The Neuro-Optometric Rehabilitation Association International is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

BLOG: What others can learn from my career-ending concussions

by Alecko Eskandarian

My first concussion happened during my very first Major League Soccer game. I have no memory of that game at all; an opposing player alerted the referee that I should be pulled from the field.

After a week of rest, I was “cleared” to play, but the hit I sustained that day had already done significant damage, compounded by two more concussions in the next 2 years.

Source: Alecko Eskandarian

Finally, a fourth concussion in July 2009 ended my playing career. To this day, I have to limit screen time, and I can’t ride in the back seat of a car or let my heart rate get too elevated. The head injuries I suffered as a player have changed every facet of my life, on and off the field.

As a coach and Major League Soccer executive, I have continued to advocate for greater concussion awareness and education. It’s important to me to advise younger players that their brains are worth protecting, and that traumatic brain injuries (TBIs) are different from other injuries. For all the progress we’ve made in the last few years, education about head injuries still needs to be emphasized more by leagues, coaches and trainers. Vision-related problems, in particular, are often overlooked during the initial evaluation.

In my case, I was suffering from vertigo, headaches and balance-related issues. Other visual symptoms were very subtle. For example, I felt like my vision was just a little “off.” It seemed like my eyes lagged when I tried to glance in the rear- or side-view mirrors while driving. But I was hesitant to even mention these symptoms to doctors because they sounded silly, especially for an athlete accustomed to pain and injury.

After my third concussion, when I sought more treatment beyond just rest, I was fortunate enough to see a neuro-optometrist at a concussion clinic. Vision and vestibular testing showed that my eyes were not tracking well, and I went through a rehabilitation plan with daily vision exercises that were very helpful in my recovery.

I want health care providers to understand that rehabilitation after a TBI is not a one-size-fits-all solution. Every concussion is different. I also want doctors to understand that athletes are uniquely vulnerable. As young people who define themselves by the sport they play, they are very likely to be in denial about the severity of their head injury. They are generally unreliable in assessing their own concussion-related deficits because their drive to return to play is so strong.

Elite athletes have a great deal of mental toughness. They have trained themselves to push through pain and stay focused on their goals. This is a huge asset when it comes to sticking with a physical therapy or vision therapy regimen, but it can be entirely the wrong attitude when it comes to a TBI, because “pushing through it” can be very dangerous.

One analogy that was helpful to me is that the brain is like a muscle. If you tear a hamstring, you don’t rest a day and then start sprinting. You have to let it heal fully, and then start rebuilding the muscle with less-taxing movements. With a brain injury, healing is such a slow, gradual process because we use our brains for everything.

Even though they will have days when they feel fine, athletes need to understand that symptoms can return as soon as they start asking more of their brains — and that can be a tough message for doctors to convey to invincible young people. We have come a long way in understanding this and protecting athletes, but there is more to be done.

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Alecko Eskandarian played for several Major League Soccer teams, including DC United and the L.A. Galaxy, and was a two-time All-Star. After retiring as a player, he went on to serve as assistant coach for the New York Cosmos and the Philadelphia Union and is now senior manager for player relations and competition for Major League Soccer. He will be the keynote speaker at the NORA annual conference, Sept. 19-22, 2019, in Scottsdale, Ariz. For schedule and registration, visit

Disclosure: Eskandarian reports no relevant financial disclosures.

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