Download The Concussion Paradigm Shift

The Concussion Paradigm Shift
“In football the object is for the quarterback, also known as the field general, to be
on target with his aerial assault, riddling the defense by hitting his receivers with deadly
accuracy in spite of the blitz, even if he has to use the shotgun. With short bullet passes
and long bombs, he marches his troops into enemy territory, balancing this aerial assault
with a sustained ground attack that punches holes in the forward wall of the enemy's
defensive line” (Monkovic, “Football is War”).
This brutal yet accurate description of football by the late comedian George
Carlin, albeit comedic, holds true from the standpoint of fans and players alike: football is
like war. The soldiers who take the field hold the line of an aggressive formation,
charging their opponents at the given signal. They hurl their bodies forward, risking their
health and even their lives with every snap of the ball, while millions of people watch
from the safety of their living rooms. Enthralled by what they see on the screen, most of
these viewers ignore the fact that the game of football is changing, and the safety of those
same players on the field are vulnerable to life-altering and life-threatening brain injuries.
The medical analysis of long-since retired professional football players has led to a
breakthrough in the understanding of the dangers of football. A pattern of brain injuries,
post-concussion symptoms, and diseases from games alone has called the virtue of the
sport into question. Football in all contexts, whether professional or amateur, has been
thrust into the spotlight of scrutiny. Cases of afflicted players riddle the national
headlines with alarming frequency, prompting changes in game-play rules, concussion
and player treatment protocol, and funding in research for concussion prevention
equipment. These changes stem directly from the paradigm shift throughout the past
twenty years of the understanding and ultimate societal rejection of football, based on the
proven detrimental health impacts of this inherently violent sport. The research aptly
demonstrates the post-career health problems that prolonged playing can induce,
regardless of diagnosed concussions, and has given rise to this shift. As a result, tackle
football in America is decreasing in popularity, and could potentially change drastically
or dissolve altogether.
A concussion, defined more accurately in the past fifteen years by Dr. Robert
Cantu MD, is “. . . any change in mental status such as confusion, disorientation,
headache or dizziness following a hit or jolt” (Carroll, Rosner 10-11). More often than
not, a person who receives a concussion does not go unconscious. Most concussion
symptoms arise shortly after actually receiving a concussion, but can remain for weeks at
a time if not treated properly. These latent symptoms can include headaches, dizziness,
short-term memory loss, concentration loss, and oversensitivity to light; these are
particular to the afflicted person in the short run (Center for Disease Control:
“Concussion: Signs and Symptoms”). In the long run -- any time after a player is cleared
of a concussion -- new ailments and diseases can emerge. These conditions, refined by
Dr. George T. Krucik MD, include memory loss, depression, cognitive problems,
headaches, and trouble sleeping or concentrating on regular tasks (Boeman, "PostConcussion Syndrome"). The acceptance of these long-term effects has adversely
impacted both professional football players and other athletes alike through both the way
the game is played, and the precautions players and doctors take in diagnosing head
injuries.
Despite neurologists’ pervasive acceptance that football concussions create
vulnerability to harmful and life-altering neurological diseases, the National Football
League (NFL) categorically denied any connection made by these neurologists made
until the 1990’s. Finally, Paul Tagliabue, the NFL commissioner at that time, stated that
the concussion problem was merely a “pack-journalism issue” (Ezell, “Timeline: The
NFL Concussions Crisis). However, in the late 1990’s and early 2000’s, many players
suffering from these ailments came out with the idea that a history of head injuries caused
by football was the common denominator in these cases. In 1997, the American Academy
of Neurology enumerated a “return-to-play” set of guidelines due to their hypothesis that
concussions positively correlated to these later-in-life problems (Ezell, “Timeline: The
NFL Concussion Crisis). However, the Mild-Traumatic Brain Injury (MTBI) Committee,
a committee founded by the NFL comprised of doctors, ruled that these guidelines were
inadequate and irrational. On the merits of the MTBI Committee alone, the National
Football League did not mandate a new concussion protocol, regardless of the knowledge
that many neurologists still believed that there was a direct correlation between football
and long-term brain injuries. However, without further supported research, the MTBI
throughout the 1990’s stood by their claims that no correlation existed.
