Clint Frazier Is Part of Baseball’s Evolution on Concussions

There are six types of concussions: vestibular, ocular, fatigue, anxiety/mood, migraine headaches and cervical. Each of those concussions’ symptoms has different triggers. For example, symptoms of an ocular concussion, which affects visual tasks and the ability to track moving objects, can be prompted by being in the bright light of a cellphone or being in a long passageway, Collins said. The Yankees have not said what type of concussion Frazier has.

Each type of concussion has distinctive therapies.

“If you can have 30 different types of knee injuries, why do we think there’s one type of concussion?” said Collins, who added that each type of concussion has about 20 subsets. “There’s different treatment to those different problems. Science is progressing rapidly now that we know it’s not a homogeneous thing.”

As diverse as the treatments might be for a concussion, they are almost all active, involving some sort of exercise or exposure to conditions that might exacerbate symptoms, Collins said. What is important is not pushing too far or easing off too much.

“It’s a brain injury; it takes awhile to recover,” Collins said. “But it’s a treatable problem. The best way to prevent concussions is to manage it effectively when you have one.”

Though concussions are typically associated with high-impact sports like football or hockey, or in a sport that requires heading a ball, like soccer, they do occur with some frequency in baseball. The Yankees, for example, have had a player get a concussion in six of the last seven seasons.

An ocular concussion can be significant for a baseball player, given how it impacts vision. “Try to hit a 95-mile-per-hour fastball with really good eyes,” said Collins, who treated the former Yankees infielder Stephen Drew when his 2015 season ended with a concussion he received after being hit in the face with a ground ball.

Research is indicating that even when players return from a concussion, their performance lags in the weeks upon their return. Erin Wasserman led a study of the performance of players who spent time on the disabled list with a concussion between 2007 and 2013, and used as a control group players who went on paternity or bereavement leave.

Wasserman found that batting average dropped 31 points, slugging percentage declined 62 points and on-base-plus-slugging percentage fell by 99 points in the first two weeks upon players’ returns from concussions. Performance was still lower four to six weeks after returning, but not significantly so, Wasserman said.

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Jacoby Ellsbury sustained a concussion last season when he ran into the outfield wall, and he struggled at the plate after he returned. Credit Kathy Willens/Associated Press

“The symptoms and neurocognitive computerized testing is all we have to measure whether an athlete is recovered, but the neurocognitive areas that are required for hitting may not be fully recovered,” said Wasserman, a sports injury epidemiologist at the Datalys Center for sports injury research in Indianapolis. “We didn’t find any evidence that it was dangerous for these players to return, but there may still be some sort of deficit.”

That may help explain why Yankees center fielder Jacoby Ellsbury, who missed a month with a concussion last season, experienced a sharp decline in his performance when he returned, leading to his eventual benching.

Ellsbury was having a solid season, batting .281 with a .771 O.P.S., when he crashed into the center-field wall at Yankee Stadium making a catch. In a little over three weeks between his return and his benching, Ellsbury batted .177 with a .497 O.P.S.

Ellsbury declined to be interviewed for this article, but General Manager Brian Cashman said that Ellsbury’s decline after the concussion was not a surprise and that it was explained by a neurologist last season.

“It’s almost like a period of time they’ve got to work through on their own, regardless,” Cashman said. “You have to grind it out and be patient.”

Eventually, Ellsbury found his peak form, hitting .337 with a .912 O.P.S. in September.

A tipping point in how baseball began to view concussions came 10 years ago with Ryan Church, a Mets outfielder whose career was derailed after he was allowed to continue to play for about a week despite experiencing symptoms from his second concussion in a two-month period. After a steep decline in performance, Church retired after the 2010 season at age 31.

His case spurred Major League Baseball to develop a concussion protocol, which was updated in the most recent collective bargaining agreement in 2016. It requires baseline testing of players when they enter professional baseball and dictates what tests must be administered before a player can return. It also allows for a seven-day concussion disabled list, removing an incentive for teams to keep players off what was then a 15-day disabled list. (It has since been shortened to 10 days.)

It also calls for a game to be stopped and a player to be evaluated on the field by a trainer if there is an incident that carries a high risk of concussion. If the trainer detects signs of a concussion, the player must be removed and examined further. But because a concussion’s cause can be so nebulous, it is hard to know just what constitutes a high-risk collision.

