Sunday, January 9, 2005
In the milliseconds it takes for a player's head to recoil from a sledgehammer tackle, his brain swishes like a fat olive in the cocktail glass of his skull. Synapses snap. Nerve fibers shear away. Bathed in a swirl of cerebrospinal fluid, the brain stem twists inside like a dish rag, wringing out cognition.
Some concussions are mild, dizzying jolts that heal quickly. Others cause temporary blindness, amnesia, loss of breathing and permanent brain damage. Long-term effects from repeated blows include depression, punch-drunk syndrome and precursor symptoms for Parkinson's and Alzheimer's disease.
Five concussions in eight years ended the career of former Steelers fullback Merrill Hoge. There was that time he found himself playing in
His wife would tuck her telephone number into his wallet
because, inevitably, he would space out while driving, unable to remember his way home. And sometimes, when he got there, the family didn't look familiar.
He played through the dizziness, the blurry hulks of linebackers coming at him, the excruciating pain of a throbbing skull, because that's what men in the NFL do when they want what's best for their kids.
"You've got to put the pain out of your mind," recalled Hoge, now a respected football analyst for ESPN. "For me, in my last years, the game came down to managing six seconds. You leave the huddle and you say to yourself, 'Listen, I know it's going to hurt. It's really going to hurt, but you've got to suck it up for six seconds.
"And you do, you know? Your world is compacted into six seconds, so you get up, and it hurts, and you say to yourself again, 'Six seconds.' Do it 20 more times.
"'Six seconds.'"
Dings and thungs
But all those seconds can add up to a lifetime of expensive medical bills, and that has the National Football League Players Association worried about the cumulative effects of blows to the brain.
"Those head injuries are going to become what knees, backs have always been," said the union's director of benefits, Miki Yaras-Davis. "Concussions will take the forefront. What's different, from a union's standpoint, is how do you measure the impact of concussions? I have some former players now who are getting Alzheimer's or other organic brain disorders. What's the connection?"
Players who suffer five concussions in a career are three times more likely to experience depression as other men their age, and they carry increased risks for stroke and Alzheimer's disease, according to a landmark 2001 study of nearly 2,500 former pros conducted by Dr. Julian Bailes, a
Bailes' research found that three of five retired NFL players had experienced concussions on the field, and 11 percent later suffered from clinical depression.
Seven of 10 players reported they didn't come out of the game after hurting their heads -- a practice that increased the risk of future concussions and could have killed them on the spot had they received another jarring blow, a rare phenomenon called "second impact syndrome."
Players say they're trained from Pop Warner days to shrug off the "dings" and "thungs" because their teams need them. A 2002 NCAA study of college football players found that up to 72 percent of concussions go unreported, a reality pros say continues every Sunday.
"I got so dizzy, I dare say there were minor concussions," said Steelers star running back Jerome Bettis, reflecting on a 12-year romp through the NFL.
"But that's one of those things. What are you going to say? As a running back, you're going to get a slight concussion four or five times a season, but it's not something you talk about. You're always going to take some dings."
Head games
On weekly injury reports, NFL clubs documented 203 brain "dings" in 2000 through 2003. The highest rates were suffered by players involved in high-speed collisions downfield -- wide receivers, running backs, tight ends, defensive backs -- and quarterbacks, who are often blindsided by larger, faster men.
There are likely far more concussions than the teams report, says Dr. Elliot Pellman, team physician of the New York Jets and chairman of the NFL's subcommittee on mild traumatic brain injury. He estimates 200 players suffer concussions every year -- four times the rate clubs disclose to each other.
By analyzing game video and then recreating the explosive impacts with crash-test dummies, Pellman found that 71 percent of all NFL concussions came from helmet-to-helmet contact.
But much of the impact wasn't absorbed by the crown of the head, where researchers used to believe most blows landed, but rather by the face mask, sides and backs of helmets. Other concussions stemmed from glancing tackles against the body that violently twisted the head, sloshing brain matter like yolk in a shell.
Pellman found that nearly a quarter of players had problems with memory, amnesia or processing information after receiving a concussion, but more than half of all pros returned to practice the next day.
Nearly 36 percent continued to play in a game despite a concussion. About 16 percent returned immediately to the field after a concussion was diagnosed. Pellman said that minority might be a unique "subset of players" pre-disposed to withstanding head trauma.
"We need to deal with the issue of concussions scientifically, not emotionally," he said. "There is a small subset of players who can return to the game. You make sure they're properly cleared through testing. "
Pellman says that the NFL "has never been more proactive" about brain trauma and will continue to "fine-tune" diagnoses and treatment because of the "millions and millions of dollars" the NFL has spent on medical research.
