It all started with a header.
In a fight to win the ball during a game last September while playing for his club team, Liam Kroontje pushed his feet off the ground to meet the soccer ball with his head. As the 18-year-old player, who was a senior at Lynden Christian High School at the time, felt the ball rebound off his skull, he immediately realized the ball was over-inflated, making it as hard as a rock.
Minutes later, he had to head it again. And again.
He asked a teammate to take the next one. But, as luck would have it, they kept coming to Kroontje. After the game, with his head spinning, he knew something was wrong.
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A trip to the doctor confirmed concussion No. 1 of Kroontje’s senior year.
Concussion No. 2 came two weeks later, delivered in the form of a ball to the back of the head while he was sitting out because of his first head injury. He struggled to regain his senses and then vomited.
Concussion No. 3 came, like clockwork, two weeks later at school, as Kroontje backed into a glass case while talking to a friend, shattering it. He didn’t know what to do, he said, so he just went to class.
Kroontje is one of the thousands of high school athletes who have suffered a concussion from sports or recreation-related injuries in the United States.
In 2009, the Center for Disease Control reported that unintentional blunt force was the second-largest cause of concussions or traumatic brain injuries, making up 15.5 percent of all reported cases. But while concussions can be a common occurrence in contact sports like football and soccer, the effects can often be hidden once the player steps off the field.
After three concussions in four weeks, Kroontje was suffering from headaches, occasional vomiting and would often get inexplicably tired. Not usually one to get emotional, he would start crying without warning.
And as time would soon show, it wouldn’t be his first bout with concussions.
From the field to everyday life
Stories like Kroontje’s are not uncommon.
They happen all too often in sports — a tackle gone wrong, the hollow “thunk” of a head as it hits another, a ball to the temple — and they can linger, sometimes unknown to the athlete, for much longer than a game.
Months after his first series of concussions, Kroontje was riding in the team van to a high school soccer game last spring, when a car behind them rear-ended the vehicle. His head and neck went forward and then snapped backward. At first, Kroontje said he felt fine.
“But the same thing happened to me when I got my other concussions,” he said. “A few minutes after the accident, tears just started coming out of my eyes.”
Although Kroontje said he wanted to play, the Lynden Christian trainer decided he had to sit out of the game.
Two days later, Kroontje was back playing on the field and a ball hit him in the head.
“Then that’s when I said to myself, ‘Yeah I’m kind of out for a while; I need to rest,’” he said.
Now, Kroontje has headaches more frequently and sometimes finds it hard to keep up with his day-to-day activities.
“Often times with friends or at school, I’ll just say ‘I want to go home now,’ because I just want to rest,” he said. “Especially after the car crash.”
Running or moving up and down will hurt his head. He often doesn’t drive at night because the headlights from oncoming traffic can cause pain as well.
At 18, Kroontje already is feeling the effects of multiple bumps to the brain. He is not alone, though.
From 2009 to 2010, the CDC reported 981 people ages 15-24 visited the emergency room for a traumatic brain injury.
From the sidelines, struggling to keep children safe
While athletes have to battle with the effects of concussions, parents are often forgotten in the struggle.
“It’s a little frustrating,” Lesa Kroontje said when asked about her son’s concussions. “It’s not like you can see if a concussion is getting better or worse. Liam would go for a while without reporting any symptoms at all, and we’d think he was getting better. And then all of a sudden he’d have a relapse of symptoms.”
Kroontje said the hardest part was deciding how much activity her son should engage in after his concussions.
“You feel like you may be a bad parent if you do allow your child to play sports if they are concussion prone,” she said.
But she also knew how much her son loved the sport he’d played since kindergarten. Being safe and smart in every decision, she said, is key to keeping him safe.
The doctor’s view
In Kroontje’s experiences, a visit to the doctor provided little comfort — or answers.
Brian Weeda, who works at Performance PT — a Bellingham-based physical therapy rehab center — emphasized the usage of more than just the traditional tests.
“It may not just be we take them in and put them in a room and have them work on balance, but we introduce multiple stimuli and have them work on it from that surface in the recovery process,” Weeda said.
A 2015 study done by researchers at the University of Pennsylvania School of Medicine shows that athlete’s answers can also often be affected by their motivation to return to the field. According to the findings, “athletes experience an increase in motivation post-concussion, and that high motivation at baseline improves their performance on neurocognitive tests,” leading to results that may mask the true problem.
Wayne Sebastianelli, the director of Athletic Medicine at Penn Sate University, admits that the tests are less than perfect.
“It’s the best we have and it’s a good screen, but there are people who are gifted in their ability to do these sort of things,” he said.
These people can pass a test that would normally detect a head injury and head back onto the field with a possible concussion, unbeknownst to coaches and possibly even the player him or herself.
Instead, Kroontje and his family found more answers from a doctor that focused on the long-term effects of concussions as opposed to the short-term goal of getting players back on the field.
“That doctor explained that a player is never really cleared,” Lesa Kroontje said. “You can be symptom-free for a couple of years, but there can be a recurrence of symptoms.”
According to the Sports Concussion Institute, after someone has received a concussion, they are one to two times more likely to receive a second, and after a second, a third concussion is two to four times more likely.
Additionally, a study published in the International Review of Psychiatry stated that post-concussion symptoms, such as headaches or increased memory problems could last from months to even years. However, the study found that people who were educated about their symptoms following their injury had less post-concussion symptoms and were able to manage the symptoms that did show better than those who weren’t educated.
While many factors that play into concussion recovery can be ambiguous or unique to each individual, what the medical community seems to agree upon is a need for more research, said Dr. Amaal Starling, who specializes in neurology at the Mayo Clinic based in Arizona.
“It’s still quite limited,” Starling said. “The medical community is definitely changing that; we’re actively very involved in lots of research, and having conferences.”
Starling added that an availability of strong medical evidence will help doctors and athletes make better decisions about concussion care.
For now, Liam Kroontje is taking a break from his post at center defense.
This fall he will head across the border from his home in Lynden to study business at Trinity Western in Langley, B.C. He won’t be playing soccer, because he said he wants to focus on his studies and because of his concussions, which could become increasingly dangerous at the more-aggressive college level.
For Kroontje, it may have started with a header, but it won’t end with one.
Additional reporting by Reed Strong
Concussions reported in 2012, double what was reported in 2002.
Percent of sports-related concussions happen at practice.
Percent of all sports-related concussions occur during high school football.
Percent (one in five) of high school athletes will sustain a sports-related concussion during the season.
Percent of high school athletes who have a sports-related concussion report two or more in the same year.
Percent of most diagnosed concussions do not involve a loss of conciousness.
Amercians live with a traumatic brain injury-related injury, the Center for Disease Control estimates.
Concussion rates per sport
The amount of sports concussion taking placer per 100,000 athletic exposures. An athletic exposure is one athlete participating in one organzied high school athletic practice or competition, regardless of the amount of time played: