Intentional Hits: Preserving The Game We Loved
by One Foot Down Archives on Feb 24, 2011 7:37 PM EST
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PrintSometimes we are unaware. Sometimes we are unsure. Sometimes we don't know what the future will bring. Yet, if anyone could see a glimpse of the future, we can only speculate Dave Duerson could. As a member of a six-man volunteer panel that oversaw applications for the NFL's disability plan, he had listened to the retired players' or their wives' stories. Duerson worked for the 88 Plan, a fund created to help provide some care for more than 150 players with dementia. The 88 Plan is named after the jersey number of Hall-of-Fame tight end John Mackey, who was diagnosed with dementia when he was 59.
The Repetitive Trauma Spectrum
As more expert studies have emerged, more coaches and players are viewing football's collisions and impact on the brain as a spectrum of hits over time, beginning with their play in youth football through high school, college and possibly the NFL. These repetitive head traumas may be spectacular such as John Carlson's in the NFL playoffs where he flipped in the air, landed on his head and shoulder on a frozen sideline in Chicago and was carted off the field in a stretcher. Carlson described what he remembers: "I hit my head, got knocked out for about a minute. I’ve recovered really quickly. I had a concussion, but the memory’s come back, and I feel really good....I remember the play, I remember getting flipped up in the air, but I don’t remember hitting the ground and I don’t remember anything from hitting the ground to halfway through the ambulance ride. I don’t remember them putting me on a stretcher. And the doctors say I probably will never remember that."
Ryan Grant, who became dizzy and wobbly after a hit in the Packers' preseason game, almost regrets his actions that led to being diagnosed with a concussion: "Maybe it would've been a little different if I'd have stayed on a knee and said, 'I just got the wind knocked out of me, let me take a couple plays off and come back....I'm going to do everything I can working with them to get back, because I don't want to be out. But at the same time, I know it's severe and you've got to be smart about it."
Dan Wenger suffered two concussions in less than a month last year, sidelining him for almost the entire year, but has petitioned the NCAA for a sixth year of eligibility with the Irish.
High School Hits
Dr. Aaron Dalan is not your typical pediatrician at 6'7" with the built of a former offensive lineman. Dalan played at the University of Washington and then with the Oakland Raiders. Dalan understands the mentality, "As a lineman, 75% of my hits were helmet-to-helmet. That’s just the way it was. I spent eight years of my life engrossed in the gladiator mentality, so I understand it pretty well. The question was, were we tough enough to give and take hits, stay in the game, and play through it." Now a pediatrician in Seattle, Dr. Dalan has taken on the challenge of educating parents his young patients as to the subtleties of concussion symptoms. He wants those patients in organized sports to let an adult know if noise bothers them, lights are suddenly annoying, or they feel like they’re "in a fog" after a hit - not to just "take a few plays off".
Also in Washington state, a near tragic incident has inspired legislation to help prevent Second Impact Syndrome, which descibes a second brain trauma before the first one is allowed to heal . Zachary Lystedt, who played both ways on his middle school football team, was hit and his head struck the ground. In obvious pain, he went to the sideline, stayed out for about 15 minutes and then returned for the rest of the game.
Zachary forced a game-winning fumble on another hit at the end of the game and collapsed. The second hit caused a brain hemorrhage that resulted in coma for almost three months and the removal of both sides of his cranium. The Zachery Lystedt Law prevents football players who have had head trauma are prevented from returning to a game until they have been examined by a medical professional. Similar versions have been adopted in many other states and is being considered at the federal level. (link for state laws)
One study of American high school and college football players demonstrated 94 such catastrophic head injuries (defined as significant intracranial bleeding or edema) over a 13-year period with only two at the college level. Seventy-one percent of the high school players suffering such injuries had a previous concussion in the same season, with 39% playing with residual symptoms. While the metabolic mechanisms of traumatic brain injury are still being learned, it is apparent that the brain needs time to heal, otherwise a second trauma can be catastrophic. The incidence of football-related concussions involving loss of consciousness is estimated at 300,000 annually by National Center for Catastrophic Sport Injury Research and the American Association of Neurological Surgeons. Since two studies have shown only a 8%-19% of concussions involve loss of consciousness, the incidence of all sports-related concussions is from 1.6-3.8 million a year. (link) It is estimated 20% of football players will have a concussion each year.
Removing players from play and practice until the brain heals will help reduce catastrophic Second Impact Syndrome, but the problems of concussions, subconcussive impacts and cumulative, repetitive impacts remain.
Who Protects the Players
Kurt Warner, who retired after two concussions, said: "The unfortunate thing in our business, more times than not, is that either guys don't know it or don't let somebody know it and continually play through those kinds of situations, where it's week after week, it's hit after hit, where they're not coming out of games and they never get healed. And I think that's probably -- and I'm just guessing -- where the biggest effects are down the road, is guys that may not have a record that they had 10 concussions but probably had that or more so and just played right through it." Dallas Cowboys quarterback Troy Aikman retired after suffering a documented 10 concussions in his 12-year career. San Francisco 49er quarterback Steve Young quit after his fourth concussion in three years.
Anthony McDonald's post-concussion behavior after the hit in the Washington game in 2009 was dramatic, as Charlie Weis describes: "He gets up off the ground ‑‑ you know that old thing, 'He's going the wrong way!' That was him. He was actually running the opposite way from where everyone else was going. I'm yelling for a trainer. I'm not even watching the kickoff now because I see him dazed and confused. I'm almost wanting to go out on the field myself because I'm yelling for the trainers, because you knew this is a guy who was knocked out on his feet at the time."
A study of 393 college football players from four FBS universities (Michigan State University, the University of Florida, the University of Pittsburgh, and the University of Utah)showed that 34% reported experiencing 1 concussion of any grade, and 20% reported a history of 2 or more sustained concussions of any grade and 46% reported no prior history of concussion.
A significant relationship was found between total years participating in football and total number of concussions sustained. Quarterbacks (like Warner, Aikman and Young) and tight ends (like Mackey and Carlson) had the the highest rates of prior concussion (68% and 65%, respectively in the study). Running backs–fullbacks (11 of 33) and kickers-punters experienced the lowest rates of prior concussion (33% and 46%, respectively). NFL tight ends besides Carlson that suffered concussions last year included Dallas Clark, Heath Miller, Kevin Boss, Chris Cooley, Todd Heap to name a few. Jeremy Shockey has recently retired from the Saints after recovering from a concussion while a Giant and reportedly having a subsequent seizure weeks later. NFL concussion incidences were up 21% last year over the prior year and up 34% in two years.
Multiple Concussion Data
A prior history of concussion no matter at what level puts a player at greater risk for severe symptoms in a subsequent concussion. Only 9.4% of players without any history of a concussion had prolonged post-injury mental status changes at the time of a concussive injury compared to 31.6% of those with a history of multiple concussions, according to a study. Also, 3.7% of those with no history of concussion exhibited 3 or 4 of the four severity markers used in assessing concussions (loss of consciousness, anterograde and retrograde amnesia, and confusion) while 26.3% of those with a history of concussions exhibited 3 or 4 of these severe symptoms.
In short, players with multiple concussions were 9.3 times as likely to have severe symptoms.
Football used to only track the catastrophic injuries - the death and disabilities caused by impacts. The brain injuries due to concussions are becoming more alarming as the research emerges. However, the spectrum of repetitive subclinical, subconcussive injuries over time is just as significantly alarming.
Chronic Repetitive Trauma
Repetitive subconcusive brain trauma "takes from five to 20 years to manifest itself. And then the brain cells start dying. And that’s when the people crash,’’ says Neuropathologist Bennet Omahu, a major researcher looking at the relationship of athletes and chronic traumatic encephalopathy (CTE). CTE is a progressive neurological disorder found in people who have suffered some kind of brain trauma, which has many of the same manifestations as Alzheimer’s. CTE symptoms begin with behavioral and personality changes, followed by disinhibition or depression and irritability, before moving on to dementia.
