October 9, 2013

Lasting Impact

Concussions have real-life consequences. Just ask Brad Ross.

by Corey McLaughlin | LaxMagazine.com | Twitter | McLaughlin Archive

Retired player Brad Ross, now an assistant at Bryant, has persisitent post-concussion syndrome, which has resulted in several scary episodes over the last two years.
©Bryce Vickmark

"I'm 28 years old, and I'm worried about long-term brain issues."

Those were the words from former Duke All-American midfielder and current Bryant assistant Brad Ross over the phone as he told the story of a post-concussion condition that has plagued him for more than three years.

At the time of the conversation in mid-August — less than a week before he was to get a final evaluation from neurologist Dr. Norman Gordon in East Providence, R.I. — Ross considered what his future would hold.

Not his lacrosse-playing future. That already was over. He retired before the 2013 Major League Lacrosse season, which would have been his fifth as a professional.

After six months of urging from his fiancée, a college soccer coach who recognized post-concussion symptoms, Ross in April visited a neuropsychologist, Dr. Joel Becker. He put Ross through a series of exams, including an ImPACT test, widely used in sports. Becker assessed Ross' memory, ability to learn new information and if he could maintain attention and concentration.

For someone like Ross — mid-20s, otherwise fit, well-educated with two degrees from Duke, where he was a two-time USILA Scholar All-American — a two-hour evaluation of neurocognitive functions did not resonate with his background. Nor did it match previous baseline tests. The doctor told Ross he could have suffered a concussion a week before his visit when, in fact, he hadn't played lacrosse in nearly a year.

"For a talented young man with his achievement level, these findings were not OK," Becker said. "They were way out of sync for what we'd expect."

Most concussions resolve themselves in 10 to 14 days, but a small percentage produce persistent symptoms, longer than a couple of months, although there is no consensus on how or why the chemistry of those brains remains abnormal while others may improve in similar circumstances.

***

This article appears in the October issue of 
Lacrosse Magazine, a special sports science and safety edition.

» Lasting Impact: Brad Ross Story | The Facts
» Sports Science and Safety | What's Next?
» What is a Concussion? Q&A with USL Experts
» Inside NOCSAE: USL Partners with Leader
» ACL Confessions | 'Life-Altering Injury'
» Merrill Wants Cleaner, Safer Game (Web Extra)
Don't get the mag? Join US Lacrosse and its 400,000-plus members today to start your subscription.

Ross has persistent post-concussion syndrome, which has resulted in several "episodes" over the last two years in which sudden dizziness would affect his ability to walk steadily or speak clearly. They started about a week after he absorbed a late hit playing for the Boston Cannons in the August 2011 MLL playoffs.

The first episode resulted in a trip to the emergency room. Doctors weren't sure what was wrong. They considered a brain aneurysm. Ross spent 24 hours in the hospital. After a spinal tap, multiple CT scans and an MRI, he was sent home with an initial diagnosis of post-concussion syndrome.

A few days later, Ross suffered another episode and returned to the hospital for another six hours. Six months later, he was back again. And then again in July.

The latest episode really scared Ross. It was almost two years after his last documented concussion. Ross was at Bethany Beach in Delaware during Fourth of July weekend, taking a break from his summer recruiting responsibilities. He wasn't doing anything out of the ordinary, just sitting under a beach umbrella when he got so dizzy he couldn't stand. He had trouble speaking and his right hand started twitching.

"My symptoms and diagnosis had gotten worse after a year where I wouldn't have said that I got a concussion," Ross said. "That was the biggest concern for me, my family and my fiancée."

Ross experiences headaches, memory loss and balance issues. He has had trouble concentrating for long periods of time. He said it hasn't affected him on the sideline as a coach, but sometimes Ross leaves Bryant's locker room when loud music blares. That bothers him.

***

As Ross awaited the results of his latest tests from Dr. Gordon, he thought back on the path that got him here.

