Liviu Bird

This is Part 2 of my story on Taylor Twellman’s 2008 concussion and the aftermath. Read Part 1 here.

The usual return-to-play protocol for concussions starts with a total shutdown — no exercise at all, and possibly even cognitive shutdown. Student-athletes with concussions are sometimes kept out of school because activities such as math problems can stress the brain, causing concussion symptoms to flare up.

“Since it’s a biochemical issue, you’re trying to let the brain recover without stressing it. So we shut the players down,” said Dr. Mike Morris, medical director and orthopedic surgeon for Seattle Sounders FC, in an interview in his home in February. “We do a symptom checklist daily. That symptom checklist comes from the SCAT 2 form.”

The SCAT 2 Sport Concussion Assessment Tool includes a self-assessment of symptoms as well as a battery of memory, concentration, balance and coordination tests. Players are given this test at the beginning of the season to provide officials with a baseline score in case of injury. After they are diagnosed with a concussion, until their SCAT 2 score is back to baseline, they are held out of any physical activity, Morris said.

In MLS, once players are symptom-free, they must see a neuropsychologist for more strenuous testing. However, this policy has only been in place for the last year or two, and teams didn’t used to do baseline testing, so former New England Revolution forward Taylor Twellman did not have to go through it when he was struggling to return from a concussion he suffered in 2008.

The next step after seeing a neuropsychologist is a slow, gradual ramp-up of activity.

“The first day, you would ride a bike for 10 minutes, then you stop. If you don’t develop headaches, you don’t develop any symptoms, the next day, you do some light running,” Morris said. “The third day, you start to do some light soccer play.”

At that rate, after five or six days, players are back into normal play, Morris said. However, if at any point concussion symptoms resurface, the player is shut down again for 24 hours and goes back to the previous level after that time.

Exactly nine months after his original injury and seven months after the Revolution announced he would be out indefinitely, Twellman finally felt well enough to play. He came on as a substitute against D.C. United on May 30, 2009. A week later against the New York Red Bulls, he came on at the start of the second half.

In the 56th minute, Twellman found himself unmarked and on the end of a cross, just as he did against Los Angeles nine months earlier. He jumped — uncontested this time — and snapped a header back across the goal. It bounced once and settled into the back of the net for Twellman’s 100th career MLS goal.

Twellman took off running, looping around the back of the net and dashing toward the sideline to celebrate in scene that was a near mirror image of his previous goal.

This time, he did not collapse. The 11,000 fans roared in the stands. Taylor Twellman was back.

Not even 10 minutes later, in the 64th minute, Steve Ralston grabbed a loose ball about 12 yards away from goal and tapped the ball to his right to Twellman, who took a poor controlling touch with his right foot and lunged at the ball with his left to roll it into the Red Bull goal for the second time that game.

But unbeknownst to anybody watching him play, Twellman still didn’t feel right.

“I described to people that my head felt like a sponge,” he said. “I knew something was up. I just knew in my heart of hearts, I wasn’t fully healed.”

Coming back too early from a concussion can have serious repercussions. It can lead to long-term cognitive defects in adults and second-impact syndrome in children.

“There are players out there that they’re finding who have severe cognitive issues,” Morris said. “The evidence isn’t totally clear yet, but it may have been from repetitive blows to the head.”

In addition, having a concussion makes a player much more susceptible to additional concussions. Even one can end a player’s career, if it’s serious enough. Others can have multiple concussions in their careers and not have any long-term effects or problems. It’s an uncertain area in which more research has to be done, Morris said. However, certain signs usually lead doctors to recommend players quit their sport if they follow a concussion.

“If they’ve had six concussions, and they’re not as sharp on some of their tests, and it’s looking permanent, we say, ‘Look, we don’t think you should play again,’” Morris said.

The unpredictability of concussions is what makes them scary, Twellman said.

“(It’s) not kind of scary,” he said. “It’s very scary.”

After the game against New York, Twellman sat out the rest of the 2009 MLS season. On June 24, 2010, he was placed on injured reserve, ending his new season before it started. In November, at the end of the season, the New England Revolution announced a press conference.

The saga was over. Taylor Twellman, the poster boy of American soccer, a star who was tapped by fans, players and media to lead the United States to the forefront of world soccer, would not play professionally again.

He was 28 years old.

“It’s unfortunate to lose a career to an injury. It’s not a choice. I don’t have a choice, unfortunately,” Twellman said at the press conference on Nov. 3, 2010. “When you’re told that if you want to live your life and be healthy, then soccer needs to stop, the decision is made for me.”

