NFL commissioner Roger Goodell did not acknowledge a connection between head injuries on the football field and later brain diseases while defending the league's policies on concussions before Congress on Wednesday.It's about what you'd expect. One thing that would help is putting as much distance between the coaches and the team doctors as possible. These guys need to hang out with the refs, not the team.
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These guys need to hang out with the refs, not the team.
There could even be an independent group of docs in charge of certifying when someone's well enough to come back, etc.
These two ideas seem like the simplest solutions to implement. Pretty reasonable.
From the bits I heard on the radio, the NFL sounded about as good in this hearing as MLB did in the steroid ones.
I'm conflicted. I was upset that Congress was spending its time on the steroid witch hunt, but I'm less so about this head injury hearing. Maybe because they're doing less grandstanding? Although, it seems like the steroid hearings did legitimately help the issue in the long run.
The head injuries seem less voluntary, too, for some reason. Maybe because the consequences are so little understood.
As tough as the problem may be for players in the NFL, it simply makes me wonder how much worse the problem may be for high school and college players who don't get all this attention. Neither do they have nearly as much focus on protective equipment, medical attention or follow-up care. All in the name of "fun."
I think this is exactly right. I took away two things from the Gladwell article. The first was that those who played football in college, or even high school, could still face great risk of CTE. It's not just the pros. The second was that it may not be just the concussions themselves--it may also be the repeated, non-concussive head-banging that is inherent in the game, especially among linemen and linebackers. If the research bears all of this out, then football as we know it will end. There is no way any high school, youth league, or university could allow a sport with such trauma risk to be played. Same for boxing, and possibly for rugby and Aussie-rules football. Ice hockey and lacrosse? Not so sure about those.
Did the Gladwell article implicate high school level as well? I don't remember. I would think that the incredible speed and size that's found at the pro and college levels is a huge contributing factor, and would make this type of repeated concussive injury a non-issue at lower levels. I'll have to re-read the article.
He was less conclusive on high school--but it was enough that I'd have a very long talk with my kid if wanted to play high school ball.
Contributing, sure. It's worse the further up the ladder you climb. But one of the most depressing aspects of Gladwell's article was the contention that repeated concussive injuries are the result of hundreds or thousands of cumulative blows to the head - and not of a handful of extreme blows. In other words, take a few thousand hits during high school practices and games, and the concussions will follow, even if the blows aren't as hard as they are in the pros. And it may well be that the cumulative hits, more than the concussions, are responsible for long term impairment. That's not to say that they'll necessarily build to dementia; the science doesn't appear to be in yet on just how many blows to the head one can reasonably sustain. But it's enough to make you wonder.
I think the science is less conclusive on the HS level. As another commentor said, the force of the blows found at the higher levels of the game might be a large factor as well. Think about boxing, the verdict is in as someone said, but that verdict basically states that the longer your exposure to this sort of trauma the higher the likelihood of CTE or other impairment, no? Why wouldn't that hold true for football? But think about how many men in this country outside of the elite athletes have play HS football. We'd have more cases of dementia throughout our national population if routine HS football was enough.
Doesn't mean I want my kid playing football. I played, never had a concussion and expect to be fine. I don't want to role those dice with my kid.
Also was wondering if some one would be able to clarify the point re: the less concussive hits. Was there a force threshold that made a hit material to brain damage or to the susceptibility of concussions. Also, were the sub-concussive hits enough to themselves cause CTE or is it that the sub-concussive hits makes concussions more likely and frequent and that the combination of multiple concussions plus the sub-concussive hits to a brain that's injured by concussions or not fully healed from a recent concussion.
The verdict is in on boxing, and the AAU still sanctions the sport. I think football will have to change a lot. I doubt it will end--hence the "as we know it" portion of your statement.
One thing that hasn't been discussed is the role sports like football serve in our society. Like, why do we want to have simulated war? What is at work inside us as human beings?
There is a natural bloodlust inherent in humans, even as we recoil in horror at physical injury and pain. That's why we whoop and holler when we see a dude get jacked up by a linebacker on the field, and then shudder when he's on the ground and we see a replay of his head snapping back. Our dual nature.
