C.J. Dozier remembers having a headache, but he doesn't remember the impact. He just heard the whistle and kept practicing.
"Next thing I know, I was (feeling) more and more out of it," he said.
Arizona's rising sophomore linebacker was practicing during fall camp in August 2013, just a couple weeks before the season opener against Northern Arizona.
"I didn't even say anything to anybody," Dozier says. "The next day I came to practice and we were warming up, and the trainer came up to me and said one of my teammates was worried about me. They said the day before at practice I was acting really strange. After warmups that day, that was the last time I touched the field."
Dozier is one of a number of former football players who are seeing the long-term effects of multiple concussions.
FOOTBALL WAS FOR HIM
Curtis "C.J." Dozier started playing football when he was 9 years old, embracing contact immediately.
"The second I got my first big hit, I knew football what was what I wanted to do," he says.
Dozier spent three years at Chaparral High School in Temecula, California, before transferring to St. John Bosco High School in Bellflower, California, for his senior season. He knew after his sophomore year that he was good enough to play collegiately.
"From a really young age, my dad told me that it wouldn't be feasible for me to go to college without a scholarship," Dozier says. "My dad made that clear not to scare me, but just to let me know either you're going to have to take out loans or you can try and get a scholarship and get it paid for free."
After originally committing to Arizona State, Dozier flipped to Arizona on Jan. 13, 2012, after Dennis Erickson was fired. He became the first player to commit to Rich Rodriguez, picking the Wildcats over scholarship offers from Colorado, Nebraska, UCLA and Washington, among others, according to 247sports.com.
"I knew I had to be somewhere where I could play right away," he says. "Arizona was a really good opportunity — not only for me to be in a good conference and a great school but also have an opportunity to play."
Dozier bypassed the second semester of his senior year of high school to get a jumpstart on his academics and a better sense of the playbook. It also gave him the opportunity to get ahead of his fellow high school seniors before they arrived in the summer.
As a true freshman in 2012, he played in nine games, including one start against Colorado, and recorded 27 tackles and a forced fumble. His year of hard work came together on Dec. 15, 2012, when he notched a team-high 15 tackles in the Wildcats' 49-48 win against Nevada in the New Mexico Bowl.
"That game—it was freezing, it was such a long season," Dozier says. "I wasn't even thinking about how many tackles I was getting. I knew it was the last game, and I was going to fly home after that, so I knew I had to give it everything I had."
Despite his stellar performance, his career was over a mere nine months later. Rodriguez announced on Sept. 5, 2013, that Dozier was retiring from football due to complications from concussions.
The head injury Dozier suffered that August was the fourth documented concussion of his career. More than a year later, he said he still suffers from migraines and has memory problems.
"I just had headaches," Dozier says. "As sad as it is to say, it's pretty normal for a football player to have headaches."
TRAUMATIC BRAIN INJURY
A concussion, or mild traumatic brain injury, is "a disturbance in the way the brain functions," says Holly McNulty, director of the UA's primary care sports medicine fellowship.
"Structurally the brain is unchanged, but the processing speed, reaction time and visual and verbal memory for an effective individual are affected after a concussion."
Concussions are caused by a direct blow to the head or whiplash-type movement of the head and neck, she says. As a result, sports with a lot of physical contact, such as football, rugby or soccer, have a high risk for head injuries.
Signs of a concussion include headaches, balance problems, difficulty concentrating, memory problems and dizziness. Someone who has suffered the injury can experience one or all of these symptoms, McNulty says.
With a lack of structural damage and a wide range of symptoms, diagnosing a concussion is difficult.
"The concussion is diagnosed based on the mechanism of injury and then the type of symptoms the patient presents as well as their clinical exam," she says, noting they don't show up on a CT scan or MRI.
The consequences of suffering multiple head injuries without recovering from the last one can cause post-concussive syndrome, or when symptoms of a concussion last for a much longer time or indefinitely, McNulty says.
The call to stop playing a sport due to injury is a "tough one," she says. It depends on the person, and there is no specific number of concussions that is too many. "If the symptoms from one injury don't completely resolve, that's time to consider discontinuing the sport. Or if the threshold of injury becomes less—that's taking much less significant impact for the symptoms to return—that's another time to consider that."
At the UA, at least three players have retired due to concussions since 2010: Dozier, linebacker Rob Hankins and defensive lineman Jerod Cody. Cody and Hankins did not respond to multiple requests for an interview.
Linebacker Dakota Conwell, who previously retired from Arizona due to concussions, transferred to West Liberty University in West Liberty, West Virginia, last year to resume his football career. He started at quarterback for the Hilltoppers in 2014, throwing for 1,965 yards and 23 touchdowns in 11 games.
Conwell declined an interview for personal reasons.
Kent Bultemeier, assistant athletic trainer for the UA football team, doesn't think there's a rise in the number of concussions but rather that student athletes are doing a better job reporting the injury. He attributes this to the attention placed on head injuries, which has resulted in more education.
"Personally, it's educating everyone around—coaches, student athletes—just to report signs and symptoms," Bultemeier says. "And then just educating them what those signs and symptoms are."
The football team instructs coaches and student athletes every year on all aspects of concussions, says Randy Cohen, UA associate athletic director for medical services.
While he doesn't have specific numbers readily available, Cohen says Arizona usually diagnoses between 10 and 20 concussions a year. That number is in line with other FBS (Football Bowl Subdivision) schools.