"There is something wrong with this group as a cohort. They forget things. They have slurred speech. I have had an N.F.L. player come up to me at a funeral and tell me he can’t find his way home. I have wives who call me and say, ‘My husband was a very good man. Now he drinks all the time. I don’t know why his behavior changed.’ I have wives call me and say, ‘My husband was a nice guy. Now he’s getting abusive.’ I had someone call me and say, ‘My husband went back to law school after football and became a lawyer. Now he can’t do his job. People are suing him.’ " reports Robert Cantu of Boston University's Center for the Study of Traumatic Encephalopathy (CSTE).
Targeting Linemen
So many of the ex-players who have been given a diagnosis of chronic traumatic encephalopathy (CTE) were linemen -- line play lends itself to lots of little hits that traumatize the brain over time. People with CTE, Cantu says, "aren’t necessarily people with a high, recognized concussion history. But they are individuals who collided heads on every play—repetitively doing this, year after year, under levels that were tolerable for them to continue to play."
Cantu said studies have shown a first-string college football player in a given year experiences between 800 and 1,500 blows to the head of a G-force greater than 20. That's the equivalent of about a 20-mph car crash each time.
Matt Birk, the All-Pro center and graduate of Harvard who plays for the Baltimore Ravens describes the inherent risks of play in the current NFL, "Players are bigger, faster, stronger. It's simple physics: Force equals mass times acceleration. It is a violent game, and there are inherent risks to the game itself. ... Collisions are becoming more intense." Plus the NFL is the end of the cumulative time spectrum for players' careers. Birk has donated his brain posthumously to BU's CTSE.
A thirteen-year NFL veteran like Birk, when you bring in his college and high-school playing days, could well have been hit in the head twenty thousand times equivalent each time to a 20 mph car crash. Clearly, Birk is a smart, experienced, talented NFL-caliber player who knows the risks and has chooses to play for the love of the game though he realizes the possible consequences.
Ted Johnson, a linebacker on the New England Patriots championship team, testified in the Massachusetts legislature for a state bill similar to the Zachery Lystedt Law in Washington state. Johnson had had two concussions within days of each other in 2002. Johnson said, "I know the hazards of football, but I didn’t know what repetitive hits to the head could do. I am terrified about what can happen in the long run.’’
Stun and Separate
Johnson learned a tackling technique from his former linebacking coach, Brian Cabral, called "stun and separate". "Stun and separate" brings down larger players, hitting them with your forehead to their chinstrap. Cabral reflects, "You know, sometimes I wonder if [stun and separate] isn't to blame for this mess. I wonder sometimes if I didn't help do this to him." Cabral had perfected the technique when he was with the Chicago Bears during the mid-80s, when he was a teammate of Duerson's.
Alicia Duerson, who kept in touch with her ex-husband, said that he developed a word-finding difficulties in writing and in his conversation. He also had developed short-term memory loss that, she said, "got worse as time went on." Duerson knew the stories of John Mackey, Ted Johnson, and many others through his work on the NFL retirees disability panel and the 88 Plan. "I think David knew that inside of him there was something wrong.... Somebody has to step up and acknowledge that."
Stepping Up
Duerson loved football, Notre Dame and the Chicago Bears. At Notre Dame, Dave was a two time All-American, MVP and Captain in his Senior year, an honors graduate in Economics, winner of the Moose Krause Distinguished Service Award, past President of the Monogram Club and past member of the Board of Trustees. He was 50 years old when he died and had been out of football for 17 years.
His family will scatter his ashes over the fields at Notre Dame and at Soldier Field. Yet his spirit may loom over football fields asking each of us if we have done all we can for the game we love and the players we admire and who may have been our fellow students. We cannot plead ignorance anymore.
We offer our heartfelt condolences to his family.
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Such a complicated and often sad story.
I wonder what kind of advances we’ll see in helmet and facemask technology in the coming years. The way the facemask is constructed has always seem dangerous to me leaving so many players’ chins exposed. And then you have players who wear those thin leather chin straps and it just makes it worse.
Do you think we’re inching closer to major changes in the game of football?