Too much money and passion for football to change as we know it, but Gladwell's piece is the kind that could lead to a huge reduction in HS football participation, and maybe even programs run by the school. At the very least, they're going to be forced to be extra-vigilant about head injuries to youths.
Fair enough. But if I may pose a corollary question: if we do, in fact, have an innate desire to witness, identify with, and cheer combat, how can that desire be channeled to produce the least social harm?
I think that's a really important question. Almost every society has assigned a central role to some sort of ritualized competition, often between teams. These range from soccer toward one end of the spectrum, all the way over to Bozkashi on the other (loosely: dead goat polo). I think there's a very compelling argument to be made for finding minimally violent outlets for these passions. It's the case for midnight basketball leagues - take young men who want to test and prove themselves, who are attracted to the mutualism and loyalty of a gang, and have them play out their rivalries in a confined space, without weaponry, and under close supervision. The evidence is that it works pretty well.
For all the justified attention to traumatic head injury in the NFL, the number of veterans suffering such injuries dwarfs the number of athletes. Posters have expressed concern over how young people are 'conditioned' to play, or view athletics as their sole route out of poverty; the risks of the street life are immeasurably higher, as are the social costs, but the same concerns certainly apply. That isn't an argument against doing all we can to minimize the risk to players while preserving the entertainment value of the game. But there are worse things than sports, or even than violent sports. Like, you know, actual, unfettered violence that can't be whistled to a halt. So while working to maintain the safety of the players, let's not lose sight of the larger picture.
I'm not at all sure that "war" is what sports in general are supposed to be simulating. After all, war is a activity shared by humans, ants, and termites, not many other creatures. On the other hand, most species practice non-crippling combat as mating and territorial rituals, while mammals have genetic programs for rough-housing, wrestling, etc., presumably as learning exercises.
In other words, humans should be genetically capable of resolving mating and territorial disputes and "playing" without crippling or maiming each other. War is a cultural option humans invented for conflict resolution.
I would say, then, that football is not a game that mimicks war, it is a game that does what other games do, but it has moved to the extreme of causing permanent injuries while we've been pretending it doesn't. Imagining football as war is more of a back-reference, a metaphor to share the stimulating effects of both activities.
I think the role of football was well summed-up by Mariah Burton Nelson: The Stronger Women Get, the More Men Love Football.
Our culture has what I've called a "subtractive model" of masculinity: Real Men™ are defined by doing things women don't do. The more different things women can be seen to do, the more important the things women *don't* do become in conventional definitions of masculinity. If repetitive brain injury is the price of freedom from Girl Cooties, that's a price a *lot* of guys are willing to pay.
The reason football looks like war is that *both* look like Man Stuff.
This may be one of those situations where size matters, along with strength and speed. I wonder if dementia risk has risen with the size and speed of NFL players. The forces transmitted are a function of mass and velocity. Maybe some sort of threshold has been crossed.
There's also the issue of duration of exposure. Most high school and college players don't go on to NFL careers, so they don't get another year or two or ten of hits that pro players take.
Clearly we have more serious problems in the game. Bandanas and touchdown dances aren't going to get rid of themselves
As someone pointed out in yesterday's thread, this is something that the NFLPA is gonna have to step up on, cause it really is a workplace safety issue.
Goodell is thinking about liability; that's not surprising. It doesn't matter to me whether or not he specifically acknowledges the link between concussions and dementia - I care much more what he does about it. And that's where his testimony was really appalling:
Here's the thing. It's a good idea not to put a player back into a game after he receives a concussion - and banning them from returning after losing consciousness is, well, a no-brainer. The in-game decisions are just the tip of the iceberg. They're the ones that are most visible, and it's entirely typical of the NFL's approach to this issue that it's taken strict action that's essentially confined to the portion of the week on national television. But if Goodell thinks that's the limit of the issue, he was sleeping through the rest of the testimony. What about a player who loses consciousness during a Sunday game, and whose coach demands he take to the practice field without so much as a red jersey the next morning? He may be asymptomatic, but all of the available medical guidance suggests that such a move is potentially disastrous.