Concussions sustained in games are sometimes hard to diagnose because symptoms of a concussion might not show up for 24 to 48 hours, Bultemeier adds.
When a player suffers a possible head injury in a game, the training staff administers the SCAT3 test, Cohen says. The SCAT3, or Sport Concussions Assessment Tool—3rd Edition, is a standardized tool for evaluating injured athletes for concussions and can be used in athletes aged 13 years or older, according to the British Medical Journal.
The test is administered by a physician and consists of a symptom scale, mental status testing, a balance examination and a coordination examination, according to the British Medical Journal. The test was developed at the 2012 International Summit on Concussions in Zurich, Switzerland.
If the staff suspects that a player has a concussion, a more complex in-clinic evaluation is administered, Cohen says.
The process of medical retirement, whether from head or other injuries, is determined on a case-by-case basis, Cohen says. A number of other players, including running back Pierre Cormier, defensive lineman Kirifi Taula and offensive lineman Jacob Arzouman, have retired due to various injuries since 2010.
"We look at each case individually and always make the decisions based on what is in the best interest of the patient's health and well-being," Cohen says via email.
EDUCATING THEM YOUNG
Adolescent football players are more susceptible to concussion risks because of a phenomenon called second impact syndrome, says Mike Boese, Tucson Magnet High School head athletic trainer. Second impact syndrome is when a person who has suffered a previous concussion gets a second impact to his head while still recovering from the first.
"It could have devastating effects, including death," Boese says.
Boese, who has been at Tucson High for 19 years, says concussion management is the facet of training that has changed the most during his career.
In 2013, Arizona passed a state law revising how possible concussions are handled by high schools. Under the new policy, anybody can remove a player suspected of having a concussion from an athletic competition. That player cannot return until he is cleared by a healthcare professional with concussion management training.
The Arizona Interscholastic Association also made it mandatory for high school athletes to take a tutorial called BrainBook, which highlights the risks of concussions.
"We try to teach them the seriousness of concussions and the importance of reporting them," Boese says.
At Tucson High, Boese also uses the ImPACT Testing Program to help determine when an athlete should return to competition. The program is also employed at the UA.
Athletes take a baseline test, which measures things like reaction time and memory, at the beginning of the school year. Their results post-concussion are compared to their original numbers.
Players cannot return until they get a passing ImPACT score, regardless of whether a doctor has cleared them, Boese says.
"Once they have zero symptoms and a passing ImPACT score compared to their baseline, then we put them through a five-day progression before they return to play," he says. "The average recovery time is about two weeks."
Tucson High had about 200 football participants this season and diagnosed nine concussions, Boese says. The wide range of symptoms of concussions makes it difficult to diagnose severity. "Every concussion is different, and every kid's reaction to a concussion is different."
A NEW CHAPTER
A week after C.J. Dozier suffered his concussion, he says he was still showing really bad symptoms. The trainers suggested that he shouldn't play anymore, but he wasn't ready to give up.
Dozier stayed on for a couple more weeks, attempting to get back into football shape. About a month after the concussion, he was able to take the ImPACT test, but his results were not even close to his baseline numbers.
After consulting with his family, coaches and trainers, he decided to hang up his cleats. He had to make the decision while still recovering from the concussion.
"It's really hard to accept that when you're not even in your right frame of mind," Dozier says.
His retirement was almost short-lived. Former Arizona head coach Mike Stoops, who is now the defensive coordinator at Oklahoma, reached out to Dozier and his father, asking if he'd be interested in getting a second opinion from the Sooners' doctors.
"I thought about it every day for a while," Dozier says. "I had to stick with what I decided initially."
Looking back, Dozier says he has no regrets. He was able to continue going to school because the UA honors all scholarships for student athletes who can no longer participate due to medical conditions, according to the Arizona Athletics Compliance Department.
With no football, Dozier has had the opportunity to focus more on his academics. He was able to get his GPA up to a 3.5.
"It was terrible, and I miss football every single day," he says. "But I will say that since the injury, I am much more focused on making a future for myself outside of football."
Dozier is majoring in communication and minoring in film and television. His ultimate long-term goal is to be a director for television, movies or documentaries.
After graduation, he plans on becoming a football graduate assistant coach at Chapman University in Orange, California, which is home to one of the top-ranked film schools in the country.
"That way I can get grad school paid for as well," Dozier says. "My dad is good friends with Coach (Bob) Owens there."
Dozier says he struggled initially with being around anything football. Despite living with players on the team, he didn't watch a single game during the 2013 season. He also found it tough being around football conversation all the time.
But he's been able to shift his focus to other responsibilities. He now spends his free time taking care of his 6-month old boxer, Ryder. He also picked up a part-time job at Pizza Studio near the UA campus. He got the job because one of his former roommates, Beau Boyster, who retired from the football team because of a knee injury in 2013, was friends with the owner, Trace Biskin, another former Arizona football player.
"I really try not to be stagnant because that's when I really start thinking about how I could be playing football," Dozier says. "I do everything I can to make sure like I'm not wasting my time."
While Dozier has made a lot of strides in the last 15 months, it's tough for him to compare his life before and after the injury.
"It's tough for me to tell if I'm back to normal because I don't really remember what that was like," Dozier says. "That's really the scary part. I really can't compare because I don't know."