When Haroot Hakopian was a high school soccer star, back in the mid-1980s, getting popped in the head during matches was not uncommon. An errant elbow here. Heads colliding there. It happened.
Hakopian recalls a play, in 1986, when a teammate jumped to punch at the ball and caught him flush in the temple instead.
"I will never forget, it was such a weird feeling, to have a punch to my temple cause immediate nausea," he says now. "I sat up. My coach came out. I kept saying, 'I feel weird.' I think I repeated that at least a half dozen times."
These days, with the benefit of 30 years of hindsight and a whole bunch of medical advancements, anybody can tell you what happened there: Hakopian had suffered a concussion. Now that diagnosis would — or, at the least, should — set into motion an immediate medical evaluation.
Back in '86 though, a doctor — a parent of an opposing player who just happened to be there — took a quick look at the young player, decided something looked funny, and he was pulled from the match. "The word concussion, or injury to the brain, was never used," Hakopian says.
He couldn't concentrate in class the next day, so Hakopian took a few days off. He didn't practice or play for a week, and returned afterward with few signs anything ever had happened. Even now, that's too-often a rare outcome.
"Honestly," Hakopian says, "it was just pure, dumb luck."
Who's Getting Hit?
So many athletes have stories that are so much more terrifying, so much more tragic, than Hakopian's. And remember: Concussions, considered the milder form of traumatic brain injury (TBI), are not limited to athletes.
Kids and the elderly suffer falls that result in concussions with alarming regularity. Soldiers are increasingly diagnosed with TBIs. Motor vehicle accidents continue to be a leading cause of TBIs. In fact, according to the Centers for Disease Control and Prevention, TBI accounts for 30 percent of all injury deaths in the U.S. Every day, the CDC says, 138 people die from injuries that include TBI. Further, the CDC estimates that as many as 3.8 million concussions occur every year — and that perhaps six times as many go undiagnosed.
Still, it is our playing fields that have become center stage for the national discussion about concussions. According to at least one study reported in the Journal of Athletic Training, some 300,000 sports-related TBIs occur annually in the U.S. (About 80 percent are concussions.) That makes sports second only to car wrecks as the leading cause of brain injuries in people from 15-24 years old.
Concussions — they've been termed the "silent killer" and a raging "epidemic" — strike both our kids at play and our college and professional athletic heroes. Some of their stories, unlike Hakopian's, are horrifying.
Earlier this year, Mother Jones reported that a Wisconsin woman filed a wrongful death suit against Pop Warner football, claiming repeated concussions led to her son's death. Joseph Chernach started playing when he was 11 and stopped after high school. He also wrestled and was a pole-vaulter. At age 19, post-concussion syndrome and dementia pugilistica, a form of dementia and type of chronic traumatic encephalopathy that can affect athletes in contact sports, began to alter Chernach, the family's legal team said. He committed suicide in 2012. He was 25.
Owen Thomas was a well-liked linebacker at the University of Pennsylvania, a team captain, when he hanged himself in April 2010 after what friends described as a "sudden and uncharacteristic" emotional collapse, according to The New York Times. Thomas was 21.
Thomas' autopsy later that year found evidence of a degenerative brain disease — CTE, the same disease found in Chernach's autopsy. CTE is a progressive disease, brought on by repeated trauma to the brain. It can begin years after the last concussion takes place.
Then there's Junior Seau, who spent 20 grueling seasons as a linebacker in the NFL, most of them with his hometown San Diego Chargers. The Southern California native played in more than 250 NFL games from 1990-2009. He's considered one of the greatest linebackers ever.
In 2012, after years of what his family reported as "mood swings, depression, forgetfulness, insomnia and detachment" — all signs of potential brain injury and CTE — Seau killed himself with a gunshot to the chest in the bedroom of his California home. He was 43.
An autopsy confirmed that Seau, too, had CTE.
Seau is one of at least 10 NFL players who have taken their lives after dealing with the effects of concussions. Though the link between concussions, CTE and suicide is a tricky one to make, the correlation between CTE and repeated blows to the head is not. Researchers at Boston University have discovered CTE in the brains of 87 of 91 former NFL players they've studied. That's 96 percent.
What's even scarier: The researchers at BU's CTE Center have studied not only the brains of NFL players, but also those of football players down through high school. The instances of CTE drop. But of all 165 players studied, 131 were found to have CTE. More than 79 percent.
Finding Good in the Tragedies
The concussion scourge not only has shaken the $12 billion business of professional football, it's caused ripples far beyond it.