In the earlier thread, I posted an excerpt from the devastating testimony of former TB team president Gay Culverhead. Here, in part, is how Goodell responded:
And get this. He actually managed to deliver that line with a straight face.
Here's the reality. Under the CBA, the Clubs select their team physicians. One of them has to be a board-certified othopod; there's no requirement that any of them have expertise in neurology. The Club pays those physicians' bills. Players have to consult with those physicians first, before seeking a second opinion. And it's these doctors who make the in-game decisions, and who decide when a player is cleared to return.
Technically, the doctors don't report to the coaches; and in most cases, they are not formally employed by the team, but rather, by the medical centers or practices where they work. But any doctor who crosses an NFL head coach won't find himself on the roster of team physicians for very long. And although the money the teams fork over is in the form of bill payments and not paychecks, they're still the ones selecting the docs and signing the checks. Besides which, the key financial benefit comes from the association with the team, allowing these doctors to bill exorbitant amounts for their services to other patients. So long as the doctors are selected by the team, they'll face enormous pressure to produce outcomes amenable to the team. It's just that simple. And Goodell's duplicitous evasions and denials of this obvious reality was far and away the most depressing aspect of the hearing for me.
It's such a simple thing to force the player's association and the league to jointly select the physicians - or even to leave their selection up to the players alone. As long as the league resists that obvious move, we'll know it's completely unserious about owning up to the problem.
Agreed.
The notion that head injury, a.k.a. brain injury, on the field or ground shall not lead to further injury later is medical nonsense.
It is so military, so VA.
Some of these guys have been educated in military war colleges we should remember.
Question: can we change the sport of football in such a way that linemen sustain significantly less head deceleration, and still have a sport football fans can continue to love? My takeaway from the Gladwell piece was that although helmet technology can help soften these blows, there's nothing to be done about most of it because of the way football is played; linemen line up, heads down for maximum pushing ability, and crash into one another on the snap, headfirst. It's the change in momentum of the head specifically which, upon a collision, especially one in which the head is impacted directly, makes the brain slam right into the inside of the skull. You can't put padding in there. The deceleration's got to be more at the point of impact than on other parts of the body, and way more than say, a quick corner or running back's body experiences on a fast cut, no matter how athletic they are.
What would football be if linemen didn't go headfirst? What would they do, then, start from a squat? That doesn't seem like it would work so well, both for the lineman's actual purpose of advancing his line / breaking through / blocking, and maybe not even for reducing head impacts or their severity. I don't know.
Just FYI, if a defensive linemen is taking on a block head first, somebody is teaching them some very shitty and dangerous technique. And they should never, EVER line up with their heads down.
Sorry, I meant head-first, not head-down. And my analysis may be sloppy here; I've only played football recreationally a couple of times with friends. The repeated head trauma is due to the repeated collisions on the line, right, and there must be a lot of impact to the heads of the linemen for long-term boxing-type injuries/trauma to develop, it seems.
I'm not sure if it's from contact at the line which happens from a close distance, or repeated tackling of the RB. It could be that linemen just play the game for far longer than the majority of players so they are at the highest risk of sustained head injuries. Most RBs take a big shot on every play, but most RBs don't spend 15 years in the league.
Byrk, I'm not positive, but I'm pretty sure linemen have a very short career span compared to other players.
There are some underlying issues here that should be mentioned.
1. For Goodell this is all about a liability issue. For years the retired players have been trying over and over again to have mental defect be listed as a permanent disability with the NFL so ex players can get compenssation for injuries sustained while playing. But the league has always resisted this because many of these guys are young meaning these benefits will have to be paid for a very long time and they also know that should these benefits be extended a helluva lot of guys will sign up for them.
