Lentis/Football and Concussions
The number of athletes playing football in the United States has grown since the sports beginning in the late 1800’s. Violent collisions have been a part of game since its inception, with President Theodore Roosevelt threatening the sport's ban if the rough play didn't cease.The inherit risk of injury in the sport has created a social interface where protective technology, football rules, and player culture meet. Approximately 4 out of 100 participants in football per season experience a concussion, and without proper treatment the consequences can have lasting effects on players, “premature return to play by a symptomatic athlete places that athlete at greater risk for subsequent concussion and cumulative brain injury”. The debilitating damage caused by traumatic head injuries in football combined with the growth of football in American culture has led to an evolution of ways to protect players both technically and socially. In this chapter, we focus on professional football, as changes at the highest level tend to trickle down.
Treatment of Concussions
A concussion is a “traumatically induced alteration in mental status". When diagnosed with a concusion, players should be removed from play until the player is asymptomatic. This time period can vary from days to weeks depending on the severity. However, diagnosing a concussion can be a difficult task. In a poll of Wisconsin high school football players, 47% admitted to having a concussion over the course of the season and not reporting it to a trainer or coach. Returning to play early leaves the player at a heightened risk to suffer another concussion and cause more damage, further affecting their long term health.
Once a player is suspected of having a concussion there is no standardized on field test for diagnosis. Players are evaluated by the team trainer or doctor, and the tests for diagnosis are left to their discretion. The tests are designed to evaluate the presence of the immediate concussion symptoms including headache, memory loss, confusion, and slowed reaction time. Some tests involve asking the player simple questions such as, “What field are we playing on?” while others physically evaluate reaction time and hand eye coordination. A test developed at the University of Michigan evaluates whether or not a player suspected of having a concussion has a slowed reaction time. A weighted rope is dropped by the trainer and the time it takes for the player to catch the rope is compared to a preseason time for the player on the same test. The prevalence of physical tests is increasing, but the diagnosis technique is still up to the trainer or doctor’s discretion.
History of the Helmets
Football evolved from rugby and soccer-like games in the late 1800's. Padding quickly became essential, although the history of a helmet did not begin until a 1939 NCAA rule required leather helmets. Increasingly violent play peaked during a 1893 game between Harvard and Yale, deemed the Hampden Park Blood Bath, that almost led to football's banning across American campuses and made minimum protection necessary.
Helmets evolved over the next three decades to include hard plastic shells and face masks. Extreme collisions still caused traumatic head injuries including fractured skulls and brain bleeding. Between 1931 and 1975, there were 18.9 fatalities annually in football, so in 1969 the National Operating Committee on Standards for Athletic Equipment (NOCSEA) was formed to regulate helmets.
What's Mostly Used Today
The National Football League (NFL) has conducted tests on all major helmet manufacturers and concluded that Riddell and Schutt helmets provide the most protection for players from concussions. As a result the majority of players are using the Riddell Revolution or the Schutt DNA Pro helmets.
Removing the Helmet Altogether
A more radical idea is removing the facemask from the helmet or removing the helmet from the game altogether. The idea reflects risk compensation in that helmets make the players feel safe enough to hit other players in a manner they would never do if their faces were exposed, actually increasing head injuries overall. Thus if helmets were not a part of football, players would adjust their risk level and tackle in a way that protected their head. Hard plastic helmets were first created to prevent traumatic injuries like skull fracture, not to address concussions. The development of these helmets changed the way players approached the game and ultimately contributed to the devastating collisions seen today. Australian rules football, or rugby, is a very similar and equally violent game when compared to football, but the players wear no helmets, so they must tackle in a way that protects their head. Studies have shown that players in the NFL are 25% more likely to suffer from concussions that players in the Australian Football League, the rugby equivalent of the NFL. Likewise, concussions occur in high school rugby at a rate of about 1% a year, compared to about 5-7% for high school football.
Regulation of Equipment
The NOCSAE is the regulatory agency in charge of inspecting new and reconditioned helmets. The inspection of the helmets involves various impact tests, meant to simulate "a player running at 17.9 feet per second (12.2 mph) ran into a flat surface which stopped his head in less than one inch." The NOCSAE admits that that most players run faster than this, but the head would rarely be stopped that quickly. This means that certain speeds and intensities of collisions are completely untested. Upon passing of inspection, each helmet receives a certification sticker, as well as a warning sticker that reads:
- Contact in football may result in Concussion/Brain Injury which no helmet can prevent...If you have symptoms, immediately stop and report them...Do not return to a game or contact until all symptoms are gone and you receive medical clearance. NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES, INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL.
