCLA star says that on the basis of his own concussion episodes, he will never allow his kids to play a contact sport.
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, told her parents the sting went away after a while.
Yet, two days later, on the way to a game, Champness complained of a headache and dizziness, says her mother, Kim Champness. During play that day, the ball was kicked in the air and "brushed across the front of [Ali's] face," Kim recalls. "It was not a hard hit at all, but right after that, she started stuttering."
Champness saw a doctor, who discovered 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.
"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."
This lack of awareness could be seen in training rooms of every sport, and high-profile athletes such as boxer Muhammad Ali and All-Pro safety Dave Duerson returned to action prematurely. Years later, they essentially lost their minds. Until a few years ago, the NFL's medical committee on concussions was publishing studies that concluded players were not suffering long-term damage from head trauma suffered in athletic competition.
Today, the U.S. Centers for Disease Control and Prevention estimates that as many as 3.8 million sports- and recreation-related concussions occur each year. Those result in about 235,000 hospitalizations and 50,000 deaths annually, the CDC says.
Nowinski, a former World Wrestling Entertainment pro and author of Head Games: Football's Concussion Crisis, founded the Sports Legacy Institute with noted neurosurgeon Dr. Robert Cantu. The foundation works with Boston University's Center for the Study of Traumatic Encephalopathy in performing postdeath pathology exams on brains donated by former athletes.
One of the latest specimens examined was that of Duerson, the former NFL standout. On Feb. 17, following years of dementia and depression, Duerson shot himself to death — in the chest, so his brain would be preserved. Neurologists later confirmed that Duerson, who had played for the Chicago Bears, the New York Giants and the then–Phoenix Cardinals, had 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 an 80-year-old's.
These findings have helped turn the National Football League from concussion skeptics 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 video games: 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 75 former NFL pros who sued the league in July, alleging it had 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. (At 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. A week later, the young fullback again hit his head during a game.
The blow was unremarkable, but Jake staggered to his feet and fell down. He never got back up, and was declared dead the next day 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 young 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 UCLA Brain Injury Research Center. This includes the brain of Matt Blea, who nearly died on a California football field two years ago.
On Thanksgiving Day 2009, Blea, a 16-year-old junior and starting running back for San Jose High, was hit while trying to catch an underthrown pass. Despite his modest 5-foot-5, 140-pound frame, Blea 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 Blea jumped for the errant pass, an opposing player cleanly and legally put his shoulder into his midsection. Because Blea was unable to brace himself, his head whiplashed against San Jose City College Stadium's artificial turf.
"I knew instantly something was wrong," says his father, Dave Blea, a former defensive coordinator for the team. "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, Blea crawled to the sidelines and lost consciousness. After paramedics tried unsuccessfully to revive him, Blea was rushed away for emergency brain surgery.
The boy remained comatose for 10 days. "They thought that he had suffered so much brain damage that he probably would have been mentally disabled," his dad says.
Blea would spend nearly a month in intensive care. His first concussion, suffered three weeks before the first, had not been detected, even after his father took him to a doctor after Blea said he felt "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," his father says. "He passed all of his neurological tests. I guess he was misdiagnosed."
Blea was paralyzed on the right side of his body for more than a month. "I don't remember much at the hospital," he says now. "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 his physicians, Blea recovered. The high school graduate soon will attend De Anza College in Cupertino to start a hoped-for career in physical therapy, a profession he never considered until after his injury. His first choice was to become a paramedic, but he's been told that's impossible because his right eye remains half-blind.
As for Ali Champness, she sat out the rest of the season on the advice of Dr. Mark Ashley — co-founder and head of the Centre for Neuro Skills, which has clinics in Bakersfield and Irving, Texas, specializing in traumatic–brain injury rehabilitation. Champness joined the school's swim team, but after three weeks she 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 a CAT scan revealed bleeding in Champness' brain. A cardiologist found that the initial concussion had deregulated Champness' autonomic nervous system. For months, whenever she jogged on the treadmill, her heartbeat soared high enough to trigger cardiac arrest or stroke. Champness still goes to rehab three hours a day.
Among other severe cases Ashley has handled was one dating back five years, which involved Zackery Lystedt, a 13-year-old football player from the Seattle suburbs nicknamed "Ray Ray" after his idol, rampaging Baltimore Colts linebacker Ray Lewis. In the second quarter of a game, Lystedt fell backward 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.
