Ericka Koenigsberg had no idea she was about to have the worst day of her life.

She started the day normally with a 5 a.m. wake-up call for her 8 a.m. horseback riding competition. She got dressed, climbed into the car and drove out to Wellington, Florida for the Winter Equestrian Festival. She was halfway through the second course of the day when she realized her horse was jumping abnormally, but after a while she pushed her worries aside and focused on her maneuvers. She trusted her horse, and her horse trusted her– but then it happened.

“Since I was shallow [in my jump], I was too long for the next jump,” Koenigsberg said. “She [my horse] then second-guessed herself and we skidded into the jump and fell face forward. I hit my right shoulder against the rail on my way down and then fell headfirst on my right side, down into the ground at around 30 miles per hour. All the velocity from my horse just went into me.”

Right after the fall, Koenigsberg was transported to the hospital where her computerized tomography (CT) scans came out clear. She felt fine. She was, however, sent home in a sling due to a minor shoulder injury. Thinking all was well, she went home to get ready for a party. Koenigsberg was sitting at a table when someone noticed that all of the color had drained out of her.

“I was having this really interesting conversation, but I don’t even remember it,” she said. “I just know I was having a conversation. I don’t know what I was doing; I don’t know what I was saying. It was just that I was there, but my body and brain were above me floating.”

She was displaying classic signs of a concussion: dizziness, nausea and general discomfort. And then it got worse.

“Symptoms of a concussion can be very subtle; many people are unaware that they even have one,” said Paige Kalika, a UM doctor specializing in osteotherapy. “The earliest and most common symptoms of a concussion are confusion and amnesia, [including] loss of memory of the actual injury and often of some time before and after the incident. Loss of consciousness is possible, but does not happen in most concussions.”

Only 18 hours after her fall, Koenigsberg was experiencing double vision, a lack of coordination, sensitivity to light and disorientation. She was not able to sit upright or recline fully; she had to sit at a 45-degree angle to avoid discomfort. Koenigsberg suffered the effects of her concussion for more than 10 months, and completed her senior year of high school from bed, working about 40 minutes each day. She also attended physical and occupational therapy twice a week to try to recover from her injury.

“The American Academy of Neurology defines a concussion as a trauma-induced alteration in mental status that may or may not involve loss of consciousness,” Kalika said. “Most concussion symptoms resolve within seven to 10 days, but some people have a more protracted course (post-concussion syndrome) and have symptoms that linger for up to three months.”

Concussions are a common occurrence among many athletes. According to ESPN and the National Football League (NFL) the total number of reported concussions for the 2015 season was 271, a striking 31.55 percent increase from the 2014 season. This data includes all concussions during preseason, regular season and practices since the start of training camp.

However, the NFL as a whole has not been quick to admit its faults. NFL commissioner Roger Goodell recently admitted that concussions do, in fact, lead to chronic traumatic encephalopathy (CTE), a disease often caused by repetitive brain trauma. This admission only came to light just two weeks after Jeff Miller, the NFL’s senior vice president for health and safety, admitted to the link between football injuries and brain disease.

One case in which CTE was discovered was in the brain of the late football player Junior Seau, who committed suicide on May 2, 2012, by a gunshot wound to the heart. It has been speculated that Seau chose his heart over his head in order to preserve his brain for research. Seau spent 20 seasons as linebacker for the San Diego Chargers, Miami Dolphins and New England Patriots. However, according to ESPN, Seau was never documented as having had a concussion during his time with the teams.

This is not an isolated case. Other football players have chosen to end their lives this way. On Feb. 17, 2011, Dave Duerson also committed suicide via a gunshot wound to the heart.

According to an article in the Chicago Tribune, Duerson’s ex-wife received a text message stating, “I love you. I always loved you. I love our kids,” he wrote. Then she received another message that said, “Please, see that my brain is given to the NFL’s brain bank.”

After Seau’s death, his brain was studied at the National Institutes of Health (NIH) in Washington under the leadership of Dr. Russell Lonser. In 2013 Lonser told ESPN that the study of Seau’s brain was what they call “blinded.” Neuropathologists from outside the NIH were given three unidentified brains, one of which belonged to Seau. One of the two remaining brains was affected by Alzheimer’s disease and the other belonged to a person who had no reported history of brain trauma. The study showed that Seau’s brain had signs of CTE, which included a protein called “tau” that forms in the brain. With CTE, large amounts of tau form into neurofibrillary fibers in a very unique fashion that is specific to this disease.

