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Wake-up call

Former New England Revolution star Taylor Twellman suffered a concussion that left lasting damage and sidelined him for good. Now he’s committed to making the beautiful game safer, in professional soccer and on school playing fields.

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By Scott Helman
April 24, 2011

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The moment he went down, things were just looking up. It was a muggy Saturday night in late August. Gillette Stadium rocked with nearly 40,000 people. They came to see the first-place New England Revolution battle the Los Angeles Galaxy, a star-studded club on its only trip to Foxborough of the 2008 season. Adrenaline coursed through the players. About 21 minutes into the match, the Revs struck first.

Midfielder Khano Smith controlled the ball in Galaxy territory. He stole a look at the box and chipped in an elegant pass with his left foot. His target was the guy the Revolution counted on to make big plays in big games: Taylor Twellman, a fearless striker, the team’s marquee player, and one of the top goal scorers in Major League Soccer history.

For Twellman, then 28, the game was an opportunity to prove on a big stage – in front of the Revolution’s largest-ever regular-season home crowd – that he was back in top form after a frustrating year. The league had rejected a lucrative offer for Twellman from a second-tier English club. He’d had knee surgery. An ankle injury lingered. He had brought his parents, brother, and sister up from St. Louis for the Galaxy game.

As Smith sent the ball forward, Twellman darted behind the defenders. The Galaxy goalkeeper, Steve Cronin, reacted late. Twellman, looking over his shoulder as he sprinted in, fixed his eyes on the ball. Cronin, looking up as he charged out, did, too. What happened next remains, almost three years later, very hard to watch.

Twellman leapt to rocket the ball into the net. Cronin leapt to punch it out. Twellman won the duel – the ball skipped off his head into the goal, setting Gillette afire. “I remember thinking, ‘Wow, this kid just took this moment and just ran with it,’ ” says Jay Heaps, a former defender for the Revolution who played that game and many others with Twellman over the years.

But this goal, the 96th of Twellman’s regular-season career, came at great cost: Cronin accidentally punched the right side of Twellman’s face with both fists, snapping his head back and sending him to the ground. The force broke Cronin’s hand. “It was almost like running as fast as you can into a wall,” Twellman told me recently.

The severity of Twellman’s injury was not immediately clear to him, to anyone. He had always played with abandon, body be damned. That’s what made him so good. His face bleeding, he bounced up, ran to the sideline, and shot his hand into the air. Teammates arrived to mob him. But something was wrong. In the replays, you can see him grabbing his head as he receives the celebration. You can see him turn to teammate Shalrie Joseph, point to his head, and say gravely, “I got a concussion.” You can see him fall to his knees, then roll onto his back. “It’s so hard to look back on it,” Heaps says. “Here we were celebrating the greatest moment. But it was the moment his career would start to slowly unwind.”

***

The balletic nature of soccer – it’s called the beautiful game for a reason – masks an uglier reality on the pitch. From youth leagues to the pros, sublime artistry is punctuated by bursts of aggression, violence, and danger.

For years, concussions in soccer were treated, like in other sports, as just another occupational hazard. You get your “bell rung,” you shake it off. English legend Nat Lofthouse, knocked unconscious in scoring a famous winning goal for his country over Austria in 1952, prided himself on returning to that game, afterward embracing the nickname “Lion of Vienna.” Countless other players at every level could tell similar stories.

That mind-set has begun to change, as new research, media attention, and high-profile casualties over the past couple of years have laid bare the long-term consequences of repeated blows to the head and the risks of returning to play too soon after a concussion. Football and hockey have drawn the most attention, with story after story of current and former players’ struggles with brain injuries. But soccer’s high rates of speed, lack of padding, and frequent use of the head can make for a perilous combination. Serious head injuries in most cases result from two heads colliding, or an elbow to the head, or a hard fall to the ground. “Most people think of soccer as being so safe,” says Dr. Robert Cantu, a concussion specialist affiliated with Boston University, Emerson Hospital, and Brigham and Women’s. “But in terms of the head and concussions in general, it’s a very significant risk.”

