From Sun Magazine: After concussions shattered a season, Brian Roberts sees recovery ahead

Just over a year ago, on Sept. 27, 2010, the Orioles were leading the Tampa Bay Rays, 4-0, in the ninth inning of a largely meaningless road game when second baseman Brian Roberts came to the plate.

He felt prepared for the at-bat, and believed reliever Joaquin Benoit would throw him a changeup. With the count 2-2, the right-hander did.

Roberts still swung and missed.

"Sometimes the pitcher could tell you what's coming and you still wouldn't execute your plan right," he says, clearly still miffed.

On his way to the dugout, he did something he has done countless times: in frustration, he thwacked himself on the helmet with his bat. All of Tropicana Field began to whirl. And so began a tailspin that would sideline the two-time All-Star for 145 of the next 168 games.

He had given himself a concussion — an injury that proved more severe and complex than Roberts or anyone watching the game could have understood at the time. He would return briefly in 2011 and sustain a second concussion, an extension of the first that would sever him from his team — and send him into a time of pain and uncertainty he calls the darkest months of his life.

Back in Baltimore last month for the first time since June, Roberts, who turned 34 last month, said he had just experienced his first pain-free two weeks since the concussion. Friends were telling him he looks completely different from the way he did as recently as September. He and his doctors say he'll be recovered by spring and in the Oriole lineup for 2012, all but good as new.

"We're still taking it slow and steady, but we're definitely hopeful," he said.

Asked why he'd have taken such an at-bat so seriously in the first place, Roberts answered quickly and forcefully.

"Baseball is a game of failure, where you make an out way more often than not," he said. "But people don't understand this: You still want to succeed every time. It's hard to find that balance. If you're not the kind of person who wants to be out there competing every second, you're not the kind who's going to make it to the big leagues."

Concussion test

It requires no cast, no bandage, no surgery. It's invisible to the naked eye. There's no set timetable for recovery, and even you, at times, wonder whether it's all in your head.

Experts and victims alike say it time and time again: A concussion is an injury like no other.

After the Tampa Bay incident, when Roberts returned to the dugout, he found the bench spinning. When he headed back on the field for the bottom of the ninth, it felt as though he was walking sideways. And when teammates tossed the ball around the horn, he was amazed he caught it.

"I have no idea what happened, but I am messed up," he remembers thinking.

He couldn't sleep that night for the jumpiness, dizziness and nausea, but he got up the next day, went to the ballpark and took ground balls and batting practice as always.

"I'm thinking, 'It's all right. I can get through this,' " he says.

But it wasn't. Roberts approached team trainer Richie Bancells just before game time.

"I think I have a concussion and can't play," he said.

There were many reasons the switch-hitting infielder resisted his self-diagnosis.

Plagued by back and abdominal injuries, he had already missed 97 games in 2010 season, the first year covered by a four-year, $40 million contract extension he'd signed in 2009.

In addition to the responsibility he always feels toward teammates with whom he has endured so much, Roberts says, he owes his good financial fortune to the faith owner Peter G. Angelos and then team president Andy MacPhail — men he holds in high regard — showed in him.

"Before I signed that [extension], people told me, 'Whatever you do, don't let it affect the way you think or how you approach the game.' But [the money] comes with responsibility, and certainly, you have a tendency to ask yourself, 'Am I living up to expectations? Are they getting what they thought they were getting?' You have to let go of that eventually, but it's not easy."

In addition, according to those close to Roberts, he has a distaste for inactivity.

"My husband goes crazy when he's not able to play baseball," says his wife, Diana C. Roberts.

That evening in Florida, though, there was no escaping the facts. The O's sat Roberts down in the clubhouse for a computer-based test that Major League Baseball uses to measure concussion symptoms.

Called ImPACT (Immediate Postconcussion Assessement and Cognitive Testing), it assesses reaction times, multitasking, the quality of one's memory and more — functions typically affected by concussions but that don't show up on MRIs or CT scans.

"The data was indicative of someone who's having a hard time," says Michael W. Collins, assistant director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, where the test was developed.

