Dave Mirra's Tragic Legacy: CTE and Extreme Athletes

"They'll die. Just like I would when I was younger. I would have died to win."

Dave Mirra, who committed suicide on February 4th, 2016, poses at his training facility in Greenville, North Carolina in 2005. Credit: Gerry Broome/AP

For most of his career, BMX rider Dave Mirra was so good he avoided the nasty falls that put other pros in the hospital. Known for his flow – or ability to seamlessly string together one intricate trick after another – Mirra was the best his sport had ever seen: He won a then record 24 medals at the X Games, had a video game named after him and a hosting gig on MTV. Other than Tony Hawk and Shaun White, no extreme sports star had ever been bigger. But by the mid-2000s, the nature of BMX competitions, and action sports in general, changed. The X Games had become a juggernaut, with 38 million people tuning in to watch in 2013 and millions of dollars in sponsorships on the line. The only way to make the podium was through bigger air and more dangerous tricks, and for a new generation of riders willing to test the limits of time and space, gnarly crashes became a daily occurrence.

"I could see it in their eyes, man, they'll do whatever it takes to win," Mirra said in an interview last year. "They'll die. Just like I would when I was younger. I would have died to win."

Whether it was the psychological toll of years of injuries, or the breakneck evolution of the sport, Mirra struggled to keep up, and began taking his fair share of falls. In 2006, on the park course at the Los Angeles X Games, Mirra fell 16 feet from a ramp on to his head, crashing so hard he lacerated his liver. A few years later, at a Dew Tour event in Chicago, he fell 14 feet to the bottom of the ramp, momentarily losing consciousness. He later said it was one of the worst slams of his career, but he competed in the finals anyway, even though he "felt out of it." 

"We ride until we crash," says Mirra's friend Mat Hofman, who by his own count has had over 100 concussions. "That's just the nature of the sport."

While action sports athletes don't endure the constant battering to the head that football players do, they often suffer the worst kind of concussions, the type that can lead to traumatic brain injury, or TBI. And because many action sports competitions have lax protocol around concussions, it’s common for athletes to compete despite hitting their head, sometimes just hours later, when the brain is most vulnerable to serious, irreversible injury, including death. "I remember seeing guys knock themselves out cold in practice and then come back and ride and win it, purely on instinct," says TJ Lavin, a close friend of Mirra's. "They didn't even know where they were."

By the time Mirra retired in 2010, a series of high-profile crashes had raised major concerns about the risks of repeated concussions. In 2011, for instance, Lavin – who had replaced Mirra as the sport's newest crossover star, with his own MTV hosting gig – ate it hard at a Dew Tour event in Las Vegas and spent eight days fighting for his life in a medically induced coma. The next year, a veteran big air rider named Jay Eggleston crashed in the finals of a Dew Tour event in Maryland, shearing brain tissue near his thalamus, an area associated with sensory perception and movement, leaving him unconscious and near death for days. The next year, a highly-touted 17-year-old BMX rider named Brett "Mad Dog" Banasiewicz crashed attempting a 720 at a competition in Virginia, causing swelling and bleeding in his brain. He remained unconscious for 15 days and had to teach himself how to talk, walk and swallow again.

"I think that's when we started to realize we had a problem," says Mark Eaton, a documentary filmmaker who has worked for the Dew Tour and X Games. "It was like, 'Whoa, these guys are really getting messed up.'"

Mirra rarely talked about the long-term effects of his concussions, but in the final months of his life, they had become impossible to ignore. In conversation he'd get stuck on one topic, returning to it again and again, forgetting what he’d just said. He’d become moody, and emotionally fragile, breaking into tears in the middle of everyday conversation. To his wife and closest friends, he seemed lost and unable to put his finger on what was wrong.

On the morning of February 4th, 2016, Mirra stopped in at a popular Italian eatery in his hometown of Greenville, North Carolina. He greeted a few friends, joked that he'd been out late the night before and, at 41, was getting too old for that. He then drove home, parked his truck in a friend's driveway and shot himself in the head. He left no suicide note or explanation. At a press conference the next day, Allen Thomas, the mayor of Greenville and one of the last people to see Mirra alive, suggested repeated concussions might have caused Mirra's death. "I just didn't see how there were any other explanations," Thomas says. "This was a guy who had everything going for him."

Now we know Mirra did in fact have CTE, a degenerative brain disease linked to concussions and depression, making him the first action sports athlete diagnosed with the condition. In May, Dr. Lili-Naz Hazrati, a neuropathologist at the University of Toronto announced that she had found tau buildup in Mirra's brain, a tell tale sign of CTE. "What we're learning about this disease grows every day," Hazrati says. "But I think one thing this tells us is that the number of concussions it takes to get CTE may not be as high as we thought."

