As a teen, huddled with friends around a transistor radio, I reveled in Howard Cosell’s color commentary for boxing matches. But in my twenties, I realized that no amount of color commentary should allow me to watch a sport characterized by brain injuries. Now, I face the same realization with football. I have been a football fan since grade school—not a rabid fan, but a fan nonetheless. But current research on the dehumanizing effects of football concussions gives me pause.
Despite full knowledge of evidence to the contrary, the late Gene Upshaw as head of the NFL players’ union publicly discounted the claims of a relationship between concussions suffered during players’ careers and their later suffering from dementia, depression, and cognitive impairment in retirement. Even though he paid the University of North Carolina at Chapel HIll’s Center for the Study of Retired Athletes $172,000 to investigate a possible connection between concussions and later brain dysfunction, he is said to have essentially ignored, at least publicly, the center’s periodic dissemination of findings that indicated definite problems.
A large part of the problem is a “gladiator mentality that separates the ones who make it to the NFL and stay there,” according to Dr. Thom Mayer. Mayer, who was hired by Upshaw, is the medical director for the players’ union. Mayer continues: “Look at how he [Upshaw] died—ignoring pain. I mean that charitably. Particularly guys from that era, you just got through it. You sucked it up. No excuses.” Upshaw’s successor, DeMaurice Smith, has set out to make up for lost time. Appearing before a congressional hearing last week, Smith vowed to bring all relevant concussion research to the table and to take appropriate action.
The name of the condition suffered by retired players is CTE—chronic traumatic encephalopathy, and is identified by the accumulation of tau proteins associated with Alzheimers’s disease. But CTE is not a disease: it is the result of injury, of repeated injuries. The tau protein in CTE accumulates on the brain’s surface causing disruptions of normal neuronal firing patterns that lead to memory problems, mood disorders, and so forth.
In the The New Yorker for October 19, 2009, Malcolm Gladwell wrote a piece on the NFL and brain injury entitled “Offensive Play.” It is a must read for football fans. It includes summaries of many interviews with players and neurologists. He quotes Dr. Ann McKee, director of the neuropathology lab at the Bedford, Massachusetts, Veterans Hospital, and a lifetime football fan, as saying when asked if she recommended her 19-year-old son pursue football: “Not if you want to have a life after football.”
So what is the research saying, and what should we do about it?
Here are findings from Kevin Guskiewicz, University of North Carolina at Chapel Hill, lead author for the National Athletic Trainers’ Association position paper on concussions:
- All-out practice sessions incur the same rate of brain injuries as games themselves.
- The cumulative effect of “subconcussions” is as much a cause of future dementia as full concussions.
- An errant elbow to the helmet can have a g-force up to 100, equivalent to being in a car crash, so it is not just a matter of head-butting and other intentional blows to the head.
- The average number of blows to the head over a ten-year NFL career (that includes high school and college play) is 18,000, based on an averge of 1,000 blows per season. That’s the equivalent of 18,000 car accidents with ensuing whiplash and so forth.
- NFL players who experience three or more concussions in their career show increased risk for cognitive decline by age 50.
- Retired NFL players between the ages of 60 and 89 have significant dementia, including Alzheimer’s disease, at a rate five times greater than the population at large.
- One in ten high school players experiences a concussion; however, no evidence exists at present from long term studies that might show increased risk.
Guskiewicz bases his conclusions on his high tech HITS program, whereby transmitters in players’ helmets signal a remote computer whenever a player’s helmet received a blow, and records the g-force.
Neuropsychologist Michael Collins, Henry Ford Health System in Detroit, reported (in Journal of the American Medical Association, September 8, 1999) that, in a study of 393 college football players, those who had suffered two or more concussions were significantly more likely to evidence problems with headaches, sleep, and concentration. In addition, they scored significantly lower on tests that measured word learning, thinking speed, and ability to handle complex tasks. Furthermore, those players who had learning disorders in addition to the two or more concussions performed even lower.
In a related study, amateur soccer players fared worse on tests of memory and planning ability, in comparison to other amateur athletes. Blows to the head, including “headers,” accounted for the difference. In both the football and soccer studies, “concussion” was defined not just as being “knocked out,” but also to include blows to the head that resulted in dizziness, headache, confusion, difficulty with balance or memory, or even personality change.
Outside the realm of organized sports, similar effects are coming to light. In the realm of roller coasters, no less! Since 1991, 13 documented cases of severe brain injury have been attributed to theme park rides traveling at speeds as high as 90 miles per hour, a speed creating G-forces above five, which is greater than that experienced by astronauts on shuttle takeoffs. Injury in these cases comes not from being hit, but rather from the kind of whiplash created by severe forces creating a sloshing of the brain against the inner wall of its carrier.
Mark Lovell, director of University of Pittsburgh Medical Center’s sports medicine concussion program, has begun collecting data on the long term effects of concussions suffered in high school. He recommends that teens who suffer concussions should not resume play until a physician trained in concussion management gives the all clear (i.e., all healed) signal. Teens who appear to be concussion-prone should be advised, if not forced, to take up a sport with less risk for concussions.
- Teens who experience concussions heal slower than adults, because brain and nervous system are still developing
- Slower healing among teens means increased risk for all kinds of injury
- With increased publicity about long term effects of concussions, some players—both teen and adult—are keeping their symptoms secret so they won’t be benched and held out of play.
Dr. Anthony Alessi, chair of sports neurology for the American Academy of Neurology, asserts that every high school football program should have a certified athletic trainer at every practice and game. At present, 42% do. He also has found that teams holding only one all-out, full contact practice weekly perform just as well as teams who hold daily full contact, no holds barred practices. He is working on updating the 1997 guidelines.
- Limit full contact practices to one per week. UNC-CH coach Butch Davis, based on Guskiewicz’ research, has already cut back significantly on full-contact practices. Perhaps that is why they upset Virginia Tech last week–playing with clearer heads!
- Have a concussion management expert available at all games and full contact practices.
- Identify the moves that account for most of the concussions, and ban them: eject players who violate the ban, and suspend them for at least one game. Administer a hefty fine, and distribute it to families of retired players suffering from concussion effects.
- More blows to the brain occur during kickoffs than at any other time in a game. Eliminate kickoffs, and/or replace them with an opening that is less of a free for all.
- Disallow coaches, parents, and players from deciding when they are ready to resume play after having suffered a concussion: the concussion management expert should have sole and absolute authority to make that decision.
- Technology can help. However, improved helmets tend to encourage play with more abandon. Make the HITS program universal, and pull players after experiencing a blow to the head above a certain threshold, not permitting them to return to play for an agreed upon time span.
- Dr. Gerald Maher, team dentist for the New England Patriots, has devised a mouthpiece that reduces the effect of head hits. The Patriots are using the device. Make it league-wide, and take it down into college and high school.
- Convene an international think tank to come up with creative solutions, both technological and procedural, coupled with a commission that decides on and implements recommendations.
- Limit the career length for all NFL players—but especially linemen and linebackers—to six years, as suggested by Ira Casson, co-chair of the NFL committee on brain injury.
Until these recommendations, or an acceptable facsimile, are implemented, I will personally abstain from watching football of any kind. That doesn’t mean I won’t joy in my team’s wins—but I won’t encourage senseless brain injuries by watching. For the time being, that means I’ll get more reading and yardwork done.