Concussions and the Future of Football

From the lecture series: The Skeptic's Guide to Health, Medicine, and the Media,

By Roy Benaroch, M.D., Emory University

The prevalence of concussions has caused many to be pessimistic about the future of football. Youth participation in the sport has dropped drastically by almost 30 percent since 2010. College and professional programs are paying attention.

High school football player in for the touchdown hitting his head.
(Image: Margaret Kite/Shutterstock)

Journalists as Advocates

Media interest grew after a very widely viewed sports replay. This was before YouTube and Facebook, but millions of people saw it on television—the hit on Troy Aikman, Dallas Cowboys quarterback, a knee to the head during the 1994 NFC championship game.

Over and over again, in slow-motion, the clip was played again and again. Aikman said that he never remembered the game afterward. “[W]henever I see footage of that game,” he said, “it’s like somebody else is out there doing it.”

The National Football League (NFL) commissioner, Paul Tagliabue, didn’t buy into any concern. He said afterward that the concussion issue was being caused not by football, but by journalists.

And journalists drove this story. 

The concussion story is a great example of the media getting it right. The NFL wanted the story to go away, but that’s not what happened.

This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, on Wondrium.

Mike Webster was a hard-playing center in the NFL for 17 seasons, mostly with the Pittsburgh Steelers. Some consider him the best center in NFL history.

His nickname was “Iron Mike.” Like the Iron Horse, Lou Gehrig, even iron can be damaged, if you play long and hard enough.

Mike Webster retired in 1990 at age 38. Afterward, Iron Mike’s mental and physical health went downhill. He suffered amnesia, depression, and debilitating body pains. For a while, he was homeless, living out of his truck or in train stations.

In 1999, the NFL retirement board declared that he was totally disabled as a result of head injuries sustained as a football player, awarding him disability payments for what was left of his life.

But this ruling wasn’t made public until two reporters uncovered the story. The media would not let the NFL bury this.

Learn more about how to think like a skeptic when reading news in any medium

Disturbing Repercussions of Football-Related Head Injuries

In 2002, Iron Mike Webster died of a heart attack. The medical examiner, Dr. Bennet Omalu, decided to take a closer look at his brain, knowing that Webster had suffered serious mental illness.

What he found was a brain like that of boxers, or elderly people with advanced Alzheimer’s—a brain showing years of damage, with a neuropathologic condition called chronic traumatic encephalopathy, or CTE.

CT scan of a normal brain (left) and one with CTE (right)
CT scans of a normal brain (left) and a brain showing years of damage with CTE (right). (Image: Boston University Center for the Study of Traumatic Encephalopathy/Public domain)

Until then, CTE had only been seen in boxers, never in a football player. But once Dr. Omalu documented it in Mike Webster, there was no way for the NFL to minimize the truth of what their sport was doing to at least some of their players’ brains.

Still, they tried. In a series of papers, the since-disbanded NFL brain injury committee said that no NFL players had ever experienced brain damage from repeat concussions.

But when doctors looked for CTE, they found it. One of Mike Webster’s teammates on the offensive line, Terry Long, killed himself by drinking antifreeze. His autopsy showed he had CTE, which almost certainly led to his depression and suicide.

Another NFL player, Justin Strzelczyk, died in a car crash after a hit-and-run accident and a 40-minute, high-speed chase with police. He had CTE on his autopsy, too.

These first cases were more medical news than national news—the deaths made the newspapers, but the autopsy findings, not so much, at least, not at first.

But when former Philadelphia Eagles safety Andre Waters committed suicide, his story ended up on the front page of The New York Times, on January 18, 2007.

We now know that retired NFL players have five to 19 times the risk of dementia as compared to the general population.

Learn more about chronic traumatic encephalopathy

Concussions: Not Just an Issue for the Pros

It’s not just professional football players at risk. CTE has been found in 79 percent of the donated brains from people with any level of football playing experience, even down to the high school level.

Research has shown that it’s total lifetime exposure to repetitive head trauma that is associated with CTE—the longer you’ve played, the younger you started, the higher the risk.

It’s not just those who had so-called “dingers” on the field who can later suffer the effects of brain damage. Any violent shaking and jarring of the head, even without causing immediate symptoms of concussion, can be damaging in the long run.

