Was It Worth The Risk?
It was the darkness that terrified Mark Tingstad most. As he lay face down on the seven-yard line, the weight of his helmeted head pressed his face mask into the turf, shutting out the sunlight. With 1:30 left in the first half, Washington quarterback Cary Conklin had dashed through a hole in the line. Tingstad, Arizona State's left inside linebacker, read the play, tossed aside a blocker and stepped up to meet Conklin. Conklin began to slide, turning his back to Tingstad as Tingstad's yellow helmet crashed into the back of the quarterback's shoulder pads. The impact snapped Tingstad's head back.
Now he couldn't move. "I felt a rush through my whole body. Then it was numb," Tingstad said later. "I couldn't feel anything. I knew it was important to move my legs, but I couldn't."
He pleaded with the Arizona State trainers to roll him over. "I've got to get some air," he said to them. Aware of the danger involved in moving a person who may have a spinal injury, they at first refused. But in the darkness of his helmet, Tingstad was panicking, so they carefully rolled him onto his back.
Spectators and teammates, concerned that Tingstad might be paralyzed, were relieved to see his arms and legs move. They did not know that the limbs were contracting on their own—pressure on the spinal cord had caused electrical impulses to fire, opening and closing his right hand and twitching his legs like detached limbs in a horror movie. "It was like looking at somebody else's hand," Tingstad says.
The game against the Huskies was in Seattle, and Tingstad's parents were in the stadium, having come from their home in Spanaway, Wash., 35 miles away. As he was rolled onto his back and then strapped onto a wooden board, Tingstad saw his mother kneeling at his side. She held his left hand in her right. In her other hand she clutched a cross. "Praise God, help my son," she said as she raised the cross in the air.
A few minutes later Tingstad recovered the use of his hands, and by the time he reached the emergency room of University Hospital, he had regained control of his legs. There were two games to go in the '89 season, and Tingstad, a senior, would miss them both. But a week and a half after the Washington game, he was feeling no effects from the tackle that had prematurely ended his football career.
These days, as Tingstad walks around the Arizona State campus in Tempe, people come up to him and tell him how sorry they are that he missed the Sun Devils' last two games. But viewed another way, the frightening episode in Seattle was a happy ending to a tense personal drama that could serve as a case study of ethics in medicine and in college football.
Last February, Tingstad had suffered a similar, though less severe injury during spring drills. In the five months that followed, he was evaluated, and his condition discussed, by family, doctors, coaches and Arizona State administrators. All of these people, who know and care about Tingstad, were forced to confront a number of sensitive issues: What are a student's rights? Whose decision is it to forbid a student to participate in college sports? If every football player accepts some risk when he steps on the field, when does that risk become unacceptable? What young man who has played football for more than half his life would risk his life to play another game? What young man wouldn't? Says Charles Harris, the athletic director at Arizona State, "The questions raised in Mark's case are as basic as, What is college athletics?"
On Feb. 21, the fourth day of contact during the Sun Devils' spring football practice, Tingstad made a tackle. There was nothing unusual in that: Last season he led the Pac-10 in tackles, averaging 15.6 per game, and was fourth in the country, with 172, a school record. What was unusual was the numbness he felt in both arms after the hit.
This was not a stinger, the burning sensation down the arm that a player sometimes feels after he takes a shot to the top of the shoulder. A stinger means that a nerve has been momentarily pinched or irritated, as happens when the funny bone is hit. But stingers affect only one side; Tingstad collided head-on and was numb down both arms. When an X-ray showed no fracture, he returned to practice the next day.
Four days later Tingstad made a tackle and had a similar experience. This time he felt the tingling in both arms down to his fingertips, and the sensation remained in his left palm and wrist for 20 minutes. In instances where there is numbness in both arms simultaneously, the affected nerve may be the spinal cord itself, so team doctors referred Tingstad to a specialist, Dr. Volker Sonntag, a neurosurgeon in Phoenix.
