When Taylor Twellman won Major League Soccer's MVP award in 2005, he threw his head at balls in the penalty box with the force of a bird smacking into a window. That's how the U.S. and New England Revolution forward scored 101 goals in eight MLS seasons -- and how his playing career took an irretrievable turn on Aug. 30, 2008.
In a game against the Los Angeles Galaxy, Twellman beat goalkeeper
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
"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:
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: