'Is it worth it?' After multiple concussions, Texas guard Audrey Warren turns to Q-Collar

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When her daughter Audrey Warren slides in front of a charging offensive player and goes flying to the ground, when Audrey’s neck snaps back and smacks against the floor, that’s when Stacy Warren holds her breath.

Parents everywhere will understand Stacy’s reaction: her stomach drops, her hands get clammy, her mouth goes dry. For a few agonizing minutes, it feels as if her heart is outside her body. For Audrey, a senior guard on the second-seeded Texas women’s basketball team, which plays Friday against sixth-seeded Ohio State, a concussion blackout typically lasts three seconds. But for her mom, it’s “the longest five to 10 minutes, waiting to see if she’s OK.”

In four years at Texas, Audrey has become known for her all-out style of play. She takes pride in sacrificing her body for her team, and thinks nothing of stepping in front of someone barreling toward the basket. But it has come at significant cost: over the course of her career, she’s sustained six concussions.

Last season, the Warren family — dad Cliff Warren, mom Stacy, daughter Audrey and her five siblings — along with a team of doctors in Texas athletics’ sports medicine office, had serious conversations about if Audrey needed to give up the sport.

Rather than walk away, Audrey, like many elite athletes, learned to make in-game adjustments. Changing her style of play wasn’t an option, but learning how to fall correctly was. For months, she agreed to not take charges in practice. And this season, she’s been aided by the Q-Collar, a medical device worn by a handful of professional athletes designed to help reduce severe head injuries.

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The collar, which resembles a thick black choker necklace, always sparks questions from interested fans.

“I love to tell people about what it does and how it’s helped me,” said Audrey, who averages 8.3 points and 4.3 boards off the bench for Texas. “It’s been a game changer.”

Still, the risk is hard on a mother who has watched her daughter take too many hard hits.

“Sometimes I see comments online where people are saying, ‘How can her mom let her play, doesn’t she care about her daughter?’ Those comments, they eat me up, they make me cry,” Stacy said, her voice catching. “Of course I love my daughter. We’ve had every scan and test done to make sure she’s not doing any permanent damage.

“People don’t get it. It would destroy her if she couldn’t play basketball.”

'My family hates that I take charges'

Audrey Warren learned to love defense at an early age.

A late bloomer offensively, Audrey quickly realized that even if she couldn’t score at will, stopping someone else from scoring was a valuable skill, too. And boy, could she rebound.

Cliff, who coached and trained Audrey growing up, encouraged her to play with boys, and match their physicality. She couldn’t get enough.

“She just plays so hard,” Cliff said. “She puts herself in situations that a lot of girls don’t. She has no regard for her body or how she could hurt herself — she is just there to get the job done, and win.”

At Texas, Audrey again found her way onto the floor by playing defense. In a freshmen class stacked with All-Americans, Audrey played more minutes than any other rookie, eager to corral rebounds and scrap for loose balls. She recalled her first concussion happening in practice, when her temple made contact with an errant elbow. She had a headache, and sensitivity to light. But she recovered, and returned within days.

Later that season, on Feb. 9, 2020, a charge at Texas Tech terrified her parents.

Cliff remembers it vividly: A Texas Tech player flashed to the high post, then barreled toward the block. Audrey, in a help defense position, slid over, trying to catch the offensive player unaware. They crashed into each other in spectacular fashion.

“Audrey’s feet were off the ground, and she was parallel to the floor,” Cliff said. “This was not the type of play that happens in a contact sport — this was a collision. This is the type of hit you would expect in football.”

The worst part? Both Stacy and Cliff were watching from home, and when the feed blacked out for 10 minutes, neither of them knew if Audrey was OK.

Fortunately, Stacy’s parents were in Lubbock and able to travel with Audrey to the hospital. The collision broke Audrey’s nose and gave her a nasty black eye. It also sidelined her for three weeks.

