Sophie Cunningham talks about Audrey Holt
Audrey Holt’s career ended in the middle of a Missouri State women’s basketball practice.
During a drill, Holt cut across the court and collided with another player coming off a screen. They bumped heads.
For most people, the collision wouldn’t lead to a serious injury. But Holt had a history with concussions and had developed a propensity to getting them. The collision rocked her brain and gave her a troubling 14th concussion in nine years.
Holt had been through various concussion protocols enough times to know she needed to get off the court immediately. She exited the practice, and she began to cry.
The head trauma wasn’t causing her tears. A looming decision was.
“I knew what that meant for me,” Holt said. “A lot of those feelings were like: ‘Why me? Why does that always happen?’”
A few weeks after that November 2017 collision, Holt sat down for a meeting with Missouri State coach Kellie Harper and numerous members of the Bears’ athletic training and medical staffs. The 6-foot-1 forward decided to medically retire two months shy of finishing her college career.
Holt’s medical history isn’t a common one, especially in college basketball. Her head injuries have come via a mixed bag of athletic collisions and freak accidents.
Still, Holt and medical experts are more optimistic about her long-term health than her lengthy history of brain trauma suggests.
And instead of avoiding the ongoing conversation about concussions, she’s trying to be a part of it. She has already signed up to posthumously donate her brain to The Concussion Legacy Foundation.
‘In every play’
Jill Nagel, Holt’s high school coach at Rock Bridge in Columbia, said the forward played at one speed: “100 percent.”
“She’s in every play,” said Nagel, who coached Holt to three state championships.
Playing alongside Missouri star Sophie Cunningham, her childhood friend, and former Tigers stalwart Cierra Porter, Holt was her high school team’s defensive anchor. She didn’t believe in a brake pedal, and while Rock Bridge became a national power, college coaches who couldn’t lure Cunningham and Porter came to the gym for Holt.
Two days after Harper took the Missouri State job, in April 2013, she was in Rock Bridge’s hallways recruiting Holt. The Columbia native’s style of play and winning pedigree are traits she wanted as the foundation of her new program.
Holt’s high level of play earned her a college scholarship, but it also got her banged up.
“She would just bowl them over,” said Holt’s mother, Lisa Holt. “They were afraid of her, but she wasn’t afraid of them. But still, you get a knee to the side of the head, even if they’re smaller than you.”
Holt’s first concussion came from a soccer collision when she was 12. When she sustained a second soccer concussion a few weeks later, the first person to notice something was wrong was her English teacher. The teacher called home a few weeks after the incident to say Holt had uncharacteristically forgotten a homework assignment and had been “acting odd.”
“That’s when we started digging and found out she’s had a concussion now for weeks and we’ve not been managing it at all,” Lisa Holt said. “She was still going to practice, school, every day — her regular routine.”
In high school, Holt’s nose-first style of play led to her third concussion when she dove for a loose ball and had a head-to-head collision with another player. Two more came in car accidents the summer before her junior year, one after she fell asleep at the wheel and drifted into a ditch.
Police told her “it could have been a lot worse.”
Because her pre-college concussions had no correlation in terms of where or how they occurred, the subject wasn’t really an issue during her college recruitment.
“If you have three on the basketball court, you start to become a little more aware of it because it’s happening in the same setting,” Nagel said. “When they’re not all happening in the same place, not all of the same people are there. It doesn’t come to light as much when they start piling up at Missouri State.”
After Holt committed to Missouri State, her parents filled out paperwork regarding her medical history. That was when they realized that they had never sat down to fully account for them all.
‘She’ll never make it four years’
Holt’s first concussion in Springfield came during a preseason practice her freshman year when she was hit with a weighted ball during a 2-on-2 drill.
Her parents had wondered if she’d medically retire after her fifth recorded concussion, but no conversation took place.
“When she got that first one freshman year, I said to myself then, ‘She’ll never make it four years,’” her mother said.
Harper said she relied on her medical staff throughout Holt’s career and kept playing her because she always fully recovered from the concussions. Holt never exhibited any lingering effects, but she did become more prone to experiencing concussions, according to her coach.
The NCAA has no formal rule that requires athletes to retire after a certain number of concussions, instead deferring judgment to the institutions to handle such cases. Missouri volleyball player Melanie Crow, for example, was unable to continue playing at Ole Miss due to her concussion history, but she was able to transfer to Mizzou and resume her career.
As Holt’s concussions piled up throughout her career, Harper became more cautious with her handling. During Holt’s last two years, Harper held Holt out of most contact drills during practice and doubled the length of her concussion protocols. When Holt received another concussion during a rebounding drill, Harper pulled her from those, too.