Kevin O’Neill, former Miami Dolphins head athletic trainer, worked with Seau during Seau’s three years with the team. O’Neill and Seau spent time together both on and off the field and O’Neill described their relationship as “pretty close.”

“He was a true leader of the team. He had what I call the most incredible love for the game of any player I have ever had,” O’Neill said. “ A lot of players love the game, but he was incredible about how much he loved it. He stood up and professed it to the team on more than one occasion and told them, ‘Love this game. Don’t treat it like work, don’t treat it like a drudgery, love this game because it could do so many great things for you.’”

Despite the NFL’s past oversights regarding concussions, the organization has added some precautionary protocols.

In 2011, the NFL also introduced spotters after Cleveland Browns quarterback Colt McCoy sustained a concussion but was not pulled out of the game. According to the NFL, the team’s trainers did not see the helmet-to-helmet impact as they were tending to other players. After the game, McCoy was diagnosed with a concussion. Just a short two weeks after this occurrence, the league added spotters, certified athletic trainers who quite literally “spot” concussions during the game. Every stadium has two spotters, a primary and a backup.

and a backup.

NFL spotter and former head athletic trainer for the then-called Florida Marlins Larry Starr calls himself “lucky” to not have seen that many concussions during his time with the NFL and the Miami Dolphins.

“It’s an interesting gig,” Starr said. “It’s a different perspective of how you watch the game.”

While he is spotting, Starr sits in the press box and watches two screens: one broadcasting the live game, and one showing what viewers see at home, which is delayed 17 seconds for censorship purposes. Starr also listens to both television and radio sportscasters in order to make sure all incidents are documented and checked out.

“The one thing that makes our job even a little more dramatic is that we now have the ability to stop the game if we think a player has a head injury,” Starr said. “The way I do that, and the way anybody in my position does that, is that we have a direct line to the head official and we press one button. It’s almost like a nuclear war button and I [say] ‘Medical stop, No. 17 has to come out of the game for examination,’ and the game stops right there.”

While football is notorious for leading to concussions, any type of sport presents the risk of brain, neck and spine injuries. Baseball, for example, is not technically categorized as a collision sport, yet sometimes a ball does hit a player in the head, which can cause serious injuries. In 2015, Major League Baseball (MLB) decided to ban home plate collisions, citing health concerns, namely concussions.

Joseph Maroon, a professor of neurosurgery at the University of Pittsburgh Medical Center and a team neurosurgeon for the Pittsburgh Steelers told NBC News that there should be concern about any type of head injury.

“These certainly do occur in baseball, but not with the frequency as they do in football, soccer, hockey or even field hockey. We know that multiple blows to the head may lead to prolonged problems,” he said.

Cliff Floyd, former MLB player for seven teams across 17 seasons in the MLB, is trying to prevent some of the concussions that happen in baseball with his new product, the Ball Cap Liner (BCL).

The BCL is a headpiece made to prevent concussions in baseball players that comes in two models– one with temporal protection and one without. The BCL weighs a light 4.3 ounces and utilizes D3O technology, which is based on a soft and flexible polymer that stiffens and distributes force upon impact. The greater the impact, the more the molecules stick together, which means more protection.

The BCL is endorsed by Cal Ripken Baseball, Babe Ruth Baseball and Babe Ruth Softball. Floyd is marketing the BCL to little league, high school and collegiate level players.

“I know what direction I’m going, I know that these kids need to realize how important it is to have it on their heads,” Floyd said. “It’s not about me making $100 million, it’s about saving that one kid. I think that’s important.”

Floyd is in the process of altering the design of the BCL to make it even more comfortable and to accommodate glasses. In addition to this, he is developing more models of the BCL for watersports.

“I am in the process of having one made for swimming. I had no idea that there are a ton of head injuries on the water,” Floyd said. “Heads hitting the water, cranial bleeding. It is scary.”

King Henry II of France, whose eye was gouged out in a jousting accident, experienced the first documented concussion according to “The Tale Of The Dueling Neurosurgeons.” This was in a time in which people still believed in medical astrology and bloodletting. Needless to say, we have made countless medical advancements since then. However, retired athletes affected by head injuries will tell you that more needs to be done.

“I think we could all do a better job going forward with it,” O’Neill said. “I think the key to it is getting the best, accurate information so that we can make the most informed and knowledgeable decisions.”

words_rori kotch. photo_rori kotch.