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Head games

T.J. Lavin is still recovering from a head injury suffered at October's Dew Tour Championship. Justin Kosman

It was one of the simpler maneuvers he had attempted in a 14-year professional BMX dirt-jumping career. But while performing a nac nac combination during qualifying at the Dew Tour Championships last month, T.J. Lavin failed to get his feet back on the pedals before landing, sending him headfirst over his handlebars into the flat. Lavin, 33, who won two gold medals (1997, '98) and one silver medal (1996) in dirt at the X Games, wound up in a medically induced coma at University Medical Center in Las Vegas. He sustained bleeding on his brain and a broken wrist and orbital bone.

Lavin, who lives in Las Vegas, checked out of University Medical Center last week after nearly a monthlong stay and doctors expect him to make a full recovery. Yet his brain injury is just the latest of several high-profile examples in action sports during the past year. They come at a time when studies demonstrating a link between cumulative concussions and degenerative brain disease later in life have spurred rules changes in professional sports leagues such as the National Football League and National Hockey League.

Action sports athletes have taken notice.

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I was always in a total rush to get back. I never knew what it meant to get a concussion, and the seriousness of having one. I was never educated about that stuff.

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-- Kevin Pearce

"It's crazy how in the NFL these guys are getting head injuries and they were not really making a big deal of it, and now they're starting to realize what happens to people who get repetitive concussions," says Kevin Pearce, who was favored to win a medal in Olympic halfpipe snowboarding earlier this year until he sustained a traumatic brain injury following a fall in December 2009.

Pearce referred to research showing that athletes who sustain multiple concussions during their careers are at increased risk for chronic traumatic encephalopathy -- known as CTE -- a degenerative brain disease with symptoms similar to Alzheimer's. The brains of several former NFL players who exhibited a range of cognitive and neurological problems during their lives were examined after they died and exhibited CTE, a condition more commonly associated with boxers.

"KOs are what I fear more than any other injury," Travis Pastrana, whose motocross stunts and crashes have earned him a reputation for injuries and fearlessness, says by e-mail.

The relationship between blows to the head and CTE remains a subject of continued study; 400 former and current athletes have agreed to donate their brains after they die for research at the Center for the Study of Traumatic Encephalopathy at Boston University Medical Center. So far none has come from the action sports realm.

"These people don't need to worry about somebody else hitting them, but they do need to worry about all of their faculties, especially balance and judgment, visual perception and so on being perfectly 100 percent as good as it can," says Dr. Robert Cantu, a professor of neurosurgery and part of a team at Boston University Medical School that helped establish the link between multiple concussions and CTE. "These people are carrying out very dangerous stunts and if they're doing it impaired, they're courting greater disaster than they would if they weren't impaired."

Pastrana, 27, does not know the number of concussions he has sustained in a career that has spanned two decades across motocross, freestyle motocross and rally car racing, but he knows he has been knocked unconscious more than 20 times.

"My worst symptoms were a spell of three weeks throwing up regularly," Pastrana says. He has learned to wait until symptoms pass before he rides again. In 2001 he sustained three blows to the head in succession during the outdoor national motocross championships and could "barely walk down my driveway to get the mail without passing out from what felt similar to exhaustion. I had to take six months off before I felt normal again."

Pearce reckoned he had about six concussions during his snowboarding career. But they seldom slowed him down. "I was always in a total rush to get back," he says. "I never knew what it meant to get a concussion, and the seriousness of having one. I was never educated about that stuff."

In December 2009 Pearce sustained a concussion at a Grand Prix event at Copper Mountain, Colo., where results would determine the selection of the U.S. team at the Olympics. "That was on a first run, and I actually took another run after that which is completely insane to me," Pearce says about pressure he felt to qualify for the Games despite being impaired.

Three weeks later, on Dec. 31, Pearce sustained a career-altering injury during practice on a halfpipe in Park City, Utah, when he struck his head while attempting a double cork, a difficult inverted maneuver. He was wearing a helmet. Pearce spent a month at the University of Utah Hospital before beginning rehabilitation at Craig Hospital in Denver. In May he returned home to Norwich, Vt., where his rehabilitation continues.

Now Pearce wonders whether his earlier concussion contributed to his more serious brain injury. "I don't know if this would have been the outcome if I didn't have that," he says.

In the run-up to the Olympics in February, several snowboarders sustained blows to the head.

Torah Bright of Australia sustained three concussions in the five weeks before the Games. Bright, 23, rested for 10 days following the first. The next two came in three days during practice at the Winter X Games and she spent two weeks resting at home in Utah. Bright arrived in Vancouver and was cleared to compete following neurological testing and showed no ill effects from her concussions, stomping her signature backside 720 to win a gold medal in women's halfpipe.

Shaun White famously slammed his face against the halfpipe during practice at the Winter X Games in January while attempting a double McTwist 1260 during practice. His helmet flew off but White was cleared to compete in the final later that night and won. Weeks later he won an Olympic gold medal, too.

