The NFL and Unnecessary Head Trauma

If you look at what we now know about head trauma/CTE (Chronic Traumatic Encephalopathy,) perhaps this doesn’t seem like such a pointless exercise:

1. Head trauma is cumulative.
2. It doesn’t require a particularly forceful blow to cause damage.
3. Any damage is bad. (See Item No. 1.)

It’s worth reviewing what constitutes a concussion—the players themselves are slowly coming to realize there is a stricter standard for injurious head contact than they had long assumed:

1. A concussion can occur (and generally does) without loss of consciousness.
2. The onset of symptoms of a concussion may not occur until many hours after the hit takes place, and not all are evident to the victim.
3. Although the initial symptoms, if any, (dizziness, fatigue, headache, irritability, and so on,) usually disappear within a few days, the underlying damage doesn’t necessarily completely resolve for six to 18 months. The $65,000,000 question is whether the damage ever resolves.
4. Repeated concussions can cause permanent damage, including mild cognitive impairment, CTE, and post-concussion syndrome. The latter is what they used to call shell shock.

One of the most disconcerting things to come out of the still-emerging evidence about TBI (Traumatic Brain Injury)/concussions is the cumulative nature of head trauma, especially within a short period of time. The victim suffers an initial concussion, and before the damage from this concussion has been fully resolved, a second impact occurs. This impact doesn’t need to be particularly forceful.

Pittsburgh Penguins center Sidney Crosby was a cautionary tale of the more dramatic form of this. He was blindsided on January 1st of 2011 by Capitals center David Steckel. He didn’t look good when he got up, but took a shift later in the game. Four days later he was driven into the boards headfirst by Tampa Bay Lightning defenseman Victor Hedman. Crosby finished the game, flew to Montreal with the team, but was sent back to Pittsburgh with disquieting symptoms.

It turned out to be just the beginning of an odyssey for both Crosby and Penguin fans. He eventually returned to the ice after well over 11 months. A great many days were spent in a darkened room. He had headaches, spatial and balance problems, and other manifestations that left many wondering not when but if he would ever be able to play hockey again. His story has a happy ending, sort of. There are certainly those who know a lot more about hockey than I do who say he has never been quite the same player since.

About the time I wrote the original rant, Jahvid Best, the running back who the Lions traded up to get at the end of the first round in 2010, had suffered two concussions during the 2011 season within the space of six weeks or so. As of that writing he had been unable to play for well over a year after the second concussion. I thought I would see what happened to him.

The news isn’t good. He tried to return for the 2013 season, but he had so many concussion-related health problems that the Lions released him. He joined the men’s basketball coaching staff at California while finishing his degree there. He has just begun running track. Clearly he will never play football again—or any sport which carries the risk of a head injury, if he has any sense whatsoever.

Big hits like the ones which felled Crosby or Best are obviously a problem. But constant minor hits can also cause a great deal of damage.

This rather counter-intuitive conclusion was reached after studying soccer players, as detailed in the linked article in the New York Times:

[In 2013,] the journal Radiology published results of a study by [Dr. Michael L.] Lipton and others of 39 amateur adult soccer players, with a median age of 31, who had played soccer since childhood. It concluded that “heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance.”

Those who most frequently used their heads while playing showed a losses in parts of their brains involved with memory, attention and the processing of visual information. Only one of the study participants reported ever suffering a concussion, and yet the damage pattern was consistant with that from a traumatic brain injury.

Note these are amateurs. The number of head “hits” they were reporting averaged out to two or three per day.

This is why I propose to do away with what seems at first blush a harmless and traditional practice. I first begin thinking about this when I read this item from “Wolfley’s View from the Sidelines” following the second Ravens game in December of 2012:

On the bus heading for the airport after the game, I happened to be sitting a row ahead of Heath Miller. So I asked Heath how Kelvin Beachum had done. Heath said he played great and then went on to say that during warm-ups Beachum head-butted him so hard that Heath almost crumpled to his knees. Heath said, “I figured he was good to go.”

This comment made me really start paying attention to how often players slap each other’s helmets or use their own helmeted head to hit the helmet of a teammate. A touchdown catch appears to require head slaps or bumps from any and all surrounding teammates. When the player returns to the bench, the coaches start slapping them upside the head. But almost any play considered to be well-done can bring on a volley of head-bumps or slaps.

It may seem silly to worry about a friendly head slap or bump, but my question is, why even take the risk? In a small way it is adding to the burden playing football places on the player’s brain. If you are going to play anything resembling what is currently called “football,” there is going to be some amount of unavoidable brain trauma. Why not remove the avoidable forms?

If nothing else, I would hope coaches and parents of children will eliminate this practice at the youth level. It is already clear that children’s brains are more easily damaged than even those of young adults. And if kids don’t grow up doing it perhaps it will eventually die out altogether. But if I had any power in the NFL it would have been eliminated a long time ago, whether the players liked it or not.

If you want some depressing reading, check out the PBS “Concussion Watch.” As of yesterday there were 25 reported concussions.* Of those, here is a position breakdown:

1. Quarterback: 5 (That would include the Brown’s Josh McCown. It was a really nasty hit he took.)
2. Running Back: 1 (I assume this does not include Carlos Hyde, since he reportedly passed the concussion protocol Sunday.)
3. Wide Receiver: 2
4. Tight end: 2
5. Offensive Line: 3
6. Defensive Line: 2
7. Linebacker: 4
8. Defensive back: 6 (One of those is presumably Will Allen.)

Interestingly, they get their data only from NFL reporting, as it might look suspect otherwise. But there is always the question of unreported data, and it undoubtedly doesn’t include players who came off the field but passed the concussion protocol. And if a player comes off the field you can bet your socks there is some damage, even if it doesn’t show to the extent of triggering the concussion rules.

Football is a violent game, and violent hits are somewhat inevitable. But surely it makes sense to eliminate non-essential head contact.