The NOCSAE’s critics complain about the lack of significant updates in regulations since the early developments in the 1970's. Tests were originally designed to grade helmets in their ability to prevent skull fracture, and have remained largely unchanged, without specific tests to address concussions. The NOCSAE counters that in order to prevent concussions, helmets would need to be rated about four times better than the standard, and the only way to do this would be to increase the size and amount of padding. Increasing the size of the helmets this much would make the helmet much heavier resulting in neck fatigue, causing players to drop their head down in a manner that leaves them more vulnerable to both concussions and neck injury.
The Culture of Football
Football is an inherently dangerous sport; however, certain dangerous plays, such as tackling a defenseless punt returner who has called for a fair catch or tackling a kicker after he has punted the football, are met with steep penalties  and occur relatively rarely. Helmet-to-helmet hits and concussions continue to afflict more players each week, with an average of 7.7% of all players suffering at least one concussion per year . Since other dangerous football play has been eliminated or reduced substantially, why do dangerous helmet-to-helmet collisions and concussive trauma continue to be major problems?
The answer is not simply in education. When novice football players are taught to tackle, they are instructed to lead with their shoulder, not their head, and wrap up the opposing player in order to take him to the ground, as shown here. Following these guidelines of correct form renders the tackle much less likely to be illegal, cause injury, or miss. Although players know how to properly tackle, they often revert to reckless techniques that expose themselves and their opponent to higher risk, mostly because more violent tackles draw more attention from the media and fans.
From 2003 to 2006, ESPN included a popular segment titled "Jacked Up" . In this segment, the commentators would show the five hardest hits of the previous week. On the NFL website store, a huge number of hits depicting hard hits and tackles are available for purchase. In fact, a picture of linebacker James Harrison's illegal, helmet-to-helmet, concussion-inducing hit on receiver Mohamed Massaquoi was available for sale until the NFL realized their mistake and took it down . The indication is simple: big hits make money. Many fans are attracted to violent hit, which brings revenue to the NFL. As ESPN commentator and former NFL player Mark Schlereth states, "We glorify these hits. We make money on these hits. That's what we do, and the NFL profits on that." .
The Culture of the Players
Many players agree with Schlereth's sentiment that big hits bring them glory and profit. Harrison, who has become the poster child of the NFL's crusade against dangerous hits and has been fined hundreds of thousands of dollars for illegal hits over his career, is also a three-time pro bowl player and was named 2008's defensive player of the year by the Associated Press . Others take the opinion that big hits are simply part of the game. Linebacker Calvin Pace claims, "The game is built of toughness and physicality, and people are trying hard to take that away" . Of course, many of the players voicing these opinions are the ones administering the hits, not taking them, and the ones receiving the new punishments. Many offensive players, such as quarterback Aaron Rodgers and tight end Todd Heap are instead speaking out in favor of the new enforcement, arguing that players' health should be protected and dangerous plays should be prevented .
Culture of Fans
The success of NFL photos, commentary segments like "Jacked Up," and football marketing at all levels show that fans respond positively to heavy hits. A quick internet search for "Jacked Up" actually returns a clamor of fans asking where the segment had gone. The popular football video game series Madden NFL actually includes a "hit stick," a specific control that a user can press while on defense that causes the player they control to deliver a highlight reel crushing tackle . This reinforces the fact that many fans love big hits and encourage such behavior to continue despite the danger.
In addressing the issue of concussions in football holistically there are two paths to change. Some argue for a top-down approach, where professional play needs to be changed and youth players will mimic the professionals. This would create a cycle where the younger players grow up playing less recklessly and become the players that the new youth will imitate. The other approach is bottom-up, focusing extensively on proper tackling techniques in youth football and emphasizing why copying the professionals is dangerous. This way the cycle is broken and the youth will become the professionals that tackle properly and set better examples. With the bottom-up approach, it is also important to address the crowds that erupt in cheers for illegal and dangerous hits. Gary Basset, member of the USA Football Rules Committee, explains:
- "You can talk to coaches all you want, but if the father is over there telling his son something else - to knock someone's block off - and you don't see it, how do you stop that?"
The issue of concussions in football stresses the moral that technical solutions are not enough in society. For effective change to be implemented, the culture behind football needs to be addressed. In this chapter, we focused on the NFL but further authorship could investigate how this culture varies within college and youth football and how to best alter attitudes at these levels.
- Denney, R., Riesman, D., (1951). Football in America: A Study in Culture Diffusion. American Quarterly 3(4). 309-325
- Maroon, Joseph, Mark Lovell, John Norwig, Kenneth Podell, John Powell, and Roger Hartl. "Cerebral Concussion in Athletes: Evaluation and Neuropsychological Testing." Neurosurgery 47.3 (2000): n. pag. Neurosurgery. Web. 20 Nov. 2010.