Lystedt 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, Lystedt 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 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 survived, but his serious health problems continue.
Concussive episodes in youth aren't limited to soccer and football players, says Dr. William Jones, a staff physician at the Memorial Hermann Sports Medicine Institute in Houston. In recent years, due partly to better detection, Jones has witnessed a staggering increase in concussions, even in high school cheerleaders and 10-year-old gymnasts.
Because of this, 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 too expensive for some districts. And many of those that do buy the program cannot afford to pay a specialist to administer it. Instead, that duty tends to fall on coaches or trainers, who often are unqualified to conduct the test. As shown in a case in the New York City suburbs, the results can be tragic.
In 2008, Ryne Dougherty, a 16-year-old high school linebacker in Essex County, N.J., 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; he died within a week.
Dougherty's ImPACT results were ominously low, the family has claimed in a lawsuit against the school district. Additionally, according to the test results, Dougherty reported feeling "foggy" but still was cleared to play.
"Fogginess is the lead predictor of lasting head trauma," says Beth Baldinger, the attorney representing Dougherty's family in a suit against the district. "This case screams ignorance."
Michele Chemidlin, the trainer who administered the test, did not respond to phone messages and an email requesting comment for this story. She told Sports Illustrated that Dougherty's test was interrupted by a "disruptive" teammate, which made the results "invalid." But Baldinger says the trainer retracted that story in a recent deposition.
"She testified that she never even bothered to see Dougherty'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 by a medical professional.
"It's better than nothing," says UCLA's Hovda 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 so that if he takes postconcussion tests, the results won't look as bad. NFL Commissioner Roger Goodell later said that cheating on concussion testing is an issue the league must 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 still can experience fundamental brain changes that may be detrimental.
For two seasons, three Purdue professors tracked every practice and game hit sustained by 21 football players at Lafayette Jefferson High School in Indiana. "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.
Florida is one of the few states to balk at concussion legislation for youth athletes, a nationwide trend that started in 2009 when Washington gave a thumbs-up to the Zackery Lystedt Law. A prototype for dozens to come, that legislation requires that any athlete younger than 18 who suffers a suspected concussion receive written consent from a medical professional before returning to play. (There is no similar federal law.)
In Texas, Natasha's Law, named after a soccer player who suffered brain damage, was signed by Gov. Rick Perry in June after the Senate passed the bill by a 31-0 margin. And, beginning Jan. 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 state Sen. Dennis Jones (R-Seminole), a chiropractor, was miffed that the language did not include the back-cracking set among "medical professionals." Jones' view is that, "As chiropractors, we've been treating head injuries since 1931. The symptoms of a concussion are not that difficult to diagnose."
California's concussion legislation has been in the works for the past two years but, due to financial constraints, has not made it out of committee.
As more and more states enact concussion laws, medical professionals, athletic trainers and school administrators are wondering if these laws actually will help prevent a condition that's inherently difficult to detect.
St. Louis University's head athletic trainer, Anthony Breitbach, says the concussion law in Missouri "comes up a little short 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 follows 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 Gov. 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; that caused an AIA attorney to threaten legal action. The two since have made up and are partnering to test all Arizona contact athletes during the 2011-12 school year, starting with football.
Steve Hogen, athletic director of Mesa Public Schools, had concerns with Arizona's law even before it passed. "It put the burden on us that we had to make sure that all Pop Warner football kids were tested," Hogen says. "That's impossible. 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 declined to comment about specific clients, a records search shows that he defended La Salle University in a lawsuit filed by the family of a former player. Preston Plevretes claimed that he had suffered 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 frightens me." He says sports organizations say they don't have a plan and that "an athletic trainer is too expensive."
Randall Scarlett of the San Francisco–based Scarlett Law Group admits it's a "dismal state out there in terms of concussion protocols that coaches and others are to follow." However, Scarlett doesn't think there will be a deluge of lawsuits if and when the state's bill is approved.
"In California, you're not going to get litigation unless you get some pretty egregious facts, because of the burden of proof and the lack of standards for non-physicians," he says.
Before concussion laws came into vogue, the mother of Illinois high school football player Demond Hunt Jr. took her son's coach and the local school district to task in a lawsuit.
In 2008, Hunt, a 16-year-old linebacker for East St. Louis High School, collapsed on the sidelines during a game. A blood vessel had burst in his brain, which sent him into multiple seizures and strokes.