Sonntag examined Tingstad on March 13, taking X-rays and an MRI (magnetic resonance imaging), which produces an image not only of bone but also of soft tissues, like muscles and nerves. The MRI revealed that Tingstad has a condition known as spinal stenosis—a narrow spinal canal. The spine is essentially a bony canal, composed of vertebrae stacked one upon another, that encircles and protects the spinal cord. Normally there is enough space between the cord and the vertebrae to allow the cord to move back and forth as a person bends or stretches. Tingstad's spinal cord is normal, but his canal is narrow—only eight millimeters in diameter, when it should be at least 12 millimeters in someone his size.
When Tingstad's head snapped back, his vertebrae momentarily pinched the spinal cord. It was as if he had banged his funny bone against the edge of a table, but instead of the shock firing down one arm, it shot down both arms.
Sonntag felt that Tingstad should not play football again. "I told him that he had a greater risk of paralysis [than other players]," says Sonntag. "I wouldn't let anyone with that spine play football. I told him by all means to get another opinion. I showed him the X-rays and his eyes welled up with tears, and so did mine. I didn't want to do it. I've been an Arizona State supporter and a Mark Tingstad supporter for years."
Stunned by Sonntag's recommendation, Tingstad drove back to campus. "I had no idea he would say I was finished playing. He said if I was his son, he wouldn't let me play," Tingstad says. "I was alone, but I didn't go crazy." Tingstad understood the particulars of spinal stenosis—a congenital abnormality that affects perhaps 5-10% of the population—but he didn't understand why he had to quit playing football. After all, he had played the game since junior high, and his spinal canal had been like this since he was born. Even more frustrating was the fact that unlike injuries he had endured before, the problem with his spinal column wasn't really caused by something that happened on the field, and there was no brace or cast he could wear to help him get over it.
Tingstad and his parents did seek a second opinion, from a neurosurgeon in Seattle. Dr. Gordon Mulder examined Tingstad on April 10 and agreed with Sonntag; Tingstad, he said, should not be playing football. Arizona State coach Larry Marmie, who spoke with Sonntag and was told of Mulder's diagnosis, says, "They told me that he could die. I didn't want him out there." And so Marmie began planning for the 1989 season without Tingstad, the most valuable player on the team last year, and a quiet leader who had been named a cocaptain for the coming season.
Initially Tingstad seemed resigned to putting his football days behind him. "Neither of my parents ever said I shouldn't play, but I figured it was over," he says. "My parents assumed I wasn't playing. We didn't really talk about it. I figured I had played the card as far as I could."
But Tingstad never totally accepted that he wouldn't play again. He lifted weights and ran with his teammates all during the off-season, and when they asked him why he was sweating alongside them, Tingstad told his teammates that he wanted to stay in touch with something he loved.
Then in June, Perry Edinger, Arizona State's head football trainer, gave Tingstad new hope. At a meeting of the National Athletic Trainers Association in Dallas, Edinger had heard a presentation by Dr. Joseph Torg, an orthopedic surgeon at the University of Pennsylvania. In his speech Torg, an expert on cervical spinal stenosis, said that men with Tingstad's condition were not necessarily in any more danger of paralysis than those with normal spinal columns.
Edinger passed this on to Tingstad and his parents and asked them whether they wanted to solicit a third opinion—Torg's. Figuring they had nothing to lose, the family agreed. "The last thing I wanted to do was send Mark to doctor after doctor, looking for one who would say O.K.," Marmie says. "If you look long enough, you'll find someone. Would I like to have Mark Tingstad play? Yes. But under those circumstances? No. We'd have stopped after doctor number one if his folks hadn't wanted to go on."
Tingstad showed up in Torg's office in Philadelphia on July 10, with X-rays, MRIs, films of the spring practice collision and a 16-millimeter projector under his arm. By the time Torg walked into the examining room, Tingstad had already set up the projector on the examining table.
Torg, the founder and director of the National Football Head and Neck Injury Registry and a former team physician for the Philadelphia 76ers, has seen about 50 football players with narrowed spinal canals like Tingstad's. "Cervical spine injuries are fraught with ignorance and misunderstanding," says Torg. "Most neurosurgeons will say that someone with this condition has a greater chance of ending up paralyzed. They are wrong."