It still seems like we’re such a long way away from understanding the brain and concussions, although increased awareness will help in the short-term.
by Eric Murtaugh on Feb 24, 2011 10:01 PM EST reply actions
I’ve been intrigued by the suggestion of some— JoePa for one— that we should actually remove face-guards. The idea is that face-guards give players a false sense of security and lead to lots of intentional helmet-to-helmet hits; if they were removed, players wouldn’t lead with their heads anymore.
It would definitely result in a lot more broken noses, but it would also force shoulder-to-chest form tackling.
by Whiskeyjack on Feb 24, 2011 10:10 PM EST reply actions
Eric,
As far as advances in technology, several colleges and a few high schools are using accelerometers inside a player’s helmets to record the force and location of head blows. This is named the HIT (Helmet Impact Telemetry) system and can be used to teach players safer techniques. Top of the head impacts, such as when a player lowers his head, are particularly dangerous to the brain. Players at all levels are being taught to keep their heads up at all times and use their arms. Coaches are minimizing contact in practices more and – for those who have HIT – are keeping a closer eye on those players who drop their heads to reinforce good technique. The HIT helmets cost $1,000 each, affordable for the top colleges, but out of reach for most high school programs. I don’t know if ND uses them.
Many helmet companies are exploring better material based on impact data, but you are right in that there are many types of impacts, including those from below striking the chin, acceleration/deceleration injuries, side impacts, rotational impacts, etc.
I threw in all the photos above mostly of some of last year’s concussion hits in the NFL to show the different angles of impact and helmet striking areas.
Here’s a Wikipedia article on the pathophysiology of a concussion that is known. http://en.wikipedia.org/wiki/Concussion
Prevention of the worst impacts, teaching proper technique and players to report concussion symptoms and limiting as much as possible multiple impacts as well as letting the brain heal are the keys.
Thanks for your comments.
by Michael Collins on Feb 24, 2011 10:55 PM EST reply actions
Jack,
Sounds like JoPa was hit in the head too many times. Consider that high school players still get concussions with current protection. I doubt that removing the face mask will change behavior. Some head trauma experts feel that a jaw hit can have a resulting brain impact. Many defensive NFL players are upset that they could be severely fined for a helmet-to-helmet hit, which is their habit. Old habits die hard and taking off a face mask is not going to help.
I remember Gordie Howe who did not wear a facemask. What hockey player now does not? BTW, ND’s Eric Ringel’s concussion ended his career as a player last year, though he is transitioning to a student assistant coach for the hockey team this year. http://www.und.com/sports/m-hockey/spec-rel/102710aaf.html
Thanks for your comment.
by Michael Collins on Feb 25, 2011 1:26 AM EST reply actions
Ice hockey is experiencing many of the same problems. As far as improvements in equipment in hockey, eveything I’ve read on it states improvement in equipment will have a minimal effect. Simply, helmets mostly protect the outside of the head, not the brain inside.
by TLNDMA on Feb 25, 2011 5:51 AM EST reply actions
Both interesting and thought provoking. What ever happened to teaching “see what you hit.” I think ESPN should take some of the blame for the current state of tackling technique, as the big hits become highlight reel material. Overall, the fundamentals have gone by the wayside over the years as players look to make a big hit instead of a routine tackle.
A while back, I read an editorial article written by Dr. James Andrews. Most avid sports fans (and all true baseball fans) will know that name, as he is “the guy” everyone with arm problems goes to see. He also happens to be the chair of a group that is trying to institue change in youth sports across the nation (which is sorely needed in my opinion). Basically, the point came down to not allowing tackle football until junior high at the earliest for football and replacing tackle football with flag football for younger children. Given the development of the brain is even less understood than the cumulative effect of repeated impacts over a season/career/etc, this only makes sense.
One final thought. The number of injuries at the high school level is staggering. This is likely due in part to the overall number of participants when compared to college athletes. But one factor that may not be as clear is the size of some high school football players vs. their teammates. As fans, we hope that many of the seemingly college-ready prep athletes choose our favorite school to attend, but are they the ones causing a significiantly higher level of injuries due to their superior size/strength/athletic ability?
by Jim Miesle on Feb 25, 2011 9:10 AM EST reply actions
Michael, I believe it’s Ted Johnson you refer to. His story is well known in New England. The consequences of his head injuries have been horrific.