Pellman's research already has changed the way helmets are manufactured and tested, and new designs are expected to help reduce head trauma. Pellman believes the NFL's focus on concussions is filtering down to the franchises.
As running backs coach for the Washington Redskins, Earnest Byner agrees, saying he's now far more cautious about his players' head injuries that he was about his own during a 14-year career. In his day, a player went right back onto the field. That's not something he expects from his rushers.
"I tell the guys sometimes, like if I forget to call someone the right name or something, 'I took too many hits, fellow. You've got to understand that,'" he said.
"I'm sure my brain was jarred, probably, 15 or 20 times. Easily. When I got hit there was a 'THUNG!' Like one of those sounds. It was a sound, but it was like a feeling, too. Easily 20."
Second opinions
While many neurosurgeons are glad to hear coaches like Byner take head trauma seriously, others remain concerned that Pellman and the NFL underestimate both the number and severity of concussions in the league. Pointing to a 1997 study of the Canadian Football League that reported nearly half its players suffered concussions annually, they fear the NFL is trying to hide a major health problem.
"The NFL is not really reporting any kind of problems with concussions. They're trying to make the point that the NFL is different. They say, 'These are preselected players. This is a safe league. This isn't dangerous.' But look at the Canadian Football League. They're a fairly comparable group. They're often interchangeable players. They reported a 47 percent incidence rate," said
The Steelers' team neurosurgeon, Dr. Joseph C. Maroon, estimates 30 to 35 mostly mild concussions a year for his team. That puts the Steelers' rate of brain trauma closer to the CFL findings than the NFL research.
To remedy head injuries, Maroon screens the Steelers before the season to determine how their brains function normally. If trainers or coaches suspect a player suffered a concussion, he's immediately withdrawn from a game and is sidelined until he either passes a computerized test indicating his brain has returned to preseason "baseline" levels or a neurosurgeon says he's OK.
"I can assure you that no Steeler player ever returns to the field unless we certify him ready to go," said Maroon, a pioneer in the diagnosis and treatment of brain trauma at the University of Pittsburgh Medical Center. "That really should be the standard of care for every NFL team."
Trainers and doctors leaguewide pointed to the Steelers as the model for concussion care, but 12 of the 32 franchises still don't use computerized baseline testing designed by Maroon and colleagues Mark Lovell and Micky Collins to screen concussions.
That surprised researchers from
"The computerized testing is important because it gives you an objective assessment of where a player is as he heals," said Dr. Alex Collie, developer of the Concussion Sentinel computer program used by Notre Dame and the British boxing team. In the American Football Conference, only seven of the 16 franchises follow the Steelers' model of a computer in the clubhouse and a neurosurgeon on the field.
A handful, including the Buffalo Bills, Miami Dolphins and Pellman's Jets, didn't report following either standard.
A severe car wreck
Many of the innovations in preventing concussions from football aren't coming at the professional level. At
Some players, however, had collisions measured at more than 120 G's, which is akin to a severe car crash. This year, Duma's team linked the detectors in the helmets to beepers on the sideline, allowing doctors to monitor in real time the hits that cause concussions.
"Otherwise, the medical staff might not have a clue whether a player has received a concussion," Duma said.
Duma believes Virginia Tech's technology can be adapted for the NFL game, and researchers are now comparing the field data with medical files to see if hits on the gridiron are linked to health problems later.
Other reforms seem impossible to implement. Because they play on concrete-hard AstroTurf, the Rams became so concerned about concussions that they asked Dr. Rosanne Naunheim, a professor of emergency medicine at
"It would be harder for players to cut, harder for them to generate force and speed. It would be similar to what some players
already experience on muddy fields -- kind of like playing on a marshmallow," she said.
Pros can control some of their neurological fate by simply letting a doctor rub their gums with a cotton swab.
An unusual type of protein embedded in the genetic structure of a human cell, apolipoprotein E4, signals a greater risk of receiving a concussion.
Most players interviewed by the Trib strongly objected to any mandatory genetic tests designed to protect their health.
"Knowing what I know now, I would say I would (get the test). But if the question was asked when I was first coming into the league, 'Would you like to know, even if it means you can't play fullback?' The answer would have probably been, 'No,' " Hoge said.
Carl Prine can be reached at cprine@tribweb.com or (412) 320-7826.
Images and text copyright © 2006 by The Tribune-Review Publishing
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