"I nearly threw up at the computer," Roberts says.

He sat out the last six games of the year, had six months off ahead of him, and figured he'd be fine in a few weeks.

Shutting in

Two months ago, the usually sunny Roberts was uncharacteristically morose in an interview on the ESPN program "Outside the Lines," as he described his past year as "very dark times."

In the off-season after the self-inflicted blow, things didn't start off that way.

After the grind of the long season, the Robertses usually enjoy traveling. Diana, a model and former pharmaceuticals marketer, planned a three-day get-together in North Carolina to celebrate Roberts' 33rd birthday on Oct. 9, 2010.

Oriole doctors and at least one Baltimore-area neurologist had told him, above all, to get rest. What, the couple figured, could be more relaxing than a drive to the mountains? But at a dinner party one night, Roberts found himself struggling to follow the conversation.

One voice merged with another. The less he understood, the dizzier he got. That night, he went to bed with what he has come to call a "screaming headache" — pain that charged through his skull, impervious to Tylenol, so severe that he couldn't sleep and light and random sounds made it worse.

"All you can do is lie there and suck it up for four or five hours, until it just goes away," says Roberts, who had the experience four or five times per week for months.

The couple relocated to their new off-season home in Sarasota, where Roberts continued avoiding strenuous activity, per doctor's orders. But he found it was ordinary stuff that caused the trouble.

When he pushed a cart down the grocery aisle, Roberts feared he'd hit the displays. The sidewalk seemed to move when he walked his dog. Driving made his head pound.

In nearly every case, a screaming headache would hit full force within hours, and he'd miss another night's sleep.

Over the next several months, Diana says, her husband — a man she says chafes at being indoors too long — had to shut himself inside the house for days on end, and she was scared by the transformation that caused in him.

His eyes often looked vacant and had bags, his mood was always low, and he was more lethargic than she had ever seen him.

"[Brian] is a godly, happy man," says Diana, a Fort Lauderdale native. "And I've seen him go through every injury under the moon, and still he still wants to play. I have to tell you, there were times I had to call [the doctor] and ask what was going on because I was afraid to leave him in the house by himself."

By mid-November, the time by which Roberts usually starts his off-season training regimen, it was clear something was very wrong. It wasn't for another six months that either Roberts really understood what.

Not again

In the first inning of a game on May 16, 2011, the Orioles' 40th of the season, Roberts stepped into the batter's box at Fenway Park.

He lined the first pitch he saw off the ribs of Red Sox hurler Daisuke Matsuzaka. Dustin Pedroia, the second baseman, charged the deflected ball, then threw.

And Roberts did what he often does on a close play at first: He went into a headfirst slide.

His chest hit the ground, his helmet slammed over his face and his head jerked back.

"It was similar to what happens when you're hit from behind in a car — a whiplash effect," Roberts says.

Over the course of that off-season, his general program of rest had, indeed, helped the player feel better, to the point that the headaches were few and far between, and when they did occur, he attributed them to being sick. At spring training, his progress sufficiently impressed team doctors that they cleared him to start the new season.

Within seconds of hitting the ground, though, his head was throbbing with another concussion.

"Please, not this again," Roberts thought.

Concussions are mysterious by nature, and many who get them — including athletes — sometimes hope they'll just go away. (Roberts, it should be noted, stayed in that game, going 0-for-4 the rest of the way. He didn't report his symptoms until the following day, after experiencing more fogginess while playing cards during a rainout.)

Why, for instance, should a person sustain a concussion when conking his helmet with a bat — a blow that few who saw it on TV apparently considered especially violent? How can concussion occur when there's no direct blow to the head at all?

"The general public still doesn't understand how complex and variable this injury is," says Collins, the Pittsburgh specialist. "No two concussions are alike. Neither are the ways in which they affect people."

Among other things, Collins says, research shows that some human beings — athletes or not — are, through no fault of their own, more susceptible to concussion symptoms than others.

A person is more vulnerable to concussion, he adds, after experiencing an earlier one — if and only if the first one never had a chance to heal fully.

And a direct blow isn't always necessary.

