Is Football As We Know It About To End?

by Scipio Tex on Jul 1, 2010 4:04 PM CDT in Texas Longhorns and Other Football

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.

Tweet Comment 42 comments | 0 recs |

Do you like this story?

Comments

The extensive, and public, cognitive damage that Muhammed Ali experiences has played no small part in boxing’s move to the margins in the pantheon of American sports, IMO. The day may come where a similar figure in football, similarly beloved, does the same thing.

The thing that most amazed me in the Gladwell piece was the force of the shots to the head that linemen take in practice. Many of those, on their own, are sufficiently strong to create the sort of lesions that have been shown to cause the long-term damage that turned up in the autopsies.

I have no idea what the proper solution to all of this will be. Maybe this will finally turn the US into a soccer powerhouse, much to the pleasure of Huck, Vasherized, Magnus and me.

by Toadvine on Jul 1, 2010 4:15 PM CDT reply actions

As far as helmets, couldn’t putting padding on both sides help? It should help protect the wearer and whomever is hit instead of having the weapon-like hard plastic currently.

by M on Jul 1, 2010 4:23 PM CDT reply actions

Nice piece.

My son left college football early for many of these reasons. He knew college football was going to be more violent than high school. But it’s hard to fully grasp that until you get there.

For most kids, there comes a point that they realize that – this is it. There is no football after this point. And while the scholarship was nice, and the fringe benefits even nicer, the long and short of it is that he didn’t need the scholarship to go to college. Then it becomes a job – albeit a very low paying one, considering how many hours are put in.

A kid starts looking at his future vs. the potential risk to his long term health, and it was an easy decision, especially since he had never been badly injured. He still had his health but saw that almost everyone who stayed with it long enough sustained injuries they carried for the rest of their lives.

by Ag_in_TX on Jul 1, 2010 4:26 PM CDT reply actions

Actually, as Scipio alluded to, there are nearly as many concussions in soccer as football. And those that aren’t concussed can be damaged as well.

The vast majority of soccer concussions occur upon head-to-head contact or unplanned ball-to-head contact, e.g., a ball kicked from close range strikes a defender’s head before they can dodge it. Intentional headers don’t cause many from what I recall.

by Huckleberry on Jul 1, 2010 4:27 PM CDT reply actions

They say we only use about 10% of our brain, but I think we really only use 10% of our hearts.

Ha.

Seriously, good post. Gonna try to keep my wife from reading it though.

by Kevin Berger on Jul 1, 2010 4:27 PM CDT reply actions

I once had a team doctor gives this example. He said put on shoulder pads and a helmet, put your garage door down, go to the middle of the street and then run headlong into the door 20-25 times.

That’s what it is like to be an NFL running back.

by srr50 on Jul 1, 2010 4:28 PM CDT reply actions

Basically the end game is that baseball becomes popular again.

by Huckleberry on Jul 1, 2010 4:28 PM CDT reply actions

“The vast majority of soccer concussions occur upon head-to-head contact”

I can attest first-hand to this one. All 3 of my soccer concussions came from crashing heads.

by Toadvine on Jul 1, 2010 4:29 PM CDT reply actions

Toadvine -

I think boxing declined when the NFL and the NBA offered better terms of employment and boxing’s corrupt governing bodies stood in stark contrast to the professionalism of its comparators, but there’s no doubt that Ali provided a public reminder of the sport’s cost.

What interests me most is if someone can develop a pre-screen tool to evaluate who is the most likely candidate for this. As I wrote, there are a lot of athletes playing football who exhibit no CTE. I wonder – is there a test one can perform to assess likelohood of tau protein formation?

M -

Maybe, maybe not. See my boxing glove example. It may help if the padding is of a type or quantity such that it would minimize concussive force. But players might all look like Lord Dark Helmet.

Remember, the brain if floating free in there.

by Scipio Tex on Jul 1, 2010 4:32 PM CDT reply actions

Great stuff. Adam Jacobi @ Black Heart Gold Pants had a good article here.

by Sailor Ripley on Jul 1, 2010 4:42 PM CDT reply actions

Some brains float freer than others…..

by Ag_in_TX on Jul 1, 2010 4:49 PM CDT reply actions

Ag –

Great point. Your son made a cold rational decision, weighing enjoyment and payoff vs drudgery and injury. I don’t think people fully appreciate how hard the hits are out there on every play. It’s eye opening to stand on a college or NFL sideline.

srr50 -

Increasingly NFL teams are realizing that and platooning two running backs is more and more common. Mike Shanahan proved that the running back is a commodity, other than a handful of specials ones. I don’t think its because they care about long term health so much as they realize that their primary running back is hurt every week.

by Scipio Tex on Jul 1, 2010 4:51 PM CDT reply actions

I think that if the game’s rules were changed to reduce or eliminate the head injuries, it would still be popular (assuming the physicality below the skull were maintained).