For example, Ellsbury was allowed to remain in a game last May after running into the wall at Yankee Stadium to make a catch. But when he was re-examined at the end of the inning, he was removed from the game. He missed a little more than a month.

It is not clear how Frazier became injured. He fell backward making a catch on Feb. 24 in Bradenton, Fla., and his head hit the wall. A trainer did not examine him until he came off the field at the end of the inning. Later in the game, Frazier caught a ball on the warning track and his shoulder hit the wall, jarring him. He did not begin experiencing symptoms — a headache and nausea — until after the team returned from Bradenton.

Frazier has undergone a CT scan and an M.R.I. and has visited regularly with a league neurologist, as well as one in the Tampa area.

After Frazier spoke with reporters last Saturday, expressing his frustration that the symptoms had improved but had not cleared up, he was barred by Cashman from speaking to the news media.

Cashman pointed to the N.F.L. and the N.B.A., which make their players off limits to the news media while they are recovering from concussions.

Asked when Frazier, who had come to spring training motivated to make the opening day roster, might get back on the field, Cashman shrugged.

“No one can predict that,” he said.

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After a Concussion, Clint Frazier Turns to Bottled Water

Wilson himself has experience with the issue. During a game in December, he ducked in and out of a treatment tent in a matter of seconds after he was sent there for a concussion evaluation. The Seahawks were hit with a $100,000 fine for evading the protocol.

While baseball is not the contact sport that football is, the Yankees still are no strangers to head injuries. Catcher Austin Romine was sidelined with a concussion in 2013, as was infielder Stephen Drew in 2015.

And last season, Jacoby Ellsbury missed a month with a concussion after crashing into the center-field wall at Yankee Stadium to make a catch. Ellsbury was allowed to remain in the game to finish the inning.

Frazier’s first collision on Saturday came when he made a leaping catch in the first inning before falling and hitting the back of his head on the outfield wall. But his injury may have been the result of a second, lesser collision he had with the wall several innings later. His head did not hit the wall, but his shoulder did, leaving Frazier to wonder if the second collision was jarring enough to exacerbate the first.

Frazier was not evaluated on the field, but was checked out when he returned to the dugout at the end of the first inning.

“I made it through the game and felt fine,” Frazier said. “That’s why it was frightening afterward. That’s why you have to take it seriously.”

Still, Frazier admitted to feeling conflicted. He arrived to spring training determined to play his way onto the opening day roster, a tall task but one that is not out of reach for a former No. 4 overall draft pick. He can’t earn a spot unless he’s on the field.

“It’s not fun watching your goal slipping away while you’re sitting on the shelf,” Frazier said.

Scott Rodeo, the team doctor for the N.F.L.’s Giants, emphasized that concussions were a unique type of injury. He said he had seen jarring hits resulting in a near-loss of consciousness leave no signs of a concussion, while an innocuous collision could leave persistent symptoms.

As for water helping out?

“I don’t know of any physiological reason why drinking water would make a difference in alleviating symptoms of a concussion,” Rodeo said.

Major League Baseball’s concussion protocol, instituted in 2011 and updated in the most recent collective bargaining agreement, was supposed to take decisions about handling concussions away from players and managers. It calls for the game to be stopped and a player to be evaluated by a certified athletic trainer if there is an incident with a “high risk of concussion.”

Manager Aaron Boone said there was some thought to removing Frazier from the game at the end of the first inning, but tests did not show any symptoms.

“I think we were comfortable with how we checked him out and checked in on him,” Boone said. “There wasn’t anything in the immediate right there to suggest getting him out of the game.”

When the Yankees returned from Bradenton, Fla., after the game, Frazier’s head began to hurt and he began to feel nauseous. He notified a trainer, who put him through a battery of tests: balancing on each foot with his eyes closed, looking at lights, reciting the months backward, remembering five words they told him at the beginning.

“I passed all that,” Frazier said. “It was just the headaches.”

He did not feel any better on Sunday or Monday. When Frazier arrives at the clubhouse each day, he typically eats three scrambled eggs with cheese, three pancakes and hash browns. In recent days, he barely touched his food. When he went outside, the sunlight was blinding.

Frazier said the first time he was diagnosed with a concussion was on Monday, when he was sent by the Yankees to a doctor outside the organization.

On Tuesday, Frazier rode an exercise bike for 11 minutes to build his heart rate up. He felt O.K., so he then went to the batting cage to take some swings in a soft-toss drill, but he became dizzy tracking the flight of the ball.

