Confronting the Concussion

All of a sudden, everything was black.

Chris Harvard lay on the rubber mat, unable to remember where he was and what he was doing.

Bubba had moved too fast, his kick had been about six inches closer than it should have been. And now, he was enveloped in pure darkness.

It is one of the few concussions former wrestler Chris Nowinski ’00 can even somewhat remember.

“I have memory of it partially,” the former wrestler says. “I don’t know what’s memory and what’s been recreated. It was amazingly not traumatic because no one [in the crowd] realized what really happened.”

But Nowinski knew the feeling. He had experienced it five times before.

Nowinski’s time at Harvard and later his time spent as a professional wrestler would help shape what is now his life’s passion: ending America’s concussion crisis. As research increasingly shows that brain trauma has significant neurological implications—and can even induce severe depression—Nowinski has helped the public and professional athletes understand the serious risks posed by damaging blows to the head.

AN UNDERGRADUATE ATHLETE

The concussions began in college, back when Nowinski was a member of “The Polish Connection,” along with roommate Isaiah Kacyvenski ’00.

As best friends who share a Polish background, the pair anchored the heart of Harvard football’s defense for four years, including its 1997 Ivy League championship team.

“We ended up spending time as roommates,” Kacyvenski says. “I was the middle linebacker, and he was your nose tackle, so it worked...a lot of stuff we did we played off each other.”

Nowinski was a three-year letterman for the Crimson, achieving honorable mention All-Ivy distinction after his junior year and second team All-Ivy status following his senior season.

“He came to Harvard as a very good athlete,” Harvard coach Tim Murphy says. “Eventually, he became an outstanding player...he was one of the key kids on our ’97 championship team, just a kid you could always count on, a kid that was very dependable who was a great teammate to all the guys on the team.”

It was during his collegiate career that Nowinski received his first two concussions, but like many football players at the time, he did not report them to the coaching staff out of a lack of understanding of their severity and a desire not to appear weak. Instead, he chose to live with what he calls a “suck-it-up mentality,” one that still exists in college football today.

“With any injury, there’s a feeling of frustration that you can’t be out there with your teammates,” explains Harvard senior quarterback Andrew Hatch, who has suffered multiple concussions in the past.

“There’s definitely pressure to come back. There’s the expectation that if you seem like you can play, you should do everything you can.”

BEFORE THE CAUSE, IN SEARCH OF A CAREER

During their college days, Nowinski and Kacyvenski shared many things—shaved heads, a propensity for stopping the run, and even a bunk bed (despite their combined weight of 550 pounds)—as part of what Nowinski called their “symbiotic relationship.” The summer before their senior season, the Polish Connection lived together in DeWolfe House, during which time Nowinski cooked and worked as a finance consultant from eight-to-five and trained with his teammate for the NFL at night.

“He was in the top bunk, I was on the bottom,” Kacyvenski says. “He would snore unbelievably loudly, because he was 50 pounds overweight. I developed an ability to throw pillows and shoes at him. Anything to get him to stop, even really loud clapping.”

After Kacyvenski finished his career as the Crimson’s all-time leader in tackles, the linebacker seemed destined for the next level, and was drafted in the fourth round of the 2000 NFL Draft by the Seattle Seahawks.

But two shoulder surgeries after his senior season meant the other half of the Connection was not destined to continue his football career.

After graduating cum laude with a degree in sociology, Nowinski moved on from football, beginning his first job as a consultant at Trinity Partners, a life sciences consulting firm in Waltham, Mass., that gave him his first experiences with the medical world.

There, he was paid well, but began to become uncomfortable with the long hours he needed to work and with the life he had begun to lead. He realized then that he was not a 40-hour-a-week guy.

His way out was just down the hall.

Nowinski’s boss, John Corker ’79, was, like Nowinski, an avid wrestling fan, and the two would often converse about the sport as an escape from work.

“We both expressed our somewhat hidden enjoyment of professional wrestling,” Nowinski says. “John had friends in the business and thought that I could make a career out of it.”

As a natural athlete, Nowinski decided to take the suggestion and run with it.

“[John] put the idea in my head that the consulting job would be there forever, but the window to be a professional wrestler was short,” Nowinski says. “He kind of gave me a license to go over to Killer Kowalski’s Pro Wrestling School and let me head out early to train.”

The former football player spent four nights a week honing his skills, turning in 14-hour days on a regular basis. After Nowinski spent a few months at the Allston facility, Corker—who had a few friends in the television industry—helped his consultant obtain a preliminary tryout with the WCW, the wrestling organization owned by Turner Broadcasting.