You are right, TLNDMA. My bad in rushing to get this out. Here was a pretty good article that I read about him, which provided the “stun and separate” information – http://www.5280.com/magazine/2009/08/ted-johnsons-brain?page=0,2
Thanks, mike
by TLNDMA on Feb 25, 2011 9:58 AM EST reply actions
Football is always going to be the most talked about. It has the most concussions, but then there are those players like offensive linemen who suffer repeated head blows on every down, may never suffer what medical experts can define or diagnose as a concussion, but nevertheless develop major problems when they get older.
I think that’s the scariest part of this whole issue. With increased awareness of concussions themselves I think there will be inroads in this battle, but we are so far away from understanding the brain, from properly protecting it (if we ever really can), and being able to truly understand how players develop all these terrible symptoms later in their lives.
I go back to the facemasks…I’ve always thought they should be redesigned. I know in hockey that a lot of players get concussions because of hits to the jaw and face. There is less of that in the NFL but still enough where I think they’d start wearing more hockey-like facemasks that do a better job protecting the jaw. I was talking with Michael and I said we’re probably not too far away from NHLers being mandated to wear full visors or cages.
by Eric Murtaugh on Feb 25, 2011 10:27 AM EST reply actions
“Cantu said studies have shown a first-string college football player in a given year experiences between 800 and 1,500 blows to the head of a G-force greater than 20. That’s the equivalent of about a 20-mph car crash each time.”
The question must be asked: were human beings built to sustain this kind of prolonged abuse? Should we allow the game of football to continue to be played? We look with disgust upon the ancient Roman practice of gladiatorial combat. But is football that much better? 800-1500 20 mph car crashes per year? Wow.
I boxed in the Bengal Bouts and grew to love the sweet science. I would want my kids to enjoy boxing and football like I have. But to have them play 4 years in high school, 4 to 5 years in college, and 5 to 10 years in the NFL? I wouldn’t want them exposed to that kind of risk. F = ma. There’s too much “m” and “a” in pro, college, and even high school football.
by Mouth Of The South on Feb 25, 2011 5:01 PM EST reply actions
I think Whiskey Jack has the right idea — helmets give players a fall sense of security. It’s the same reason why seat-belt laws often INCREASE the number of accidents and why derivatives designed to decrease risk on the stock market actually made things worse: people are more prone to take risks if they think they are protected.
Like, hypothetically, the safest thing you could put in a car would be a spike through the center of the steering wheel — pretty sure people would be a lot more careful driving.
In a world where players were wearing leather helmets, would they use their heads as a weapon? That might be the way to go long-term. I love football, but I don’t want to watch someone die on the field.
by tjarks on Feb 25, 2011 5:11 PM EST reply actions
Hey WhiskeyJack—are you surprised that JoePa would suggest a return to days sans facemasks? I’m sure he also thinks that being alive shouldn’t be a prerequisite for being a DI head coach.
Seriously though, I think you make an interesting point. The pads and facemasks give the players a false sense of security. It makes sense in the abstract, but I’d like to see a comparison of concussion rates between American football and other similar sports in which they don’t use the same protective equipment: I’m thinking rugby, maybe even gaelic football.
by Mouth Of The South on Feb 25, 2011 5:16 PM EST reply actions
On a related note, JoePa feels that the newfangled “forward pass” is dangerous as well, and she be removed from the game (I kid.) Your comment made me laugh, MotS.
To clarify, the idea definitely isn’t to remove helmets or any other pieces of safety equipment; just the face mask. The hope is to remove as little protective gear as possible, in order to affect a psychologically-driven change in behavior on the field, without actually increasing the probability of serious injury.
It makes sense to me. If my helmet didn’t have a face mask, I’d think twice before launching myself head first into a tackle. Michael could be right that leading with the head is too entrenched with many NFL players to be changed at this point, but I could also see it going the other way; not wanting to dive head first into a solid object is pretty instinctual, even for an NFL vet, I’d bet.
