Concussions in figure skating: How they happen

This is the first article in a series about the occurrence of concussions in figure skating. In this installment, we look at the ways in which skaters get concussions.

It doesn't take a fall out of a lift, or crash into the boards on a quadruple jump. In figure skating, a concussion sometimes doesn't take much at all.

For Gabriella Papadakis, all it took was a small misstep on some footwork to take her and partner Guillaume Cizeron out of the 2015 Grand Prix Series.

"It was some simple step, I don't even remember what," said Marie-France Dubreuil, who coaches the French world ice dance champions in Montreal. "They clipped each other's blades, and she fell right on her head. The symptoms were instant. We could see she was walking wobbly; she had trouble putting words together. It wasn't a dramatic fall, but the symptoms were strong and dramatic."

For Dubreuil, Papadakis' symptoms were all too familiar. The two-time world ice dance silver medalist suffered two concussions during her career. In 2001, partner (and now husband) Patrice Lauzon slipped and fell on top of her in practice. Seven years later, while training for season one of CBC 's Battle of the Blades, retired NHL left winger Stéphane Richer lost control of a lift and dropped her. She continued skating, and the couple placed third.

"Like an idiot, I kept going and then my body started breaking down," Dubreuil said. "Then I got pregnant, thank God. I had to stop skating, and my body started healing. But the symptoms are horrible. Even if you keep pushing through, your brain tells your body it is not working."

Papadakis' injury was also déjà vu for three-rime U.S. ice dance bronze medalist Madison Hubbell, who trains alongside the French couple in Quebec. About two years earlier, Hubbell and partner Zachary Donohue, then training at the Detroit Skating Club (DSC), had a similar accident.

"When these things happen, unfortunately, it does come down to lack of focus, as painful as that is to admit," Hubbell said. "I finished twizzles, I did my 3-turn, and I fell off my heel."

"Most of the time, the worst falls are on things we kind of take for granted," she continued. "We think crossovers are easy; we don't think, at all, about going super fast around the ice. We don't think about the risks of just falling on something simple."

In Hubbell's case, the injury was immediately apparent. Her coach at the time, Anjelika Krylova, pulled her off the ice and canceled an upcoming show appearance. The skater spent six weeks recovering.

"We realized when Madi went up in the air, in the three seconds it took her to come down, that it was serious," Donohue said. "There was a softball growing out of her head. We all went, 'OK, that's that.'"

Papadakis and Hubbell were skating at good speed when they were injured. Ice dancer Jean-Luc Baker, who placed fourth at the 2016 U.S. Figure Skating Championships with Kaitlin Hawayek, was almost stationary when he suffered a concussion earlier this season.

"We were at a standstill, doing a stop in the short dance before the creative pattern," remembered Baker, who trains at DSC under Krylova. "We moved around each other; I was going clockwise, and she was counterclockwise. I was inhaling at the wrong time; my jaw was really loose, I was expressing out. The next thing I knew, she clocked me in the mouth. We don't even really know if it was an elbow or wrist. There was a significant amount of power. She's stronger than she thinks she is."

Not realizing the severity of his injury, Baker took some Advil and soon returned to the ice. About 45 minutes later, Krylova sent him home for the long Labor Day weekend. He resumed training the following Tuesday, but his return proved too soon.

"I skated for 15 minutes, doing the Ravensburger (pattern), and all of a sudden I wanted to throw up. So I went over the boards and lost my cookies a little bit," Baker said. "I was out of it. I couldn't take sunlight or loud noises. I couldn't focus. I was going out to dinner wearing sunglasses."

After consulting with doctors, Baker took about a week and a half off. When he returned to the ice, the team's training was limited for another week.

Tim Dolensky, the seventh-place finisher at the 2016 U.S. Championships, sustained a concussion under more dramatic circumstances: In the fall of 2014, he collided with another skater on a practice session at his home rink in Kennesaw, Georgia.

"I had crossovers in my choreography and had to look down," Dolensky said. "I didn't see her and it was like, boom, boom. My head hit the ice, and I think I was out for a couple of seconds."

Fortunately for Dolensky, an emergency medical center is down the road from his rink, and the doctor on duty was well versed in concussion injuries.

"He worked for sports teams before, so he knew the drill, and I'm happy he was there," Dolensky remembered. "He said, 'You definitely have [a concussion], but you're doing pretty good.' It happened on a Wednesday. I was off the ice through the weekend and back on Monday afternoon, to go to sectionals on Wednesday."

Joshua Farris, the 2015 U.S. bronze medalist, wasn't so fortunate. Farris lost the entire 2015-16 season after suffering a concussion during practice at the Colorado Springs World Arena.

Many skating fans remember the televised fall that Tatiana Totmianina took on a difficult axel lasso lift during 2004 Skate America in Pittsburgh, Pennsylvania. The future Olympic pairs champion skater slammed into the ice head first, only to return a few months later to win the European title with partner Maxim Marinin. But even for pairs, many concussions happen on simple moves.

"I've been teaching pairs for over 25 years now, and I've seen kids get concussions from falling on crossovers and not even hitting their head, just falling hard enough so that they get whiplash," said Dalilah Sappenfield, coach of U.S. silver medalists Alexa Scimeca and Chris Knierim. "You don't have to hit your head to have a concussion. I think it's very important to listen to the skater, be aware of what they're telling you and as a coach, not play doctor."

This summer, Madeline Aaron, who came in fourth at the 2016 U.S. Championships with partner Max Settlage, suffered a mild concussion after a fall on a basic move for an elite skater: a mohawk, a turn that involves a change of foot but no change of edge.

"We're skating on a blade an eighth of an inch wide; you try to avoid any injury, (but) some things are out of your control," Sappenfield said. "We do our best to make sure there is a lot of safety. It's very hard to say where these concussions are coming from; it goes across all sports. All we can do is make sure we are responsible in taking care of the athlete and making sure they are not in harm's way."

Jim Peterson, who coaches newly crowned U.S. pairs champions Tarah Kayne and Daniel O'Shea in Ellenton, Florida, agrees with Sappenfield. Christine Mozer, a talented skater who competed with O'Shea prior to his partnership with Kayne, ended her pairs skating career partly due to a concussion suffered in practice. (Mozer, a scholar-athlete, will graduate from Dartmouth College this year.)

"In my experience, it's not so much a big crash or a big knock on the head -- it's more the subtle things that create the concussion situation," Peterson said. "With Christine, it was a fall on a throw, but it was a gentle throw. She didn't even hit her head on the ice; she just cracked the whip with her neck."

"I had a young lady, an intermediate skater, and she was dizzy almost three months coming out of spins," he continued. "She was just given the clearance (to return to the ice). It's almost odd -- it's usually some small thing (like) when the neck is whipped back very quickly."

While there is still no word on when Farris will resume full training, many of the skaters mentioned in this article returned to the ice and thrived. Papadakis and Cizeron won their second straight European ice dance crown last week.

For Papadakis, it helped having two people at her rink who are well versed in concussions.

"I know how boring it is to wait out a concussion, so we tried to do whatever we could to make it a little less mundane for Gabriella," Hubbell said. "She's not someone who cooks a lot, so she would come over and I would cook for her, give her leftovers. Everyone at the rink encouraged her to take her time coming back."

"We waited on bringing Gabriella back, and that was the right thing," Dubreuil said. "Before French nationals, I saw in her eyes she was back to the version of herself before the concussion. It was very, very disappointing for Gabriella and Guillaume to miss the Grand Prix (Series). But it was worth it to wait a little longer, and not have to deal with symptoms for years and years."