And not just in the pros. Across all sports, 18 percent of middle and high school students who answered a 2009 state Department of Public Health survey said they had experienced symptoms consistent with concussion following a blow to the head in a game or practice over the previous 12 months. In soccer, the concussion rates at the high school and college levels are right up there with football and ice hockey, says Cantu, who cofounded the Sports Legacy Institute, a nonprofit devoted to advancing the study and treatment of brain trauma. A national survey of 100 high schools by Dawn Comstock, principal investigator at the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, puts soccer lower. Boys’ soccer players in the 2009-2010 academic year suffered concussions at a rate of 6.4 per 10,000 competition appearances, compared with 27.3 in football and 16.1 in hockey, the survey showed; the rate for girls’ soccer players was higher, at 8.2 per 10,000.

Several doctors and concussion specialists I talked to said soccer has been slow to face its concussion problem, but that it is getting better. Youth leagues are putting a greater emphasis on concussion awareness for teams and coaches. High schools are increasingly using neurocognitive testing to assess athletes’ readiness to return to play. Major League Soccer put new head-injury protocols in place for this season, including a requirement that any player suspected of suffering a concussion be removed from the field immediately.

All these developments point to an important shift, given how many children and teens play every season. Soccer has been the most popular sport among high school girls in Massachusetts for years, according to Massachusetts Interscholastic Athletic Association figures; among boys, it has trailed only football since 2008. Massachusetts, with more than 180,000 children competing in leagues, also has the highest rate of youth league soccer participation in the nation.

Despite the progress on concussions, though, the sport clearly has a long way to go before players, coaches, trainers, parents, team officials, and teachers universally recognize how critical it is to manage the injury responsibly. That means giving concussed athletes the necessary time, space, and accommodations to heal. The stakes could hardly be higher.

***

Venous Hamza wanted to play so badly. So badly she told everyone her symptoms were gone. She was lying.

A 16-year-old junior at Revere High School, Venous helped anchor the defense on the girls’ soccer team last fall, as it battled to make the playoffs for the first time in years. One Friday in late September, they hosted Peabody at home. A ball came into the penalty area. Venous went to clear it with her head. The back of her skull collided with a teammate’s forehead. She went down. She blacked out. “I opened my eyes and there were stars everywhere, so I just shut my eyes again,” she says.

Her mother, Hind Akwan, got an urgent call from one of Venous’s teammates. Venous was lying on the field. They halted the game. Akwan was told that someone had called 911, though that wasn’t true. She was frantic. “I drove 80 miles an hour from Wakefield to Revere,” Akwan says.

Venous, with help, eventually hobbled to the sideline. Her mother took her home. It was Venous’s third concussion since eighth grade. They called the doctor’s office, and a nurse said to monitor her closely for the weekend and to bring her in on Monday. Akwan, relying on the nurse’s instructions and her own prior experience helping her daughter through concussions, fixed Venous mashed potatoes and soup. She gave her showers with lukewarm water. She wouldn’t let her sleep more than two hours at a time.

Venous’s doctor told her to take two weeks off from playing, then said one week might be enough if she felt better, Akwan says. The doctor also urged her to see a concussion specialist. After the week off, the school trainer asked Venous if she still had symptoms. She said no. “I just could not stand sitting and watching them. I hated it,” Venous says. So she rejoined the team for about a week, she says, playing in two games. Her headaches became unbearable. Some days she couldn’t get up. “I felt like there was a drum set in my head,” she says. When they went to see Dr. William Meehan, a concussion specialist at Children’s Hospital in Boston, his verdict was met with tears: Venous’s season was over.