Nowinski then took matters into his own hands, submitting an application tape to the MTV reality show “Tough Enough.” His video was accepted, and though initially hesitant, Nowinski decided he would take the gig.

There was only one problem—there was already another Chris N. on the show.

Nowinski, then, needed a new name, and he didn’t have a choice in its selection.

Chris Harvard.

“I was tagged with the moniker that followed me for years,” Nowinski says. “It was an interesting gimmick, which of course cemented my future as a bad guy.... There’s not a lot of sympathy for Harvard grads in the real world.”

After participating in the show for nine weeks—which required nine-to-five days of physical activity—Nowinski won runner-up.

“He really wanted to play in the NFL and didn’t get a shot, and I think he still wanted to be in that arena,” Kacyvenski says. “I remember him undertaking it and I was like, ‘yeah okay.’ I wasn’t sure if he would be tough enough ... but he made it work.”

‘CLEAR THE COBWEBS’

Nowinski continued to train and improve after the show and was eventually offered a contract with the WWE. On June 10, 2002, the wrestler made his professional debut on “Monday Night Raw.” Over the next year, his character would deprecate the other “less intelligent” wrestlers, drawing the vitriol of the WWE fanbase.

Of course, in professional wrestling, Chris Harvard was merely putting on an act.

“The gravity is the most real part,” Nowinski laughs. “And a few moves. Everything else is staged.”

Much of the character that Nowinski created came from his experiences at Harvard, and the wrestler often wrote much of his own material. His favorite move was “The Harvard Buster,” which was topped with an “honor role,” in which Nowinski would flip his opponents on their backs and pin them by their shoulders.

“His ability to speak to people came across wonderfully well when he was doing his vignettes,” Kacyvenski says. “The creative freedom was perfect for him. And it’s similar to football in that it’s a very macho culture.”

Chris Harvard is recognized as the youngest Hardcore Champion in WWE history, which he won with a 2002 defeat of a wrestler named Crash Holly.

But the character would also often lose, and the threat of injury was real.

In June 2003, Nowinski was wrestling 300-pound Bubba Ray Dudley in Hartford, Conn., when—after taking a hit to his chin from Bubba’s boot—Nowinski quickly began to lose his vision. Bubba made his move and went for the pin, but Nowinski couldn’t remember what he was supposed to do next. He realized that something was terribly wrong.

“That was one of the first times where I blacked out and forgot where I was and what we were doing,” Nowinski says. “I just went backstage and hid and tried to clear the cobwebs.”

The next day, his headache had almost faded, and Chris Harvard told his doctor that he felt fine. He was back in the ring an hour later.

But he had spoken too soon. Just as Bubba connected with a forearm to the back, Nowinski’s vision began to grow fuzzy again. The blood was pounding so strongly that he became afraid his head would explode. After the match, the headache was much worse, but the pain went away after an hour, and Nowinski figured he’d give it another go the next night.

He performed as such for three more weeks, but soon realized that the concussion had left his brain in terrible shape. He was suffering from severe migraines and even depression.

“I didn’t understand why I had headaches everyday, and why my short term memory had disappeared,” Nowinski says. “My parents were always worried about me. I became very tough to be around, so my friends were supportive at first and then I think I became a drain on them. It wasn’t until I went to my eighth doctor that I started understanding that what was happening could be explained by biologically.”

“For a solid year he was not himself,” Kacyvenski adds. “He’s usually unbelievably charismatic, but he was a different person. He could not function at a high level both emotionally and mentally.”

A NEW BEGINNING

After taking an extended absence from wrestling, Nowinski decided he needed to officially retire from the WWE in 2004. He then started to investigate what was wrong with his brain, and to research the dangers of concussions and the long-term brain trauma they could lead to.

After talking to former teammates and friends, he discovered that information about the hazards of brain injury had never truly reached the sports world, and that people were dying because of it.

Something had to be done.

“Once my eyes were opened to how easy the fix was to save so many lives, I felt obligated to try and change it myself,” Nowinski says.

He began to try to spread the word about the dangers of concussions, but says he faced a world that was often skeptical about the dangers posed by sports-induced head injuries.

“So many people wanted him to stop,” Kacyvenski says. “So many powers that be wanted to push him out and squash him, but he would say ‘no.’”

HEAD GAMES

Shortly thereafter, Nowinski met doctor number eight—Robert Cantu, the Chairman of the Department of Surgery, Chief of Neurosurgery, and Director of Sports Medicine at Emerson Hospital in Boston.

