Doug Saffir

As we learn more about the impact of traumatic head injuries on athletes of all kinds, I felt compelled to go back into my archives and find an essay I’d written on concussions back in 2010. It’s a longer read, but I appreciate you taking a look, as well as any feedback you’d like to leave in the comments.

“People ask if it’s going to take a death for something to change the way we deal with concussions. It’s the wrong question, since it already has.” – Will Carroll

Football has risen through the ranks, past basketball and baseball, to become the most popular sport in the United States. Every weekend, millions of sports fans clamber onto the couch to watch their favorite helmeted heroes battle on the gridiron. For sixty minutes, those heroes line up, smash themselves into one another, and then line up again. The violence of the game is oddly captivating, which is part of the appeal. The hardest hits get those fans up out of their seats to cheer and holler. Seconds pass, and the victim of the bone-crushing hit is still on the ground. Suddenly, the hollering subsides as shock sets in. Our hero has fallen. How is he not getting up? After all, it’s just a game.

That is the moment fans start considering what happens underneath the helmet. The sacrifice and pain that goes into being a hero reveals itself. We see his anguish, his fear becomes our fear. We watch as he is strapped to a board and carted off the field. He weakly raises a thumbs up, and the fans erupt in more cheers. The cart disappears out of sight, and play resumes. Our hero’s pain is quickly forgotten.

That is the case on most days. The discussion of injuries and how they are treated in football has been swept under the rug. Fans, experts, and officials are quick to dismiss the dirty secrets of football for the sake of the game’s success. The physical toll taken for our entertainment is ignored. That was true until recent research began to lift the shadows. Trips into the dark world of football are revealing the mistreatment and misdiagnosis of injuries, especially concussions. The hero’s brain, once disregarded and ignored, is becoming the battlefield away from the gridiron. It is now the front line of football’s future.

“Teenagers’ heads, already chock-full of hormones, confusion and dancing images of Megan Fox, are being battered around on the football field, their brains sloshing inside their skull like the coffee in your mug when you take a turn too fast.” – Will Carroll

It is Wednesday night. Many weeks’ worth of practice are culminating in fierce competition. Two high schools are meeting to play football. The student-athletes fly around the field, modeling themselves after the professional athletes they admire.

All of sudden, number 44 is lying on the field. He collapsed after hitting the ball carrier, and he shows no signs of movement. This is not a hero sacrificing for entertainment. This is a kid paying the price we never talk about. This is Ryne Dougherty. He is later rushed to the hospital, diagnosed with a brain hemorrhage, and subsequently loses his life to a game he loved.

In that game between Montclair High School and Don Bosco Prep, Dougherty gave his life to another cause: the fight against the mistreatment of concussion patients in football.

He was the third teenager to die because of football related activities in New Jersey in 2008. In 2007, three high school players in the United States died because of head injuries. The Journal of Athletic Training estimates that from 2005 to 2006, 55,000 concussions plagued high school football. Dougherty is just one case among thousands. High school is the center of the concussion epidemic. It is ground zero.

As hundreds of thousands of student-athletes play their hearts out throughout the week, they are suffering, just like Dougherty did. They suffer because these are not professional athletes under professional care. They are children under the guidance of coaches who often are just parents or teachers filling the role. Most schools do not have full time athletic trainers, although many bring one on game nights. Unfortunately, many symptoms present themselves after game night, when coaches are left to make the decision on a player’s health.

This dilemma couples dangerously with a lack of preparation in most athletic programs. Schools across the country do not have protocol for how to treat head injuries. Those one night a week trainers, if present, are the only medical expertise available. Yet there is no plan on how to take advantage of that expertise, no procedure for how to handle a patient, and no guidelines on what to do in the days to come.

Even worse, the competitive atmosphere surrounding the game clouds players’ judgment. The one person with the power to say no, the player suffering the symptoms, often is too ashamed to speak of them. The mentality of athletes, particularly in America, is that winning at any cost is the only way. Student-athletes take this to heart. They come back early from sprains and breaks, hurrying the healing process for the chance to play again. It is only easier to do this with concussions. They hide or deny the symptoms of the sometimes-fatal injury because doing otherwise is equivalent to weakness.

Schools are simply not doing enough. The years in which their students play football are some of the most crucial in brain development, a process that is not complete until 20 years of age. As these children’s brains are growing and developing, building connections and a framework, they are being battered around. And the brain needs to heal. But more often than not, the brain never gets that chance.

