Is Football As We Know It About To End?

Possibly.

And the culprit will be chronic traumatic encephalopathy (or CTE).

I first learned about CTE after reading a Malcolm Gladwell piece in the New Yorker where he argued that football and a dog fighting are fundamentally the same.

Gladwell's comparison is, of course, specious. And unfortunate, because it obscured, for me, the most interesting aspects of the story: CTE, and its implications for the game we love.

Football players, unlike pit bulls, have free will, we don't engage in massive genetic engineering to create them (culling those who don't come out to specifications), and we don't execute players outside the stadium with a shotgun if they don't play well. Marv Marinovich excepted. We pay the best handsomely and don't house them in kennels, half-starving. There are extant societal and social pressures, to be sure, but football players, unlike pit bulls, are possessed of free will.

We can dismiss Gladwell's comparison, but we dismiss the facts underpinning some of his arguments at our peril.

And the facts are pretty troubling.

CTE is caused by repeated blows to the head and researchers are finding some preliminary results that are troubling. Neurosurgeons have found CTE in the brains of dozens of deceased athletes - many who died in troubling, destructive ways - NFL players, pro wrestlers, and NHL players, and some researchers and many in the media are beginning to link it to early death, psychological issues, substance abuse, and dementia, during and after a playing career.

There are three major rites of passage for a football player: a concussion, a stinger (compression of the brachial plexis), a blown knee. I experienced all three playing only through high school (my first stinger in junior high I proclaimed myself "paralyzed" and thrashed about in confusion while my coaches chuckled at me, taking delight in describing to my mother after practice exactly what it looked like). A concussion wasn't treated with much more seriousness, particularly if it was "mild." We would rewind the inflicting play during film sessions over and over, high-fiving. Stingers were a lesser injury, concussions were of moderate concern, and a knee injury was, of course, tragic, as it meant a blown season and a painful rehab.

Now we know that calculus may be very wrong.

Researchers recently examined former Bengals receiver Chris Henry after his death and noted extensive brain trauma. Trauma caused long before his accident (falling out of the back of a speeding truck, some contend was a suicide).

I've long lamented the increasing pussification of children, the prevalence of helicopter parents (hovering over kids at all times), and the resultant soccer trophy mentality that creates emotionally fragile little monsters, but proper concern over this matter isn't a societal form of hyper-parenting. Nor does proper concern mean mindless What Are We Doing To Our Children, We Are No Different From Ancient Rome babble either.

It's new ground that we don't know much about and it needs study.

Most athletes accept that physical injury is a part of the game, and, indeed risk is why football is appealing. Safety is not an absolute good, whether in dealing with terrorism, deciding to leave your house in the morning, or violent sports. However, we don't respect brain trauma enough and we understand it even less.

We intuitively understand things that bleed - and treat them promptly, but we don't understand degraded neural fibers from poisonous tau proteins unleashed by hits. It's a subtle way to degrade.

The most troubling fact, according to the ESPN article, is that a concussion - diagnosed or otherwise -isn't necessary to cause that trauma:

But it doesn't take a collision with another player for brain trauma to occur. "The brain floats freely in your skull," said Bennet Omalu, a neuropathologist who is co-director of BIRI. "If you're moving very quickly and suddenly stop, the brain bounces."

Bounce your brain enough times and you have the potential for CTE. Even during collisions that are routine. As in OL play, where dramatic hits are infrequent, but constant pounding is guaranteed.

A few observations:

Science

Several dozen athletes dying under troubling circumstances who then have brain-autopsy revealing CTE may be a classic case of self-selection by publicized death. It ignores the millions of athletes without CTE, or, if they possess gradations of it, have manifestations that are benign. This is a crucial point and a context the media all too rarely provides. Aspirin and NSAIDS kill 7,500 a year.

