Concussions take toll in soccer too

In a game against the Los Angeles Galaxy, Twellman beat goalkeeperSteve Cronin to a cross and scored, only for Cronin's fist to slam Twellman in the jaw like a sledgehammer. Twellman staggered and told a teammate that he had a concussion, but he was allowed to stay in the game and played eight more weeks despite dizziness, nausea and headaches.

Since Twellman was diagnosed with post-concussion syndrome, the player MLS commissioner Don Garber once called "our Tom Brady" has played in only two games over the past two seasons -- and not once in 2010.

He'll soon make a decision over whether he should retire from the sport.

"My neck can't support a head ball," says Twellman, who at 30 should be in the prime of his career. "I'm kind of at a crossroads. I've played with everything: sports hernias, painkiller shots, broken feet. But concussions are scary. Your brain controls everything." When he attended Game 5 of last season's NBA Finals, Twellman says he saw Phil Jackson sitting next to Doc Rivers in his left eye even though they were on opposing benches.

Football may be attracting the most attention for head injuries in sports these days, but fútbol has also suffered a rash of concussions that have derailed the careers of prominent U.S. players. According to Dr. Robert Cantu, a concussions expert at the Boston University School of Medicine, soccer provides the third-highest number of his patients among professional athletes, behind only football and ice hockey. But unlike those sports, soccer has two big differences: Its players don't wear helmets, and the pro and international games allow only three substitutions per match with no chance to return, putting pressure on teams to make hasty decisions to keep injured players on the field.

"The problem in Taylor's case and in general is how concussions are managed," says Cantu, who has treated Twellman in Boston. "It's essential that these athletes not be allowed to physically and cognitively exert while they're still symptomatic and recovering from a concussion. The athletes themselves must take responsibility if they're symptomatic. They can't safely work out or play, and if they try to do that they'll aggravate their condition almost certainly, and that could decide whether they ever come back in the future."

Other leading U.S. soccer players who've been sidelined by concussions include:

• Lori Chalupny. A one-time captain of the U.S. women's team, Chalupny scored a goal in the 2008 Olympic gold medal game victory over Brazil and is considered one of the best attacking backs in the world. At 26, she would be a lock to play for the U.S. during next week's qualifying tournament for the 2011 women's World Cup, but a U.S. team doctor has refused to clear her to play for the national team after a history of concussions. Chalupny finds herself in an odd spot: Doctors in the Women's Professional Soccer league did clear her to play this season -- she started 21 games for St. Louis and Atlanta -- and she says a CT scan revealed that her headaches from earlier this year were the result of sinus congestion, not concussions.

Is U.S. Soccer showing admirable restraint with Chalupny? Or is it being overly cautious?

"I'm doing great, and I feel healthy," Chalupny argues. "Every doctor has an opinion, and hopefully [the U.S.] will clear me one of these days. I'd love to play in the World Cup and be with the team, but at this point I'm not holding my breath."

• Alecko Eskandarian. The MVP of the 2004 MLS Cup final and a former No. 1 overall draft pick, Eskandarian suffered his fourth concussion as a pro in a 2009 friendly between the Los Angeles Galaxy and AC Milan and hasn't seen the field since.

"Playing soccer isn't even on my mind right now. Living a healthy, normal life is," says Eskandarian, 28, who has returned to the University of Virginia to finish his degree and work as an assistant coach.

Eskandarian still marvels at the response to his first concussion, in which he flipped and landed on his head in his pro debut for D.C. United in 2003. He says he was unconscious for 10 to 15 seconds.

"I don't remember anything, and the sad thing was I actually stayed in the game," he says. "When I watched the video, as I got up, my head was looking straight but I ran 15 yards to the right, just off balance. You can see [teammate] Earnie Stewart's face, and his eyes are saying, 'Are we really letting this guy play?' "

Those aren't the only scary effects faced by soccer players who've had concussions, whether they've come from contact that is head-to-head, head-to-ball, head-to-ground or head-to-elbow. Former MLS player Ross Paule retired at 28 in 2005 as the result of four successive concussions the previous year, and while he now coaches youth soccer in Memphis, he says he still deals with dizziness, headaches and difficulty recalling words. Former All-Star Josh Gros retired at 25 in 2007 after being diagnosed with seven concussions that year alone. The Marine Corps cited Gros's head injuries in refusing to readmit him -- he'd graduated from Officer Candidate School before the start of his soccer career -- and he now works on the Philadelphia Union staff.

Likewise, D.C. United's Bryan Namoff, 31, hasn't played since September 2009, when his post-concussion symptoms included such painful headaches that he says he had to sit in a dark room for much of the following six months.

"It's difficult for me to read. The words are kind of bouncy," he says. "I look completely normal, but on the inside I'm sitting here talking with you right now and I'm in kind of a dizzy state. I'm just ... off."

In an effort to improve its response to concussions and education for team trainers, coaches and players, MLS hired a chair for its new Concussion Program Committee in August: Dr. Ruben Echemendia, a clinical neuropsychologist who has a similar position with the NHL.

