Concussions derail promising careers

Two of college soccer's best players, Emily Oliver of Stanford, left, and Becca Wann of Richmond retired within weeks of each other, the result of multiple concussions over a series of years. Jim Shorin/isiphotos.com, University of Richmond

When she was in high school, Emily Oliver, a goalkeeper, broke her left hand during action early in the second half of a game against a rival club team. The score was 1-1, and not knowing the extent of the injury, she shook off concerns and stayed on the field. It was, after all, a rivalry, Illinois girls against Michigan girls.

Perhaps playing through the pain wasn't the sensible thing to do. It wasn't the rational thing to do. She was sidelined for weeks afterward, her left hand in a cast. But her desire to play speaks to the balance of selflessness and ego inherent in an athlete's existence. Her teammates needed her to sacrifice for them; she believed she was still their best option.

She made the necessary saves that half, including more than one with her injured left hand, and her team won 2-1. It didn't win a trophy. It didn't make headlines.

"It was just kind of cool to be able to get that huge win against one of our rivals," Oliver said. "Even with a broken hand."

"No pain, no gain" may be a phrase mercifully fading into disrepute, but success sometimes hurts. That remains a part of sports.

What Stanford's Oliver and Richmond's Becca Wann, two of the best players in college soccer, accepted this fall is that there is a price that is too steep to pay. In retiring from the sport within weeks of each other, in each case as the result of multiple concussions sustained over a series of years, they chose instead to protect their futures.

Oliver's broken bones from that early encounter healed soon enough, and she went on to Stanford as one of the top talents in her class. In each of her first three seasons with the Cardinal she was selected to the College Cup all-tournament team, which recognizes the outstanding players in the semifinals and final of the NCAA tournament. Her acrobatic save late in the second half of the 2011 national championship game, at full stretch pushing a Duke shot bound for the top corner over the bar and out of harm's way, preserved a 1-0 win and the program's first national title.

At 5-foot-7, it wasn't her height or athleticism that turned heads on the college game's biggest stage. She was an excellent shot-stopper, but her best qualities were the fearlessness and aggressiveness with which she approached the task. She excelled under pressure. She was exactly the kind of player who would worry about broken bones after a game was over.

Then came a collision early in the second half of a game against Portland on Aug. 31, the third game of Oliver's senior season. The result was her fourth concussion, the third during her time at Stanford. She came out of the game immediately. On some level, she understood even then she wouldn't return on that or any other day.

"Looking back on it, I think I knew that that was my last one, that I couldn't do it anymore," Oliver said. "I couldn't put myself at risk and play like that. I think I knew that night."

Six days earlier, Wann leaped to head a bouncing ball near midfield late in Richmond's game against Old Dominion. Because the senior relied on her aerial game and because she had a history of concussions -- the first sustained when she was just 10 years old and a pogo stick on which she was bouncing in her family's garage slipped out from under her on the concrete floor -- she always wore a protective padded headband on the soccer field. In this instance, the headband slipped out of place as she jumped, and her forehead collided with an opponent's head.

A multi-sport athlete who didn't play high-level club soccer and didn't attract a lot of interest from top college programs out of high school in Virginia, Wann emerged as a legitimate star at Richmond. She dominated the Atlantic 10 and earned a place on the U.S. under-20 national team that won a world championship a year ago in Japan. University of Virginia coach Steve Swanson, also the coach of that U-20 team, called her as good a header of the ball as anyone he had ever seen at her age. He also noted she routinely put herself in harm's way as a result.

A few days after the collision against Old Dominion, when the headaches and other symptoms wouldn't go away, Wann sat in a neurologist's office and was asked what she would do if she couldn't play soccer again.

"There are definitely moments where I'm standing off the field watching my teammates play, and I want to be out there," Wann said of her experience since. "There are nights when I go out and I just shoot.

"But I know it's for the best. Obviously the brain is something you don't mess with."

