Eugenie Bouchard, Casey Dellacqua And Concussions In Women's Tennis

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Casey Dellacqua suffered a concussion from an on-court fall in October. She already has pulled the plug on her January schedule.

Sprained ankles? Yup. Torn rotator cuffs? You know it. Pulled hamstrings, strained abdominals, sprained wrists, stiff knees, inflamed backs? Check, check, check, check and check. The list of ailments tennis players deal with over the course of their brutal year-round seasons reads like a human anatomy textbook.

Now, it seems, we need to add a chapter on concussions.

While brain trauma caused by a blow to the head will never be an everyday occurrence in an individual, non-contact sport such as tennis, two high-profile cases invaded the WTA Tour in 2015 and will linger into at least the start of 2016.

Australian Casey Dellacqua, who made it to the doubles final at both the French Open and US Open this year, suffered a season-ending concussion in October from an on-court fall in Beijing. Earlier, Canadian star Eugenie Bouchard fell in a US Open locker room that led to her fourth-round withdrawal from the year's final major.

Even as concussions have become part of our pop-culture lexicon -- prompting rule changes and new medical protocols in sports, not to mention the upcoming movie "Concussion," starring Will Smith -- there are still those who think head-injury awareness has morphed into hypersensitivity. So-called "old-school" sports fans remember the days when athletes played through serious physical issues without regard to potentially dangerous long-term consequences. In tennis, where there is little risk of a repeat injury, some fans struggle to sympathize with lingering concussion symptoms such as dizziness, headaches, visual disturbances and memory loss as players attempt a return to the tour. How bad, they say, can it be?

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On the night of her accident, Bouchard returned to the US Open training room for an ice bath after the staff had left for the day, according to a member of her team. A dark room and a recently mopped floor allegedly led to a backwards fall, a blow to the back of her head and an end to her disappointing 2015 season. A month later, the 21-year-old retired from her comeback match in Beijing, citing dizziness. She hasn't played competitively since.

Sentiments like the following from an online commenter have been echoed by casual observers of the Bouchard case: "I've never really known someone to need this long to recover from a concussion brought on by a fall. Sure, a car accident or something like that. Perhaps she's just trying to gather herself after the whole incident and this terrible year."

AP Photo/Andy Wong

Eugenie Bouchard shut her season down after a scary comeback attempt in Beijing.

Dr. Summer Ott, neuropsychological consultant for the Houston Texans and Houston Rockets, as well as the director of the Memorial Hermann IRONMAN Sports Medicine Institute's Sports Concussion Program, is all too familiar with concussion skeptics.

"Would you want your ACL surgical repair conducted with 20-year-old technology?" Ott asked, explaining how she addresses doubters. "Most people are going to say no. You wouldn't care for your brain in an antiquated way, either."

The American Academy of Neurology first released standardized guidelines for grading and managing concussions in 1997. That blanket system of evaluation was largely overhauled in 2013 in favor of a more individualized approach. The revised standards recommend that any athlete thought to be experiencing concussion symptoms be removed from competition immediately, giving no set timeline for a return to play.

Part of the challenge, experts say, is that unlike traumatic brain injuries, concussions leave no pathological findings on traditional neuroimaging tests such as CT or MRI; nothing that doctors can use to definitively diagnose their severity or predict recovery time. Medical professionals have years of research and empirical evidence proving that whether you're a football player, a tennis player or have no athletic background at all, concussions can be life-altering.

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Pittsburgh Steelers quarterback Ben Roethlisberger was battered -- taking rattling hit after rattling hit -- during a Nov. 29 game against the Seattle Seahawks. Finally, after a shot to the head in the fourth quarter, he took himself out. Compared to the violent impacts like those in football -- and similar collisions in hockey and soccer -- Bouchard and Dellacqua's falls may seem innocuous.

But Ott says a fluke injury can be even more dangerous than the blows we see in contact sports.

"If you're a lineman and you're going toward someone to block them, you're naturally tightening your neck muscles and bracing for that impact," Ott said. "If you think about something like a car accident, there is nothing you are doing with your body to soften that blow.

"When people fall and hit the back of their head, those concussions can be pretty nasty because they affect so many things like our sleep-wake cycles, our nausea centers and our visual-motor cortex," Ott continued. "Sometimes it's more about region of the hit than the sport you're playing."

While rare in tennis, Dellacqua and Bouchard aren't the first WTA athletes to battle concussion-induced layoffs. As a 17-year-old, American Lauren Davis, now 22, was briefly knocked unconscious when lighting and video equipment fell on her head during a 2011 interview. In addition to sitting out for nearly three months with intense headaches, she experienced emotional effects, which were later diagnosed as post-concussion syndrome.

Sometimes it's more about region of the hit than the sport you're playing.
Dr. Summer Ott

"I suffered the worst anxiety everywhere," Davis said at the 2014 Miami Open. "If it weren't for my faith and the people God put in my life, I would have quit [tennis] so long ago."

With the rise in concussion awareness, most are familiar with the general symptoms, but the length of time necessary for recovery varies.

Former world No. 1 Victoria Azarenka tripped and hit her head during her off-court warm-up before her second-round match at the 2010 US Open. Disoriented, she fell to the ground just 30 minutes into the contest and left the stadium in a wheelchair.

"When I got a concussion, I was racing to the court 15 minutes after I fell, so that's why I collapsed," Azarenka explained. "That probably wasn't a very smart move, but I didn't know what I had at that moment."

Azarenka was lucky. She had no lingering effects and took a week off before hitting the courts again with a clean bill of health. But a premature return to competition can have serious consequences.

"Athletes are sometimes rushed back even faster in sports like tennis and golf because they think, 'Well, I'm not heading a soccer ball or hitting another football player with contact to the helmet,' " Ott said, adding that a concussed tennis player could struggle with everything from reaction times to the ability to remember an opponent's scouting report. "The brain may have difficulty regulating blood flow in the first few hours and days following a concussion, so when players increase their heart rate, it aggravates the brain and worsens symptoms."

Bouchard reiterated that theory while retiring from her comeback match in October, telling opponent Andrea Petkovic that her symptoms tend to return with physical activity. The Montreal native, who is suing the United States Tennis Association as a result of her fall, spoke publicly about her status for the first time at a November promotional appearance in Toronto.

"I'm really looking forward to being healthy and playing next year," said Bouchard, who plans to return to play in January at the Hobart International, a tune-up for the Australian Open. "It's all a process."

Dellacqua can no doubt sympathize with Bouchard's lengthy rehab.

It has been nearly two months since Dellacqua's fall, and on Friday, the 30-year-old withdrew from the Australian Open, which starts Jan. 18. Her manager, Sam Maxwell, said Dellacqua is still having headaches and neck pains.

"Unfortunately I have not sufficiently recovered from the concussion injury I sustained at the China Open in Beijing in October and have been forced to withdraw from the whole Australian tennis summer," Dellacqua wrote on Twitter on Friday. "It is a shame that I won't be playing in front of the Aussie fans this year."

Sprained ankles, stiff backs and torn rotator cuffs probably sound pretty good to Dellacqua right about now.

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