Holt sustained another concussion during a summer workout when she was hit by a basketball. She walked into on a pass intended for a coach.
“By the end of my career, some of the concussions I’d be getting were just like a regular basketball play that most people just shake off,” Holt said.
Chris Nowinski, CEO of the Concussion Legacy Foundation, never worked directly with Missouri State or saw Holt’s medical information but said Harper and her staff handled Holt’s case the right way.
“If she kept recovering, a lot of doctors wouldn’t have retired that athlete,” Nowinski said. “You can’t say she got bad advice or bad treatment.”
But even after each successive concussion, Holt’s style of play did not change. Harper recalls a game Holt played in after sitting out the previous few because a concussion. She subbed into the game and immediately took a charge.
After every concussion, the Missouri State medical staff would sit down with Holt and make sure she understood the risks if she continued competing.
When Holt suffered her 14th, she sat out the next three games while undergoing the school’s concussion protocol. It was her third since June, which heightened the medical staff’s concern. The two she received that summer were from a tubing incident at Lake of the Ozarks and another collision during a workout. Three weeks after her November 2017 concussion, the Missouri State trainers told Holt’s parents that Audrey’s concussions accounted for more than half of the entire athletic department’s.
“That,” Holt’s father, Dan, said, “was an eye-opener.”
Throughout the conversation, Harper and members of the MSU staff told the family that if they were in Holt’s situation, they would medically retire. Holt compared the conversation to an intervention.
The dilemma for Holt was simple — play out the final two and a half months of her career and potentially suffer concussion No. 15, which could have long-term effects, or hang it up.
“When your coach is sitting there and everyone has your kid’s best interest at heart — that’s when you know,” Dan Holt said. “This is a life decision. This isn’t a game decision.”
She decided to retire before Christmas but needed a few days to come to terms with the choice. While home, she began practicing what she was going to say out loud to her teammates and confided in friends such as Cunningham about her plans.
Cunningham is known for her toughness and ability to play through injuries. Even she was surprised when Holt filled her in.
“You don’t realize how many she had,” Cunningham said. “It was kind of weird to know that she has 14. I think she should’ve stopped earlier.”
Still, Cunningham admired Holt’s persistence to keep playing.
On Dec. 26, 2017, Holt made the three-hour drive from Columbia to Springfield for a 6 p.m. practice. She was dreading telling her teammates.
After Harper addressed the team, she left the Missouri State players alone in the locker room so Holt could speak to them. Holt said it was the hardest thing she’s ever had to do; most of her teammates didn’t know she was pondering retirement.
“’You guys all know about my history with concussions,’” Holt remembers saying. “’Because the number is getting so high, after talking with our doctors we decided I would take the Christmas break to decide if I would continue playing basketball or not. So I have made the decision to stop playing.’”
“When your brain is injured, you can’t fix it,” Lisa Holt said. “You can fix your ACL, your broken wrist, and that puts her in a different position.”
Missouri State went 17-4 after Holt’s decision and ended the season 21-12 with a second-round loss in the women’s National Invitation Tournament.
Lisa Holt said her daughter held up fine on the sidelines while the team was winning without her, but the losses were hard to cope with at times.
“She (felt) some responsibility, that, ‘Maybe I could have made a difference,’” Lisa Holt said.
Holt is now 11 months removed from her playing days and said she has no known lingering issues from the concussions.
While playing, Holt experienced severe migraine issues that were triggered during preseason workouts. But because she’s no longer playing, those haven’t been a problem.
Holt saw the movie “Concussion” when it was released in 2015. Her health-related anxiety dropped after seeing the film because she realized she hadn’t endured the constant head-to-head collisions of a football player.
Despite the high number of concussions she’s had, Holt doesn’t have a high probability of being diagnosed with CTE, according to Nowinski.
“We don’t have experience with basketball players to suggest there’s a risk of CTE among (them),” he said.
Even with a potentially lower risk, Holt still wants to donate her brain because she feels her situation is unique and can aid in concussion research.
On pace to graduate in December, she has no regrets about her basketball career. Her parents simply wish they had handled the first concussion in middle school more properly. Maybe they could have prevented their daughter from getting to 14.
Holt knows she’ll always have to be careful with the activities in which she participates now because of her sensitivity to concussions. But she said that she believes that if she’s careful, her history of brain injuries won’t affect her everyday life.
She even plays pickup basketball every now and then — with one rule: “Don’t touch Audrey’s head.”