Her story is more common than you might think. Not only are girls more likely than boys to suffer concussions, their symptoms are often worse. Doug Michaud, the girls’ soccer coach at Shawsheen Valley Technical High School in Billerica, had four starters out with concussions last fall, each resulting from a different injury. Specialists say the higher rate among girls could be because their neck muscles tend to be weaker, and therefore less capable of preventing or diminishing whiplash. Or because girls are more likely to report concussions. Or both.

The gender disparity underscores the variability of concussions – athletes suffer them in many ways, experience different symptoms afterward, and recover at their own pace. A concussion results from the brain sloshing violently back and forth, or in a rotational motion, inside the skull, which sets off chemical changes that impair brain cells. Where you get hit may determine your symptoms, which can range from dizziness to behavioral and emotional changes. If it’s in the back of your head, near the section of your brain that controls vision, you may have difficulty seeing. If you get hit in the front, near the frontal lobe, you may have trouble remembering things and with problem solving.

Researchers are getting good at cracking concussions’ elusive codes, says Dr. Micky Collins, a concussion specialist at the University of Pittsburgh Medical Center. They now know that a history of migraines, for instance, can worsen a person’s response. Fogginess as a symptom can mean a longer recovery. Youth appear to be more susceptible to concussions, and their brains are less equipped to handle them.

The biggest risk, specialists say, comes when athletes return to play prematurely, while their brains are still healing. As the brain is trying to fix itself, the damaged cells can die if they’re re-injured, even by a relatively minor bump. Repeated injuries can cause severe and lasting brain impairment. “It’s all about recognizing these symptoms early on, and getting the kids off the field,” Collins says.

Because concussions can be difficult to diagnose, researchers are working to develop better methods of confirmation. “Let’s say we had a blood test to say, ‘Yes, this is a concussion,’ ”

says Dr. Ann McKee, director of neuropathology at the Bedford VA Medical Center and a co-director, with Cantu, of Boston University’s Center for the Study of Traumatic Encephalopathy. “That would be the ideal world.”

***

I sobbed a lot,” Twellman says, recalling his low moments after the 2008 injury. “When I would cry, and literally let it out from the deepest part of you, I’d fall asleep. I knew I could cry myself to sleep. There’s still nights that I’m like ‘Screw it. I gotta somehow get into this and cry.’ ”

For four months, he sat in a dark room in his apartment, above the bustle of Newbury Street. His brain couldn’t handle TV or reading or really anything. He couldn’t drive for weeks. His sparkling career was suddenly in doubt, and he couldn’t fix it. Not this time. Depression hit hard.

“It’s because you can’t help yourself,” he says. “And your loved ones look at you, your family, and they go, ‘What do you want us to do?’ And you’re miserable. I mean, it’s like someone’s in your head, squeezing your brain as hard as it can. That’s the worst feeling in the world.”

Not only had Twellman, with the Revolution’s blessing, played the rest of the 2008 season, he had stayed in the Galaxy game. Later in that match, he says, he began celebrating what he thought was his second goal. A teammate, Steve Ralston, told him he had missed by 5 feet. Twellman was seeing two nets. It went downhill from there. As the season continued, he tried to play through the double vision, the nausea, the dizziness. He knew he was in a bad place when he was taking three Vicodin and two Excedrin before a game. He sat out the 2008 playoffs.

Through the long fall and winter of 2008 and into 2009, Twellman, having already suffered several concussions in his career, tried to fight his way back. He started keeping a journal about how he felt. He sought out specialists. He underwent intensive therapy on his neck. Finally, on May 30, 2009, he came in as a sub in a game at Gillette against DC United. The crowd roared. The next game, a week later against the New York Red Bulls, he scored the 100th goal of his career, a major milestone, on a header. His team rushed over to celebrate, but inside Twellman didn’t feel much like celebrating. His head felt like a sponge. “I kind of knew I was in trouble,” he says. It would be the last game of his career.