2. Even though things aren't perfect I can tell you for a fact that they have gotten better. For one players can now go and get a second opinion from a doctor that isn't employed by the team. For two there have been stricter concussion guidelines put in place in the last few years that take the control out of everyone but the trainers hands. Also the NFL had been outed cooking the books on concussion studies and are now already under a lot of scrutiny so its highly likely that soon they will come with real data about the effect of concussions on NFL players. Oh and the equipment and especially the helmets have come a long way in terms of protecting against concussions. And of course the rules have even been changed to penalize players who deliver blows that as a general rule put the opposing player in jeapardy of having a concussion.
3. Again I have to point out that the overwhelming majority of coaches in the NFL are not going to to try to rush guys back with concussions anymore. Some of it has to do with simple practical issues. If they rush a guy back and he gets dinged again then its likely they will lose them longer term if not for the season. But some of it is also the fact that a lot of these coaches actually used to be players and they have seen what some of their teammates have gone through. Now that is not to say there aren't any coaches who would, but what I am saying is that every coach shouldn't be painted with that brush because its not realistic.
4. And maybe most important, with the CBA up for negotiation a lot of this will be addressed by the NFLPA so again its highly likely that there will be more reforms coming to help keep players safe.
Now again this isn't about praising or condemning Goodell or the rest of the NFL. Its just more info that is needed to have this conversation. Again its not as black and white as a lot of people might think.
For the record, concussions are probably not even the issue. It's in the nature of the game. An athlete's brain (much like a soldier's) can't withstand repeated blunt trauma, even if its not severe enough to cause concussion. Think about it as being akin to cancer or AIDS; if symptoms are present, then the disease has progressed a very long way.
John Grimsley never had to be taken off the field, yet his brain looked like that of a ~85 year old Alzheimer's patient when he died...
However, the new helmets should help because if they soften the blows enough to prevent a concussion they would soften every blow making each one less dangerous. I still think that the NFL, NCAA and high school level need to make the newish anti-concussion helmets mandatory, end of discussion. There's no reason any NFL, NCAA or high school football player should use the old style helmets.
Disagree.
The entire problem with the NFL is that every time it's faced a crisis over the rate or severity of injuries, it has responded with additional safety equipment. And - here's the rub - that has made the problem significantly worse.
Rugby players don't suffer dementia, and while they're prone to all sorts of orthopedic injuries and lacerations, they don't get many concussions. If you're playing rugby, you don't make a hit with your head. It hurts too darn much. You're also liable to bust the skin open, and nothing bleeds worse than a head-wound. Helmets seem to alleviate that risk. You don't feel the impact the same way - but the sudden deceleration is just as bad, as the brain slams against the skull. The NFL clings to the delusion that it can put safer helmets on its players, but these are likely to make the problem much worse, not better. Players who think that the helmet will protect them will play more aggressively, and suffer harder blows.
Frankly, the best solution would be to go back to the MacGregor helmet. Its abandonment in favor of the plastic helmets in the post-war years led to a sharp rise in the number of traumatic spine injuries, as players, feeling invulnerable, began to use their heads as battering rams to spear other players. The cure was worse than the disease. Only changes in the rules to ban spearing brought the epidemic of injuries under control.
What afflicts these players is the false perception of invulnerability. They don't feel the hits as traumatic, so they don't avoid them. Sometimes, less protection is a better safeguard.
Do you have a cite for that? I've heard that argument, but I don't really buy it. Remember, people were dying on the football field back in the day. Teddy Roosevelt was threatening to outlaw the sport. And medical technology to even properly diagnose dementia and brain injury was nowhere near what it is now. Do we know the concussion rate and dementia rate of players from those days?
And there was a post in yesterday's thread that showed a serious concussion problem in rugby as well.
Cynic: "Rugby players don't suffer dementia, and while they're prone to all sorts of orthopedic injuries and lacerations, they don't get many concussions. If you're playing rugby, you don't make a hit with your head. It hurts too darn much."
Not sure about dementia rates among rugby players, but there is evidence of a pretty high number of concussions. From a 2001 UNC study--
"Using data from a large, high school–based rugby
program in the United States, we have demonstrated that the
incidence of concussion in rugby is probably much higher than
previously suggested."