It’s funny. People were getting killed and paralyzed in games 100 years ago. Two things happened- the rules were revised (as you mentioned) so that offenses (which initiated the collisions) had to start from a stop (set), and were limited to how many bodies could be concentrated in an area when a play began (7 men had to be on the line). The other change was that protective gear was required. This protective gear consisted of thin leather covers for the head and shoulders, and probably did (and does) more to increase violence than limit it.

I think the first thing they should look at is eliminating intentional head impacts, through regulation and equipment changes. You could put a collapsible shell on the front of a helmet, and everytime it collapses, require the player to sit out a possession.

All of us get tremendous pleasure from this game. Surely the thought that it can damage the players detracts from our enjoyment. The best argument for getting rid of astroturf I ever heard was that it saps players’ enjoyment from the game.

by TaylorTRoom on Jul 1, 2010 4:53 PM CDT reply actions

I actually recieved a concussion playing soccer…co-ed IM soccer… She was a freaking Amazonian. We only had 7 show up for 7 on 7, and our goalie wasn’t one of the people who made it. I drew the short straw for goalie in the second half. Never played the position before. She got past our defense. I didn’t know what else to do other than charge and dive sort of side ways at the ball. I got a piece of the ball, but she got all of my head with her knee. I rolled over on my back to watch the ball slowly roll about 2" past the goal line.

I can give examples of how head injuries are blown off, as I’m sure many others can who played high school sports.

Freshmen at our school were used as practice dummies for the varsity. We were ‘walking’ through plays when one of the WR Srs thought it would be funny to do a crack back on a freshman. I was ‘diagnosed’ with a ‘mild’ concussion by our 67 year old asst coach who’s only qualifications were being a history teacher and staying at a holiday inn. I played in our Thursday game 2 days later.

As a Sr, i got knocked the fuck out playing baseball. I collided head to head with the center fielder going after a fly ball. I was out for a few minutes. I have little to no memory of the following 2-3 hours. I had a nice gash to go along with my swelling head. No one called an ambulance or my parents. The principle finally agreed to let one of the teachers present at the game drive me the 2+ hours back to our town.

by UT-06 on Jul 1, 2010 4:53 PM CDT reply actions

Scipio – Thoughts as it pertains to MMA?

And I like the Roman angle.

I can’t see this ever really threatening football because the audience is so big, so lucrative, and likely callous and/or not sophisticated enough to really worry about this deferred, albeit permanent, damage. Should your point about not everybody having the predisposition switch switched on be borne out, it becomes even less of an issue.

Really, the only potential competitors who would have been likely to switch to baseball or whatever based on these real of supposed dangers are not of the demographic tranche that usually ends up in the NFL anyway.

Big money from an audience of people who don’t really care combined with a talent pool of people willing to roll the dice because the risks are worth it will carry the day.

by Sailor Ripley on Jul 1, 2010 6:09 PM CDT reply actions

I wonder – is there a test one can perform to assess likelohood of tau protein formation?

We should use HenryJames as a test subject.

I suffered two concussions skiing and one playing soccer. The results are evident.

by Vasherized on Jul 1, 2010 6:33 PM CDT reply actions

-UT-06

Ha-ha You got beat by a girl.

by Nelson on Jul 1, 2010 7:01 PM CDT reply actions

I read the Gladwell article, and some other research on it and decided for the first time that I don’t want my son (if the baby my wife is working on is a boy) to play football.

I never would have thought that in the past- when I thought of it as broken arms, broken legs or ripped up knees. I think that stuff is good for kids and every kid should break something in their lifetime or they aren’t doing a good enough job at being a kid.

But when you start talking about brain trauma that is upping the ante to a point I’m not willing to deal with. Maybe football becomes a flag, 2 below type sport or linemen aren’t allowed to contact above the sholders- I don’t know. As I’m a big guy and my progeny would not likely run a 4.5 I’d be looking at an offspring playing on the line or TE- and surprisingly enough from reading the articles that sounds like the most dangerous- essentially because they don’t ever get that kill shot that knocks them out, but they get a ton of barely sub concussive hits. Scary type stuff.