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Live the rest of your life wishing you went for it? Or live the rest of your life not remembering you did? Most athletes who make it to a championship situation would probably rather live with the latter.

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-- Travis Pastrana

In BMX, Lavin is just the latest athlete to sustain a serious blow to the head. During BMX Street practice at the X Games in July, Van Homan fell and struck his head. He was not wearing a helmet. Homan, 30, who won silver (2008) and bronze (2009) medals in Street at X Games, cracked his skull and sustained a brain injury. He spent nearly three months recovering before he rode his bike again.

Unlike with Lavin's or Homan's injuries, it's not always obvious if an athlete is impaired following a crash.

"If they do have a head injury, are they very carefully worked up and checked out before they're allowed to go back and do their stunts?" asks Dr. Cantu. "Because they're pretty much largely on their own, without like a quote-unquote team physician looking out for them."
Both X Games and the Dew Tour have implemented protocols to evaluate athletes following a slam.

"It's very simple: What we do is we go through a standard neurological evaluation," says Dr. David Chao, chief medical officer for the X Games and team doctor for the San Diego Chargers. "We have athletic trainers and staff at multiple practices and every event as well."

At X Games, athletes undergo a battery of tests for balance, memory and coordination to determine if they have a concussion. The policy at the Dew Tour is similar.

"We had to put in certain standards so if something happens on sight, now we have control of the situation," says Rick Bahr, president and CEO of Winning Medicine International, which contracts to provide medical service at the Dew Tour. "We can say, 'Look, you're not going to go for X amount of hours, or days, or what have you.' That is our way of handling the situation."

At both the X Games and the Dew Tour, if doctors feel an athlete is impaired, they can hold the athlete out of competition. That's what happened to freestyle motocross competitor Jackson Strong at the X Games in August. Strong, 19, of Australia, fell hard during practice and hit his head. A doctor recommended he not ride again for weeks, according to Paul Taublieb, motocross sport organizer at the X Games.

"These kids are really tough," Taublieb says about the decision to bar Strong from competition. "Injuries are like going to 7-Eleven for them, and there's a 'red badge of courage' factor as well."

Chris Stiepock, ESPN vice president for content and sponsorship at X Games, says: "The fact we're only four days a year for these guys, a lot of them might carry injuries into the X Games. But it's stated loud and clear on paperwork that they sign: If our medical team says they're not fit to go, they're not going to go."

Requiring helmets has been another way to protect athIetes. In 2009 the Winter X Games mandated helmets for all athletes and the Dew Tour followed suit last season after Pearce's fall.

"They guaranteed me that if I didn't wear a helmet I'd be dead right now," Pearce says about his doctors.

Gary Young won a bronze medal in BMX Park at the X Games last summer while wearing a helmet. In 2007, Young slammed while riding on the street without a helmet, striking his head and fracturing his skull in three places. Blood poured from one of his ears and he spent three days in intensive care.

Ever since, Young, 27, always wears a helmet while riding his bike, a choice that still carries a stigma in his sport. "I've gotten crap from some of my friends for wearing a helmet before," he says.

Although ambivalent, Young says "in contests, a helmet should be mandatory."

But across action sports, where individuality is prized, many are uncomfortable with rules or restrictions.

"I respect that everyone should wear a helmet, like I wear a helmet," professional snowboarder Keir Dillon says. "But I don't think it should be mandated. For me, I always get worried about mandating or having governing bodies over our sport."

Without a governing body or players' association, individual athletes determine the level of risk they're willing to take, Chris Nowinski, co-director of the Center for the Study of Traumatic Encephalopathy, says. Nowinski's career as a performer with World Wrestling Entertainment ended following a concussion in 2003, one of several he had sustained during years of playing football and wrestling.

"With extreme sports, one half of the argument says that adults can do risky jobs if they're aware of the risks and reasonable measures are taken to protect them," Nowinski says. "Whether you're talking about firefighters or you're talking about miners, there are protections in place with governing bodies. I don't necessarily have a problem with extreme sports. But when you watch some of the tricks and you look at the arc in growth of risk, you realize you need some group of people sitting down and asking, is it worth it?"

For action sports athletes, it has always been a fundamental question.

"I don't feel like anything changed a lot in our world, or the risk of injury," Tony Hawk says. "All along that's something that's a concern in our sports. I feel like our sports are as safe as you want them to be. It's on the person. There's no coach telling them they have to get back in there. There's no team relying on them for their success. It's just a different approach how we do it. There are plenty of guys who do it to a fault, who just get back in there too soon."

Pastrana explains why an athlete would intentionally risk potential brain damage.

"When everything is on the line, the chances of an athlete being honest with their coaches or themselves is slim to none," he says. "But at the end of the day, they are the ones who will have to live with the decisions they've made.

"Live the rest of your life wishing you went for it? Or live the rest of your life not remembering you did? Most athletes who make it to a championship situation would probably rather live with the latter."