The information on the screen in the Bedford High School auditorium was as jarring to Alex Starr as the hits he had taken on the football field months earlier.
Starr, a sophomore at Bedford High, was in the audience earlier this week listening to a presentation about sports head injuries. The featured speaker was Chris Nowinski, a former Harvard University football player and World Wrestling Entertainment performer who has suffered at least six concussions. He eventually retired from wrestling because of the lasting effects of his head injuries.
Nowinksi is the author of the book Head Games: Football's Concussion Crisis. He's also the president of the Sports Legacy Institute, which studies the effects of concussions and other sports-related brain injuries.
And on this night in Bedford, Nowinski wanted to impart a lesson to the athletes in the audience: Concussions can be a serious issue, and if they aren't properly treated with rest, they can lead to long-term problems such as headaches, memory loss and depression. In severe cases, he said, citing studies done by doctors, multiple
concussions have been linked to death.
But, he reminded the crowd repeatedly, with enough rest and medical guidance, athletes can get back on the playing fields after a head injury without fearing further risk to their health. Athletes, however, have to know the symptoms and be honest enough to report them to coaches, trainers or parents.
"Take ownership of your health," Nowinski said.
The message was an eye-opener for Starr. This past fall, he suffered three concussions while playing running back for Bedford's varsity team. As someone who has had multiple concussions, he was familiar with the term "second-impact syndrome." Yet he didn't know the extent of its dangers.
"Before this," he said, "I never knew that anybody could be killed from second-impact syndrome."
Devastating consequences
After Nowinski was diagnosed with post-concussion syndrome and was forced to retire from WWE at age 24 in 2003, he began researching head injuries. He found research linking multiple concussions with serious long-term neurological disorders such as Alzheimer's disease, memory impairment and depression.
In 2006, his book Head Games was published. In 2007, he helped found the Sports Legacy Institute along with Dr. Robert Cantu, the chief of neurosurgery service and director of sports medicine at Emerson Hospital in Concord, Mass.
Early last year, Nowinski heard about the suicide of former Philadelphia Eagles and Arizona Cardinals safety Andre Waters. Suspecting that Waters's history of concussions may have been linked to depression, Nowinski asked Waters's family for a sample of his brain tissue.
Bennet Omalu, a Pittsburgh neuropathologist, analyzed the tissue and found that it resembled that of an 85-year-old man and showed early indications of Alzheimer's. Omalu has also analyzed the brain tissue of three deceased former Pittsburgh Steelers offensive linemen who all suffered from head injuries - Mike Webster, Terry Long and Justin Strzelczyk. Webster died of a heart attack amid significant psychological problems in 2002, Strzelczyk died following a high-speed chase with the police after suffering from an apparent mental breakdown in 2004, and Long committed suicide in 2005.
Omalu found that all four of those ex-NFL players had a condition called chronic traumatic encephalopathy (CTE). He says each of their deaths followed a similar pattern: concussions, which led to brain damage, which led to depression.
The Sports Legacy Institute also played a role in the examination of WWE wrestler Chris Benoit, who killed his wife and child before committing suicide last June. His brain also showed extensive signs of CTE.
During his presentation in Bedford this week, Nowinski talked about those deaths and the medical findings linking them to head injuries. And he also provided information that hit closer to home - to the high school athletes, parents and coaches in the audience. According to a 2007 New York Times article, since 1997, at least 50 high school-aged or younger football players have been killed or have suffered serious head injuries on the field.
Dr. John Pettinato of Concord Hospital Neurology Associates said those statistics shouldn't frighten athletes and their parents, but they should make them take notice of the dangers of concussions.
"You have to take those kind of statistics with a little bit of caution because you don't know exactly what caused the death," he said. "However, I still think there's probably a lot more head injuries in high school (kids) and younger (kids) that we are probably not paying attention to.
"I don't think it's alarmist," Pettinato continued, "but we should pay attention. We should pay attention when kids get knocked around. When they lose consciousness it's straight-forward, but when they get dazed, we're a little more lax. I don't think we should be alarmed about it, but we should be vigilant."
Changing times
When Starr suffered his first concussion last year in the season opener, he ended up in the hospital that night and eventually sat out four weeks before he was cleared for contact. He was hurt again in his first practice back and missed an additional few weeks. He finally got back into a game in the season finale, and promptly suffered another concussion.
Throughout the season, his condition was carefully monitored by the Bedford medical staff, according to Bedford Athletic Administrator Thor Nilsen.
"Trying to keep him contained was sometimes difficult," Nilsen said. "He was one of those kids, he didn't want to displease the coach, didn't want to lose his position. He wanted to (play). But the medical staff was totally on board with all of this."
Starr acknowledged that he felt peer pressure to get back because the team was struggling.
"Some of my friends' parents (said), 'Alex you gotta get back. Come on, we need you,' " he said.
Yet Starr sat until he was cleared by the trainers.
Indeed, the culture surrounding head injuries appears to be changing.
"It's too early for any great statistics on how things have changed," Nowinski said. "I know more athletes are coming forward and ... the media isn't letting anyone get away with anything anymore. In the old days a coach would say, 'don't worry, he'll be back on the field tomorrow.' "
Concord High Coach Bob Camirand, who has been on the Tide sideline for 22 seasons, the last 14 as head coach, acknowledges how much the culture of injuries has changed through the years.
"Any time a kid came out of a game 35, 40 years ago, it was a sign of weakness," he said. "Fortunately we've become more in tune with the athletes. At Concord we don't put a kid back on the field back until he's been cleared by a trainer." Bow High trainer Cliff Chaluda, however, says that trainers are still learning when it's safe to put a player back in after a concussion. "There's still misinformation, sometimes even as high as a doctor, about when it's okay to go back in," said Chaluda, who has been at Bow for nine years. "My standard is if they show symptoms, we're not going to return them to play that day. If they show any dizziness, any difficulty remembering, any headache, we pull them from the remainder of the game." Afterward, the trainer will follow up with the parents to check on the athlete's condition, and then, depending on the severity of the symptoms, they would require a physician's note to return to regular participation. Camirand said a Concord player who suffers a concussion misses at least one game, then needs medical clearance to return. But trainers can only help so much. According to the National Athletic Trainers Association, only 42 percent of high schools in the United States have access to a certified athletic trainer. And, as Nowinski says, head injuries can be an invisible injury known only to the affected athlete. "That's why you have to work so much with coaches and athletes to take ownership," Nowinksi said. "You are the one who has to deal with it. It's your brain, it's your pain." Nowinski, who suffered his first two concussions while playing for Harvard in the late 1990s, said players need to speak up, to not be afraid of losing playing time, of disappointing coaches. "Ten years ago, if you don't suck it up, you don't deserve to be on the field," he said. "Players bought into that, as well. We wouldn't tell anybody when our heads hurt. If you were an offensive linemen, other offensive linemen would point at who to block, instead of telling (you) to get off the field." Starr, who will play lacrosse this spring and plans to play football in the fall, said he won't fall into that macho trap. He said he wouldn't hesitate to confront a teammate if he suspects there's been a head injury. "Definitely," he said. "Because they could die with that second impact if they want to keep playing, if they want to be the hero. Obviously I don't want my friends, my teammates to get hurt." (Jeff Novotny can be reached at jnovotny@cmonitor.com.)