It’s worth studying anyway. I’m sure they could design a helmet that offer jaw protection with a relatively open face; the desired outcome is purely psychological, so it could work as long as the players feel like their faces are less protected, even if that’s not really the case.
The NHL analogy doesn’t strike me as very helpful. Most of those head injuries are caused by collisions with equipment: pucks, sticks, the walls of the rink, etc. In football, the nasty collisions almost entirely involve intention collisions between players. If you change their behavior/ mindset, a much greater level of safety could be achieved.
by Whiskeyjack on Feb 25, 2011 5:52 PM EST reply actions
I don’t really see much of a solution to this problem. Huge men hurling themselves at each other is going to cause concussions. Improvement to equipment and education on technique and such will help some. In the big picture though, there will always be head trauma. Recognizing head injuries and limiting their frequency (retirement) is the only way to reduce problems later in players lives.
I don’t know if you can put a number on how many is too many in this situation. It seems severity and other factors make each case different. One thing for sure many players come back too soon from these injuries and thus make themselves much more susceptible to more and worse injury. Reducing pressure on players to return before they should would certainly be one of the first steps to take.
by TLNDMA on Feb 25, 2011 8:59 PM EST reply actions
Great comments and discussion.
Jim,
I agree with all three of your points. First, teaching fundamentals with heads up has to begin early and reinforced until it’s habit. How about Madden Football as a contributor?
Second, football hits in youth football can be minimized or gotten rid of. This decreases the cumulative hits over a football career. What part multiple hits in a developing brain could be a part of this. We have two knees, two elbows, two shoulders, but one brain. There has been some suggestion that learning disabilites may be at a higher rate among high school football players. Whether this is a result of impacts or a combination of factors could be difficult to prove. Players need to learn proper technique and develop their bodies before acting like college or NFL players.
Third, I thought of the photo with the article I posted on Aaron Lynch, so made it the featured photo. At the time, I liked it for the hit and after reading much about concussions, I began thinking about the small QB he was sacking. Most of all, these young players need to report concussion symptoms rather than trying to play through them and writing them off.
On a college level, Owen Thomas, the captain of the Penn football team who hanged himself in September, “never had a diagnosis of a concussion on or off the football field or even complained of a headache, his parents said, although they acknowledged he was the kind of player who might have ignored the symptoms to stay on the field.” After death, his brain was autopsied and was diagnosed with CTE. He was 21. http://www.nytimes.com/2010/09/14/sports/14football.html
by Michael Collins on Feb 25, 2011 11:20 PM EST reply actions
MoS,
Awesome comment. We all love football (and boxing and hockey). (Some smart guy is going to figure out the acceleration/deceleration damage caused by bungee jumping.)
Our challenge is to find ways of mitigating the damaging hits to the brain evidenced in concussions and subconcussions. Do you have to suffer 800-1500 hits per year? John Gagliardi, the winningest coach in college football history at D3 St. John’s, a perennial powerhouse, does not allow tackling in practice.
As far as the pathophysiology of CTE, as Eric wondered, it is due mainly to an abnormal buildup of a protein in the brain, called tau. Here is a great explanation from the CSTE people at Boston U in a video. http://www.bu.edu/cste/
by Michael Collins on Feb 25, 2011 11:46 PM EST reply actions
Great post, great discussion. Given that this focus on concussions is still relatively “new” I have to think that significant changes are in the mail both in terms of equipment and rules. The debate between those wanting to “preserve the game we love” and those campaigning for player safety will only intensify in the coming years. The game could look very different 10 years from now.
by whiskey on Feb 26, 2011 5:30 AM EST reply actions
Is there an association between concussion histories and learning disabilities? Here’s an article that concludes: “Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance.”
Published in the Journal of the American Medical Association – http://jama.ama-assn.org/content/282/10/964.full
(I am not the primary author.)
by Michael Collins on Feb 26, 2011 9:58 AM EST reply actions
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