"In no way is this anyone's fault, really, but my own," Ross said. "It's not like you broke your ankle and you can't walk. The onus is really on the players to communicate what is going on with them to their coaches and training staff. Unless you're showing huge symptoms and you got knocked out or something, what are they supposed to do in that situation?

"When you're a player, all you're thinking about is the next game. But sometimes you get to where I am now. It's scary stuff."

Ross recalled six collisions spanning his college and pro careers that likely resulted in concussions. In the third game of his freshman season at Duke, he got blindsided after winning a faceoff against Maryland. A month later, he took another shot in transition against Ohio State.

The next one didn't happen until his senior year in 2008 against Virginia, when Ross was hit high after taking a shot. "I remember the field getting all blurry," he said. "But I ran back on defense and, in my head, was begging the person I was covering, 'Please just don't go the goal.'"

Ross was knocked unconscious for the first and only time of his career during his fifth year at Duke in a game against Georgetown. He doesn't remember how long he was out.

In the MLL, he believes he had two concussions. One came in a mid-August 2011 game against the Hamilton Nationals, when he caught a "buddy pass" at midfield that led to a violent collision. He had headaches for three days.

The other came in the playoff semifinals 18 days later against the host Chesapeake Bayhawks. As Hurricane Irene drenched the eastern seaboard, the Cannons played the Bayhawks at Navy-Marine Corps Memorial Stadium in Annapolis, Md. Ross scored a goal from the left wing, was hit hard after the play and came up groggy while teammates celebrated around him.

***

Ross believes he sustained his sixth concussion in the 2011 MLL semifinals at Navy-Marine Corps Memorial Stadium. Playing for the Boston Cannons as Hurricane Irene drenched the eastern seaboard, the midfielder scored a goal from the left wing, was hit hard after the play and came up groggy while teammates celebrated around him.
© John Strohsacker



"When you play our game, there's only one way to play it: as hard as you possibly can."

 — Brad Ross

All of those collisions are significant, Dr. Becker told Ross during his first visit in April, but what may have happened in between concerned him just as much — the cumulative effect of smaller hits. That and the potential for future head injuries prompted Ross to retire.

"Although everyone's main concern is the 'concussion,' my doctors have told me that a lot of the things that end up really hurting athletes is what they call sub-concussive injuries, which are the little shots you take during a game," he said. "You get to the middle and someone comes across and gives you an elbow in the face after you shoot it. You shake your head once and you're fine. Over a career, those things build up."

Ross, a three-time All-American at Duke and two-time MLL champion, said he couldn't play the game as he wanted to anymore. He announced his retirement in May and made sure to say why. He didn't want people to think he walked away for no reason.

"The thing that is really hard is when you play our game, there's only one way to play it: as hard as you possibly can," he said. "Everyone is talking about taking the hitting out. I don't know where the game goes if you take the hitting and the physical nature out of the game."

The then-Toronto Nationals drafted Ross in 2009. He won a championship with the team in his rookie year before being traded to Boston. He spent two-plus seasons with the Cannons, including an MLL All-Star Game appearance in 2011, before those two jarring hits changed the course of his playing career. He got off to a slow start with Boston in 2012 and was traded to the Rochester Rattlers. Ross said he often would go blank for extended periods of time while standing on the sideline waiting for one of his midfield shifts.

"I would snap out of it, and realize I had been completely zoned out for a minute," he said. "You try to get your head right before you run on the field and take your shift."

***

Concussions are a complex subject. In recent years, they have been the source of debate within several sports communities about how or why to alter the games on the field to prevent unintended health issues off of it.

In July, the NCAA awarded a pair of researchers nearly $400,000 to examine the long-term effects of head injuries in college athletes. In August, the NFL reached a $765 million settlement over concussion-related brain injuries among its 18,000 retired players, agreeing to compensate victims and pay for health care up to $5 million for players who have or develop ALS, Parkinson's disease, Alzheimer's disease or another severe cognitive impairment. At the same time, the NFL has enforced stiffer penalties and discouraged hits to the head and hits on defenseless players.