“My family hates that I take charges,” Audrey said. “My uncle made a sign that says ‘There’s your one charge!’ that he’ll hold up during games. My mom tells me she has grey hair from it. My dad knows I’m not going to change the way I play, but all my family, they cringe when they know I’m about to take a hit.”

Audrey came back that season — wearing a mask to protect her fractured nose — but then missed the first 11 games of her sophomore year because of more concussion issues. Last year, after taking another hard hit that sidelined her again, UT coach Vic Schaefer told Audrey they should talk about if basketball was worth it.

Getting educated about concussions

Cliff tries to compartmentalize how he thinks of Audrey, saying he treats her like any other athlete he trains. He has to take his emotions out of the equation he said, “because if I’m Dad, then the first charge she took, I’d have taken her out and wouldn’t let her go back.”

But he understands well the risk of head trauma. Cliff’s brother Steve Warren played three years in the NFL, where discussions about traumatic brain injuries increase in volume every year. As UT doctors started discussions about Audrey’s future, Cliff used it as a teaching moment.

“That was a turning point for us, as a family, to become so educated about concussions,” Cliff said. “We talked a lot about, you don’t want to be 30 years old and have something be a problem because of when you were playing.”

For her part, Audrey made a list of questions to ask doctors.

“My biggest thing was always memory,” she said. “Personally, I feel like my short-term memory has gotten worse from the first time I hit my head — but I also don’t know if it’s actually from hitting my head or not. Could this get worse? Am I going to lose my memory? Am I not going to be able to function?

“Every time I wake up from my three-second blackout I think, wow, what if that blackout was longer? What would that do to me?”

Initially, Audrey was advised to “not get in the fray when there’s a bunch of people around the ball, maybe pick and choose my spots a little more." She didn't care for that advice. 

Instead, after doctors (she also saw a specialist outside the UT program) assured her that she had “a very low chance of doing long-term damage,” Audrey learned how to take charges in a safer, more controlled manner. Trainers and coaches taught her how to tuck her chin during contact to avoid “being so out of control when I fall,” she said. While there are no guarantees regarding an athlete's future health after experiencing head trauma – neuropathology experts continue to study the effects concussions have on CTE – she and her family have educated themselves about the risks, and felt comfortable with her decision to keep playing.

At the start of this season, the training staff introduced the Q-Collar.

Developed in 2012, the Q-collar applies subtle pressure to the jugular vein, helping increase blood volume in the head, which reduces brain movement. This helps guard against what UT sports medicine director Allen Hardin called “the sloshing effect,” when someone hits their head and the brain, sloshing around, ricochets against the skull, causing injury. With the Q-Collar helping blood flow, the brain has more of a protective cushion in the event of impact.

Approved by the FDA in February, the Q-Collar is sold over-the-counter and has been seen on professional athletes including Meghan Klingenberg of the NWSL’s Portland Thorns and former Pro-Bowl tight end Vernon Davis. 

Of course, Audrey’s parents acknowledge that NFL players like Davis who wear the Q-Collar and risk concussions often have a million dollar paycheck waiting for them. That type of safety net doesn’t exist for most female athletes.

“Oh, you don’t have to tell me that,” Stacy said. “And it wasn’t going to hurt my feelings if she had given up basketball. I didn’t want to tell her what to do — what if she resented me? We all talked about how she was old enough to make her own decision, and she got educated about it. At the end of the day, you want your child to be safe and happy.”

So far this season, Audrey has had no diagnosed concussions (the UT training staff is quick to point out that an athlete going through concussion protocol does not mean they actually have a concussion). It’s impossible to know, Hardin said, how much of Audrey’s health this season is directly related to the Q-Collar vs. her tweaked style of play and, potentially, sheer good luck. But the device has given Audrey peace of mind.

“This is something that gives me more confidence to play the game I love the way I like to play it,” she said. “Every athlete makes sacrifices. Every time I take a charge, I do ask myself if it’s worth it. But I just love this game so much, and I love what it’s done for me.

"I didn’t want to let that part of me go yet.”

Follow Lindsay Schnell on Twitter at @Lindsay_Schnell