His 12-member committee (which includes Twellman) met for the first time in September and is producing a set of guidelines to help determine when a player with a head injury can be allowed to return to action.

"As long as there is contact in the game, there is going to be the possibility of concussion," says Echemendia, who notes that foam headgear has not been shown on the field to reduce concussions. "The best preventative approach is one of educating the players about the signs and symptoms of concussions, and recognizing that when those symptoms exist they need to tell the medical staff and get off the field." MLS has also conducted baseline testing on all its players for the past three seasons.

With his playing future in doubt, Twellman has started working as a commentator for ESPN in what may be the next phase of his career. He recently joined 300 other athletes -- including former U.S. women's soccer star Cindy Parlow, who retired at 28 because of post-concussion syndrome -- who have agreed to undergo annual testing and donate their brains after death to a Boston University medical school program studying the impact of concussions. And he's well aware that there are 18 million soccer players in the U.S., 78 percent of them under the age of 18.

"Raising awareness like the NFL is something we have to do," Twellman says. "I'd love to be a spokesperson for concussions for soccer and educate people. This is something that has to be talked about."

The MLS Cup playoffs start this week, so I should get some picks out in print. Let's break it down:

WESTERN CONFERENCE

Los Angeles vs. Seattle: The Galaxy swept the Sounders this season, but L.A. was a lot harder to score on at that point than it is these days. Seattle, too, is a changed team after sending Freddie Ljungberg to Chicago. While Fredy Montero has cooled off, Seattle has a huge speed advantage, not least because Steve Zakuani and Sanna Nyassi are in form.

The pick: Seattle in a mild upset.

Salt Lake vs. Dallas: I could go on for hours about MLS' dismal playoff structure, which forces the two best teams over the season (L.A. and Salt Lake) to meet two other heavyweights in the first round. Both Salt Lake and Dallas possess the ball well and exemplify team play without any DPs. Dallas has struggled a bit of late and has been hurt by injuries to Kevin Hartman and Daniel Hernandez. And while David Ferreira has had a marvelous season in the attack, Salt Lake brings an even more varied attack spearheaded by Javier Morales. Look for Álvaro Saborío to have a big impact.

The pick: Salt Lake.

EASTERN CONFERENCE

New York vs. San Jose: I'm surprised by how downbeat a lot of pundits are about the Red Bulls, who merely went from worst to first in the East this season under new coach Hans Backe. Thierry Henry may miss the first playoff game to injury, but New York has a lot of other solid players. San Jose, meanwhile, relies a lot on the scoring of surprise Golden Boot winner Chris Wondolowski, though Geovanni has established himself as a first-rate setup man. I'm expecting New York's Joel Lindpere and Dane Richards to make a difference in this one.

The pick: New York.

Columbus vs. Colorado: The right shoulder injury that has knocked William Hesmer out of the playoffs is the latest bad news for a team that has struggled in the league of late. Momentum is everything in this four-week knockout tournament, and Columbus just doesn't have it right now. Colorado has one of the league's best forward tandems in Omar Cummings and Conor Casey, and the Rapids will take advantage of opening at home (at altitude) to build a lead from which Columbus can't recover.

The pick: Colorado.

FINALS

Western Conference final: Salt Lake over Seattle.

Eastern Conference final: New York over Colorado.

MLS Cup XV: Salt Lake over New York.

I always wish MLS would wait until after MLS Cup to hand out its awards. But if we have to give out awards now, here are my choices:

Most Valuable Player: Chris Wondolowski, San Jose. Wondo won it for me with his electrifying surge in the final weeks to win the Golden Boot. Barely beats out David Ferreira and Landon Donovan.

Rookie of the Year: Tim Ream, New York. Hey, I actually got a preseason pick right! Ream had only a few hiccups all season while playing a lot in the central defense. Noses out Andy Najar and Danny Mwanga in an excellent rookie class.

Coach of the Year: Hans Backe, New York. Give credit to Schellas Hyndman for turning around Dallas (albeit with a lot of ties), but Backe took the worst team in the league and finished first in the East. Apparently foreign coaches can succeed in MLS.

Defender of the Year: Jamison Olave, Salt Lake. The rock of the champs' record-setting stingy defense.

Goalkeeper of the Year: Kevin Hartman, Dallas. Hartman was in the news all season long, from his collective-bargaining-example limbo to his freak injury against New York to (most important) his consistently excellent play in goal.

BEST XI

Goalkeeper: Kevin Hartman, DallasDefender: Heath Pearce, DallasDefender: Jamison Olave, Salt LakeDefender: Omar Gonzalez, Los AngelesMidfielder: Landon Donovan, Los AngelesMidfielder: Kyle Beckerman, Salt LakeMidfielder: David Ferreira, DallasMidfielder: Javier Morales, Salt LakeMidfielder: Sebastien Le Toux, PhiladelphiaForward: Edson Buddle, Los AngelesForward: Chris Wondolowski, San Jose