Twellman believes he would be playing today had he been removed from that 2008 Galaxy game and kept on the sidelines afterward to heal. He doesn’t blame the Revolution exactly, and he acknowledges that he and other athletes cannot be trusted to say, “Take me out.” Plus, he says, he never failed the neurocognitive test used by the team. But it’s evident he resents that the Revolution did not recognize the seriousness of his injury. He told me: “You think I’m gullible enough to think that they didn’t say, ‘Well, let’s just put him through this?’ But there’s also no hard feelings there. Because I understand that.”

Michael Burns, the Revolution’s vice president of player personnel, says the team would never put the club’s needs before a player’s health. At the time, Burns says, they didn’t know that the collision with Cronin was more serious than the many others Twellman had walked away from. “How many of those did he take in his career? Probably two hundred,” Burns told me. “It didn’t appear any different than a play we’ve seen him do many times.”

Through 2009 and 2010, Twellman says, the team was “100 percent” supportive as he fought to return. But it became clear, as he worked with Dr. Cantu, that he never really would. Last November, Twellman called a press conference to announce his retirement. He recounted how Cantu had looked him in the eye and said if he wanted a shot at a healthy life, he had to hang up the cleats. “Was it a relief?” Twellman said. “Kind of.” He also recalled something his father had long said: “Give ’em hell – you never know when it’s your last game.” Twellman’s voice broke with emotion. “Unfortunately, Pops,” he said, “I know what it means.”

***

The pressures to play through injury come from all sides. Athletes are taught from childhood to compete. Coaches are paid to win. Parents, who want to see their children excel, are sometimes the most aggressive at pushing them back in the game too soon, specialists say. “The parent learning curve is huge,” says Dr. Kenneth Lawson, chief of emergency medicine at Signature Healthcare in Brockton. Concussions are also largely invisible to everyone else. There’s no cast, no bandage, no gash. This invites skepticism, and sometimes damaging peer pressure: Is he really hurt? What’s her problem? Why can’t she play?

Massachusetts and several other states have stepped in with new laws to regulate how schools manage concussions. Under the Massachusetts law, almost anyone who has contact with middle and high school athletes – coaches, trainers, parents of athletes, even the marching band director – must complete a safety training program on head injuries. Any player suspected of having a concussion must be removed from the game or practice immediately. The player cannot return without written certification from a medical professional with experience treating concussions.

Like other physicians, Dr. Lauren Smith, medical director for the state Department of Public Health, says the crackdown on concussions is not about keeping youth from playing soccer or making it less fun. It’s about managing head injuries correctly when they happen. “This is not about not doing sports,” she says. “I cannot underscore that enough.”

More schools are also adopting the ImPACT test, a neurocognitive exam that Major League Soccer also uses and that Collins, of the University of Pittsburgh, helped develop. The idea is that all student-athletes at a school take the computer-based test that measures memory and reaction times when they’re healthy, to establish a base line. If they suffer a concussion, they take it again, and coaches and trainers use the results to help determine the players’ fitness to return. Everyone acknowledges that, as Twellman’s case shows, the ImPACT test and others like it should never be the sole metric used to assess an athlete’s condition. But having hard data can be a godsend, says Michaud, the Shawsheen coach, because he can present failing test scores to aggressive parents or student-athletes itching to return to play. “It totally gives me cover.”

Specialists say one thing that is still uneven across school districts is how teachers and academic administrators handle concussions among student-athletes. Schoolwork can exacerbate post-concussion symptoms, and injured students often need not just time off but leeway on assignments and tests. Venous Hamza says some of her teachers in Revere failed to grasp how serious her struggles were last fall. By contrast, Rachael Gilbert, a 17-year-old soccer player at Braintree High School, says her teachers understood what she was going through after a season-ending concussion last fall disrupted her balance, sapped her energy, and affected her ability to concentrate. It took her twice as long as usual to get through assignments. “I could have a lot of difficulty focusing and understanding the homework,” Gilbert says.

