Story by Blake Richardson
CHAPEL HILL, North Carolina — Alex LaGrand stared at the scrawl on the worksheet, trying and failing to discern meaning from the jumble of letters on the page. Her head throbbed. Why was this so hard?
That’s when she realized she couldn’t read.
It had only been a few weeks since LaGrand’s fourth recorded concussion — the worst the 17-year-old soccer goalkeeper had experienced. LaGrand was poised in front of the net at a Coastal Carolina recruiting camp in October 2012, when a player fired the ball at the goal. It smacked LaGrand between the eyes.
Dazed, but she’d be fine, she figured. Getting hit in the head was a regular part of playing goalie — on the ground, against a post, by the ball or an attacker’s shoe. LaGrand had grown used to it.
But then she looked down at her glove, and she only saw blood.
“OK, someone sub in for me so I can go check this out,” she told a fellow goalie nearby.
Concussion. The athletic trainer knew right away, because the pupils in LaGrand’s eyes were shaking. Concussions come from severe head injuries that temporarily impair brain functioning, but recovery typically takes a week. There was no way to predict that LaGrand’s concussion would last five months, or that it would rob her of her ability to read. The problem was repetition. LaGrand doesn’t know how many concussions she had that went untreated. Doctors estimated she seriously hit her head about four times per year when she played soccer — 36 times total.
Soccer was supposed to be her chance. Nobody told her that soccer, with its promise of a college scholarship, could become the villain, that the sport that shaped her identity could also damage her brain.
The pressure to get an athletic scholarship for college or play professionally burdens younger and younger athletes. Youth sports’ heightened intensity carries dangerous health implications. As athletes are pushed toward the expectation of excellence, they risk overexertion.
But what happens when their body can’t take it anymore?
LaGrand joined a recreational soccer team when she was 9 — her first and last time playing soccer only one season of the year. By the time she was 10, she was playing in the fall and spring, and by seventh grade, she was playing year-round. It was the only sport LaGrand played competitively.
The choice to specialize is common among athletes, but specialization also drastically increases injury risk, because athletes risk overusing muscles. High school athletes who specialize are 70 percent more likely to suffer a serious injury, according to a study by the National Federation of State High School Associations.
“(If an) athlete specializes in one particular sport, you’re doing the same movements over, and over and over again,” said Adam Wall, Clayton High School’s head athletic trainer. “So that definitely creates the mechanism for more catastrophic injuries to occur.”
But for most athletes, the chances of seeing specialization pay off are low. Only 2 percent of high school athletes receive a college scholarship, and only 2 percent of those athletes play professionally in the major league of their respective sport, according to the NCAA. The health risks are high for such a narrow chance of those dreams becoming a reality.
Joseph Collins’ junior year on the Clayton High School football team was going well, for the most part, even though his shoulder couldn’t seem to stay in its socket.
Clayton High School’s head athletic trainer, Adam Wall, recommended physical therapy for Collins’ shoulder to strengthen his tissue muscle. He warned Collins that without physical therapy, the dislocations could worsen.
But Collins wasn’t worried. It was only a minor inconvenience, a few seconds of pain before popping his shoulder back into place, so he was inconsistent with physical therapy. The false sense of invincibility is common in high school athletes, said Dr. Heath Thornton, medical director of Wake Forest Baptist Medical Center’s high school athletic training program.
When Clayton played Garner High School on Oct. 10, 2016, Collins was caught in the moment. Clayton was losing badly when Garner’s running back broke free at the 20-yard line. Collins was the only defender quick enough to catch him and stop the touchdown.
He grabbed the running back a few yards away from the end zone and dragged him down, but Collins landed at an awkward angle. Then Garner’s running back rolled on top of his shoulder, and Collins felt a rush of pain.
“I was just laying there, trying to get up,” Collins said. “But I couldn’t get up, ‘cause my bone was out of place, and I felt numb. And I was just sitting there crying.”
Wall helped Collins off the field and got his shoulder back into place. But Collins later learned that he chipped his bone and tore a ligament in his shoulder. He needed surgery.
Serious injuries in young athletes are not uncommon. More than 1.35 million children visit the emergency room for a sports related injury in 2012, according to a report by Safe Kids Worldwide. The most common types of injury are sprains or strains, fractures, bruises or scrapes and concussions. Dr. Janet Simon, an Ohio University assistant professor who researches athletes’ health, said even a sprained ankle can cause chronic pain long-term when repeatedly re-injured.
In the four years Wall has worked at Clayton High School, three to six athletes per year have needed surgery for a severe sports injury, and he said he has treated five to 10 concussions per season. In the fall 2017 season, Wall treated 11 Clayton athletes for concussions — six football players, four soccer players and one cheerleader. And in each of the past two years, an athlete has been forced to medically retire because of concussions.
Despite the prominence of high school injuries, most schools are poorly equipped to treat them.
One study found 70 percent of public schools and 58 percent of private schools offer students access to athletic training, and only 37 percent of public schools and 28 percent of private schools have an athletic trainer working full time, as Wall does. Melissa Kay, a UNC-Chapel Hill sports medicine Ph.D. student, said the disparity is worse in lower socioeconomic status schools and in rural areas.
Athletic trainers who do serve at the high school level are constantly busy. One trainer is in charge of every team in the school. How does one person manage that?
“That’s a great question,” Wall said, laughing. “I don’t know how I do it either. It’s really just time management.”