Thousands of former NFL players have sued the league for failing to warn them of, and knowingly hiding from them, the consequences of brain injuries. (The NFL's handling of the issue is exposed in the PBS Frontline documentary "League of Denial.") The $1 billion suit was settled earlier this year, though it's currently under appeal. Many others lawsuits are pending. The 2015 season saw the NFL add "injury spotters," whose job is to keep an eye out for players getting injured during games and communicate with officials in case a medical timeout is warranted. Of course, the spotters don't catch everything though.
Participation in youth tackle football, according to the Sports and Fitness Industry Association, has plummeted, down almost 18 percent from 2009-2014 (although that figure includes casual and pickup football games, too). It's a decline that many pin, in large part, on parents' newfound fears about concussions.
Some good has come from that increased awareness. All 50 states now have a version of the Lystedt Law, first enacted in Washington in 2009. The law — named after Zackery Lystedt, who suffered a major brain injury in a Seattle-area middle-school game in 2006 — prohibits someone who has suffered a concussion from returning to play without an OK from a licensed health care professional.
Unfortunately, most of those laws apply only to high school students. They don't cover young athletes in local recreation leagues, for example.
"When you hear people say that, 'Oh, in all 50 states, there's concussion legislation that's been passed,' almost all of it has to do with high school sports." says John Engh, the chief operating officer of the National Alliance for Youth Sports, a Florida-based advocacy group. "It's so short-sighted. Why would you take the time to do that kind of law and not include the unsupervised activities? It's a big problem."
Still, most reputable youth sports leagues at least now have protocols to follow when an athlete is suspected of having suffered a head injury. Many are based on the CDC's groundbreaking "Heads Up" campaign. A catchphrase: "When in doubt, sit them out."
The safety push is not limited to football. For example, the Concussion Legacy Foundation sponsors the Safer Soccer initiative, which calls for a ban on heading — hitting the ball with your head — for anyone under the age of 14, saying that it could eliminate as many as 30,000 concussions a year in middle-school players, according to the foundation. In November 2015, U.S. Soccer said it would prohibit players 10 and under from heading the ball, and limit headers for players aged 11-13. The rule change resulted from a class-action lawsuit.
Much remains to be done, though, to educate the players, coaches, trainers and administrators on the athletic front lines.
"The issue really comes down to when you try to apply it. That's harder," says Dr. David Wright, the director of Emergency Neurosciences at Emory University. "There's a bit of insidious nature to sort of balancing, 'Wow, does he really have a concussion, does he not have a concussion? I really need this player in the game.' All of that is in the back of everybody's minds. It's hard to be dogmatic when you're in real life about some of these things. Right or wrong, that's the truth."
This Christmas, a potentially explosive new movie about the NFL and its alleged cover-up is scheduled to be released. It stars Will Smith as Dr. Bennet Omalu, who discovered CTE in football players in 2005. The movie is titled "Concussion."
The Hollywood treatment may spur yet another level of awareness about concussions and their effects. Regardless, experts agree that we've come a long way from telling a kid to "shake it off" and get back in the game. Now, everyone should be following these basics:
• Pull them from the game if a head injury is even slightly suspected.
• Don't let them return to play that day.
• Don't let them return to practice or play without permission from a professional who knows concussions.
"There were a host of things that came together to get this in the spotlight," says Wright. "The issues with the NFL, the soldiers returning home and the consequences of their injuries, the [Department of Defense] pouring money into that — you really have to give it to the DoD. Nothing has had an impact like the DoD has had as far as advancing the knowledge."
Last year, the DoD and the NCAA announced a joint $30 million initiative to "enhance the safety" of both soldiers and student-athletes. It includes, according to the NCAA, "the most comprehensive study of concussion and head impact exposure ever conducted."
After graduating high school and playing soccer for the U.S. Army in Germany, Hakopian moved into coaching. He is now the varsity girls' soccer coach at Churchill High School in Potomac, Maryland, and the director of girls' soccer for the Montgomery County Public Schools district.
He's seen plenty of concussions in his decades in the game. He, too, is convinced soccer is safer now than it has ever been.
The key, as he sees it, is getting parents, trainers, coaches, teachers and league administrators on the same page, teaching them to recognize a concussion and to care for someone who has suffered one. (There is no "cure" for a concussion, Wright says; rest is critical.)
With everyone watching, Hakopian says, everyone is safer.
"Even when I was in the military, quite honestly, they just assumed you got dinged — you got your bell rung or whatever cliche — and that was it, you went back in," Hakopian says. "Now, it's taken so much more seriously. I love the fact that we have everyone involved."