In a December 1986 study published in The Journal of Bone and Joint Surgery, Torg found that football players with spinal stenosis do indeed have a greater chance of experiencing the sort of temporary paralysis that Tingstad had in spring camp, but they do not have a greater chance of becoming permanently paralyzed. Of 177 men Torg contacted who had been permanently paralyzed on the football field, none had experienced an episode of temporary paralysis before their paralyzing injuries. In his article Torg also cited seven football players who had spinal stenosis and returned to football after experiencing temporary paralysis. None of them, according to his research, later suffered permanent paralysis. "Our data clearly indicate that athletes who have developmental spinal stenosis are not predisposed to more severe injuries," Torg wrote.
In a continuation of the same study, Torg examined three groups of football players: active players with no history of neurological damage, quadriplegics, and athletes who had experienced some form of temporary paralysis.
Torg discovered that the first and second groups were alike in that there was little or no evidence of spinal stenosis; however, among those who had experienced temporary paralysis, nearly all had spinal stenosis. Thus, Torg believes that there is no relationship between spinal stenosis and permanent paralysis.
Torg says that nearly every paralyzing injury suffered by football players comes as a result of diving into tackles headfirst—spearing—and the diameter of the spinal canal is irrelevant. Mississippi cornerback Chucky Mullins, who was paralyzed from the neck down during a game against Vanderbilt on Oct. 28, was subsequently found to have stenosis. But Mullins's injury occurred on a spearing tackle, and it's uncertain whether stenosis had anything to do with the mishap. Last year, at a trial in Charleston, S.C., Torg testified that Dr. E.K. Wallace Jr., the team doctor at The Citadel, had not been negligent in allowing Marc Buoniconti to play in a game in 1985 in which Buoniconti's spinal cord was crushed as he attempted to make a tackle.
Buoniconti, who is permanently paralyzed from the neck down as a result of the injuries, sued Wallace for $22.8 million, claiming that he should not have been permitted to play, as he had spinal stenosis, two old vertebrae fractures and a curvature of the spine. Torg, called as an expert witness by the defense, said that Buoniconti had speared the ballcarrier when making the tackle and that this was the reason he had become paralyzed. The jury agreed with Torg, and awarded Buoniconti no damages. Torg found the same abnormality in Tingstad's spine that the two neurosurgeons had, but he reached a very different conclusion. In a letter to Edinger, the Tingstads and Sonntag, Torg wrote: "In view of the fact that [Tingstad] has unequivocally had trial by battle and that he is not predisposed to a more significant neurologic problem, I see no contraindication to his further participation in football. However I think that Mark and his parents should be aware of the fact that the developmental narrowing of the cervical spine could result in...an episode of transient [meaning temporary] quadriplegia. Of course, the responsibility for his playing must lie with Mark and his parents."
Torg's opinion is controversial, and he is the first to admit that many doctors have difficulty accepting his recommendations. Sonntag is one of those who are mystified. "Torg is known in this field. He is no slouch," Sonntag says. "But I don't understand how someone could have a high chance of transient quadriplegia and that not be a contraindication to participation in football. We disagree. But doctors don't always agree."
Because the doctors had taken opposite positions, it was up to Tingstad to make a hard choice about his future—and after his visit to Torg, Tingstad was leaning toward playing again for the Sun Devils. While he considered his options, he had no shortage of advisers; they lined up on both sides, and some stood firmly in the middle.
Among those who offered counsel to Tingstad, none had greater cause for ambivalence than his parents. Ed and Darlene Tingstad had always encouraged their three sons to play football. Last season Mark played against his older brother, Ed Jr., a running back for Washington State. Younger brother David plays fullback at Boise State.
The boys' love of football was instilled in them by their father, who was a wide receiver at the University of Puget Sound in the late '50s and early '60s and a high school football coach for 13 years, and is now the athletic director for the Bethel, Wash., school district. "I've dealt all my professional career with people who said, 'My son is not going to play football because he could get hurt,' " says Ed Tingstad. He understands these parents' concerns, but he believes they are largely unfounded. In fact, he fears that publicity about Mark's experience will discourage parents from allowing their sons to play football. "I've had doubts in my mind since Mark began playing in junior high school," says Ed. "It's a typical parent's reaction. You're concerned about the welfare of your child. But I'm concerned every time he's out late and I hear a siren.