In 2002, Dr. Bennet Omalu of the University of Pittsburgh Medical Center
performed an autopsy on retired NFL player Mike Webster, who had passed away from a
stroke at the young age of 50 (Fainaru-Wada 10). Webster had reportedly suffered from
symptoms ranging from depression, memory loss, and insomnia, all the way to difficulty
communicating. Upon brain dissection, Dr. Omalu found that Webster’s brain contained
Chronic Traumatic Encephalopathy (CTE), a neurologically deteriorating disease
typically found in boxers at a much later age than Webster’s mere 50 years. Due to
Webster’s relative young age at the time of his death, Dr. Omalu concluded that despite
few concussion diagnoses throughout Webster’s career, the repeated head traumas -however mild -- directly caused his cognitive diseases. Put simply, football was the
reason for Webster’s cognitive issues. As the story of Mike Webster traveled throughout
the medical community, other similar stories were brought to light.
Between 2002 and 2004, Dr. Omalu diagnosed more than three additional cases of
CTE in deceased former-NFL players. As research progressed, between 2004 and 2009
more than 40 additional cases of CTE were found in deceased former-NFL players (Ezell,
“Timeline: Concussion Watch”). Due to the magnitude of these statistics, the denial of
football causation consistently expressed by the MTBI Committee and the NFL until
2009 was finally withdrawn. Only one month into the 2009-2010 football season, the
NFL mandated a change in “return-to-play protocol” that helped keep players sidelines
until more accurate concussion clearance could be given by trainers. This admittance
was more than a decade after research from expert neuroscientists released their
conclusions on the matter in 1997 (Ezell, “Timeline: Concussion Watch”). From then on,
due to the tremendous influence and the economic prowess of the National Football
League, concussion protocol began to change not only for all levels of football, but for
many other sports as well.
This new concussion protocol stems from the systemic acceptance of the longterm effects that football-related head injuries have on the body. Further, the protocol is
based on the understanding that, as MSNBC health columnist Linda Carroll describes,
one initial concussion makes an individual prone to receiving another concussion, and
thus even further vulnerable to these life-altering effects (Carroll, Rosner 14). Concussion
protocol is now broken down into six consecutive steps that must be adhered to in order
for an individual to be granted clearance to play: waiting 24 hours until after symptoms
are completely gone; performing light aerobic activity; performing moderate activity to
produce sweat and an increased heart rate; performing heavier non-contact activity such
as weightlifting or sprints; practicing with full contact; and reevaluating
symptoms. According to the Center for Disease Control, only after these six steps can a
player return to game action (CDC, “Managing Return to Activities”). The new protocol
also offers a significant change not before present: the component of treating a person as
an individual, rather than a statistic. Instead of choosing an arbitrary time requirement,
this process allows every single person to heal from a concussion properly as it takes into
account the symptoms and severity of the injury itself.
A trainer or physician must go through this individualistic protocol in order to
ensure that these symptoms are completely gone prior to resuming play. The rule
requiring time to elapse between being cleared from a concussion and being cleared to
play ensures that fewer faulty diagnoses are made by a physician, thereby eliminating the
possibility of this same individual returning to play with an active concussion. This rule
arose in part due to the second-impact syndrome, which occurs any time “. . . an athlete
suffers a jolt of the head too close on the heels of an earlier concussion … which could
result in catastrophic brain swelling and injury.”(Carroll, Rosner 14). Repeated
concussions in succession also contribute to a person’s susceptibility to these permanent
brain injuries. These cases are much more prevalent to football than those other sports, as
concussions in football are statistically much more common. Indeed, the game of football
itself is still evolving in an effort to eliminate the danger to its players.