Wall spends practice with the football team, because those athletes are injured most frequently, but he also visits other teams’ practices. He does rehab with athletes during the school day and even finds time to incorporate “prehab,” which Wall defines as “rehab before the injury occurs.”
And Wall has to keep in mind that for many of his athletes, a high school team is only one piece of an athlete’s activity.
“You have club teams, you have rec teams, you have high school teams, and none of those people talk to each other…” Kay said. “When you specialize in one sport, you’re putting all of the stress on one part of your body, and nobody’s regulating how much stress you’re actually putting on it.”
A lot of the athletes Wall works with hire personal trainers to help them reach collegiate or professional level of play. But Wall said many of those personal trainers are not properly trained, and athletes risk injury while working with them. He estimated that 6 percent of Clayton High School’s athletes have been injured during personal training.
When an athletic scholarship is at stake, the trainer’s job is even harder. Often, athletes rush recovery or play with residual injury.
“They’re willing to do whatever they can to try to get a scholarship,” Wall said. “Whether it’s sacrificing their health, they’re willing to do it, unfortunately.”
Collins wanted to run in college, but his injury made it painful to push off the starting block, so Collins’ times slowed his junior year. If he didn’t restore his speed, he risked losing college’s attention, and his chance at a track scholarship. But if he pushed too hard, he risked re-injury. As Collins recovered from shoulder surgery, he had to strike this balance.
Collins dutifully followed Wall’s physical therapy regimen, and in March 2017, he won the 200-meter race in 23 seconds flat — a time impressive to recruiters that qualified him for a regional meet. Now a senior, he switched to offense in football to avoid re-injury, and he said his shoulder is 90 percent healthy. He is optimistic that it will continue to improve with rehab and strengthening.
“I trust my shoulder,” Collins said. “I know it won’t break on me or anything, because I’ve been working my tail off to get it where it’s supposed to be.”
LaGrand sat down with a Shakespeare sonnet and played audio of the poem in hand. She would listen to the sonnet over and over while studying the writing until she understood each word’s meaning — no matter how long that took. She repeated the routine until she could read.
“I figured if I could read Shakespeare, I could read anything,” she said.
Five months after her concussion, LaGrand’s doctor cleared her to play soccer again. Her junior year, she led her soccer team as the captain and goalie. After four concussions, LaGrand’s recruiting prospects were more limited, but she still received offers. She accepted a scholarship to play at Western Carolina.
But every day after practice that spring, LaGrand came home with pulsing pain in her head. She would retreat to her room and sleep for an hour. Could she really keep living like this?
“I loved the game so much,” she said. “But it became a thing that would break my heart to go to, because I knew it would hurt me.”
In September 2013, LaGrand officially retired from soccer. She was at peace with her choice, but that didn’t make it any less painful. Now that she left soccer behind, who was she?
Kaufman said athletes who specialize are particularly vulnerable to feeling this loss of identity with medical retirement, because their sport dominates their world.
“It’s a grieving,” Kaufman said. “And then, you know, moving forward, what do you want to put your energy into to redefine yourself?”
Wall reminds athletes that retirement spares them from long-term health problems. Simon found that on average, former college athletes have a lower quality of life, sleep less than non-athletes and suffer more chronic pain. She attributes these differences to youth sports injuries.
Some health care providers question the implications of Simon’s research. Health care today is better than when the athletes Simon studies competed. But Simon noted older athletes did not specialize and train year-round like athletes today. Since specialization is relatively new, it’s hard to predict the consequences.
LaGrand was told she has a higher risk for Alzheimer’s — terrifying news for anyone, let alone a 17-year-old. Now a senior at UNC-Chapel Hill, she still does concussion therapy twice daily during the week and three times daily on weekends. During the 10-minute sessions, she stares at a stick in front of her while shaking her head.
“For a normal person… anyone can to that,” LaGrand said. “But for me, I feel like I’m in a car going 100 miles an hour when I’m going back and forth. Because my brain’s just like, ‘dude, what are you doing?’”
She gets carsick more frequently, and running hurts her head. She got glasses because the concussions and frequent reading damaged her eyes. Loud noise hurts her head, so she avoids concerts, clubs and rowdy parties; she rarely goes to movies because of the flashing lights. She cannot do homework for more than an hour at a time, and must take breaks to recover after classes. LaGrand meticulously plans her day and has developed OCD because of her need for routine.
And LaGrand’s concussions erased almost all of her memories before fourth grade. She pieces together her childhood from family stories and the occasional foggy flashback.
A senior honors student, LaGrand is double majoring in English and Dramatic Art with a minor in Medieval and Early Modern Studies, specializing in Shakespeare. She is excelling in school, far beyond what any doctor would have expected.
Since leaving soccer, LaGrand has fallen in love with theater. She has researched at the Folger Shakespeare Theater and designed sets for UNC performances, and she is planning to pursue MFA in dramaturgy or scenic design.
LaGrand suffered two more concussions this year from hitting her head on a low ceiling over a staircase and on a closing door. After the concussions, she grew depressed at the vulnerability of her brain. But like she has in every moment of adversity she’s faced, LaGrand grew even more determined. She won’t let her injuries hold her back.
“My mom sat me down, and she was like, ‘it’s just a thing that you’re going to have to live with,’” LaGrand said. “Because it’s guaranteed I’ll get another concussion at some point in my life.”
Lex Juarez contributed reporting.