The study found that of all rugby injuries in its sample population, about 24% were concussions. Which would suggest an even higher rate of sub-concussive brain decelerations of the kind that the recent research outlined in Gladwell's article suggests might lead to CTE.
http://www.nata.org/jat/readers/archives/36.3/attr-36-3-0334.pdf
Any concussion problem is a serious problem. That said, the data in the post yesterday were highly suspect - showing only the relative percentage of all injuries that were concussive, and not the actual rate of concussions. The best published information I can find shows that a player is likely to suffer a concussion once in 25 hours of semi-professional game play, and that the rate of concussions during practice and training is virtually nil. (TJ Gabbett, "Incidence of injury in semi-professional rugby league players," J Sports Med, 2003.) To put that in context, games in the study ranged from 60-90 minutes - so that's one concussion per player per 17-25 games. Other studies produce similar findings - high overall rates of injuries, but very low rates of concussions, and those almost exclusively confined to games.
I'm not pressing for Rugby, mind you. It does appalling things to other parts of players bodies. But that's precisely why it's such a compelling comparison. Rugby players tear their tendons, mangle their ears, snap their bones - in general, collide with terrible violence. But they're not getting concussions at anything like the rate of NFL players. It's not their smaller size, either - they're moving fast enough and hitting hard enough to break all kinds of things, after all. It's that when you're not wearing a huge padded helmet, you try a little harder not to smash into someone with your head.
My more general cite is to Edward Tenner's "Why Things Bite Back." He points out that there were only a few deaths during intercollegiate games in 1905, but 23 players killed in practices and intramural games. It took two sets of rules changes to alter the situation, including legalizing the forward pass. Changing the rules got the job done, not protective gear - the deaths virtually ceased. Gladwell himself acknowledges this.
In the postwar years, the introduction of the plastic helmet, ostensibly as a safety measure, had the opposite effect. Dr. Joseph Torg did the pioneering work here, analyzing game tapes to discover that the wave of spinal injuries had occurred almost exclusively when players lowered their heads to use them as battering rams, something they had not done with leather helmets. Another rules change ensued, and once again, the problem abated - there were 36 catastrophic injuries in 1968, the NCAA changed its rules in 1976, and by 1991 there were just 2. The pros saw a similar drop. And what was true of helmets was true, more generally, of other safety gear. From 1918 to the 1950s, four in ten pro players had injuries prolonged absence from games, and one in three required surgery. By the 1980s, that had jumped to seven out of ten, and two out of three. To be sure, there were other factors at work, including the professionalization of the sport, better training, and larger players - all of which combined to result in more frequent and devastating collisions. But throughout this period, protective equipment has improved. There's a fundamental disconnect there. It might be the case, I suppose, that those improvements simply haven't been able to keep up with the other changes. But I think there's a simpler explanation.
In the abstract, the safety equipment is fantastic. But it alters the incentives for players - encouraging them to hit harder, because they're relatively more insulated from injury. That leaves the league with two options. It can change the rules, to put the incentives back into alignment, as it did with spearing. Or it can remove the margin of safety, producing more minor injuries but fewer major ones. So far, it's taking the third path - allowing the injuries to pile up. But that's not sustainable. And as Gladwell points out, it's unclear that any rules change can prevent players from hitting each other cleanly but hard. So that leaves, to my mind, just one choice...
Claudius:
Thanks for the link - hadn't seen that. I'd point out that the study looked at one high school team over three seasons, and extrapolated its findings from seventeen concussions. That's a less than robust sample, and as the study itself takes pains to point out, it contradicts the established consensus based on ten other studies which were in broad agreement. Of the seventeen, two were Grade 2, and one Grade 3; 12 took place during games. So this study concurs with the others that rugby concussions are mostly mild, and that despite the greater frequency of practices, they mostly take place during games. It's also tantalizing that the majority of the players in the study had previously played football; one wonders whether that rendered them more susceptible.