In 2009, on-the-field rules began to change in order to not only help eliminate
dangerous plays, but also protect the players from receiving concussions. Some of these
rules, written and released by the NFL itself, include changing the format of the kickoff,
increasing fines and penalties for head-to-head tackles by defenders, and prohibiting high
hits on “vulnerable” or “helpless” players (NFL, “30 Years of Health & Safety Rule
Changes”). These changes are for player safety reasons and can potentially diminish the
number of short-run brain injuries as well as long-term injuries. It was clear to the NFL
that the number of concussions since 2003 had increased each year not because the game
became more dangerous, but rather due to how the accuracy in method to the diagnosis of
concussions has improved. Therefore, changes occurring on the field of play by the NFL
in order to protect these players can be deemed as successful.
Through the addition of these rules, it is apparent that the NFL will begin to make
the game of football even safer for the players by attempting to eliminate more dangerous
collisions. In order to diminish the number of these collisions, more severe consequences
in the form of large fines are now in place (Fox, "NFL Taking a Hard Line on Illegal
Hits"). Other negative incentives were also mandated for certain players who have
multiple offenses. Five to six figure fines and multiple game suspensions serve to
discourage repeat offenders from playing in a way that is dangerous to other athletes.
Despite the fact that many current and ex-football players disagree with these rules,
criticizing them for being “over-sensitive”, the NFL now sees the bigger picture; the
integrity of the game, the safety of its athletes, and the long-term preservation of the
league.
Despite occasional disputes related to the new rules, many writers and
neurologists alike agree that the NFL -- and all other levels of football in America -- must
implement and enforce these rules due to the current “concussion crisis.” This so-called
crisis relies on the idea that concussions are not a bigger problem than before. Instead, we
are now showing concussions as problematic due to our accurate diagnosis and clarified
understanding of the previously mentioned short-term and long-term effects. According
to Prevacus, a statistical online resource, the number of diagnosed concussions in the
NFL has risen every year since 2002 until 2013 and 2014, when the rates dropped
(Prevacus Inc, "Concussions 101"). These statistics do not represent the rising danger of
football, but instead show how more players are becoming diagnosed by the more precise
and precautionary protocol. The drop in diagnoses shows promise that newly enacted
rules, return-to-play protocol, and concussion prevention technology are all now aiding in
the fight against this crisis. However, the NFL may have a problem bigger to tackle than
just diagnosed concussions.
While there is substantial evidence that multiple concussions lead to impactful
neurological problems, new studies have emerged that lead scientists that the
accumulation of hits alone can cause these brain function problems in football players. In
other words, the frequent and seemingly harmless collisions that take place in football are
another cause for concern, and playing football will inevitably lead to these problems.
This discovery was brought to light by a group of scientists at Purdue University, who
studied and monitored the number of hits that a normal player receives to their head
throughout a typical season. Their research helped them conclude that players who did
not retain a diagnosable concussion still retained neurological damage, supported by their
player examinations and results from season-long cognitive tests (Venere, “Deviant Brain
Metabolism”).While the study showed that the impact on the undiagnosed players was
less severe than the concussed players, the research and evidence pointed towards this
conclusion that some level of brain damage or neurological impediment is unavoidable to
anyone who plays football in both a game and in practice at any level. (Strauss,
"Repetitive Head Impacts”) Therefore, a solution to the brain injuries that retired and
current football players require is more complicated than originally perceived.