Are Prevention Measures Effective? 

Players experiencing symptoms of brain injury need to come out of the game and rest until they’ve recovered. But is there anything we can do to prevent concussions before they occur?

The rules of play can be tweaked.

The NFL recently moved kickoffs up by five yards, reducing the distance between the opposing teams, making it more likely that the kicked ball would land in the end zone. That obviates the kick return, which can be a very dangerous play for the one player who catches the ball while 11 huge men are running straight at him.

This rule change did, statistically, reduce concussions, but how this was reported in the media provides a quick illustration of one way to “spin” the data.

One headline read, “Concussions Decline after Change to Kickoff Rule.” That article stated that the number of reported concussions on kickoffs decreased 43 percent from 2010 to 2011, after the rule change. Sounds impressive.

But in the big picture, the rule change had very little effect, because most concussions don’t occur during kickoffs. The total number of concussions per year went from 270 to 266. That’s a negligible change.

We need to be careful in trusting media spin and selective reporting.

Another idea to improve the safety of football: teaching players to tackle more safely, without using their heads to block opponents. A cohort study of one specific high school program, called “Heads Up Football,” did show a reduction in overall injury rates, but not a reduction in concussions.

What about helmets? Can improving helmet technology reduce concussions and brain injury?

Probably not. Helmets do protect against things like skull fractures, broken teeth, and scalp lacerations, but there’s very little evidence that helmets can prevent the effects of concussions.

It’s a matter of simple physics. The brain is floating in liquid, and when the head experiences a sudden jarring acceleration or deceleration, the brain will slam into the inside of the skull.

It doesn’t matter what you wrap the outside of your head in. Helmets, to put it simply, protect the scalp, face, and skull, but they do not protect the brain.

Learn more about the future of football

New Awareness about Football and Brain Injuries

In 2013, the NFL agreed to pay $765 million to settle a lawsuit over brain injuries covering more than 18,000 players. Payouts will depend on the severity of illness, how long the player was in the NFL, and other factors.

For example, if a player has been diagnosed with Lou Gehrig’s Disease, ALS, or Alzheimer’s, he or his family will receive up to $5 million. Ironically, over the 16 years Lou Gehrig played for the New York Yankees, he collected about that same dollar amount in salary.

Lou Gehrig himself never expressed any regret about what his years of play did to his health.

But a good number of former NFL players do have regrets, and these messages are trickling through the media, into living rooms and family discussions, and they may change the future of football.

Young boy taking his football helmet off after a game
(Image: Suzanne Tucker/Shutterstock)

Youth participation in football has dropped drastically since 2010, by almost 30 percent, and college and professional programs are paying attention. The NFL now has put multiple, independent medical observers at every football game, empowered to stop play and get injured players off the field.

Many states and municipalities have passed legislation requiring that players suffering concussion come out of play and get a medical evaluation.

Still, a lot of damage has been done. Generations of athletes, now retired, are only now realizing what happens after a career of brain injuries.

Bo Jackson, the only player to make the All-Stars in both professional baseball and football, had this to say in a USA Today interview: 

“If I knew back then what I know now, I would have never played football. Never. I wish I had known about all of those head injuries, but no one knew that. And the people that did know that, they wouldn’t tell anybody … There’s no way I would ever allow my kids to play football today.”

Common Questions About Concussions in Football

Q: How many concussions happen in football each year?

In 2017 alone, there were 281 football-related concussions. That number is more than in the previous five years combined.

Q: What is the difference between CTE and a concussion?

The difference between Chronic Traumatic Encephalopathy (CTE) and a concussion is wide. A concussion typically results from a sharp jolt of the head which shakes the brain. A concussive person may not lose consciousness. CTE, once called “punch drunk,” is a degenerative brain disease that progresses over time to show up as brain faculty problems in the 40’s or 50’s, which ends in dementia.

Q: Do NFL players die from CTE?

Of 111 deceased NFL players, brain analysis revealed that 110 died with CTE.

Q: How many concussions does the NFL allow?

Generally speaking, players cannot play after at least 3 concussions.

This article was updated on May 13, 2020

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