As a soccer coach of high school girls I can tell you that last year we had 30 of them in our program and 6 concussions. It’s not like soccer is completely safe- but anecdotally, those that wore the headgear did not have a single concussive incident. I believe that will probably be mandatory in UIL competiton for soccer inside of 10 years but I could be FOS.

Great article (like just about everything you do is) Scipio. I can hardly wait to buy yall’s coffee table book.

by Wulaw Horn on Jul 1, 2010 7:06 PM CDT reply actions

Toadvine FTW. When a major figure like Peyton Manning suffers it, things will change dramatically.

by ransomstoddard on Jul 1, 2010 7:39 PM CDT reply actions

I decided at an early age that I had no interest in playing football… not that I would have been any good at it. While I had no idea of the exact detail of the reason, this basically was it.

by Bob in Houston on Jul 1, 2010 9:04 PM CDT reply actions

Don’t minimize the effect of headers in soccer. Just like the offensive lineman who gets pounded on every snap, a header inflicts substantial force. The offensive lineman gets tagged every play in a game but the soccer kid gets it numerous times more in practice (almost daily) than in a game. The ball is heavy and hits the head with much momentum (the force is such that most HS girls are very reluctant to use their heads to strike the ball). My kid plays keeper but I have seen how much pounding his HS and college teammates endure taking headers in practice. Several of them have complained to me about headaches.

by BornaHorn on Jul 1, 2010 9:54 PM CDT reply actions

I heard an interview with a former lineman who had talked to a neurologist. The neurologist said that getting hit in a pro game was like getting in a car wreck going 30 mph, with your head hitting the windshield. The reason they don’t die like one would in a wreck is that they are conditioned to it from 15 years of hits. So in other words, we as normal people would die if we were in an NFL game. Scary stuff.

by Bighornfan32 on Jul 1, 2010 10:19 PM CDT reply actions

When does football season start?

Wulaw-if your kids are anything like me, they’ll get knocked around in practice, get knocked out once or twice in a game, and be done with it, and better for it.

I feel bad for the NFL guys, but to me it’s like smoking. You know the risks going in. Athletes having shorter life spans is nothing new. I don’t mean to sound callous at all, but, I wonder how many of you on here are on the other side of the steroid issue in sports. I abhor the use of PED’s. Many on here pay it no mind because of the percieved increase in quality of the sport.

Toadvine, if this is kept up throughout all of sports, everyone will be wearing Petr Cech helmets, like Vasherized on a random car ride to the grocer.

by magnusbleuveigner on Jul 1, 2010 11:29 PM CDT reply actions

Interesting.

Troy Aikman retired after an excessive number of concussions. During the 2009 season, his broadcast partner mentioned changing the rules to further protect the quarterback, and Aikman nixed the idea in short order. He said further rule changes to protect the quarterback were unnecessary and would change the game too much. They should simply consistently enforce the rules that are already in place.

A screening test would be the best solution. There are a number of healthy, happy former football players with ‘normal’ brain tissue leading productive lives. Look at you, Scipio!

by java on Jul 1, 2010 11:53 PM CDT reply actions

My worst sports injury was in coed IM football in Business School.

I was rushing – big fat girl was blocking. I blew by her she stuck her knee out and hit me above my knee on my outer left thigh.

Hurt but oh well. Played that game and a mens game an hour later. Little did I know that blood was gushing out of a severed vein into my leg. Suburalmal Hematoma. Dude said the next day as my leg started to turn blue – better get that checked out thats what happened to Bo.

Turns out if I’d waited another day could easily have lost my leg.

Sports are dangerous but if you are me, essential

by horninhk on Jul 2, 2010 5:41 AM CDT reply actions

I was a high school TE, specializing as an EBS. I would have consistent headaches during the season that would stop as soon as the offseason began. This article does not sit well with me.

by stuckinmn on Jul 2, 2010 7:52 AM CDT reply actions

Our girls hated to use their head because of exactly what you were talking about. Most of the girls we played also didn’t like it. They were fine with headers on throw ins and the like, but taking it from a goalie’s punt at midfield- no how no way. 1 team in the district was willing to do that and they were awesome compared to everyone else in the district. The headers are definately like the offensive linemen example- consistent, sub concussive but probably having some effect. There is a lot of force in taking down a ball that the keeper has kicked that far. The headgear does seem to help. It looks dorky so it’s not real mainstream yet, but basic rule of thumb is once they get 1 concussion the parent insits that they wear the gear.