The numbers

Oliver and Wann are high-profile examples of what is far from an anecdotal issue. According to data published by the American Academy of Neurology, females playing college soccer suffer injury at the rate of 1.8 concussions per 1,000 games. That is greater than the combined rates of females in basketball and softball, the other sports studied. In fact, the rate of concussions for females in college soccer is greater than the rate for males in high school football (1.55). The rate for women in high school soccer was 0.97, second only to football among high school sports studied.

What we know is, relative to other sports, women's soccer players are at a higher risk of being diagnosed with a concussion. What we don't know is just about everything else, from why that's so to what it means for the sport and for the affected athletes in the long run.

Dr. Jeffrey Kutcher is the director of the University of Michigan's NeuroSport program, which states as its mission to treat and prevent brain, spinal cord or nerve damage from sports injuries. He is also a consultant on concussion-related issues for the National Hockey League Players Association and National Football League Players Association and the director of the National Basketball Association's concussion program.

"If you asked myself or other experts on concussion very specific questions about risk factors or outcomes or any aspect of this injury, if they don't tell you, 'We don't know; we don't have data,' they're misrepresenting the case," Kutcher said. "We clearly don't have a lot of data for most of the things we talk about in concussion.

"The main reason is concussion is a clinical syndrome that is diagnosed by a physician. It is not a state or an injury that we can verify with an objective test, so therefore all of our clinical studies, all of the data we have is draped in this incredible ambiguity about the very clinical outcome that we're trying to study."

This is the world Oliver, Wann and hundreds of thousands of soccer players like them inhabit, one that can be frightening.

Darkness and fog

Wann played both soccer and basketball in each of her first three years at Richmond. In the discussions that led to soccer retirement, she was told basketball remained an option because of the relatively limited risk of sustaining another concussion. Even so, a short time before basketball practice started, Wann remained uncertain about what she would do this winter. She had more questions she needed to ask.

"I just want to make sure that the next time it happens, that I'm not in a dark room for three months," Wann said. "If it does happen again."

Her experiences thus far haven't been that severe. Oliver wasn't so fortunate.

Oliver's third concussion came during the spring season a few months after playing her part in the national championship campaign. The symptoms lingered beyond anything she had previously experienced. She had migraine-like headaches, which she hadn't experienced at any time previously. Noise and light, even at normal everyday levels, became painful irritants. She couldn't go outside during the day, couldn't go to classes or practices. She couldn't look at a computer screen.

For a period of time stretching into months, her days often consisted of sitting in a dark room listening to music or an audio book. When night brought darkness, she would finally venture outside for an hour or two. She dropped classes. Her world, in her words, became a fog.

"It was just hard because the two things I had always thought made me who I was were athletics and academics," Oliver said. "And it was like in the flash of an eye, both of those things were taken away from me.

"It was difficult to deal with. And it really did isolate me from my team and my classmates and from my friends, just because I didn't want people to see me the way that I was.

"I always thought of myself as a strong person, someone people could go to when they had a problem. But I didn't really want to be seen -- I kind of saw it as a weakness in myself, where I was at that point. So I did, I isolated myself, and it made it very difficult for me those few months."

During all that time, she said she never gave any serious thought to leaving the sport. It was too important to her that she prove she could come back, which she did in again helping the Cardinal to the College Cup last season.

The thought that did occur during those months of darkness and fog, she admitted, was what might happen if she made it back and suffered another concussion. Then it happened in the game against Portland. The symptoms afterward weren't as severe the final time, but she realized she couldn't play the way she needed to play without attracting contact. And if she couldn't play that way, the way that reflected who she is, it didn't make sense to play at all.

Although not familiar with Oliver's specific case, Kutcher noted the relationship of post-concussion syndrome to concussion is one that isn't talked about enough. Concussions generally last from 7 to 10 days. Post-concussion syndrome, in his words, is not a long concussion. It is a new physiological state that occurs after the concussion is over, and one in which the primary treatment for the original concussion, rest, can play a contributing role. In his experience, one of the most common variables in athletes who have post-concussion syndrome is that they were rested inappropriately.