- Kushner, David. "Concussion in Sports: Minimizing Risk for Complications." American Family Physician 64.6 (2001): n. pag. American Family Physician. Web. 26 Nov. 2010.
- •Collins, Michael, Scott Grindel, Samuel Sears, Guy Nicolette, Peter Indelicato, Douglas McKeag, Mark Lovell, Duane Dede, David Moser, Benjamin Phalin, Sally Nogle, Michael Wasik, David Cordry, and Michelle Klotz. "Relationship Between Concussion and Neuropsychological Performance in College Football Players." Journal of the American Medical Association 282.10 (1999): n. pag. JAMA. Web. 26 Nov. 2010.
- •McCrea, Michael, Thomas Hammeke, Gary Olsen, Peter Leo, and Kevin Guskiewicz. "Unreported Concussion in High School Football Players: Implications for Prevention." Clinical Journal of Sports Medicine 14.1 (2004): n. pag. Clinical Journal of Sports Medicine. Web. 22 Nov. 2010.
- Kutcher, Jefferey, and James Richardson. "Simple test may help judge concussion in athletes | University of Michigan Health System." UMHS Newsroom. University of Michigan, n.d. Web. 25 Nov. 2010. <http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1488>.
- Riffenburgh, B. (1986) Official NFL Encyclopedia. New York City: New American Library
- Watterson, J. (2000). College Football: History, Spectacle, Controversy. Baltimore: Johns Hopkins University Press.
- Echemendia, R. (2006). Sports Neuropsychology: Assessment and Management of Traumatic Brain Injury. New York City: Guilford Press
- Albergotti, R., and Wang, S., (2009, November 11). Is It Time to Retire the Football Helmet?. Wall Street Journal Available at http://online.wsj.com/article/SB10001424052748704402404574527881984299454.html
- Schwarz, A. (2010, October 20). Helmet Safety Unchanged as Injury Concerns Rise. The New York Times. Available at http://www.nytimes.com/2010/10/21/sports/football/21helmets.html
- Davidson, R., (1987). Schoolboy rugby injuries 1969-1986. Medical Journal of Australia. 147 119-120
- Broglio, S., Sosnoff, J., Sung Hoon, S., Xuming, H., Alcaraz, C., & Zimmerman, J. (2009). Head Impacts During High School Football: A Biomechanical Assessment. Journal of Athletic Training, 44(4), 342-349. Retrieved from Academic Search Complete database.
- Pellman, E., Powell, J., Viano, D., Casson, I., Tucker, A., Feuer, H., Lovell, M., Waeckerle, J., and Robertson, D. (2004). Concussion in professional football: Epidemiological features of game injuries and review of the literature – Part 3. Neurosurgery. 54(1), 81-84. Retrieved from Web of Knowledge database.
- NOCSAE. Frequently Asked Questions and Answers. National Operating Committee on Standards for Athletic Equipment. Available at http://www.nocsae.org/faq
- Schutt. How to Properly Fit The Schutt Helmet Systems. Available at http://www.footballamerica.com/assets/all/assets/product_files/DNA_Helmet_Fitting_Guide.pdf
- NFL. (2010). Summary of Penalties. Available at http://www.nfl.com/rulebook/penaltysummaries
- Thomas, Katie. (2010, October 21). N.F.L.’s Policy on Helmet-to-Helmet Hits Makes Highlights Distasteful. The New York Times. Available at http://www.nytimes.com/2010/10/22/sports/football/22hits.html?_r=2
- Schefter, Adam. (2010, October 25). James Harrison says he might retire. ESPN. Available at http://sports.espn.go.com/nfl/news/story?id=5706748
- Cimini, Rich. (2010, October 25). Pace rips NFL for helmet-to-helmet crackdown. ESPN. Available at http://espn.go.com/blog/new-york/jets/post/_/id/2447/pace-rips-nfl-for-helmet-to-helmet-crackdown
- NFLLabor. (2010, October 25). Players agree with stricter enforcement of rules against illegal hits. NFL Labor News. Available at http://nfllabor.com/2010/10/25/players-agree-with-stricter-enforcement-of-rules-against-illegal-hits-2/
- Rybka, Jason. (2010). Madden NFL 06 PS2 Controller Layout - Defense. About.com. Available at http://vgstrategies.about.com/od/controllerlayouts/a/Madden06ps2Cont_2.htm
- Frollo, J. (2010, November 10). USA Football Rules Committee expands wording on illegal hits to head. Available at http://www.usafootball.com/articles/displayArticle/7729/10826