"Once, when Mark was a boy, I came out of the house and saw him high up in a tree. I started to yell, 'Get down,' but I stopped myself. I knew I wasn't going to be around every tree all of his life. I just told him to be careful. Based on what we know, we make a decision, and then we have to live with it."
After Torg explained his findings to Ed and Darlene, the Tingstads reached a decision: They would let Mark decide whether or not to continue playing.
In allowing Mark to make his own choice, the Tingstads showed an unusual level of trust, not only in their son, but also in Marmie. Ed Tingstad knows well the pressure that a coach can exert on his players, but the Tingstads were relying on the close friendship that had formed between Mark and Marmie.
The two had arrived in Tempe at virtually the same time, in 1985, and both say they grew up together at Arizona State. Marmie, now 47, had been the defensive coordinator and linebacker coach at Tennessee before becoming the Sun Devils' defensive coordinator before Tingstad's freshman year. In 1988, Marmie was promoted to his first head coaching job when John Cooper left for Ohio State. Tingstad had been recruited by Cooper's predecessor, Darryl Rogers, who resigned nine days before the 1985 signing deadline. Tingstad went to Arizona State anyway (he had few other offers) and in 1989 was one of only three of Rogers's recruits remaining on the team. Drew Metcalf, another linebacker, who roomed with Tingstad on the night before games, says, "Mark Tingstad is consistent in everything he does, like Coach Marmie. Coach treats everybody the same, but his favorite kid is Tingstad."
And perhaps because of his special feelings for Tingstad, Marmie did not want his star linebacker to play anymore and did his best to talk him into quitting. "My greatest fear was that something would happen, and then I would say, I knew, I knew,' " Marmie says. In 1981 he was the defensive back-field coach at North Carolina when one of his best players, Steve Streater, was paralyzed in an auto accident. "I saw that tragedy for two years," says Marmie. "But I decided that it was not my place to tell Mark and his parents, 'I don't care what you say, he can't play.' But if three doctors had said he couldn't play, I'd have been tickled to death."
In fact, there was a third doctor who was reluctant to allow Tingstad to play. Dr. Richard Lee, one of the Arizona State team physicians, considered forbidding Tingstad to play, but ultimately, he also left the decision up to the player. It was a difficult judgment for Lee—especially because he had prevented a wrestler with a potentially more serious spinal problem from competing for the school three years ago. In order to make sure that Tingstad would not make his decision lightly, Lee asked him to sign an informed-consent document. Lee wanted the young man, like a patient about to undergo surgery, to clearly understand that his decision to proceed was not without risk. "I pushed pretty hard," Lee says. "I know a 30-year-old paraplegic. I asked Mark to come see him with me, to see how he lived every day, before he signed the form. That's pushing pretty hard." Tingstad did not go with Lee, saying he knew enough and didn't really need to see that.
Had Lee ruled that Tingstad's spinal stenosis rendered him unfit for football at Arizona State, his decision would not have been without precedent. In 1987, Steve Clayton, a sophomore defensive back at the University of Wyoming, made a tackle against Iowa State and immediately felt tingling and numbness in his arms and legs. Clayton was examined by a number of doctors, including Torg, who found that, like Tingstad, he had a narrow spinal canal. Torg recommended that Clayton be allowed to play. Wyoming held a hearing, at which Torg testified by phone. Afterward the school did not permit Clayton to play; Torg says the Wyoming administration feared liability.
Arizona State athletic director Harris, as a university administrator, represented the last obstacle for Tingstad in his desire to remain a Sun Devil. The safest course for Harris and the school would have been to follow Wyoming's lead and prohibit Tingstad from suiting up. There was a greater chance of a lawsuit if he played and was hurt than if he were not allowed to play and went to court to gain the right to rejoin the team.