Boys are willing to give up their bodies more to win then girls, they are more invested so you won’t see them shy away from sticking their head wherever and whenever. Interesting topic.

by Wulaw Horn on Jul 2, 2010 9:26 AM CDT reply actions

Pretty unrelated to football, but I think it’s a lot more tragic that CTE and other brain trauma is going undiagnosed, or purposefully misdiagnosed, in the armed forces – we’ve got former Dean’s List students now unable to read newspapers, or speak without a stutter. Pretty messed up stuff:
http://www.npr.org/templates/story/story.php?storyId=127402993

by TXinDC on Jul 2, 2010 9:33 AM CDT reply actions

This is a typical 5A high school game.

From the boy’s senior year – right defensive end, #45. He had 22 tackles in this game.

http://www.youtube.com/watch?v=RkfwdmOBKek

by Ag_in_TX on Jul 2, 2010 10:06 AM CDT reply actions

They could start by standardizing and downsizing those ridiculous shoulder pads. Trade a few broken collarbones for concussions. Some of those pads are far more about battering rams than protection.

There are plenty of cheap shots every game that could be reigned in. Start calling them more, maybe adopt a red card system. Declare before the season that the NCAA/NFL is getting serious and start with a tape review of every game each week with game suspensions for each infraction. 3 strikes and you’re out for the season. For the NFL perhaps even add a ref or three in the booth that can at any time call down an ejection for unnecessary roughness. Coaches and a-holes would scream but a major sustained effort is the only way to quickly change the culture.

by Rome if you want to, Rome around the world on Jul 2, 2010 12:58 PM CDT reply actions

C’mon, a little sensitivity would be nice.

by Find your love by Drake on Jul 2, 2010 3:22 PM CDT reply actions

One time, at band camp, I got a concussion when this girl hit me in the face with her flute. I woke up confused and my face smelled like tuna.

by Topo Gigio on Jul 2, 2010 3:24 PM CDT reply actions

I already notice a lot of complaining from educated fans about the helmet to helmet flags being thrown. Sounds like it could get much worse in the future.

by dick on Jul 2, 2010 4:32 PM CDT reply actions

Tau proteins bad. Tao proteins good.

by exuLt on Jul 2, 2010 4:57 PM CDT reply actions

Subtitle:
Free at list! Free at list! Great Liquor Cerebrospinalis, it’s free at list!

by exuLt on Jul 2, 2010 5:10 PM CDT reply actions

It’s interesting to see the soccer references. Jeff Astle [http://en.wikipedia.org/wiki/Jeff_Astle] used to be our window cleaner (player wages are a bit better these days huh?), and he immediately came to mind when this story started getting some attention a few months ago; especially in relation to the argument that repeated minor traumas are just as worrisome as the brutal KO hits.

Of course, as the wikipedia article mentions, as it pertains to soccer, at least part of this must have been ameliorated by the new lightweight balls. The things the guys were heading back 30+ years ago were medicine balls in comparison.

by UK_Horn on Jul 2, 2010 5:24 PM CDT reply actions

I don’t remember where I saw it, but I saw an NFL player from the 70s saying they all had afros because the helmets weren’t very good.

Anyway, just put a 1" foam block on the outside of helmets – or make the entire thing foam (no shell). That should help.

by Sugarpants on Jul 2, 2010 11:09 PM CDT reply actions

I think Scipio’s point was that football might be in danger. Odd that an intramurals world cup soccer discussion broke out.

by Satan on Jul 3, 2010 4:37 AM CDT reply actions

I’m getting close to the point of writing off football. IMO, the violence of the sport has already been watered down to the point that it is a shell of the game that was played in the 70s and 80s. I might have to resort to MMA or Australian Rules FB b/c American football is being completely neutered.

by DigglerontheHoof on Jul 3, 2010 7:10 AM CDT reply actions

Here’s how Gladwell protects himself…

http://images.businessweek.com/ss/05/12/bestleaders/image/gladwell.jpg

by horninexile on Jul 6, 2010 10:15 AM CDT reply actions

Change out the corrupted cerebral-spinal fluid with a fresh supply after every game, clearing away the nasty tau proteins in the process. Problem solved. :)

Kidding aside, I don’t think the response is going to be end amateur level football. Just as with steroid use, the edge cases aren’t visible enough to scare most players away. By the time fear has been whipped up sufficiently there may be treatments to diminish the downstream effects of all those hits.

by Gladius on May 2, 2011 3:44 PM CDT reply actions