"'Concussion' means a violent shaking. If the brain moves inside the skull, like an egg yolk inside an egg, you're at risk [of symptoms]," says Collins, who works with athletes at the high school and college levels on up through big-time professionals like Pittsburgh Penguins center Sidney Crosby and Minnesota Twins slugger Justin Morneau.

(Another question many ask: why do football players seem to be able to return days or weeks after concussions, while some baseball and hockey players are out far longer? Collins' theory: Head impact is so common in football that players susceptible to the injury are weeded out before reaching the NFL, leaving a concussion-resistant population at the top.)

Roberts began learning such facts two weeks after the Fenway incident. He was and remains more than happy with the treatment he has received from Oriole physicians, he says, but at the suggestion of his agent, he decided to contact Collins, a Ph.D. in neuropsychology whose department at the University of Pittsburgh is the world's largest research and clinical program devoted to evaluating and managing sports-related traumatic brain injury.

Collins says it took a him a few moments on the phone to determine he'd have good news and bad news for the player.

"Brian's symptoms indicated a specific kind of concussion, and we've learned a great deal about how to treat that type," he says.

But it was worst kind for an athlete to have — and the one that calls for the longest period of recovery.

Retraining the brain

Then and later, what Collins told Roberts helped clarify what the Oriole veteran had been going through. It framed what he'd be doing, painful and hopeful, over the next few difficult months.

And now that Roberts is beginning preparations for the coming year, and he and his doctor expect a fully healthy return for spring training, it suggests answers to a question fans always ask when an athlete disappears for months to deal with a concussion: What's taking so long?

Collins told Roberts he had suffered damage to his vestibular system, the part of the brain (located in the brain stem) that processes sensory cues, turning them into eye movement, balance and motion.

No region could be more crucial to an athlete, particularly one, like Roberts, whose agility is basic to his success.

"Look at Brian's swing. It's a thing of beauty," says Collins, a former ballplayer at the University of Southern Maine who competed in the 1989 College World Series. "The vestibular system is his money-maker."

It's also a system that consumes vast amounts of energy in any human being.

The brain contains billions of cells called neurons, he explains, and each is connected to an axon. It's energy passing across that network that causes human behavior.

A concussion sparks unwanted chemical reactions, though, releasing materials from those cells, including potassium, and causing the absorption of calcium. The changes constrict vessels and muddle transmission.

"The cells aren't working as they should. You get reduced blood flow to the brain. And you get this energy crisis," he says.

A vestibular concussion, it turns out, involves a high-functioning system most of us take for granted, the part of the brain that allows a person to move his or her eyes, take in visual information, and channel it into appropriate bodily movement.

That's why Roberts couldn't do seemingly simple things like going to the store or driving without getting sick — they demand frequent and rapid eye adjustments and plenty of integration.

"I was doing these things every day that aggravated the condition, and I had no idea," Roberts says.

Research has shown that simple head-and-eye exercises, eventually coordinated with body motion, can re-establish the neural pathways that control vestibular functions, and that this retraining of the brain reduces symptoms.

Over the next few months, Roberts did everything from following a pen back and forth with his eyes to moving his head side to side while focusing on a distant, fixed point. By June he was fielding balls tossed from behind him over one shoulder, then another.

After another initial round of headaches, and as Roberts eased into light baseball activity in July, the intense reaction to ordinary activities began gradually to lessen.

"None of this was easy, but it was nice to see a light at the end of the tunnel," Roberts says.

Fits and starts

Relaxed during an interview in his Baltimore rowhouse last month, Roberts was all but giddy to report that, for the first time since the Tampa incident, he'd felt no symptoms for two weeks.

"Baseball or not, it's wonderful to have a normal life," the 2009 Oriole MVP said, taking periodic sips from a 32-oz. designer water.

He had even walked his dog in Sarasota without pain, though he wasn't sure that constituted the ultimate test. "Luckily, he's fat and slow," he said.

Roberts has learned he has innate susceptibility to vestibular concussion, and not because he's soft on the head or in it. He has always had problems with carsickness, and recent research shows a link between that trait and a high prevalence of the injury. (Attention deficit disorder and migraine-headache problems are two other such traits.)