Additionally, CTE also has genetic predispositions, can manifest itself without repeated head trauma, and football may not even be the cause of it. Head trauma as a small child from physical abuse is one possible culprit and also offers explanative value for associated behavioral disorders. This is precisely the sort of abuse that would often not be revealed to researchers in family history interviews. Some people aren't right in the head - with or without the triggers of a blindside hit. And sometimes those hits came from Mom or Dad.

Helmets

I suspect that helmets and "safety equipment" are the majority of the problem. Artificial turf or low cut grass don't help either. A helmet is a hard weapon, offers total freedom from the discouraging effects of impact like a broken nose or lost teeth, and a sense of abandon. You feel invincible. It does not shield the brain. Your brain is floating freely in your skull. A helmet increases concussive force, in much the same way that a boxing glove does for the fist.

Helmets prevent facial injuries just as boxing gloves prevent broken knuckles. Neither was invented for the safety of the person you're hitting. It's instructive that bare knuckle matches would often go on for hours. Put 10 ounce gloves on those men, and you'll find a speedier resolution. When a fighter is spoken of being "heavy-handed", that's not accidental terminology.

Rugby vs. Football

Related to the helmet issue. The most obvious study that needs to be done? Rugby CTE prevalence vs. American Football CTE prevalence. We'd gain some understanding of the impact of the helmet vs. bare head and scrum vs. traditional line play. I suspect CTE could be less prevalent, but there are suggestions that CTE may even impact sports like soccer where clashes of heads are routine contesting headers.

Rules

In its earliest forms, football was almost banned due to on-field deaths because the rules disallowed freedom of space, allowed dangerous offensive formations like the flying wedge, and it even drew the reformist ire of Teddy Roosevelt. Rule changes saved the game.

If CTE proves to be as damaging as believed, or even if it's not and we succumb to media hysteria - what changes could we see?

Outlawing the three point stance (line play would now look more like high school prospect summer camp one-on-ones), and a mandatory three month sit-out for any player with a concussion (some researchers contend that this is sufficient time to cleanse damaging tau proteins), for starters.

Geometry

There is no game on earth, save perhaps hockey, where you're more likely to be hit while defenseless and without expectation.

Some of the violence of football is hard-wired into very rules and geometry of the game...

...linemen driving into each other on every down, a QB earholed by blindside hit, a receiver slaughtered over the middle while looking back at the quarterback, the crackback block. Unless you change the fundamental geometry, you still have a fundamentally concussive sport.

Media Treatment

This issue, as it grows, and becomes increasingly popular, will be treated hysterically as the anecdotal and scientific are intermingled and passion is mistaken for knowledge. See any debate on autism. That's bad for science. That's bad for truth. It's currently not being covered too egregiously (Gladwell's bad comparisons excepted) as it's a technical issue, it "attacks" America's favorite sport - not too popular in sports newsrooms, but as it gains legs, garners the attention of non-sport news rooms and the attention of groups who find it a useful means of attacking Big Sports or Big Society, you'll see that shift. Similarly, reactionary forces will respond in kind (you Yankees tryin' to take my football, goddamnit), obfuscating the entire debate.

Also, expect bad-behaving athletes and their agents to advance CTE arguments as explanations for murder, assault, rape, assholery, and various other social ills. I've already seen it in places as a Roethlisberger defense.

Final Thoughts

I think the science here is very preliminary, the debate itself will be obfuscated with agendas as it hits the mainstream press, there haven't been any number of useful comparative studies, the n's aren't very big, and so on.

But I don't need to see a hundred men walk into an elevator shaft and plummet to their death without calling maintenance. At the risk of making a Gladwellian false comparison with that last image, I don't think the threat is as dire or imminent as that, but this is an issue we need to study, debate what it means to us, and assess what we can do to minimize acceptable risk.

The cynical part of me will offer this though: we've known instinctively, and now the science has widely confirmed, the phenomenon of punch-drunk boxers - slurred speech, erratic behavior, amnesiac episodes. Boxing damages the brain. Our society has made the judgment that men enter freely into the sport and accept the consequences.

We'll do the same with football.

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