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Analysis

Concussion Protocols Fail Vonn

She took silver — which, the thinking goes, means she was right.

When Lindsey Vonn decided to race at the world ski championships Sunday, despite repeated evidence that she had not recovered from a concussion, she attacked her condition as much as the course. She hewed the hazards, fought the fogginess and ultimately crossed the finish line with fate a split-second behind. Given everything, she said afterward, beaming, silver felt like gold.

Only in an alternate reality somewhere did Vonn’s dice come up snake eyes, sending her careening into a tree and becoming her sport’s Dale Earnhardt. Her slip near the finish, which she admitted was caused by lingering balance issues, could have resulted in a far more serious head injury — but it did not.

Neither Vonn nor her millions of fans would learn the hard way how an athlete who could not look less like a football player can, when it comes to concussions, act just like one.

The events preceding Vonn’s downhill race Sunday in Garmisch-Partenkirchen, Germany, raised serious questions about the procedure that cleared her to compete. Since sustaining her concussion during a Feb. 2 training run, she and the United States Ski Team appeared to hit the trifecta of concussion no-no’s: they called the injury mild, blindly followed so-called concussion tests, then discounted clear signs that her injury remained.

Six days after her concussion, Vonn passed repeated concussion exams — mostly measures of balance and short-term memory administered by United States Ski Team personnel — and raced in the super-G at the world championships. Those tests did not assess her condition accurately, however, because after finishing seventh, she acknowledged to skiing “in a fog.”

She had added: “My head just isn’t thinking fast enough. I can’t process the information fast enough, and that gets me behind on the course. My body is one gate ahead of where my mind is, and that’s not a good way to ski.”

Rarely has any athlete so clearly described the real-time cognitive effects of an unhealed concussion. She said she “felt great one day and then pretty lousy the next day,” and even cited all she had read about concussions and their long-term health risks. (Sustaining another blow to the head before a concussion has healed can cause permanent neurological damage.) But as so many athletes have proved before, acknowledgement and action are not easily joined.

Vonn rested Wednesday. On Thursday, again after passing all neurocognitive assessments, she took a tentative training run — wearing a puffy jacket to keep her speed down. She went full-speed during Friday’s downhill portion of the super combined, after which she again “lost focus about three-quarters or halfway down the course,” badly enough to skip that afternoon’s slalom. Her concussion remained unhealed, the symptoms once again prolonged by her returning, evidently, too soon.

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Lindsey Vonn was second in the downhill at the world championships Sunday. Afterward, she said she had not recovered from a concussion.Credit...Alessandro Trovati/Associated Press

Her next race was Sunday, when she said she woke up feeling great, passed her tests once again and prepared for the downhill. She promised her fans on her Facebook page that if she did not feel 100 percent on the course, she would stop — as if woozily careening down a mountain at 70 miles per hour are appropriate conditions for such a call.

She finished second. She almost finished separated from her skis, too, when her waning concentration and balance allowed a bump near the end to nearly cause a crash. She finished the race too disoriented to find the scoreboard for a few seconds.

“I definitely am injured,” she said in a conference call afterward.

If an N.F.L. player was allowed to compete under those conditions, the team (and league itself) would be roundly flayed for endangering his health — and misleading young athletes about the risks of head injuries. (A poster that hangs in every N.F.L. locker room regarding concussions reads, “Other Athletes Are Watching.”) The Mets demonstrated to all of major league baseball how to ruin a promising player three years ago when they allowed Ryan Church to play despite his recurring concussion symptoms.

The United States Skiing and Snowboard Association — whose news release Sunday continued to describe Vonn as having sustained a mild concussion — said its procedure for clearing concussed athletes followed modern guidelines, in that Vonn had not shown any symptoms or failed any test immediately before a race. Her subsequent fogginess and impaired balance midway through all three races did not shake confidence in their procedures, said Kyle Wilkens, United States Skiing’s medical director.

“We followed the protocol that we have established,” said Wilkens, who confirmed that Vonn was not examined by a neurologist or expert in sports-related concussion during the world championships. “We have to rely on the system.”

Vonn said she would continue to do so as well, although she had not yet decided whether to skip the rest of this week’s competition. She was asked why she still trusted a procedure that, three times out of three, had cleared her to race prematurely and court considerably worse harm.

“Well, I don’t know,” she stammered. “I mean, uh, I don’t really know how to answer that question. Medically speaking, I’m doing what the doctors are telling me to do. It’s tough to say. Every day, I feel like I’m getting better, and every day, I pass the tests. Unfortunately, I’m still having some symptoms in the race.”

Like most top-flight athletes, skiers stare down risk as part of their constitution. They don’t fear courses, they tame them. They don’t avoid gates, they attack them. As Vonn explained Sunday, her continuing concussion problems were, “just something I have to fight through.”

She added: “I believe we made safe decisions. I passed all the tests.”

Except the 70-m.p.h. ones that, with a tiny slip or flinch of a knee, could have changed her life. Athletes can will many things. They cannot change the dots on dice.

A version of this article appears in print on  , Section D, Page 1 of the New York edition with the headline: Concussion Protocols Fail Vonn. Order Reprints | Today’s Paper | Subscribe

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