Earlier in the game, Hunt had complained of a concussionlike headache to his coach, who told him in so many words to suck it up and keep playing, the lawsuit alleges. The case is pending.
The parents of Zackery Lystedt of Seattle also sued on their son's behalf. He was airlifted on life support to a Seattle ER, where surgeons removed the top of his head. He wasn't expected to regain consciousness.
The milestones that have come since then have been both miraculous and frustratingly glacially paced. Nine months after the strokes, Lystedt had resumed speaking. By 13 months, he moved his left arm. After 20 months, he could once again eat. Now, five years later, Lystedt, age 18, 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."
Lystedt's parents, whose lives have been completely changed as they have cared full-time for their son, sued the school district for allowing him to play through his injury. The district settled, with one of its lawyers shrugging 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."
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, or old kind of sword-fighting stuff," the gregarious Minnesotan says.
And, like seemingly every other man, woman and child in the iced-over town of New Prague, 45 miles south of Minneapolis, Meyer 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. Meyer told the coach she was fine and played the rest of the game.
When she went to the nurse complaining of 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 4, at the pond near my house," Meyer explains. "It would've just felt weird not to play hockey."
Ten months later at a high school team practice, she was doing a drill she calls "mountain climbers," a sort of butt-in-the-air push-up on skates. Meyer was exhausted and her arms slipped, her forehead smacking 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 her mother, Mandy Meyer, received a frantic call to come to the arena.
Her daughter'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. Meyer's coach's solution, according to Mom: "Put a helmet on her. Let her skate through it."
But Meyer's head was too sensitive for her to even bear a helmet. She hasn't played hockey since. A year and a half since that second concussion, Meyer remains hobbled by excruciating headaches and intolerance to noise.
Her 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 10 days, others said three months," says the Texas Medical Center's Jones of information from a medical conference he recently attended. Dr. 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."
Those who decide to stick it out may 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 each other at top speeds.
Other organizations are relying on updated helmet technology to try to prevent concussions. Even though it's impossible to eliminate all head trauma in football, helmet manufacturer Riddell has redesigned and released several types of helmets over the last 20 years.
For the 2011 season, each varsity player for Houston-area football powerhouse Katy High School will don the brand-new Riddell Revolution Speed helmet, which costs $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.
Every summer, as football season approaches, parents desperate for their freshman enrollees to gain competitive advantage call Landers to ask his advice on the types of helmets to 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 believes that Texas' 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. 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 team's playoff push, was deemed unfit to continue playing football.
Though Landers realizes the doctor's decision probably was the right call, he still feels like he screwed up. "I still feel badly because he'll never get to experience what it's like to play in a Texas [high school football] playoff game," he says through teary eyes.
Former hockey player Kayla Meyer, unable to take the clatter of hallways or lunchrooms at her Minneapolis-area school, gets to her classes five minutes late and leaves late as well. She has missed 75 school days in two years. She eats lunch alone. Once a popular girl, she has been abandoned by all but a couple of her friends, so now Meyer mostly hangs out with her mother's friends.
Her plan had always been to become a veterinary technician so that she could take over the family business, a dog kennel on their farm. But now Meyer can't take barking. She can't ride horses because the motion makes her sick. And when reading, she has difficulty processing individual words on a page.
"I have reading glasses, but I always forget them and then I can only stand reading without my glasses for a couple of minutes, before the pain gets too bad," she says.
The Meyers don't have health insurance. Sending their daughter to specialists is leaching the family's finances. Though they try to keep it from her, she's noticed that the ATV and the horse trailer have gone missing, pawned by her parents for cash. Next will be the horses, and one day maybe the farm itself.
There's no end in sight for Meyer's condition. "The physical therapists used to give us targets," Mandy Meyer says. " 'It will be two weeks, two weeks.' Now they don't give her targets, because she's missed so many of them."
Though Mandy declares that her daughter's concussion was "handled horribly inappropriately," she won't consider a lawsuit. "There are just too many people who messed up," she says, including herself in that assessment.
In April, the teen testified in front of the Minnesota Senate Education Committee in favor of a concussion bill, which would educate coaches and trainers and restrict when students can return to play. The lights and noise of the Capitol in St. Paul were a gauntlet for Meyer, but the bill passed.
She doesn't blame anybody for her condition. "My coaches are awesome," she says. "They just weren't informed enough."