Lacrosse has followed a similar theme. Starting in 2011, the NCAA allowed men's officials to issue more severe penalties when a player deliberately initiates contact with an opponent's head or neck with any part of his body or stick. In the summer of 2012, the NCAA men's rules committee took intent out of the equation by removing the word "deliberate" from what it called the "targeting the head/neck rule" in the rulebook.

In its latest round of rules changes for boys' lacrosse effective for this season, the National Federation of State High School Associations (NFHS) for the first time classified the targeting of defenseless players, including blindside hits and body-checking a player who has his head down in an attempt to play a loose ball, as an illegal body check. A minimum of a two- or three-minute non-releasable penalty is to be assessed. The penalty for checks involving the head and neck was strengthened across the board, making a two-minute non-releasable penalty the minimum.

Kent Summers, the NFHS liaison to the boys' lacrosse committee said, "This revision will reinforce the need to eliminate these collisions from the game."

According to a recent video analysis study of 34 concussion incidents in Fairfax County (Va.) high school boys' games, most commonly injured players were unaware of pending contact. The study was co-sponsored by the National Operating Committee on Standards for Athletic Equipment (NOCSAE) and the US Lacrosse Sports Science and Safety Committee.

Canadian All-World defenseman Brodie Merrill sustained a concussion in March due to a blind-side hit playing for the National Lacrosse League's Philadelphia Wings.

"Those hits need to be taken out of our game." 

— Brodie Merrill on blind-side body checks

"Those hits need to be taken out of our game," Merrill said. "I'm not saying to eliminate all contact, but certainly when somebody is not looking or when somebody is in a defenseless position, we have to come down hard."

Merrill said he has changed his view since growing up a fan of big hitters like Scott Stevens in the NHL and Pat Coyle in the NLL. "There's these little decisions in a game, moments where you can pull up a little bit or you can really press it and follow through," he said. "If we just make athletes aware of the long-term repercussions of reckless play, then when we're faced with those situations, we'll tend to make the better decision."

In a blog for Philly.com, Merrill wrote about the hit that gave him a concussion — he was coming out of the penalty box in a March 1 game against the Buffalo Bandits — and how he masked his symptoms to finish the game. That wasn't the right decision, he wrote. The symptoms persisted and intensified. He wrote about sitting in a dark room alone feeling foggy and pressure in his head. He missed the Wings' next two games.

***

Some players never return to competition.

Ross left the office of Dr. Gordon, the neurologist, in late August feeling like a lot of people with post-concussion syndrome: uncertain. How long will the symptoms last? Will they ever go away? Those are questions with no answers.

"He just said that basically you have to give it time. Your brain will try to heal itself," Ross said. "After a number of concussions, your brain, for whatever reason, decides to start acting like this. There's not much I can do to stop it or prevent it. [My] brain is a little messed up right now."

The next day, Ross visited Dr. Becker. They talked about things Ross could do in his day-to-day life to manage his condition — like moderating his workouts so he doesn't get a headache, feel dizzy or get nauseous; or taking breaks every 30 to 45 minutes if he's on a computer to minimize loss of concentration or mental fatigue.

Becker asked Ross to journal, keep tabs on his history and follow up with more tests. He also told Ross to analyze his behavioral patters, note what triggers symptoms and what techniques do and don't work in managing them.

"Treatment is fairly limited in what we can offer, which is kind of unbelievable," said Becker, who has offices on Long Island and in Connecticut and works with athletes throughout New England. "In the 21st century, you'd think we have many things we can offer. The general thinking now is that you want the person to be active, within reason, but avoid any contact, collision or abrupt movement of the head."

One thing is for sure: Ross, who will be married to Nicole Hanewich in October, will never play lacrosse again.

"Maybe some of me didn't want to go to the doctor because I knew there was something wrong," he said. "You hope that maybe we could all forget about it and start playing again."


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