Harris could have asked Tingstad to sign a document absolving Arizona State of liability in the event Tingstad were injured, but Harris says, "What kind of person would say, 'Yes, we'd like to have you play for us. Just sign here.' If he got hurt, how would having him sign something make me feel better? When you sit on a living room couch with a player and his or her family, you have an obligation to that family. We ask the parents to give us their son or daughter for the next 10 semesters; we'll educate that person, allow him or her to grow and gain some experience. We owe the parents something too."
Though Harris weighed Lee's misgivings, after talking to the Arizona State doctors and lawyers, he also concluded that it was Tingstad's decision to make. He assured Tingstad that even if he decided not to play, Arizona State would renew his scholarship.
Had the athlete involved been almost anyone other than Tingstad, Marmie, Lee and Harris might not have been so willing to allow a 23-year-old to make such a critical decision for himself. But all three men—as well as Ed and Darlene Tingstad—knew that Mark would weigh his options with unusual care. Tingstad is bright and thoughtful. An accounting major, he was named an Academic All-America last season and this year was awarded one of 11 graduate fellowships by the National Football Foundation in recognition of his 3.43 grade point average.
Marmie, Lee and Harris also knew that Tingstad would be making up his mind free of the pressure that might have been brought to bear on an NFL prospect. Though a remarkable over-achiever on the field, at 6'1", 215 pounds, Tingstad was not pro material. After a redshirt freshman year, Tingstad started two games each of the next two seasons. By his junior year he had earned the starting spot and soon proved himself to be irreplaceable.
Tingstad says that when Torg told him that he thought he could play this season, "I wanted to jump, but I kept it to myself. I was elated. All along I decided that if I got the O.K., I was going to play. As long as I had no greater risk of paralysis than anyone else on the field, I was going to play."
Torg has found that many players quit after being diagnosed with Tingstad's abnormality. "Youngsters who have an episode of paralysis ain't too anxious to go back," he says.
So why would Tingstad risk paralysis, even the temporary kind, to play one more year of college football? "It was my senior year, my last year to play," he says. "The opportunity wasn't going to be around again. I love football."
Having decided to play, Tingstad was welcomed back into the Sun Devil fold. Because he had strained a muscle in his lower back (completely unrelated to his spinal condition) lifting weights during the summer, Tingstad did not tackle another player until practice the week before Arizona State's first game of the season, against Kansas State. Tingstad has always tackled with perfect form—his forehead on the ballcarrier's numbers—and one concern was that he would alter his tackling style to protect his neck, unintentionally endangering it even more. "I have to admit I was worried about my neck," Tingstad says. "I thought, I can't be hesitant. But I was thinking, What if...?"
Tingstad made six tackles against Kansas State with no ill effects. The next week, the Sun Devils played San Jose State in Tempe. With 10 minutes to go in the game, Ralph Martini, the Spartans' quarterback, rolled around right end. Tingstad came up to make the tackle but bounced off as Martini ran in for a touchdown. The collision left Tingstad lying unconscious on the three-yard line. As trainer Edinger ran onto the field, he looked for the ambulance in the end zone. For a moment he thought that everyone's worst fear had been realized. But after about 10 seconds, Tingstad came around. It turned out to be a minor concussion, and Tingstad went back in for the next series, finishing the game with 14 tackles.
Tingstad excelled through the next six games, leading the Sun Devils with 90 tackles. In the fifth game, against UCLA, he broke the school record for solo tackles in a career (207). But whenever Tingstad was slow to get up after making a hit, Sun Devil fans would fall quiet. They knew his history. A headline in The Arizona Daily Star before the opening game proclaimed: TINGSTAD RISKS HIS NECK FOR ASU.
The Washington game was the ninth of the season, and most of the principals from Tingstad's summer of indecision were on hand: Harris was in the stands, as were Ed and Darlene Tingstad. Marmie, Edinger and Lee were on the sidelines. When Harris saw Mark lying motionless on the field after Conklin's run, he thought, "This is not the way they write these things. This is not the way this is supposed to happen."
