Herring first earned a BA in biology (1975) from the University of Texas at Austin before proceeding on to the UT Southwestern Medical School in Dallas, earning his MD in 1979. (He notes, with a chuckle, that if you’re born in Texas as member of his family, you’re obligated to attend UT.) But his combined internship and residency brought him to UW’s Department of Rehabilitation up in Seattle, and he was immediately taken with the landscape. He would ultimately make the Puget Sound his home.

However, it was while he was still an undergraduate that Herring first became (unknowingly) involved with ACSM.

Having grown up in Texas, Herring of course played football from a young age, then added in baseball for good measure, though he wasn’t able to stick with either in the long term.

“I wandered through sports with no particular talent but just enough injuries to where I finally had to let that go,” he says.

He eventually took up golf, both playing on the school’s team and working on a course to bring in some money. He also started running. (“It seemed like most of my life I was running from something, so I might as well do it formally.”) But it was actually an undergraduate phys ed class at the UT that really set in motion the later events of Herring’s life.

“Back in those days, believe it or not — this is shocking — you actually had to take physical education your freshman year in college. Don’t I wish those days were back,” Herring says. “But I got hurt, so I was sent to see this fellow by the name of Karl K. Klein.

Klein, an early member of ACSM whose instruments were displayed as veritable relics in ACSM’s former building, was performing biomechanical analyses of research subjects, so as Herring worked through his own rehab, he got to sit in on some foundational research. Things sort of took off from there.

“I started hanging out with him and learning biomechanics from him and learning how to do rehab from him,” Herring says.

Herring eventually became Klein’s assistant, and Klein became Herring’s advisor. In due time, Klein suggested Herring attend medical school. It was a fundamental life choice: Herring was interested in genetics and other basic science, and he might in all likelihood have fashioned a fulfilling career for himself at the bench. But he enjoyed working with people, and he took Klein’s advice, eventually enrolling at the UT Southwest Medical School.

“So, my less than stellar sporting ability ended up with me actually meeting the man who directed my future,” Herring says.

Herring never did shy away from research, though. He is a prolific author, particularly in the study of the spine and of concussion, and as of mid-November 2024 his work has received nearly 11,000 citations, placing him, according to the medical networking site Doximity, in the top 5% of their researchers. He estimates he’s authored or co-authored roughly 130 papers and “fifty-odd textbook chapters and a few books,” as well as a number of consensus statements.

“While I consider myself mostly a clinician, my academic work has at least had some acceptance, particularly the concussion stuff,” Herring says, somewhat downplaying the truth. The humility bug, which appears not infrequently in our conversation, is biting him again.

Herring shared three titles where he was one of the authors as particular examples of his interests and impact:

1. “Consensus statement on concussion in sport: the 6^th International Conference on Concussion in Sport — Amsterdam, October 2022,”
2. “Persisting symptoms after concussion: Time for a paradigm shift,” and
3. “Persisting symptoms after concussion: Considerations for active treatment.”

The first publication, a consensus statement, comes on the heels of similar statements released at conferences in Berlin and Zurich, which collectively have received more than 100,000 citations. Impactful enough.

But the second publication, a perspective piece, is an intriguing window into Herring’s mind. In the 2022 paper, Herring and his coauthors argue that the term “postconcussion syndrome (PCS),” doesn’t serve purpose and that a more useful framing would be “persisting symptoms after concussion (PSaC).”

The authors’ first target was the word “syndrome,” which they explain “does not really accurately describe those with lingering symptoms after a sports or recreation-related concussion.” That gone, they made another interesting and ultimately revealing decision. They could have easily adopted the phrase “persistent symptoms after concussion” which was already in the medical literature, but instead elected to use the formulation “persisting,” given that “persistent” may imply a permanence to the condition that would be neither necessarily accurate nor psychologically helpful for the patient.

“Persisting” is active: the symptoms are happening now and continuing to happen, but there is no reason to discount a light at the end of the tunnel, whereas “persistent,” with its hard closing consonant, has a permanence to it that seems to say, You’re just gonna have to live with this, buddy. This is at odds with the fact that the majority of athletes with concussion symptoms do get better. In medicine, and most particularly in Herring’s line of work as a physiatrist, the patient’s psychological state is intimately and reciprocally linked with his or her physical condition. That is, why bother adhering to the treatment plan if your concussion symptoms are going to be persistent? But if they’re only persisting for the moment, it might not hurt to stick to the plan and get through this thing. Always respect the brain injury, but offer hope for improvement.

Subtle? Sure. But subtle doesn’t mean small.

Let’s let some others weigh in on Herring’s impact. According to the seven ACSM past presidents who co-wrote one of his Honor Award nomination letters, “He is internationally known for his work and leadership in concussion care and policy. He was the physician champion for the Lystedt Concussion Law in the state of Washington that set the national standard for concussion care in high school and youth sports and was the model for concussion laws in all 50 states and the District of Columbia.”

The Lystedt Law is named after junior high football player Zackery Lystedt who, in 2006, suffered what initially appeared to be a minor head injury during play and was sidelined for only three downs before heading back onto the field. Lystedt collapsed after the game, experiencing life-threatening and, ultimately, profoundly life-altering brain injuries. The law, passed in 2009, requires that youth players who show signs of a suspected concussion be seen by a licensed health care professional before they can return to play. Its passage, and his work in aiding in the passage of the subsequent laws across the country that followed in its footsteps, are some of Herring’s most prized accomplishments.

“The Lystedt laws — that was a big honor for me,” Herring says, a little later adding: “And by the way, the campaign to pass Lystedt laws in all 50 states and the District of Columbia was announced at the ACSM annual meeting in Seattle in 2009 with Zack and his parents present. ACSM was a partner in our effort to get those laws passed.”

Stay tuned: The laws and the processes that took place to get them passed will also be the topic of Herring’s upcoming Dill lecture at the 2025 ACSM Annual Meeting in Atlanta. While considering what he was going to speak about, it occurred to him that the lecture as an opportunity to discuss a unique nexus of medical knowhow and policy.

“They asked me what I wanted to talk about. And I said, well, you don’t usually legislate health care, and I can talk about why that had to happen and how the laws came to be, as well as the heroism of the Lystedt family and what’s happened since the law has been passed.”

In a letter supporting Herring’s nomination as the 2025 Honor Award winner, six other writers — including ACSM fellows Margot Putukian, W. Ben Kibler, Francis G. O’Conner, Cindy J. Chang, and Constance M. Lebrun — characterized Herring’s contributions to the field’s understanding of concussion thusly:”:

“Over the last decade, Dr Herring has mentored a new generation of leaders in concussion medicine. His experience, guidance and wise counsel are felt well beyond the U.S. Without Dr. Herring’s knowledge, influence, clinical and administrative abilities, the state of the art and practice for this important and serious injury would be much less. His perspective on this issue is probably one of the most extensive and inclusive in this area.”

Four other nominators, all Olympic physiatrists (including ACSM fellows Jonathan Finnoff and Joanne B. Allen) characterize Herring’s impact this way:

“On a personal note, we frequently call upon Dr. Herring as a mentor to help guide us through the challenges we face as sports medicine leaders. Few have the experience and wisdom of Dr. Herring, and our profession benefits from his willingness to selflessly share his time and expertise with us.”