BRECKENRIDGE — It was just a tap on the back of the helmet from a buddy. But it sent freeskiing superstar Justin Dorey tumbling, once again, into darkness.

“Each time the recovery time would double,” said Dorey, whose career of podiums was earned despite countless crashes and at least a dozen concussions that eventually left him huddling in a dark room, all but incapacitated. “It’s ridiculous how small of an impact it takes to take me out for a year and a half.”

The issue of concussions are front and center in the world of sports, thanks largely to well publicized concussion management protocols that have been established as an outgrowth of a tragic history of traumatic brain injuries among professional football players. But for winter sports athletes — who often lack the support of a league or even a team — the issue of concussions is only now emerging from the shadows. It’s not uncommon for a winter athlete to disregard reporting hits to the head as he or she pushes to the podium. They fear getting sidelined in a discipline where fleeting success rewards very few.

It happens all the time, said Dorey, 28, who recently retired from professional skiing after taking more than 18 months to recover from a slam to his head he sustained jumping off a rope swing into a lake.

“If you hit your head before the X Games, you are not telling anybody because they will take you out. Maybe it is a minor hit and you’ll probably be fine,” Dorsey said. “But if it is more serious than you think and you hit your head again, it gets bad quick. A couple times I hit my head and didn’t tell anybody because I didn’t want them to stop me from skiing.”

While the research regarding brain injuries is still in its infancy, it has been established that repeated blows can lead to Chronic Traumatic Encephalopathy (CTE), a progressive, degenerative disease that has been linked to a litany of life-changing symptoms such as memory loss, impaired judgement, insomnia, dementia and depression so deep it pushed some retired football players, such as Junior Seau, to take their own lives.

Dave Mirra, the BMX legend whose journey to 24 X Games medals included many concussions, died from a self-inflicted gunshot at age 41 last February. Neuropathologists found CTE in Mirra’s brain, making him the first action sports athlete to be diagnosed with the neurodegenerative disease. It’s unlikely he will be the last among gravity sport athletes who have long and silently endured concussions as a cost of admission.

“Athletes are not talking about this like we should,” said mountain biker Amanda Batty, who has more than 30 documented concussions in her career as a professional athlete. “We won’t be honest about the disconnect between wanting something so bad and living long enough to get it. Accidents happen. That doesn’t mean you are a bad athlete. You are a bad athlete when you keep competing with a concussion.”

Suffering in Silence

Dr. Jon Lieff, a Boston-based neuropsychiatrist who has studied thousands of patients with brain injuries for 40 years, said while research outside major professional sports is lacking, there is substantial evidence that cumulative impacts to the head will prove detrimental to some people but not necessarily all people, “not even a majority of people.”

“Twenty percent of people who play football for three, four years will suffer decreases in cognitive ability. But which 20 percent? No one can tell,” he said. “If you hit your head one way and I hit my head the exact same way, you could be fine and I could suffer memory loss for the rest of my life and there’s no way to determine what makes you more resilient than me. There is a lot we don’t know.”

A 10-year study by the International Federation of Skiing, the governing body of skiing and snowboarding, documented 320 concussions sustained by FIS athletes between 2006 and 2016, or roughly 10 percent of all the injuries counted among the FIS disciplines of World Cup alpine skiing, freestyle skiing, snowboarding and ski jumping. Perhaps most disconcerting in the FIS Injury Surveillance System report was that 51 of the 355 head injuries sustained by training or competing FIS skiers and snowboarders in that decade did not sideline the athlete for any time. But, 82 of the 355 head injuries took athletes out of commission for more than a month.

Brain researchers are learning more about the lingering consequences of a lifetime of head traumas. That research is fueling a growing awareness among action sports athletes that a brain “bruise” needs the same amount of attention, rest and recovery as any other injury.

“The pendulum has swung from one extreme to the other,” said Melinda Roalstad, the former medical director for U.S. Ski & Snowboard Association who helped establish concussion protocol procedures for FIS, protective processes that mirror those used in football, baseball, hockey and soccer, for instance.

The key to concussion management — treatment for brain trauma as well as reducing the incidence and severity of concussions — is “education, education, education,” said Roalstad, who is seeing more patients at the Think Head First concussion clinic she started in 2010 in Park City, Utah, largely due to that growing recognition of the need for proper care after a blow to the head.

Batty has become somewhat of an expert on concussions, having arrived at that designation by enduring several concussions a year in the past decade. In her late teens and early 20s she labored to earn a living from snowboarding and repeated head injuries nearly killed her.

“There is a period of my early 20s that I really don’t remember,” she said. “That’s my normal but it is not normal. It’s so (messed) up.”