Twellman spoke calmly, his voice never wavering. He never had a Brett Favre moment. But his pain was still audible.

“The hardest part of this injury is that I can do zero about it,” he said. “And that is the most humbling thing that has ever happened to me in my life.”

He reflected on his career, talking about the first goal he remembered scoring and about growing up in an athletic family.

“I just thought every kid grew up with my family. I thought every kid had seven pro athletes (in the family),” he said. “And I thought every kid, their dad played pro soccer, was successful at it, sat in that locker room, and I thought every kid did that.”

The press conference lasted over half an hour. Twellman said his favorite moment in his career was scoring his 100th goal.

Then, he answered the question many fans were likely wondering that day: What are you going to do now, Taylor?

“As for my future … I have an opportunity — I don’t know why, but it was God’s way for me — to help educate about the injury of concussions,” he said. “Sports Illustrated (and) TIME Magazine (are) calling it the invisible injury, and I take that as a challenge.

“I hate the fact that my career has ended on a brain injury as a concussion, but I have an opportunity to educate parents and kids (about) the dangers about concussions and the effects of concussions.”

In 2011, Twellman established ThinkTaylor, a nonprofit organization dedicated to helping people through concussions and getting proper treatment. From the youth level to MLS, concussion awareness is up, and it’s due in no small part to the way Twellman’s career ended.

Baseline testing is now common at all levels. The U.S. Youth Soccer Association and each state association have a section of their websites dedicated to concussion awareness.

“It’s mandatory that there’s a poster in every locker room,” Morris said. “I think the players are much more tuned in to (the issue of concussions), and they understand it.”

In most states, youth parents and coaches have to read and sign forms detailing the dangers of concussions, and players are not allowed back onto the field if any head injury is suspected.

“If you suspect a head injury, that player can’t go back in the game that day, and they can’t go back into the game until he’s released by trained medical personnel,” Morris said.

At the college level, the NCAA adopted legislation calling for every school to have a concussion management plan. As in youth sports, NCAA athletes must be held out of competition if a head injury is suspected. In MLS, a similar policy now exists that did not when Twellman played. He was allowed to stay in the game against Los Angeles even after self-reporting his suspected concussion.

“If I was taken out of that game, probably, I wouldn’t be dealing with what I’m dealing with today,” he said in February. “Would I still be playing? I can’t guarantee that because I don’t know how my brain would have healed.”

Twellman decided his career-ending injury had to be turned into something positive.

“I was getting sick of myself being depressed,” he said. “I was tired of it. I was a Jesuit school kid in high school, and the saying for Jesuits is ‘a man for others.’ I said, ‘You know what? It’s about time I wake up and get out of my own way, and maybe helping myself will be helping others,’ so I’m trying to do that.”

Along with starting ThinkTaylor, Twellman appeared on an Outside the Lines special on ESPN about concussions. His steady stream of tweets and calls for awareness are constant reminders of the grim realities of soccer that last long after the champions lift the MLS Cup and the stadium grass dies with the frost of winter.

“I’ve had a headache for three years,” he said.

He told host Bob Ley the same thing on Outside the Lines in October 2011.

“I miss my life — my normal life,” he said on the national telecast. “(A concussion) really takes away the normal things in your life, and there’s no way to get them back as quickly as athletes like us are used to.”

Twellman went on to say that he had the first dream he could remember since his injury just a week or two prior to the show.

In February, his lofty dream of just having dreams well behind him and accomplished, his focus was firmly on advancing concussion education.

“You call, you go to ThinkTaylor.org, you come to us, we’ll help you find the right doctor,” he said. “We’ll help you get through the tough times because if somebody would have done that for me, guided me the right way, who knows how I would be feeling today?”

In addition to helping others through his foundation, Twellman volunteered to join a Boston University medical school study on concussions that involves annual tests and donation of his brain to the school upon his death.

Twellman now works as a soccer analyst for ESPN. He found a way to manage his symptoms so the bright production lights don’t bother him.

“The only thing that I still miss is the fact that I can’t go for a run or just ride a bike for 20 minutes, and that’s what I’m trying to get at,” he said. “I stopped working out, and I got on a real high dosage of Omega-3s [fatty acids], and I started seeing some positive results. I still can’t get my heart rate over 145, so I’m not working out, but my bad days, ever since I’ve been on this Omega-3 diet, have gone down to the point where they’re not killing me.”

Twellman, now 32, has taken baby steps of progress since his last game in 2009. His next step toward a normal life involves an everyday reality of his for the last three and a half years.

“I’ve really done a good job of limiting the severe symptoms,” Twellman said, “and I just would like to wake up one day without a headache.”

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