The concussions started in seventh grade when she hit her head on the gym floor. By freshman year of high school, she was up to No. 5 -- which left her temporarily blind. At 17, Popyer, now a senior in high school in New Jersey, has had 11 concussions, seven of them basketball-related, and is left struggling to perform previously-ordinary tasks, like attending a full day of school.
"I can't concentrate in school, I have a headache 24/7 and I can't do the things I want to do because even a slight hit to the head makes me pass out. I can't play basketball, obviously, which is something I always loved to do," she says.
Popyer's experience is a cautionary tale, one that is echoed in research released Monday by Nationwide Children's Hospital in Ohio: the number of young people suffering from head injuries while playing basketball is on the rise.
Researchers looked at emergency room visits for children ages five to nineteen and found that traumatic brain injuries associated with playing basketball, predominantly in the form of concussion, had spiked 70 percent between 1997 and 2007. Despite a 20 percent decline in overall basketball emergency-room visits, head injuries still showed a significant increase, researchers found.
Collisions are most likely to be responsible for a head trauma, either ball to head, player to player, or as in Popyer's first concussion, head to floor, says study co-author Lara McKenzie PhD, principal investigator at the Center for Injury Research and Policy at Nationwide Children's Hospital.
"We want to encourage kids to keep playing basketball because it's a fun sport and good [exercise], but there were more than 4 million ER visits [from 1997 to 2007], those numbers are still quite high and there's more we can do to make those number smaller," she says.
Teen head trauma in high school sports has received a good deal of media attention over the past few years, and a number of studies have highlighted this issue, says Dr. Marci Goolsby, a sports medicine physician at the Hospital for Special Surgery in New York City.
Most recently, a study released last week found that ER visits for concussions occurring in youth team sports have risen sharply since the late 1990s. Sport-related concussions accounted for half of all concussions seen in teens, researchers found, and team sports, such as basketball, accounted for more than a third of those sports concussions.
This spike, like that seen in Monday's study, may have more to do with this increased awareness than with an actual increase in total head injuries, Goolsby says.
"Basketball has become more of an aggressive sport, but not necessarily more dangerous. In general the public is becoming more aware of traumatic brain injuries and there's an interest in getting them evaluated sooner," she says. More urgent evaluation, as opposed to checking out a head trauma with your family doctor, might account for the rise in concussion-related ER visits for youths.
"It's hard to tell if the higher rate of reported head injuries with basketball represents a true increase in these injuries or just better reporting," says Dr. Jerris Hedges, professor and dean at the John A. Burns School of Medicine in Hawaii. "The latter seems more likely, [though] the underlying message of concern remains true."
Goolsby, who played basketball in high school and college and now treats patients at her hospital's Women's Sports Medicine Center, says that more often than not, young basketball players experience sprains, especially of the ankle, or injuries to their fingers, not brain trauma.
"Concussions are infrequent with basketball players, but represent a significant concern when they do occur," Hedges says.
Not all head injuries are made equal, experts say, so it's important for parents, kids, and coaches to be able to recognize what's a concussion and what's just a bump on the head.
"Not all who suffer from a concussion will be 'knocked unconscious,'" Hedges says, so you have to look for symptoms of concussion such as slowed thought, headache, or confusion following an accident.
Often someone will experience amnesia and disorientation following a head trauma, but if this confusion gets progressively worse, Goolsby says, parents should seek an urgent medical evaluation for their child.
Vomiting, change in consciousness, and difficulty waking up would also be signs that a head injury should get checked out by a professional, she says.
Allowing proper rest and recovery time following a concussion is also key because insufficient recovery can leave kids more susceptible to another concussion and can prolong their symptoms, Goolsby warns.
"You need to minimize mental and physical activity while they're symptomatic and then once they've been completely symptom free for over 24 hours, you can begin a gradual progression back into activity," she says.
Returning to sports too soon, without a full recovery, may have complicated Popyer's condition and left her susceptible to her repeated concussions.
Her mother, Cathy Popyer, says that she was never told how long to wait after her daughter's injuries before she could return to activity, and so she was never given a full picture of how to handle her daughter's injuries.
"We went to all different doctors but nobody led us to believe that the concussions were cumulative or that she should concsider stopping playing at that point," she says.
Currently, most states do not have uniform guidelines about how long young athletes should refrain from playing following a head injury so often it is left up to the discretion of the doctor, parents, or coaches involved. Niki and her family now advocates for greater awareness of sports-related head injuries and how to treat them.
For the most up-to-date explanation of how to spot and treat a concussion, McKenzie recommends that parents and coaches take the free online concussion training at the Centers for Disease Control and Prevention's website: http://www.cdc.gov/concussion/.