He has also learned that, unlike, say, a torn ligament or an ankle sprain, concussions are so complex it's impossible to predict the healing period.

But some conditions prolong recovery, and Roberts isn't shy on those. They're what make him who he is.

For several days after he was injured in Boston, he stayed with the Orioles, but the act of sitting in the dugout and trying to follow the ball made him ill. Collins told him to get away, so he left the team. He didn't see friends like Nick Markakis, Adam Jones and Jeremy Guthrie for months.

Roberts lives in Canton, not far from Brewer's Hill, and he and Diana enjoy walking the streets, attending church nearby and chatting with fans. When they kept asking how he was doing, Collins advised him to leave Baltimore. He and Diana flew to Sarasota and didn't return until last month.

The research, Collins says, is clear: The less strain on a concussion victim, the better.

"There are two things you don't want to do [as a patient]. Number one, don't get hit again. Number two, don't increase the demand for energy. You can cause a lot of problems by overtaxing the brain."

That includes watching the O's on TV — which Roberts did every day for six weeks, until he says it became too emotionally painful. It includes explaining his condition on the phone — which he did regularly until it triggered such headaches he had to delegate Diana as his liaison. It includes taking batting practice and ground balls — which he started doing, gingerly at first, in June and continued to do, off and on and with increasing intensity, through July and August, when it didn't cause too much pain.

Quite possibly to his own detriment, Roberts never gave up on the idea of playing in 2011. One day, a light workout would leave him feeling fine. The next it would leave his head screaming. If he felt fine the next morning, Collins gave him the OK to try again.

The goal was to bank more good days than bad, something he and Collins were starting to achieve by mid-September. But by that point it was clear Roberts wouldn't pass the necessary health tests before the baseball season ended. So doctors shut him down.

What's left

Sometimes, when everything you know and count on is taken away, it's interesting to see what's left.

When Roberts was able to practice last summer, he did so at the team's training complex in Twin Lakes, Fla., alongside the young minor leaguers of the Gulf Coast Orioles. They asked what seemed like a million questions, the way he once did of B.J. Surhoff, Mike Bordick and Cal Ripken.

"They were so young – so naive, in a way," he says. "It reminds you of how you got here in the first place."

In other ways, it was less pleasant — and anxiety, Collins says, eats more energy than any mental function.

It hasn't shocked Roberts to learn secondhand that some fans question his desire to play. It's the nature of sports, he says, that to fans, you're only as good as your last game, and even he knew nothing about concussions before he got one.

But last August, when he realized it would harm his health to appear at Brian's Baseball Bash, the annual event for the University of Maryland Children's Hospital that has raised nearly $1 million since 2006, he canceled the event, writing a check instead to cover the amount.

Word reached him and Diana that some called the cancellation "selfish."

"Does it affect you in some way, shape or form? Of course it does," says Roberts, adding that his and his wife's Christian faith helped them keep such concerns in perspective.

But he fretted over his responsibilities to Angelos — and to his teammates.

"You don't know what the heck they think," he says. "They're having a tough year. You don't have a cast on or a torn ligament in your elbow. You didn't have surgery. Do they think you're losing your mind? Do they think you don't want to play?"

He'd be lying, he says, if he claimed never to have had such thoughts about a teammate. "Never again," he insists.

Roberts has met Collins' goal for him — becoming symptom-free in time to resume normal off-season workouts. By spring training, the doctor says, he'll have achieved recovery from both concussions — which according to the latest research means the player will be at no greater risk of concussion than he was before he ever had one.

"You may see me slide headfirst less often, but I won't alter my approach," Roberts says.

That should come as good news to O's skipper Buck Showalter, who remains convinced the team is much stronger with No. 1 in the lineup.

And Showalter isn't one with deeper doubts.

"This is a guy who played 140, 150 games a year for [seven straight] years," the manager says. "Think you can do that? Anyone who thinks Brian doesn't want to play has no idea what he's talking about."

jonathan.pitts@baltsun.com