After diagnosing Nowinski with post-concussion syndrome, Cantu explained that concussions were a serious biological problem and helped Nowinski realize that he needed to reframe the discussion in order for the sports world to better understand the repercussions of head injuries.

“When I started intensively researching the issue, I realized that the research that told us that we should change sports was out there, but wasn’t in an easily digestible structure,” Nowinski says. “I figured that putting it together into a persuasive argument was step one ... I didn’t know what steps would follow but I knew the research needed to be compiled in a way that people could sit down with it for a couple hours and walk away understanding it.”

Nowinski decided to put his ideas in writing. By the summer of 2005, his 200-page manuscript, “Head Games: Football’s Concussion Crisis from the NFL to Youth Leagues,” was finished.

With the help of Alan Schwarz, at the time a freelance sportswriter writer for the New York Times, he got in touch with publishers.

“I thought his manuscript was great,” says Schwarz, who had written one book on baseball statistics and was working on another.

Nowinski’s book—in which he called out the NFL for its “tobacco-industry-like refusal to acknowledge the depths of the problem”—was published to positive reviews in October 2006. A month later, its research was tragically validated, when former Philadelphia Eagles defensive back Andre Waters committed suicide in his Tampa Bay home.

Nowinski read about the death, and realized that something was strange—Waters was known to be one of the hardest-hitting players in the league during his playing days, but was also widely considered to be a gregarious, happy individual.  His decision to kill himself was a mystery Nowinski wanted to solve, and a brief Internet search led Nowinski to discover that Waters had once told a reporter that he had suffered at least 15 concussions during his playing days.  Nowinski decided to initiate an inquiry into Waters’ suicide.

He received permission from the player’s family to have Waters’ brain tissue examined, and sent samples of the tissue to neuropathologist Dr. Bennet Omalu at the University of Pittsburgh. Nowinski wanted them checked for chronic traumatic encephalopathy (CTE), the tangled threads of irregular proteins that cause degenerative disease and have been linked to cognitive and intellectual dysfunction, including depression.

Omalu’s findings confirmed Nowinski’s predictions. Waters had suffered from depression caused by sustained brain damage that he had accumulated while playing football. Omalu found that Waters’ brain was comparable to that of an 85-year-old man suffering from Alzheimer’s disease.

Shortly after, Schwarz heard from Nowinski, who was then still working in Boston as a pharmaceutical consultant.

“He called me and said ‘Alan, I think I have something pretty big here, and you’re the only one who ever took me seriously,’” Schwarz says. “And so he told me about the Andre Waters story.”

Schwarz jumped at the lead, and an article that linked Waters’ depression to head injury—still a novel idea at the time—was published in The Times in January 2007. A month later, HBO Real Sports reached out to Nowinski, asking him to participate in three separate features that told the story of the concussion crisis.

“It was amazing how many leaders in the sports world watched that show,” Nowinski says.

Knowledge was beginning to spread about the detrimental impact that brain injury could have. In the spring of that year, Nowinski received a call from Julian Bailes, the chairman of the department of neurosurgery at West Virginia University and a former Pittsburgh Steelers neurosurgeon, who explained that there were similarities between the Waters case and the death of former Steelers offensive lineman Justin Strzelczyk, who had killed himself by driving 90 miles per hour against the flow of traffic to evade police.

An autopsy revealed that Strzelczyk had not been intoxicated—as was initially believed—but was rather suffering from brain damage that had led him to act in a manner many assumed was bipolar. Nowinski contacted Omalu about conducting a post-mortem examination of Strzelcyk’s brain, in which Omalu again found signs of CTE.

As word of these discoveries began to spread, Nowinski began to collaborate with former New England Patriots linebacker Ted Johnson, who prematurely retired from the NFL in 2005 because of concussion symptoms that would later cause him to suffer from depression and headaches and show early signs of Alzheimer’s. Johnson placed part of the blame on Patriots coach Bill Belichick for pressuring him to participate in full contact drills three days after suffering a concussion.

Nowinski also investigated the case of former wrestler Chris Benoit, who killed his wife, seven-year-old son, and himself after suffering from depression in 2007. Nowinski contacted Benoit’s father, suggesting that years of brain trauma may have led to his son’s actions. Nowinski sent the brain to Bailes, who found it to have an advanced form of dementia caused by CTE that had brought about the behavioral problems.

FINDING A SOLUTION

These types of cases led Nowinski to realize that the problem was bigger than even he had imagined. He came to believe that a organization dedicated to the cause was needed, one that could focus solely on the concussions problem.