Mirra's death shook all corners of the action sports world, and also revealed something rarely discussed: just like in the NFL, where the implications of CTE have become one of the league's biggest stories, extreme sports athletes suffer dozens of concussions over the course of their careers. In the months since Mirra's death, fellow riders have started talking amongst themselves about CTE, wondering if this was the beginning of something much bigger. "It had been an underground conversation for a long time, but Dave's death made it public," says Jay Fraga, a former BMX racer who runs the Knockout Project, a concussion awareness program for athletes. "This was a wakeup call."

While the field of concussion research is still relatively new (CTE wasn't identified until 2000), conventional wisdom has held that it’s repeated hits to the head, the sort football players suffer over the course of a season, that raise the most red flags. But new research has found that severe brain trauma suffered by military veterans could be linked to suicide, and a study by doctors at the University of Toronto released earlier this year found that even mild concussions can increase the likelihood of suicide by three times. “It’s true that the incidence of suicide seem to increase with CTE, but we don’t really know if that’s the main factor,” says Robert Cantu, the co-director of the Center for the Study of Traumatic Brain Encephalopathy at Boston University. "Suicide is a multi factorial situation and we’re not precisely clear what each of the factors contribute to the problem."

Concussions extend the neurons and axons in the brain, which can only be stretched hard once before snapping. If they rupture, fibrous balls of protein form in the pathways that handle communication and cognitive function as part of the brain’s attempt to heal itself. That scarring, otherwise known as CTE, can cause debilitating memory problems, explosive anger and crippling depression. In a 2012 study of 85 people who had repeated mild traumatic brain injury, 68 showed evidence of CTE, and 50 of them were former football players. CTE has also been found in the brains of several prominent NFL players who committed suicide, including Andre Waters, Dave Duerson and Junior Seau. Duerson asked that his brain be studied for CTE in his suicide note; Seau shot himself in the chest, possibly to preserve his brain for analysis.

"With every other sport, it's just speculation based on football," says Chris Nowinski, the director of the Concussion Legacy Foundation. "We have a little bit of a window into the NFL. We get the brain of about 10 percent of the former players who pass away and we found the disease in about 95 percent of that population."

As a BMX racer, Jay Fraga suffered at least eight concussions before he began to feel the effects: cratering headaches, dizziness, bouts of forgetfulness and something he calls "power brownouts," when portions of his brain felt like they were short circuiting. Like a number of former NFL players, whose deaths led to the discovery of CTE in the first place, Fraga considered suicide until he arrived at a clinic that specializes in treating post concussion syndrome. There he found a room full of teenagers — not just football players, but soccer players, rugby players and high school volleyball stars. Not long after, in December of 2012, Fraga started the Knockout Project, and began encouraging other BMX stars to share their stories. Most were resistant at first. "When you're on the top of your game from a mental standpoint you don't feel like anyone can touch you," Fraga says, "and it doesn’t do you any good on the competitive side to know you have vulnerabilities."

But Mirra's death changed all that. Fraga says he suddenly got hundreds of friend requests on the Knockout Project's Facebook page, many of them from BMX riders. "I got a lot of emails from guys saying, 'I feel lousy, like the world's closing in on me,'" Fraga says. "Finally guys were talking about it."

The same thing was happening within Mirra's circle of close friends. Ben Bostrom, a former motorcycle racer who was training for an Ironman with Mirra at the time of his death, says he got a phone call from NASCAR racer Jimmie Johnson urging him to look into the connection between CTE and suicide. Bostrom had survived his fair share of crashes – he had once hit a wall at Daytona going 200 miles an hour– and had wondered about the damages he'd done to his brain. Repeated concussions had given him the same sort of symptoms Fraga had experienced – glitches in his memory, irritability, and a short fuse. "I started thinking about all of these different guys I knew who had been through similar things because of concussions," Bostrom says. "The more I looked into CTE, reading these stories of football players, I saw the same symptoms. I was like, 'Hey, this is a real thing.'"

Because action sports operate outside the purview of a specific league or sanctioning body, there's no way to know how widespread concussions are, or how many X Games athletes may have CTE (which can only be diagnosed posthumously, by cutting open the brain). It's also unknown if the sorts of concussions athletes like Mirra and Lavin suffered are more damaging than the repeated sub-concussive blows football players endure over the course of a career. "We all believe that if someone has a serious head injury that lasts a long time that's a much worse situation than something that clears up quickly," says concussion expert Robert Cantu. "But we don't know what’s more dangerous."