Though there is debate about its effectiveness, headgear has become a more common sight on soccer fields. After Reading High School defender Peter Finigan suffered a concussion his sophomore year, his parents gave him an ultimatum: Wear headgear or stop playing. So Finigan put it on, enduring some ribbing from opponents – “Oh, look at him, he has a headband!” But that fell away, he says, once he showed them he could play.

As happens with many parents, Finigan’s concussion altered how his mother, Diane, watched the game. “I could see that this isn’t as mild of a sport as I thought it was going to be,” she says. “But it didn’t change my wanting him to play or not. Because I knew how much he loved it.” When Rachael Gilbert’s mother and stepfather, Christine and David Cunningham, told me they were anxious about her playing recreational sports at college next fall, I suggested golf. “Golf!” they said in unison. I apologized to Rachael for taking sides. “No – that’s a great idea!” her stepfather said.

At the professional level, Major League Soccer has used ImPACT testing since 2007 but left it up to each team to manage head injuries in its own way. Starting this year, the procedures are far more uniform. Each club, for example, will have a consulting neuropsychologist from outside its medical team to help evaluate head injuries. The league also plans to begin tracking the number of concussions more closely. “We recognized that we needed to do more,” says Nelson Rodriguez, executive vice president of competition and game operations for MLS. The league, though, is not inclined to allow more substitutions for head injuries, a change Twellman and concussion specialists believe would remove an incentive for athletes to play hurt.

Twellman, who sits on the committee that developed the new procedures, was not the first MLS player to have his career curtailed by concussion, but he was the highest-profile. MLS and Revolution officials say losing such a big player wasn’t necessarily the driving force behind the stricter league rules. But it’s clear it was a big wake-up call. Heaps says that around the league, Twellman’s injury drew the kind of attention others’ simply had not. “He was our Tom Brady,” Heaps says of Twellman’s status among fans.

***

When I met Twellman recently, he bounded into the cafe looking nothing like a self-pitying ex-superstar. He wore a gray suit and spiky hair. He was animated about his new life – the burgeoning career as a TV sports analyst, including a new role as the color commentator for Philadelphia Union games; the soccer camps he plans to run; the foundation he started, which he says will offer financial support and other resources to 20 concussion victims at a time, not just athletes. He’s become a regular on the Boston social scene.

As hard as the past few years have been, Twellman is energized by his new mission: preventing what happened to him from happening to anyone else. No one, he says, should ever play through a concussion. No one should feel as alone as he did shuttling from doctor to doctor to try to fix his brain. He uses every medium he can – MLS meetings, Twitter, radio interviews, his Facebook page – to get his message out. He has agreed to donate his brain to the BU center. He’s helping develop a smartphone app, called HeadSmart, to give parents, players, and coaches information about how to manage concussions, where to seek treatment locally, and real-time data on concussion rates among college and pro athletes, “so people understand that they are not alone.”

“When I got this, I said, ‘Uh-uh. I want players to know,’ ” he says. “It’s not going unnoticed now.”

Not that everything’s great. He’s not 100 percent. He suffers headaches. He can’t work out hard. He may never run again. He won’t touch a soccer ball, because he doesn’t trust himself to take it easy. He finds solace on the golf course.

“I’m having better days than where I was,” he says. “But I haven’t woken up with that feeling of ‘He’s back, I’m back. I’ve got my life back.’ ”

He still loves the game, though. He hopes, if and when he has children, they will play. Does he think it’s possible, given what we now know about concussions, to play with the same fearlessness that was his trademark? “Yes,” he says. “It’s how you treat them when you get them. And that is where I think the most benefit to our awareness is coming.”

As he’s leaving for an evening TV gig, I ask Twellman whether, despite his many exploits on the field – all the goals, the games he won for the Revolution, the visibility he brought to a sport still competing for America’s soul – he thinks he’ll end up making more of a contribution off the field. “Way more,” he says after a pause. “I’m just starting to realize that.”

Scott Helman is a staff writer for the Globe Magazine. He can be reached at shelman@globe.com.

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