Without trainers to correctly diagnose concussions, and without a change in mentality making it acceptable to speak up about symptoms, high school football players leave their fate up to the gods. In a life or death matter for the young athletes of our nation, we leave things up to chance.

Some schools are taking initiative. Better equipment is often the first step. Pads that absorb the impact better and helmets that stabilize the head and neck are often the instinctive answer to this problem. Further, ImPACT neurological testing has become a staple for some high schools. ImPACT uses computer programs to test short-term memory, reaction speed, and concentration. Student-athletes are given this test before playing in order to establish a baseline score. It is then used again after concussions and head injuries to gauge if the player has fully healed. It is considered state of the art in the diagnosis and treatment of concussions.

Yet both of these solutions are limited. Many schools do not have the money or resources to purchase new equipment or take advantage of the ImPACT program. Their student-athletes have no reasonable protection between them and the damning consequences of the game they play.

There is little those schools can do. So they play on. In practice and on game day, the futures of children across the country are at risk in a game we all love. We love the big hits and the brutality of it all. And then Ryne Dougherty comes along and makes us realize the stakes of this game are much higher than we thought. He shows us that high school student-athletes are the focal point of an epidemic with no cure in sight.

“John Gagliardi, head football coach at St. John’s University in Minnesota, does not allow tackling in practice, has no playbook and does not require his players to participate in strength and conditioning workouts. There is no yelling, no tackling dummies and no whistles.” – Thayer Evans

The college game has changed a lot in the last ten years. The range of programs is diverse in talent, size, and lore. And yet, thousands of schools send out a team every year. Some schools do it out of tradition, and others do it for profit. All schools have something in common: their student-athletes.

The Bowl Championship Series (BCS) determines a national champion every year. Schools compete throughout the season at the chance to play in that championship game. Yet the BCS’ continued existence has very little to do with football. Advertising and sponsorship have made the game one of profit hoarding. The six conferences in the BCS stand to make millions of dollars by participating, while those conferences that do not participate suffer because of it. From 2005 to 2009, the six BCS conferences made $492.5 million while the remaining five made $61.9 million. Money is flowing through the college football system, millions of it going to schools and to coaches. Through all of this moneymaking, who could possibly still be missing their cut?

The answer is the student-athletes. They are rule-bound to not see a cent of those profits. All of that money passes them by, even though they are the ones making the sacrifice.

On Saturday, November 7^th, 2009, the California State Golden Bears met the Oregon State Beavers in a nationally televised college football game. In the second quarter, Cal State’s star running back Jahvid Best took a direct snap, waited for his blocks to develop, and ran left toward the end zone. The speedy back covered the seven yards between him and the goal line quickly, only to come face to face with an Oregon State defender crouched low for a hit. Best, often lauded as one of the most athletic players in the country, leapt into the air, clearing the defender in a spectacular hurdle. As he reached the peak of his jump, another Oregon State defender came from behind him, pushing him yards higher into the air. As Best seemed to take flight, it was clear his balance was lost, nothing coordinating him as he plummeted back to earth. As he collided with the ground, his helmet flew off and his body bounced from the impact. Upon settling still, his arms locked outward, his legs stiffened, and his head tilted to the side. Best had suffered one of the most horrific concussions many people had ever seen.

Best has not played since. This leave of absence is seemingly an encouraging sign of how college programs are beginning to treat concussions. But that was Best’s second concussion in two weeks. He had suffered a minor concussion a week earlier in a game at Arizona State. While Best is recovering and will obviously not play until he is healthy, consider that the concussion that took Ryne Dougherty’s life was just his third in over a month and a half.

So what are these student-athletes playing for? In a game that generates hundreds of millions of dollars in revenue, the true entertainers see none of it despite assuming all of the risk. For Best, he plays for his future, as spectacular athletes such as himself are almost guaranteed a shot in professional football. But only 215 of around 9,000 college football players ever make it to the next level. With only two percent of student-athletes making a career out of the game, what do the other 98% deserve?

It is fairly safe to say they deserve much more than they get. Surely the quality of care given to college athletes, as well as the equipment they use, is much better than many high schools. Yet the competitive spirit that drives players to fight through the pain and anguish of injuries only intensifies.