When he arrived at Steinbrenner Field on Wednesday morning, he did not feel any better. He sat at his locker with his forehead throbbing, comparing it to a migraine.

“I can’t even sit in my living room without feeling like” rubbish, Frazier said, using an expletive. “I can’t shake the headache all day.”

But then he began to drink water. He felt well enough to ride the exercise bike again and take some more swings in the cage.

He reported afterward that his head remained clear. The same could not be said for when he will be back on the field.

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Dave Duerson Found to Have the Brain Trauma He Suspected

Although the precise motivations behind Duerson’s suicide remain unknown, he had complained of headaches, blurred vision and a deteriorating memory in the months before his death.  His final note to his family finished with a handwritten request: “Please, see that my brain is given to the N.F.L.’s brain bank.”

The N.F.L. does not run the Boston University research group but did donate $1 million to its financing last year, after the league acknowledged long-term effects of football brain trauma.

C.T.E., a condition previously associated mostly with boxers and manifested in behavior more commonly known as dementia pugilistica, is a degenerative and incurable disease that compromises neural activity and is linked to memory loss, depression and dementia. Although groups at Boston University and elsewhere are pursuing tests for living patients, the condition can currently be detected only after death, by brain autopsy.

“We hope these findings will contribute more to the understanding of C.T.E.,” the N.F.L. said in a statement. “Our Head, Neck and Spine Medical Committee will study today’s findings, and as a league, we will continue to support the work of the scientists at the Boston University Center and elsewhere to address this issue in a forthright and effective way.”

DeMaurice Smith, the executive director of the players association, said in a telephone interview that Duerson’s having C.T.E. “makes it abundantly clear what the cost of football is for the men who played and the families.”

He added: “It seems to me that any decision or course of action that doesn’t recognize that as the truth is not only perpetuating a lie, but doing a disservice to what Dave feared and what he wanted to result from the donation of his brain to science.”

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Dave Duerson in 1988. Credit NFL Photos, via Associated Press

Duerson’s death rattled players both active and retired, who after years of news media coverage are more aware that the damage done to their brains could be permanent. Pete Kendall, a recently retired offensive lineman, said, “The whole issue of C.T.E. is something that players young and old have no choice but to think about.”

Duerson’s former wife, Alicia, attended the Boston news conference with their four children. Their son Tregg, 25, made a brief statement, saying, “It is our hope that through this research questions that go beyond our interest may be answered — questions that lead to a safer game of football from professionals to Pop Warner.”

He added with regard to his father, “It is my greatest hope that his death will not be in vain and that through this research, his legacy will live on and others won’t have to suffer in the same manner.”

Duerson was an all-American defensive back at Notre Dame before spending most of his 11 N.F.L. seasons with the Bears. He played safety on the famed 46 defense that fueled their Super Bowl championship in the 1985 season, and he won the 1991 Super Bowl with the Giants.

Duerson retired after the 1993 season and became successful in the food-services industry before his businesses collapsed, his marriage failed and he went bankrupt. He began showing symptoms of repetitive brain trauma, including memory loss, poor impulse control and abusive behavior toward loved ones.

Another son, Brock, 22, said that the diagnosis of C.T.E. provided an explanation for his father’s decline and final act.

“I don’t want people to think just because he was in debt and broke he wanted to end it,” he said. “C.T.E. took his life. He changed dramatically, but it was eating at his brain. He didn’t know how to fight it.”

Duerson’s case is unique beyond the circumstances of his suicide. Since 2006, he had served on the six-member panel that considered claims for disability benefits filed by former N.F.L. players. Although individual votes are kept confidential, that board has been sparing in awarding benefits, including those for neurological damage.

Duerson himself told a Senate subcommittee in 2007 that he questioned whether players’ cognitive and emotional struggles were related to football.

However, Duerson’s legacy will almost certainly be how he apparently came to believe he had C.T.E., acted upon it and requested that his brain tissue be examined for confirmation and contribution to science.

Dr. Robert Stern, along with McKee a co-director of the Boston University research group, cautioned that C.T.E. could not explain all of a player’s actions.

“When it comes to suicide and chronic traumatic encephalopathy, it is possible that in some individuals the combination of C.T.E.-related symptoms of poor impulse control, depression and cognitive impairment may indeed lead to suicide,” Stern said. “However, we can never clearly point to any cause-and-effect relationship in any one case.”

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