He approached his former doctor about forming an institute that would advance the study of the effects of brain trauma in athletes.

Cantu agreed, and the Sports Legacy Institute was founded in June 2007 to work toward a solution to the concussion crisis in sports “through medical research, treatment, and education & prevention.”

“[I knew] the research was the key to changing this,” Nowinski says. “So SLI was conceived to facilitate the research and turn it into policy and education to protect kids.”

Upon starting SLI, Nowinski and Cantu also wanted to find a home for that research at a top-tier medical school.

After seeing a presentation by Dr. Robert Stern—director of the Alzheimer’s Program at Boston University—that linked brain trauma to Alzheimer’s, Nowinski reached out to Stern about starting the Center for the Study of Traumatic Encephalopathy (CSTE), which opened at BU in 2008. As co-director, Nowinski is primarily responsible for obtaining brain donations from the families of former football players whose lives were affected by post-concussion syndrome.

And when Nowinski decided he wanted to begin collecting brains, he knew he could turn to his other half first.

Part two of the Polish Connection—having witnessed firsthand the impact concussions had had on Nowinski—readily agreed.

“It was a no-brainer,” Kacyvenski says. “Pun intended, by the way.”

According to the organization’s website, the mission of the CSTE is “to conduct state-of-the-art research on chronic traumatic encephalopathy through the study of its neuropathology, pathogenesis, clinical presentation, disease course, genetic and environmental risk factors, and ways to prevent this progressive dementia.”

“Working with the families of brain donors is very rewarding,” Nowinski says. “[So is] getting buy-ins from youth coaches, and hearing the success stories of coaches who virtually eliminate hitting from practice, as we recommend.”

As co-founder and president of the Sports Legacy Institute, Nowinski is also responsible for development, fundraising, and designing educational programs. He often travels to give presentations to schools and organizations about “conquering concussions.”

“We want to tell coaches that the brain is far more fragile than we [ever] knew,” Nowinski says. “Every hit to the head counts ... players need to understand that there are serious long-term ramifications to abusing your brain, and that there’s no such thing as a ‘tough’ brain. They need to be more careful at what they do and need to become comfortable with not only sitting out with a concussion but also not using their head as a weapon.”

Nowinski says that as awareness has spread, it’s gotten easier to encourage families of deceased players, as well as current athletes, to promise to donate their brains for research.

After Kacyvenski, four NFL players, including three former pro-bowlers—Ravens center Matt Birk ’98, Seahawks linebacker Lofa Tatupu, and Cardinals receiver Sean Morey—pledged in 2009 to donate their brains and spinal cord tissue to the CSTE upon death, so that researchers could learn more about the effects of trauma on those organs.

“There’s less convincing now because people have heard of the work,” Nowinski says. “In our first two years at BU, 20 brains were donated, and last year [we received] 50 brains.”

But despite the success, there’s a difficult part to Nowinski’s job as well.

“You’re calling the family of a famous athlete who had just died in a horrible way,” Nowinski explains. “That first call to families is something that I still will never be comfortable with ... but people understand and want to see something good come out of a tragedy.”

In the past few years, thanks in large part to Nowinski’s research, both the public and athletes have become more aware of the dangers posed by concussions.

In 2009, the NFL instituted new rules changes that enforced stricter restrictions on allowing players to return to games or practices after head injuries. Now, any player who shows certain signs or symptoms of head injury—dizziness, headaches, and memory gaps—is not allowed to return on the same day.

“There’s independent doctors on sidelines now for the players,” Kacyvenski says. “You have medical coverage that says this player is hurt with a serious concussion, and doesn’t put manhood in question ... there’s a better protocol in place for diagnosing concussions. People understand better. You can’t just kind of play it off anymore. Awareness has skyrocketed.”

The new rules have made strides towards solving what remains a major problem. Nearly a fifth of NFL players surveyed by The Associated Press in November 2009 replied that they had hidden or played down the effects of a concussion.

“The people that make it [to the NFL] are wired to ignore the pain, over and over again,” Kacyvenski says. “You can’t treat a concussion like a broken arm and leg. It’s very difficult to prove...Chris has made this not a football issue; it’s now a public health issue. That’s a key distinction…[his impact] really is kind of amazing.”

In 2010, the NFL expanded its rules to prevent defenseless players from taking shots above their shoulders, with significant fines for any player who makes head-to-head contact with an opponent. Even more stringent return-to-play guidelines were instituted for players who had suffered concussions, and each team was required to consult with an independent neurologist in every case of a head injury.