With so much at stake (the coach’s job, the security of the program, the millions of dollars in potential earnings), college student-athletes are pushed much harder than their high school counterparts. Practices become more frequent, resulting in exhaustion and fatigue, increasing the number and severity of injuries. Further, players know the cost of their failures. Often one loss can keep a team out of that revered national championship. With the threat of disappointment ever looming, players fight harder to get back to practice and to play each game. Many times, they are not ready for that return.

Best was fortunate his injury was nationally televised. After the horrific fall, the volume of people who followed his recovery probably played a role in how long he has sat out. Yet thousands of other players, including Best the week earlier, have their pains go unnoticed and untreated. Their symptoms are squelched under the burden of the competitive spirit. They are driven to the brink and then thrown off the edge all for the chance at victory.

Over 8,700 student-athletes sacrifice themselves week in and week out for four years, with no shot of turning their hard work into something. They are gladiators. They are put at risk for pure entertainment and gain nothing from it. They risk life and limb for a game that will not give a cent to them. So with two-a-day practices and games that feature players who are bigger and stronger than in high school, student-athletes in college fight on. They are better cared for and better protected, but their drive and spirit puts their lives on the line.

Perhaps the answer lies in John Gagliardi’s coaching philosophy. He does not allow hitting in practices, leaving pads and helmets for game day. He does not require that his players put in hours in the weight room or do conditioning drills. He allows his athletes to play the game and be safe doing it. His team at St. John’s University had only two concussions in 2009. His method of coaching has proven to be the healthiest. And in the midst of it all, he is college football’s winning-est coach with 463 wins and the only coach to have coached 600 games. His success and his tenure speak to the validity of his style. Yet he remains a severe minority amongst college coaches. The solution seems to be budding, but has not yet flourished.

“L.G. willingly submitted his dog to a contest that culminated in her suffering and destruction. And why? For the entertainment of an audience and the chance of a payday.” – Malcolm Gladwell

The most shocking and radical change in football over the years has been the size and speed of those who play the game. In the earliest days of football’s development, players would not top 220 pounds. Even the “big men,” the offensive and defensive linemen, were not particularly large. Further, players were not typically fast. The game was played with sheer force, as players smashed into one another. There was no forward passing and no electrifying runners. The game was more like its relative rugby than the game we know today.

Over the course of the game’s history, those players have grown. In the present day, the games largest players stack up well over six feet and often weigh over 300 pounds. Some players even tip the scales at over 400 pounds. In the past, this kind of size would be unheard of. Today it is commonplace. Those same players are capable of running at speeds unimaginable for a man that size. They can handle the forty-yard dash, a common measure of speed for football players, in under six or seven seconds. The skill players (wide receivers and running backs) can often run that same distance in under five seconds.

Come Sunday, these players take the field. For sixty minutes, in front of millions of viewers and fans, they collide with one another. They are aware of the risks, but accept them in exchange for the high salaries they receive. Besides, professional athletes are cared for like no one else on the planet. Their bodies are their profession, the product that brings in the money. And so the best trainers are hired, the most experienced doctors examine them, and the most advanced treatments are prescribed. All of this in the hopes of a sooner return of the product: the player.

But this year, more than any other previous year, has shown the culture and mentality of professional football. In one week, famed and admired quarterbacks Ben Roethlisberger of the Pittsburgh Steelers and Kurt Warner of the Arizona Cardinals suffered concussions on the playing field. In the days following those injuries, news analysts and experts opened the forum for treatment of concussions. Ex-NFL players talked about their experiences, the most common of which was a hiding of symptoms, a lack of education, and an encouragement of early return.

Across the league, this mentality was affirmed. Retired and active players alike discussed the culture of win at any cost. Players did not know the consequences of concussions, let alone how it should be treated. All they knew was that they wanted to win; that they had to win. And so they had to play.

In light of this culture, the most recent research into concussions in football has yielded appalling results. Kevin Guskiewicz, who runs North Carolina University’s Sports Concussion Research Program, has been studying his school’s football team for the past five years. His program, called HITS, places six sensors inside the helmet of each player. Those sensors measure the force and location of every blow he receives to the head. This passage, from an interview with Malcolm Gladwell, is telling of the risks entailed in football:

“The first concussion was during preseason. The team was doing two-a-days,” he said, referring to the habit of practicing in both the morning and the evening during the preseason. “It was August 9th, 9:55 A.M. He has an 80-g hit to the front of his head. About ten minutes later, he has a 98-g acceleration to the front of his head.” To put those numbers in perspective, Guskiewicz explained, if you drove your car into a wall at twenty-five miles per hour and you weren’t wearing your seat belt, the force of your head hitting the windshield would be around 100 Gs: in effect, the player had two car accidents that morning. He survived both without incident. “In the evening session, he experiences this 64-g hit to the same spot, the front of the head. Still not reporting anything. And then this happens.” On his laptop, Guskiewicz ran the video from the practice session. It was a simple drill: the lineman squaring off against an offensive player who wore the number 76. The other player ran toward the lineman and brushed past him, while delivering a glancing blow to the defender’s helmet. “Seventy-six does a little quick elbow. It’s 63 Gs, the lowest of the four, but he sustains a concussion.”

Those impacts, taken over the course of a week, or a month, or a season, or a career, all add up. Nine weeks later that same player suffered a 76-g impact, followed later that day by a 102-g impact. The result? He could not stand bright lights, and had trouble staying awake. He was sidelined for only sixteen days.

The culture of football is fatal. Players are determined to win at any cost. Coaches become famous for the brutality of their style. The players are pushed beyond limits in a game where the size and speed of those giving and receiving impacts are beyond imagination. The changes in professional football players’ stature are contributing to their effectiveness as competitors and the efficiency with which they kill each other.

The blows they suffer in practice and on game day are not just bad for their brain in the short run. Studies into the long-term effects of concussions have shown the horrifying tragedy of football.

Ann McKee, a neuropathologist in Massachusetts who also met with Gladwell, has studied the brains of football players. What she has discovered is haunting. The studies she has done show signs of chronic traumatic encephalopathy (CTE), a degenerative brain disease similar to Alzheimer’s. But its cause is not from within, like Alzheimer’s; rather it is from injuries. McKee has studied sixteen brains now. All of them showed signs of CTE. Her results reveal that not only do football players suffer concussions and the symptoms that come along with it, but that very same brain damage is leading to early onset dementia. Players, who risk their bodies for entertainment, are losing control over those bodies decades before a normal person would. They are paying a price higher than any salary can cover.

The NFL has responded to these results, along with outcries over the treatment of players. The rules regarding how soon a player can return after a concussion have changed. In the past, players were only kept off the field if they lost consciousness. Now, any symptoms of a head injury prevent such a return. Further, NFL teams are being required to hire independent neurologists who will consult on head injuries. The new rule, in full, states: “Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing and has been cleared to return by both his team physician(s) and the independent neurological consultant.”

These rule changes are encouraging signs that the highest level of the game is taking this problem seriously. It is setting a standard for how football addresses concussions. College and high school programs should follow this standard. The lives of thousands of student-athletes are at stake.

“We certainly know from boxers that the incidence of C.T.E. is related to the length of your career. So if you want to apply that to football—and I’m not saying it does apply—then you’d have to let people play six years and then stop. If it comes to that, maybe we’ll have to think about that. On the other hand, nobody’s willing to do this in boxing. Why would a boxer at the height of his career, six or seven years in, stop fighting, just when he’s making million-dollar paydays? It’s a violent game. I suppose if you want to you could play touch football or flag football. For me, as a Jewish kid from Long Island, I’d be just as happy if we did that. But I don’t know if the fans would be happy with that. So what else do you do?” – Ira Casson

Across the country, student-athletes and professionals alike play the game. We clamber to the couch to watch them play. We listen to the crunch and crack of the hits and cheer them on. And until tragedy strikes, we do not for one second consider what is happening underneath the helmet. Ryne Dougherty and Jahvid Best shock us. Ann McKee’s study shocks us. They take us by surprise because we do not know any better. We blindly admire our gridiron heroes, let them beat themselves silly for spectacle, and come back every week to repeat the process.

But that process is taking lives. It is just now coming to the surface how severe the problem is. It is scary. There is no better word for it. Money spent on new technology, more experienced trainers, and better equipment is only a stopgap. The methodology of John Gagliardi has little hope of catching on in the mainstream. And the standards for concussions treatment can only do so much. The danger we see in football is inherent to the game. It’s part of why we love it so much. Sadly, it seems nothing can be done.

So we keep watching. And they keep playing.

“There is nothing else to be done, not so long as fans stand and cheer. We are in love with football players, with their courage and grit, and nothing else—neither considerations of science nor those of morality—can compete with the destructive power of that love.” – Malcolm Gladwell

(Photo Courtesy NewsOne.com)