That isn't to say that was the case for Oliver, but it underscores just how difficult the entire conversation remains, even as head injuries in football place the issue front and center in sports.

Consider the thought experiment Kutcher presented, of the idea of giving 20 subjects exactly the same blow to the head.

"The different level of injury is going to be significant but not huge because the brain is a brain after all," Kutcher said. "But if I could take those same 20 kids and somehow give them the exact same level of injury, the physiological injury -- I'm going to tweak those neurons to the exact same degree in every brain -- I'm going to get 20 different, completely different and widely different clinical syndromes.

"That's just the nature of brains. That's just the way it is. And that's the problem."

'Nobody knew'

New concussion guidelines introduced this year by the American Academy of Neurology include the mantra "if in doubt, sit it out" in an effort to raise awareness, but changing the way athletes think is not as easy as remembering a rhyme.

Oliver left the game against Portland immediately after she sustained her most recent concussion. Wann played more minutes after her most recent concussion. At the time, she didn't feel she took the worst of the contact -- aerial collisions occur numerous times in every soccer game, and Wann was certainly no stranger to them. The obvious warning signs weren't there.

"I don't think they missed it," Richmond coach Peter Albright said. "I just think there was nothing remarkable about it, and until the symptoms emerged, we didn't know. Nobody knew."

Wann began to feel symptoms after the game. A headache lasted through the early part of the week, and at one point she found herself cooking in a completely darkened apartment to avoid painful light. Still, it wasn't until the middle of the week that she resolved to say something to the trainer if the headache remained when she woke up the next day.

"Honestly, I was hoping it would go away, and I knew I was kind of on the line of having a lot and I didn't want to sit out," Wann said. "So I kind of tried to just be like 'Oh, it will go away if I don't head the ball.' And then Thursday I woke up with a headache, and [the trainer] pulled me from practice immediately, and the next morning we were in with the neurologist."

Wann did the sagacious thing, and the game against Old Dominion was her last. But it is easy to imagine a scenario in which it didn't go that way and the player ended up back on the field the next weekend. It is easy to think that happens most weeks at some level of soccer somewhere in the country.

Coaches and trainers should share responsibility for being particularly attentive to potential head injuries, of course, but it is an injury that remains perilously dependent on the patient to report.

In addition to being one of the best players in the country, Virginia All-American midfielder Morgan Brian is one of Wann's closest friends, a relationship forged when the two roomed together on the world champion U-20 team. She, too, acknowledged having sustained multiple concussions. As someone who relies on heading as an important part of the skill set that makes her already a semi-regular with the senior national team, she sees what her friend is going through and knows full well it could just as easily be her or any player. She understands the dangers of concussions and speaks earnestly about not taking such matters lightly.

But if it came down to it, could she take herself out of a national team game or an ACC title game as a precaution? Could she sit it out?

"Probably not, no," Brian admitted. "It's a hard thing to do, especially when you keep telling yourself, 'OK, nothing's really wrong. You got hit in the head, you have a headache,' or something like that. As a player you want to keep playing, so you're going to tell yourself in the moment, with all the adrenaline, that nothing is wrong.

"So that's the hard part."

There don't seem to be any easy parts in the discussion, one women's soccer must continue to have.

As might be expected of someone who started playing soccer when she was 4 or 5 years old, Oliver doesn't remember a time in her life when the sport wasn't part of her world. It has always been there.

Like Wann, she remains a part of her team in a non-playing capacity, going to practices and helping serve balls to the goalkeepers. Like Wann, she isn't sure what comes next. A human biology major, she thinks about medical school. Law school and business school have their appeal, too, with an eye toward the business side of sports. All she is sure of is that she can't leave sports.

Even if she had to leave the field.

"My hope is that I chose correctly here and that will be the decision that helps me 20 or 30 years from now," Oliver said.