Note: UNC Media Hub has changed Emma’s name to protect her identity.
“Even the sound of the birds chirping was too loud. I couldn’t hold a conversation for more than two minutes because that part of my brain would fatigue.”
Emma talks slowly as she recalls the darkest time of her recovery: the three months immediately following her fifth concussion in 2014, the concussion that ultimately ended her soccer career and her time on the UNC Women’s Soccer team.
Liz Keel, a third year doctoral student in the Interdisciplinary Program of Human Movement Science, demonstrates a hand-eye coordination activity used to assess athletes with concussions.
Keel places an EEG cap on a mannequin head to demonstrate what many athletes suffering concussions experience.
Keel tries to keep her balance as she demonstrates a machine that tests balance and coordination by moving the floor and walls of the machine.
Keel shows the results from her hand-eye coordination test. After completing the activity, athletes are able to see the areas where they meet the average ability for their sport, the areas where they excel and they areas where they are subpar.
“In addition to feeling like I constantly had a dagger in my head, I had a really bad ringing in my ears,” she said. “The part of my brain that was hurt was the part that controlled movement, but it also controlled emotion. So if I walked too long, I would break down crying.”
Her family affectionately called her the little vampire. She had to take a semester off from school and left her room only at night, never caught without ear plugs and blackout goggles. And she remembers the months of physical therapy, which included physical and ocular activities she had to complete five times a day.
“Physical therapy would wear me down and wear down my body,” she said. “I would curl up in a ball because I was in pain, and so then I would have to spend the next hour stretching to work that out. And then by the time that whole cycle was done, I had to do physical therapy again.”
But exactly two years after her concussive injury, Emma is planning what she calls a brain anniversary party: an event marking the progress she’s made and her decision to stop playing soccer for the sake of her health.
Life is better now. Aside from the occasional migraine and her inability to play contact sports, she’s planning to finish her degree. She’s currently a senior at the University of North Carolina at Chapel Hill. Graduating wasn’t something she was sure of a year and a half ago.
She’s proud of her progress, yet she isn’t disclosing her name.
“I’m very interested in being supportive of people who have had (concussions), but I don’t want to have it as a label,” she said.
“For future employers, I don’t want them to google search my name and realize that I have had multiple brain injuries. I don’t want that to impede my place in the workforce. It’s already taken away my ability to play the sport that I love, I don’t want it to take away other future opportunities.”
Those who have had concussions can feel stigmatized, and that, Dr. Johna Register-Mihalik says, is a concept many don’t understand. According to her, stigma stems from a variety of fears: fear of letting down the team, fear of letting yourself down and fear of letting down the sport. It’s more complicated than many other sport-related injuries.
Register-Mihalik is an assistant professor in the Department of Exercise and Sport Science. In addition to her role in the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, she serves as a research scientist with the Injury Prevention Research Center.
She says stigma in concussive injuries is relatively common, and it often plays into athletes deciding not to report the injury.
“We actually spend a lot of time understanding what people’s perceptions of that stigma are and how we can work to change it. Because it’s really closely related to people not wanting to disclose that injury, not wanting to know that they have had a concussion or multiple concussions.”
Nicole Cordero’s athletics career ended in high school because of concussion, and now she dreams of becoming an orthopedic surgeon. An exercise and sports science major at UNC, she says her experiences with injuries as an athlete have inspired her to enter the medical field. In high school, Cordero was a softball and soccer player, and had considered playing softball at UNC, but after multiple concussions, her neurologist told her she didn’t have a choice: Contact sports were out of the picture.
Cordero recalls her first concussion. In a warm-up before a game, her coach hit a ball to her, and it slammed right into her temple. She said the dizziness was unlike anything she had felt before.
“Our coach had never given us a lecture and he had never made it a big deal, so I thought maybe it’s just me. And he went through a few little tests and brushed it off and put me back in the game,” she said.
“The next day, I actually threw up in the middle of practice because I felt so dizzy. That’s when I thought maybe I should talk to someone, but had that not have happened, I probably would have just kept playing.”
Cordero says she agrees there’s a stigma, especially among elite players.
“Our pitcher experienced a concussion that same year, and she didn’t want to tell anyone because she was our star pitcher. If she’s out, we’re going to start losing games. You let your teammates down, your coach starts getting angry at you and people might think you’re making it up.”
She didn’t want others to think she was exaggerating the pain, a concern many athletes have.
Lindsey Broadwell has been playing contact sports for years, so she’s not new to the world of concussions. A rugby player at UNC, she experienced her second concussion last fall. Although doctors have told her she is at risk of long-term effects after a third, that’s not keeping her out of the game.
Broadwell says her experience as a college athlete has been positive, and she feels safe when she’s playing because of the resources UNC provides.
Missy Frasier is a fourth year doctoral student in the Human Movement Science Program at the University of North Carolina at Chapel Hill and helps provide those resources. Her research includes emergency care and the relationship between repeated concussions and neurological behavior.
Aside from her professional research, she has experience with traumatic brain injury that makes her work much more personal. As an athletics trainer, she was covering a baseball game, and a ball hit her in the head. As she suffered a skull fracture, brain bleed, arterial bleed and ruptured eardrum, her injuries were beyond the scope of what most athletes experience. She says her personal injuries make her that much more interested in keeping athletes safe.
“My goal is to help people much like myself and help people with significantly worse injuries and work on prevention of these injuries and to predictive models of who is at greater risk for injury,” she said.
She says some states, including North Carolina, are passing laws making it illegal to allow a child to play after exhibiting signs of concussion.
“Not only are we educating athletes, coaches and parents, but policy changes in government are happening. We didn’t have laws about concussions until just recently, and I think that is definitely helping.”
She says much of the stigma comes from people not understanding what a concussion is and the painful effects. Because they can’t see the injury, there can be a stigma of weakness.
“If you sprain your ankle or break your arm, there is a sling, a cast or a boot or something to signify that you are injured,” she said. “But most people when they sustain head injuries, they look totally fine.”
So while some of it stems from pressure from other people, she argues much of it comes from oneself.
“People often feel pressure, and sometimes it’s self-inflicted pressure. If you’re an athlete, you’re competitive and you’re taught to work through ankle sprains and jammed fingers,” she said.
Register-Mihalik says females are more likely to report concussions and admit to severe pain, but research varies regarding whether females are more susceptible to concussions or if it’s societal pressure that leads males to hide their injuries. It’s complicated, she says, and there are a lot of factors that play into it.
“It’s not the same type of stigma, but it’s a stigma very similar to mental illness where people don’t want to tell people that it’s happening for fear of how people are going to perceive them.”
Education, she says, is the core of the solution. And often that starts with the coach.
“That perception of a stigma is going to be magnetized when you have a coach who is not going to support you.”
She says often the negative statements that affect young athletes are unintentional. Coaches sometimes give advice, not realizing the power of even the most seemingly innocent statement.
She references an interaction with a child when providing information on concussive injuries at a local school.
“We were talking to a six-year-old and his mother,” Register-Mihalik said. “We asked him would he keep participating in sports if he had been hit in the head and didn’t feel well afterwards. He sat there for a minute, and he looked and me and said said ‘I’d keep playing.’ His mom looked horrified. So we asked him why he would keep playing. He looked at his mom and said, ‘well my mom told me to never quit.’”
She says the interaction speaks to the root of the problem.
“We give these messages that are good things, good qualities like perseverance, not quitting, courage, being tough. You have to be to be a positive member of society, but being tough doesn’t mean being illogical.”