For the past decade, her life has been a scary navigation of post-concussion syndrome, a maze of headaches, dizziness, memory loss and uncertainty. In March 2009, she slammed her head so hard while snowboarding her brain began bleeding. She spent six weeks in the hospital. In 2012, fighting to establish herself on the pro downhill mountain biking circuit, she crashed and collapsed her lungs, an injury that masked yet another concussion from the slam. The brain damage was piling up.

“I had just had these series of concussions that I never took seriously,” she said. “I was so hungry and so hell-bent. I was young. I was stupid. Concussion research wasn’t really a thing back then.”

Batty wants more discussion about concussions among all stakeholders in gravity sports. She wants federations, governments, sponsors, parents and coaches at the table. But the movement has to start with the athletes, she said. She’s helping lead the charge, looking to influence awareness of brain safety among the next generation of up-and-coming action sports athletes.

“Having recovering concussed athletes talk with kids and getting the coaches on board to talk about it in a positive way and then giving them a system that is simple to follow, that’s an important part of the awareness process,” Roalstad said.

It’s Up to Athletes

Athletes, Batty said, need to step up and not just model proper head protection but visibly step away from competition after a head injury. The whole “shake-it-off-bro” mentality has to stop, she said.

“Until athletes do their job to protect themselves, federations and governments can’t do their jobs,” she said. “It’s a multiprong approach.”

Dorey is stepping up, telling his story to encourage kids not to just to wear a helmet, but recognize that a brain injury needs rest, just like any other injury.

As a teenager, Dorey would lose memory of a crash that left him concussed. The following few hours would evaporate as well. The next day, he would usually feel okay. The more recent concussions, however, resulted in lingering impacts that progressively worsened though the hits weren’t particularly hard.

“The stupidest, smallest impacts,” he said.

The head tap from a pal. An innocuous fall on the slope. But the blows would leave him debilitated. He would hide in a darkened room for a week, then two weeks, then a month, then a year.

Today, 18 months after his last hit to the head, Dorey still gets headaches every day. They worsen if he exercises. He’s studying business in college in Vancouver and hasn’t noticed any cognitive decline, but the headaches are crushing.

“Not being able to be an athlete in the future is going to be a really big challenge for me,” he said. “I’ve defined myself as an athlete for my whole life.”

He wants the next generation of winter athletes to know more about concussions. Specifically that each one of those blows piles upon the previous.

“Just know what you are getting yourself into and if you do get a concussion, treat it seriously because it’s really important to fully recover,” he said.

Dorey knows that’s easier said than done. For young athletes scrambling for exposure in an industry teaming with eager competitors, there’s a lot of reasons to hide a head injury. Especially when coaches and team doctors follow strict, often legally regulated protocols when it comes to a head blow.

Dr. Moin Salah, a doctor who watches over athletes at the Dew Tour, which stopped in Breckenridge for its ninth show in early December, said awareness of head trauma and its cumulative impacts is growing. It’s a cultural shift that is rejecting the previous notion that no one drops from an event because of headaches.

“Before, it was about keeping it quiet and pushing through,” Salah said. “That’s changing. As soon as you say ‘Hey, we want to get you to a position where you are performing at the highest level and you are going to be much more successful if you take care of this injury,’ then they will be much more receptive to the feedback and buy into it.”

Even as a vocal advocate for brain safety, Batty was struggling to protect herself from herself as recently as last spring. After a year of diligent training and a lengthy recovery from injury, she was counting on a comeback at the World Cup downhill mountain biking race at the Mont-Sainte-Anne resort outside Quebec City last spring. That was the race that would reignite her biking career, which had elevated her as one of the nation’s top downhill racers, renowned for her aggressive style and speed.

On her third practice run, she tumbled down a rock face. It wasn’t a big crash, she said, but at the bottom of the course she felt her vision blurring and synapses slowing. She tried to ignore the tell-tale signs of her concussion.

“I was not walking into that clinic,” she said. “That’s the disparity of an athlete’s desire to win. I had trained so hard for this race. This was my race.”

She called a friend. He noticed her slurring her words. He persuaded her to get checked out. At the clinic, the doctor quickly noted her dilated pupils and slurred words. But she aced the memory exam because she had memorized the test. The doctor pulled her from the competition.

“It broke my heart but that shows the dissonance from what I want and what’s ultimately good for my brain,” she said. “I’m still so sad that I self-reported, but that’s a small part of me. On other hand, I’m so glad that the system works when you self report. But athletes won’t start self reporting until federations stop treating their athletes like a replaceable commodity.”