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What athletes across action sports do know is that the tricks to win contests today have become so dangerous that concussions are a daily concern. In 2007, a skateboarder named Jake Brown had just landed the first 720 in the X Games' Big Air event over a 55-foot gap when he lost control and fell 47 feet. He hit the ramp with such force his shoes flew 50 feet, and his head momentarily snapped under his back. Bob Burnquist, widely regarded as the greatest big air skater of all time, collapsed to the deck in tears, believing he'd just witnessed Brown's death. In the years since, other action sports athletes have died during competitions or practice, including the motocross star Jeremy Lusk, freestyle skier Sarah Burke and snowmobiler Caleb Moore, the first fatality at an X Games event.

"We call it pushing the progression of the sport," says Kevin Robinson, a big air vert rider who won multiple X Games gold medals. "And it’s a choice – nobody is making us do it. We have the opportunities in our lives that we choose to face those dangers."

By his own count, Robinson has had over 100 concussions and has been knocked unconscious 30 times. One of the worst crashes was in 2003 at an X Games event in which he fell 25 feet onto his head, sending him to the hospital in a coma. When he emerged he couldn’t communicate with his wife or kids for two weeks. "I'd try to talk and only gibberish would come out." A few years later he had another concussion that caused a temporary loss in cognitive function, making it impossible to button his shirt, or his kid's jacket.

Once Robinson understood the effects of head trauma, he reached out to a team of neurologists and sports doctors to customize treatment. He now checks in whenever he feels his memory fading, or rising irritability. He has also learned a set of mental exercises that calm him and reverse what had been a cascading effect of anxiety and confusion. "I had a hard time being out in public among people and had to go on anti-anxiety medication just from different hits I’ve taken over the years," he says. "It all snowballs, you have to start taking medicine, and that starts messing you up and you start getting wrapped in this lifestyle you don’t want to be in."

Robinson was close with Junior Seau, and he says that in Mirra's final days his behavior began to remind him of Seau – the inability to focus, the forgetfulness, the mood swings. Mirra's wife Lauren told ESPN that he couldn't have a conversation without breaking down and crying. Friends started urging him to watch Concussion, the movie about the discovery of CTE and the NFL's efforts to deny the disease was real, or had anything to do with concussions.

"I remember seeing him sitting on our bed one day, in the last month of his life," Mirra's wife Lauren recently told ESPN this summer. "I had just gotten out of the shower and saw him hunched over with the blankest lost look. I sat down next to him and held his hand. I said, 'What is wrong? Are you ok?' And he just shrugged his shoulders. He couldn't even speak. He didn't know. He couldn't put it into words. He was lost. He was helpless. It was completely different from who he was."

Mirra is the first action sports athlete diagnosed with CTE, but he may not be the last. "The reason that he's the first is because he's the first one tested," Lavin said. "There are other guys who have taken their lives who it just didn’t make sense. I have little doubt they probably had CTE too." Most of the NFL players diagnosed with the disease after death didn't begin to manifest any symptoms until their 40s and 50s. That's the age of Mirra, Hoffman and other early icons of BMX, the sport's first generation who have seen contests move from mall parking lots to dizzying, and increasingly, dangerous heights. "I don't believe there was a huge worry about concussions 20 or 30 years ago, because the tricks were different," says Kevin Pearce, a former snowboarder who was seen as Shaun White's biggest rival before suffering a career-ending crash that nearly killed him in 2009. "But now, with all the money and prestige, guys feel like they have to go bigger, do another 360, do stuff beyond their limits to win, and part of the risk there is hitting your head." In 2012, two of the top six finishers on the Mega-Ramp (62 feet tall and 293 feet long) were under 16.

The organizers of action sports events are starting to address the problem. Since 2010, for example, the X Games has pulled anyone from competition that suffers a concussion, no questions asked. Helmet manufacturers are also working on new technology that will allow the brain to better absorb impact. And at events for Nitro Circus, a traveling action sports tour, the athletes now have giant air bags to cushion their fall. "The goal is to be able to do the craziest stuff and get up and laugh about it," says Travis Pastrana, the head of Nitro Circus. "It's not fool proof, there will always be a danger element to this. You'll never make these sports safe. But if everyone could do it, it wouldn't be as exciting."

Lavin says Mirra's death isn’t going to change the push for bigger air and riskier tricks in action sports, but now, because of the diagnosis, athletes know the long-term risks like never before. "We can't claim ignorance anymore," Lavin says. "Everyone in my generation didn’t know they were damaging themselves in the long haul. For parents who have kids in it now, they know there's the possibility of a long term impact that could affect the rest of your life."