Football and Concussions

By Bob Gariano

When the Indianapolis Colts play football against the New Orleans Saints in Super Bowl 44 in south Florida on February 7, 2010, the game will mark the penultimate event in a sport that is most reflective of our national personality. While baseball may be our national pastime, professional football is certainly our most archetypal sport as a country. Married to the medium of television, football’s combination of pageantry, velocity, scale, and, yes, violence, seems to be a perfect fit to the speed, diversity, and color of modern American life.

This enthusiasm for the game of football is reflected in all ages and at all skill levels. More than five million young people play football in grade schools and high schools in the US each year. Colleges finance major expansion programs on the back of alumni support and television revenues derived from the sport. Football transcends race, economic condition, and locale. The sport’s natural meritocracy is reinforced by uniforms that eliminate personal characteristics and reinforce team identity. When the helmet is on, no one knows what a player looks like, just how many yards he has carried the ball.

Collision Sport

The football field is what some sports injury specialists call an impact rich environment. Vince Lombardi said that football is not a contact sport, it is a collision sport. Whether tackling, blocking, or running with the ball, the basic posture is the same. The player drives through the numbers on the chest of the opposing player’s jersey, often being coached to use the hard helmet as a battering ram to concentrate the speed and mass of the collision. At the skill level of the professional player, these impacts create the spectacle of the sport. But even at the grade school and high school level, football is a violent impact sport.

Concussions are defined as a jarring blow to the head where energy is transferred to the brain through the energies of sudden deceleration or acceleration. The resulting symptoms are stunned senses and sometimes unconsciousness. These events and injuries were usually deemed to be transitory. In no sport, with the possible exception of professional boxing, are concussions more common than in football. New evidence from engineers and doctors who are studying football head injuries and the incidence of concussions in players are starting to change our ideas that these symptoms are innocuous.

The brain is difficult to study in a living organism and especially so in human beings. This most complex and valuable organ can not be adequately analyzed through modern medical imaging like CAT scans or MRI techniques. The soft tissues that make up the brain do not easily yield to modern medical imaging. This

is changing through the work of skilled doctors and engineers at universities and helmet companies around the US. The results are surprising sports injury specialists who thought that they understood head injuries in contact sports.

Studying Players’ Brains

Some of this pioneering work is being conducted by the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine. The CSTE studies brain tissues dissected posthumously from football players whose families agreed to donate their brains to this project. Doctors have found that brain tissues from a 45 year old former NFL player had permanent scarring from multiple concussions and that the scarring and damage closely resembles the tangled cells of 80 year old patients who are suffering from Alzheimer’s disease and other forms of dementia.

 More alarming, the researchers later found such damage in the brain tissues of an 18 year old varsity football player who had incurred multiple concussions during his high school playing career. Every player studied exhibited some level of such damage.

Researchers at the CSTE have studied the brain tissues of approximately 100 former football players whose families have agreed to donate the player’s brain tissues post mortem. In every case, the researchers have found such concussion based scarring and brain damage. The CSTE has found that this damage is permanent and most often affects the parts of the brain that control emotion, rage, hyper sexuality, and even some basic functions like breathing. The CTSE has determined that much of the observed brain damage is permanent and may even be progressive.

Dr. Ann McKee, co- director of the CSTE and a neuropathologist who works at the Veterans Administration Hospital in Bedford, Massachusetts said, “I knew what traumatic brain disease looked like in the very end stages in severe cases. To see this kind of change and damage in younger people was simply unheard of.”

Designing Better Helmets

Engineers and helmet designers are studying these phenomena in real playing conditions. Last year, researchers at Indiana University outfitted their football players with sophisticated helmets that help trainers and team physicians track head injuries and impacts. Called the “sideline response system”, the researchers use helmets that are fitted with sensors that detect impact G-forces and transmit these data to the side line via a wireless network. Indiana is the only Big Ten school and only one of ten Division I schools in the country to use this expensive system to supply information about the force and frequency head impacts. Next year, a similar study will be conducted with high school players at Lafayette High School in Indiana.

The system measures how fast the player’s head moves inside the helmet during impact. This deceleration is measured in G-force units. The NFL has determined that 98 G’s is the cut off point. The NFL has found that 50 per cent of players who are subject to a 98 G-force impact suffer a concussion. The scale is easy to understand when one considers that an unrestrained occupant of an automobile that hits a stationary and immovable barrier at 35 miles per hour sustains a 65 G-force impact.

In the course of this instrumented study, the Indiana University research has revealed another surprising issue. Head impact is not an acute problem occurring only when the two players meet in a violent collision in front of 100,000 fans on game day. Football players are subjected to damaging impacts many times during the course of normal practice sessions. Some researchers are claiming that such routine head impacts are resulting in cumulative, chronic brain damage.

Continuing Research

Intensive research continues. This last autumn, The National Center for Medical Rehabilitation Research at the National Institute for Health commissioned a $3.6 million study to examine the underlying causes and results of mild traumatic brain injuries in football players. The biomechanics of the impact event is a special concentration of this work. Already, the Center has published a series of papers based on their new library of data from more than 600 amateur and professional football players. The library documents more than 400,000 collisions and impacts.

NFL players have joined the supporting voices encouraging such work. Troy Aikman, the former Dallas Cowboys quarterback, retired from the game at age 34 after sustaining his tenth concussion. Aikman has been vocal in his support for better rules and equipment to protect players at all levels.

Helmet specifications developed in the 1970s have made football at all levels a safer sport. Nevertheless, new advances are underway which will make football a safer sport for players while not, hopefully, eliminating any of the spectacle and excitement of this uniquely American game.

When we see that thrilling tackle or exciting goal line running play on Super Sunday, it might be worth reflecting for a moment on the dynamics of a violent game and the researchers who are trying to make it less damaging to the people who play it.

   

Bob Gariano is President of RGA, an executive search firm that recruits senior executives and board members for public and private companies. Bob can be reached at rgariano@robertgariano.com