These concerns aside, it's imperative that their be a broad-based, rigorous study of concussion rates in rugby. And in football. Almost all the work that's out there relies on self-reporting, or on team-based monitoring in the absence of rigorous medical attention. One recent study surveyed 72 high school football players, and concluded that 65% of them had suffered concussions during the season. That's an eye-popping number. A Minnesota study the next year surveyed more the coaches of more than 3,000 high school players, and concluded that 78% of them had suffered concussions, and that 19% had suffered at least a Grade 2 concussion. And so on down the line. Any one of those numbers makes the rugby incidence look comparatively small, and that's truly frightening - because the rugby numbers are themselves appallingly high.
At the moment, I think the only sure thing is that we just don't know enough to be sure. I think there's good preliminary data to suggest that concussions are vastly more common than we realize, and that they're much more frequent among football players, who were superb helmets, than among rugby players, who don't. But we're going to have to wait and see on that.
While I totally agree with you about it not just being about concussion, your point about Grimsley misses the mark. Football players back in the day and probably now play with concussions with out even knowing it because they are mild. They might be dizzy but they figure its just a part of the game. I know of a handful of guys who definitely had concussions but didn't have to be taken off the field. They just couldn't remember where they hell they were at later.
This is the huge problem. It's not I got one big concussion and stopped playing. It's I got a series of small concussions that add on top of each other. This makes it seem very difficult to deal with in terms of football, where you can get hit on just about every play.
I don't even know if the modern NFL is even viable if they're going to opt for protections against dementia. They'd probably have to go back to leather helmets and rugby-style tackling.
My grandfather, now in his late 80s, played football in high school and college back in the 1930s and 40s. He hasn't had any issues with dementia, despite the fact that "helmets" back then, when they wore them, were made of thin leather, with practically no padding. I spoke to him a few years ago about the differences between football back in the day and today, and the main thing he talked about was the size of the players. Granted, the typical NFL player is still generally bigger than the typical HS or even college player today, but back when he was a kid, football was a sport for fairly normal-sized dudes. The force of two 250 pound guys ramming into each other is significantly greater than the force of two 190 pound guys ramming into each other. There is no inherent advantage to having enormous linemen unless the OTHER team has enormous linemen- it's a kind of arms race. And the kind of weight training these guys go through for the sheer purpose of becoming enormous has all kinds of other detrimental health effects- bad knees, heart conditions, etc. I know we love our behemoths, but perhaps some of this could be mitigated by imposing weight limits. You probably wouldn't actually exclude anyone who is naturally large, you would just keep the same guys from adding muscle for the sole purpose of adding weight.
Re: weight limits: maybe this could be a new use for BMI?
Brief anecdote here: I once interviewed this 101 year old man for a non-profit I was working at. We went into his life story a bit, and I found out he played for NC State in the 20's. This was amazing to me because, for one, he was black and I would have figured he'd have been kept off the team. However, the other thing about his career was rather shocking was that he played D-line...weighing in at 140 lbs. Now I'm not for weight limits or anything like that, but it's pretty shocking that 140 lbs man could ever play d-line at a college level.
Dithering...that's some funny shit, TNC.
It's no surprise Goodell didn't do right thing and act like a real person. He's a lawyer and a business man. He has a job to do. Protect his product. That's fine.
But when I saw Gladwell on PTI, and heard him say the NFL is open about this, this isn't the tobacco companies we're talking about here...
You gonna tell me Goodell doesn't sound like the Tobacco companies? Really? Love to hear Gladwell respond to this now.
What should happen based on what we now know is that there needs to be a comprehensive survey done of EVERY SINGLE NFL PLAYER who ever played basically. Why should that be a problem? How much would it really cost? $25 million seems like enough money to get that done. The NFL could pay for that easily. But they won't because they don't want to know the answer. They're afraid. And if the NFL is afraid of the answer, we need to know what they're afraid of. Somebody needs to fund that study, and force the NFL to comply. Frankly, the Players Union should demand it. And if the NFL doesn't agree, they should go talk to Congress and demand it.
Sad part is a lot of the players already knowingly put their health on the line to make millions. But this dementia shit is no joke. You gotta know what the facts are.
Dithering!