Ed Tingstad saw the collision through his binoculars and quietly pleaded with his son to get up: "O.K., Mark, time for the next play." When Mark didn't move, Ed turned to his wife sitting next to him, but her seat was empty.
Darlene had already begun making her way to the field. "Every parent scans the field after a play to see if their son is still standing. Mark wasn't," she says. "For a second, I was angry: Wait a second, we were told it was O.K. for him to play. But that passed quickly." By the time she got close enough to talk to Mark, he was able to tell her that he was all right. "I never thought I wouldn't walk," he says. "For some reason I knew the control would come back."
In the hospital emergency room, doctors and nurses cut Tingstad's jersey off, slipped the ear pads out of his helmet and then slowly eased the shell of the helmet off. He was administered an intravenous cortisone steroid solution to keep the traumatized spinal cord from swelling within the canal. The pinching of the cord had caused the skin on his arms to become hypersensitive. His mother caressed his arm to comfort him, but the slightest touch felt like a shock on his electrified skin, so he asked her to stop. The pressure on his skin from the bedsheet alone "felt like there were needles sticking into me," he says.
The X-rays were negative: Tingstad had suffered another episode of temporary quadriplegia, exactly as Torg had anticipated. He was released after three days in the hospital, a cervical collar and some residual tingling down his right arm the only reminders of the tackle in Seattle. And though his condition was essentially unchanged from what it had been four months earlier when he decided to continue playing, Tingstad knew his career was over. "No matter how much I might have wanted to play," he says, "they weren't going to let me—and let's face it, it's not the smart thing to do."
Tingstad has no regrets about playing this season. He is grateful for those nine games and says he would make the same decision again. But his agreeing to quit after the Washington game made this particular medical dilemma easy for everyone else involved. Things could have gotten sticky if Tingstad had insisted on playing in Arizona State's last game, against archrival Arizona. Edinger says that Arizona State would have had to find itself another trainer. Marmie says, "I would be scared to death if they said he could play again." And Harris says he would have told Tingstad, "No, Son, sorry."
What if Tingstad were not a senior, and what if he had realistic hopes of making a career for himself in pro football? How does a school decide when the risks to the student and the university's liability outweigh the student's right to choose and his right to showcase his wares for NFL scouts?
There are no rules for coaches or doctors or administrators to follow in a situation of this kind. While there will inevitably be many people with interests to protect, the student's health should always be the primary one.
Guided by the advice of well-intentioned people, Tingstad finally made the decision to quit, with his head. But his heart may not be as convinced. While he was unable to bring himself to quit last summer, after a second scare his career is finally over. Or is it? If an NFL team should invite him to camp this spring, Tingstad says, "I'm not sure what I would do."
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SCOTT TROYANOS/ARIZONA STATE PRESS
Before making the tackle that led to his being taken from the field, Tingstad was warned of danger but decided to play anyway.
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TOM STORY/THE ARIZONA REPUBLIC
[See caption above.]
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PETER READ MILLER
[See caption above.]
TWO PHOTOS
PETER READ MILLER
Sonntag (top) urged Tingstad to quit after an MRI revealed his spinal stenosis; Lee wanted him to be aware of the risks.
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LANE STEWART
Torg believed Tingstad was in no more danger of permanent paralysis than any other player.
ILLUSTRATION
LEWIS CALVER
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PETER READ MILLER
Ed, an athletic director, and Darlene encouraged their sons to play football.
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BILL GILLINGHAM/ALLSPORT USA
Though Tingstad was a star, Marmie did not want him to take the field.
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DAVID G. MCINTYRE
The sidelined Tingstad (left) helped the Sun Devils celebrate a win over Stanford.
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PETER READ MILLER
Even today, Tingstad isn't certain how he would respond if the NFL beckoned.
Normally, a fluid-filled space 12 millimeters wide surrounds the spinal cord, preventing the vertebrae from touching the cord. With a narrow spinal canal—i.e., stenosis (inset)—a movement of the neck can bring the cord into contact with vertebrae, causing at least numbness in the arms.
Vertebrae
Spinal cord
Fluid-filled space
Narrow spinal canal
Nerves to the arm