Murphy, who has coached college football for 24 years and is currently Vice President of the American Football Coaches Association, could not be more impressed with the impact his former player is having.

“I follow his work very, very closely, and first and foremost I’m very proud of Chris,” Murphy says. “I don’t think there’s anyone else in the country who’s helped advance the knowledge of athletic head trauma as much as he has. I think a lot of what you’re seeing in changes in rules in protocol dealing with head trauma is a result of the work that he’s done.”

CHRIS HARVARD’ S IMPACT

Nowinski is now a prominent voice on an issue that is increasing in public awareness every day. Considered an expert in the field of concussion-related research, his work was featured on ESPN’s Outside the Lines in September 2007 and CBS’ 60 Minutes in October 2009. Sports Illustrated’s Pablo Torre ’05, a former Crimson editor, nominated him for Sportsman of the Year in 2010. Next year’s version of the popular Madden football video game will feature concussions for the first time.

“From 2006 to now the culture of the game is so much different and a lot of that can be attributed to Chris,” Kacyvenski says. “He has been the driving force—this thing could have died. It’s not like he’s got a huge head; he doesn’t care about [success]. He just wants to ensure safety, to ensure the pathway to research that’s not biased without any agendas.”

Nowinski’s work also influenced Schwarz to pursue the topic, and the journalist has since written over 200 articles on the concussions problem.

“There’s no person more singularly responsible for raising public awareness of concussions than Chris Nowinski,” Schwarz says. “I am given a lot of credit for being that person, but I wouldn’t have had anything to write about had Chris not educated me for the first year or so.”

In 2010, CSTE’s research discovered the first pathological link between head trauma and such neurological diseases as ALS.

But the tragic deaths that seem to be linked to repeated concussions have continued.

In April 2010, after Penn football captain Owen Thomas committed suicide, examination of his brain revealed that CTE had led to Thomas’ depression. Ten months later, former Chicago Bears defensive back Dave Duerson took his own life by shooting himself in the chest, leaving a note requesting his brain be given to the NFL’s Brain Bank at BU to be examined for the same type of damage found in other decreased NFL players. The brain was sent to the CSTE, where Duerson’s self-hypothesis was confirmed. He too had suffered from CTE.

To Nowinski, these sad cases show that young athletes still need to be educated about the dangers associated with head trauma.

“We want to provide people with information and inspiration to play sports more safely,” he says. “[Our presentations] revolve around stories of mistakes that we’ve made, showing the brains of athletes who have taken their own lives, and helping people understand that they have a moral obligation to protect kids because kids aren’t old enough to accept the risks that we expose them to.”

Presently, more than 300 athletes, including 100 current and former NFL players, are on the CSTE’s brain donation registry, with 65 cases currently being studied.

“Chris has been very instrumental in bringing awareness to the potentially serious ramifications of concussions in sports,” NFL spokesperson Greg Aiello wrote in an email. “He has been a leader on this issue, and we have worked with him and supported his Boston University research group. Chris is a great example of someone making a positive difference for millions of young athletes and their parents.”

Knowledge about brain injury is starting to spread to other sports as well. On May 13, 2011, after suffering a concussion that caused him to miss half this season, New York Rangers left wing Derek Boogaard was found dead in his apartment at the age of 28. Boogaard’s family agreed to have his brain donated to the CSTE at BU, where it is presently being examined for CTE. The CSTE had previously found the disease in the brain of former Chicago Blackhawks enforcer Bob Probert, who died in July 2010.

Because of those types of cases, Nowinski’s long-term goal is to develop a diagnostic test for CTE while players are still living, and then to find a cure and treatment.

Kacyvenski has faith that his friend can accomplish this and much more.

“Chris has a brilliant mind,” he says. “He’s unbelievably intellectual, able to command a room and able to say what he has to say in a manner that’s pleasing to all sides. He believes that he can change the world. There weren’t many people who saw his vision, or a huge amount of people that understood. But he stayed on it, and it’s impressive to see him every step of the way. Moral of the story about Chris Nowinski: don’t bet against him, ever.”

Nowinski has a simpler message he’s trying to share.

“You only get one brain your entire life,” he says. “There’s no medal at the end for abusing it the most.”

From the top bunk in Dewolfe, Chris Harvard has certainly come a long way.

And it all began with a kick from Bubba.

—Staff writer Emily Rutter can be reached at erutter@college.harvard.edu.

—Staff writer Scott A. Sherman can be reached at ssherman13@college.harvard.edu.