The most significant problem the NFL faces today revolves around the concern
regarding the seemingly unavoidable head injuries caused by football. This problem,
finally acknowledged by the commissioner only in 2009, is speculated to have been
discovered by the MTBI in the 1990’s. Based on this belief, many retired players are
suing the NFL on the basis that the fear of decreasing league popularity led to they
withheld information regarding concussions. (Drummond, "Can the NFL Survive Its
Concussion Crisis?"). To some people, football is a way to successfully pursue higher
education, and perhaps make a professional career. For other people, football merely fills
extracurricular time throughout middle school and high school. Regardless of the
motivations behind the playing itself, all of these players become a part of the
“concussion crisis.” Between 2010 and 2012, little league football enrollment dropped
almost ten percent (Drummond, "Can the NFL Survive Its Concussion Crisis?"). Many
people believe that as more cases come to light of retired players suffering from postconcussion symptoms, parents will not allow their children to play tackle football.
Eventually, the loss of youth interest and youth involvement may result in football
becoming merely a trend, rather than a sport that survives the ages in America.
The shift in the concussion paradigm has come a long way, but it remains an
evolving one. Today, football faces its biggest challenges due to the paradigm shift: has
this generation seen the last of football? Will the sport even legal in the coming decades?
Will the NFL dissolve due to the number of lawsuits that are currently being filed? Will
the popularity diminish due to the inherent violent nature of the sport? It is hard to
imagine professional football, a multi-billion dollar per-year industry, becoming extinct;
as they currently seem to completely monopolize a day of the week in the United
States. Of course, a change will not happen quickly. As all football fans know, progress
happens one yard at a time.
List of Resources:
"The American Association of Neurological Surgeons." AANS. N.p., 2015. Web. 28 Nov.
2015.
Belson, Ken, and Alan Schwarz. "Concussion Treatment Cited in Suit Against N.F.L."
The New York Times. The New York Times, 20 July 2011. Web. 24 Nov. 2015.
Boeman, Joe. "Post-Concussion Syndrome." Healthline. Ed. George Krucik. N.p., 24
Jan. 2014. Web. 01 Dec. 2015.
Carroll, Linda, and David Rosner. The Concussion Crisis: Anatomy of a Silent Epidemic.
New York: Simon & Schuster, 2011. Print.
"Concussion: Causes, Symptoms, Diagnosis, Treatment, and Prevention." WebMD.
WebMD, n.d. Web. 01 Dec. 2015.
"Concussion Signs and Symptoms." Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention, 16 Feb. 2015. Web. 01 Dec. 2015.
Drummond, Katie. "Can the NFL Survive Its Concussion Crisis?" The Verge. N.p., 31
Jan. 2014. Web. 01 Dec. 2015.
Ezell, Laruren. "FRONTLINE." PBS. PBS, 3 Oct. 2013. Web. 30 Nov. 2015.
Fainaru-Wada, Mark, and Steve Fainaru. League of Denial: The NFL, Concussions, and
the Battle for Truth. New York: Crown Archetype, 2013. Print.
Fox, Ashley. "NFL Taking a Hard Line on Illegal Hits." ESPN. ESPN Internet Ventures,
22 Sept. 2013. Web. 30 Nov. 2015.
"Managing Return to Activities." Centers for Disease Control and Prevention. Centers
for Disease Control and Prevention, 16 Feb. 2015. Web. 30 Nov. 2015.
Montkovic, Toni. "Football Is War! (George Carlin's Routine)." The Fifth Down Football
Is War George Carlins Routine Comments. The New York Times, 31 May 2008.
Web. 02 Dec. 2015.
"Statistics - Prevacus." Prevacus. Prevacus Inc, n.d. Web. 01 Dec. 2015.
Strauss, Lindsey Barton. "Repetitive Head Impacts: A Major Concern At All Levels of
Sports." Repetitive Head Impacts: A Major Concern At All Levels of Sports.
MomsTeam, 6 Apr. 2012. Web. 01 Dec. 2015.
"30 Years of Health & Safety Rule Changes." 30 Years of Health & Safety Rule Changes.
The National Football League, 2015. Web. 30 Nov. 2015.
Venere, Emil. "'Deviant Brain Metabolism' Found in High School Football Players." Purdue University. N.p., 19 Aug. 2015. Web. 02 Dec. 2015.