Concussions in Football

I have to applaud today’s editorial in the New York Times that anticipates a new football season. Here is the first paragraph —

The millionaire players of professional football are suiting up for the new season with a startling caution on their locker room walls. A poster headlined “CONCUSSION” warns players that lifelong brain damage can result if they persevere with macho gallantry through multiple head injuries.

And the Times editors are applauding changes in attitudes about head injuries in football.

In the National Football League, players are generally not considered real men unless they shrug off injuries and play on. As common and even understandable as it is, this attitude has undesirable consequences when the brain is injured. A hearing before the U.S. Congress in October 2009 called attention to the long-term effects of head injury in professional football—and by extension provided cautions worth heeding by the parents of football players as young as age 6.

At issue is the growing awareness that repeated blows to the head, not just those that are severe enough to cause concussion, increase the risk for a variety of symptoms later in life, such as depression, poor motivation and concentration, and problems with learning and memory.

Consider what happens to the brain on impact. It accelerates very quickly, then decelerates just as quickly as it bangs into the skull. Nerve cells get stretched, connections between nerve cells get disrupted or sheared. Neurologists dispute the definition of a concussion, but terminology aside, all of this causes a shortterm disturbance in brain function. It’s no wonder that victims feel dazed, assuming they remain conscious.

But there is growing evidence that professional football players are prone to the kind of brain damage common in boxers, a condition that used to be called dementia pugilistica, but is now referred to as chronic traumatic encephalopathy (CTE). Postmortem analyses of the brains of players who died relatively young have revealed signs of neurodegeneration similar to that found in Alzheimer’s disease.

In recent years, researchers have focused attention on the effect of repetitive impacts, which are common in football. One concern is that of “second-impact syndrome.” If two head injuries occur in relatively rapid succession, such as within the course of one game, the outcome can be catastrophic, with brain swelling and death. So players are at great risk if they return to the field too soon.

But perhaps just as worrisome as serial concussions (however they are defined) is the sum of smaller impacts over time. The typical football player—over the course of a high school, college, and pro career—will encounter thousands, if not tens of thousands, of hits to the head. Many experts now believe this increases the risk of CTE.

NFL leaders have not been quick to endorse the idea that employment as a player is a risk factor for chronic brain disease. Of course, everyone involved in the sport knows that it is violent. It has not been clear what part of the responsibility for managing risk of injury should fall to owners and what portion to players.

Pros who play at a high level accept the dangers and hard work, while also enjoying the game’s challenges and rewards. In fact, many players and commentators have openly disdained rules that soften the game. Thus, long-term risks usually don’t become salient to the players until long after they’ve retired. They are more focused on the thousands of hours of work they have invested to attain their position than on the number of head bumps they’ve received along the way. It is probably impossible to walk away from the rewards of playing at a high level.

Last year, NFL commissioner Roger Goodell explained to members of Congress that football is the most popular spectator sport in the United States and that more than four million children play for their school teams. Almost 100 million people watch the Super Bowl each year. This puts NFL leadership in a powerfully influential position. By establishing safety guidelines that no doubt would be emulated by youth programs, NFL leaders could protect the brain health of countless children and young adults. They should delight in the pleasure of making such an enormous contribution to the public health.

Real men would grab that opportunity and run with it.