• Dave Duerson Concussion Findings Cannot Be Ignored

    Former Chicago Bear Dave Duerson's suicide note said that he shot himself in the chest so that his brain could be studied. The study showed that Duerson had a moderately advanced case of Chronic Traumatic Encephalopathy. Boxers would call this "punch-drunk syndrome." Chris Henry, Merril Hoge, and Terry Bradshaw are all people I know who have had major issues related to concussions. There is also no question that my memory isn't what it used to be, but how do you know if it is related to football or just aging? You don't. From a liability and survival of the game stand-point, I am sure this is an issue the league enjoys discussing about as much as the CBA. But, just as the CBA is now a part of the NFL, so are concussions.

    The league is going to standardized testing for evaluating concussion symptoms on the field and giving doctors final say whether a player will be allowed to continue. If the doctor determines the player is a "No Go" then that player is escorted to the locker room and will not be available to the media after the game. As many of you know, the triangular relationship between the player, team, and doctor is one that I have questioned. Medical decisions should be made between a doctor and his or her patient. Unfortunately, it would be tough for each player to have his own doctor on the field for every game, so team doctors are hired. Even top quality team doctors have built-in pressures to allow players to play as soon as possible. I am confident that team doctors believe they always make the decision that is in the best interest of the player, but when the team is the one that decides who the team doctor will be, the third prong of that relationship cannot be denied. I always ruffle feathers with that comment, but believe me, it is something that players talk about. The greatest marketing tool any doctor can have is being the "Team Doctor" for an NFL team. (For example: If my son needed knee surgery, I would want to know who operated on Carson Palmer for the Bengals and consider him for that surgery. The assumption being that the Bengals have researched the top doctors in town). If I owned an NFL franchise, I would want the players to have a "Player's Doctor" on the sideline as well. If those two doctors concurred on medical decisions, my liability would be reduced.

    The other area of improvement has to come in helmet design. I have had physicists tell me that their should be a hard shell, then an outer layer of padding, and another hard shell. Would it reduce concussions? I don't know, but I am told that nobody could deny that it would reduce the force of the hit.

    Rule changes are another possibility. Some on the worst semi-concussions (I know, no such thing) I received came from two different tackles. First, from having my arms pinned by a tackler and driven back on the turf. When you are driven backwards and driven into the ground, your head whips to the turf. I see it every week in the NFL. Currently quarterbacks cannot be driven into the ground, perhaps that rule should be extended to all defenseless players. By the end of my career, I knew when a whip-like concussion was coming in mid-tackle. There was nothing that I could do about it. The second concussion causing tackle for wide receivers comes from being flipped. I will never understand why the NFL lets defensive backs undercut receivers leaping for a pass. It is an intentional act that will lead to a very serious injury or death one day. The tackle is an easy one to make when a player is in the air. Intentional flipping of defenseless players is inexcusable and should lead to ejection.

    Having two sons currently playing high school and college football, I have a vested interest in this topic. I believe the NFL is serious about making positive changes on the concussion issue. The more it is discussed the better. Maybe some of those new ideas will originate here. I hope so.

    Comments 17 Comments
    1. Swami's Avatar
      Cris,

      Why don't the players hire the team doctors, maybe with a specific funding commitment from the owners, instead of the owners? That would eliminate some of the triangular problems.

      I don't have many good answers on the concussion front, other than to say the brainstorming should continue at full throttle. We're at least moving in the right direction.
    1. Winter's Avatar
      Loved the article Chris! But as far as doctors go, there is only one way for there to be a legit "player" doctor, and it will be a headache.

      First you would need every player on the team to agree on using one doctor. Second you would need to install in their contracts a portion to be taken out to pay for said doctor. It can be done, but this would be the only way to effectively remove the "Team" from the picture of responsibility. Any ideas as to if the players would accept such a proposition?


      I have always wondered why they don't use extra foam or something in the back of players helmets. Possibly reshape them some, but most of the concussion impact doesn't come from the initial blow, but the smashing to the ground creating the whiplash scenario like you stated. Surely something can be created to slow the heads motion inside the helmet.
    1. Dave Lapham's Avatar
      Many concussions come from the "second contact". If a player is knocked off his feet by either being blocked or tackled, concussions occur when it is a one point landing on the player's head into a hard and or frozen turf/field. That whiplash effect you talked about Cris. Players I have talked to fear a hard shell, padded, another hard shell helmet will be too cumbersome and heavy. They are afraid it will slow them down or make it easier to not lift your head to see what you are hitting when your neck fatigues. As we know hitting with the crown of the helmet can cause serious head and neck trauma. I can't understand why with today's advancements a super light, high impact resistant hard shell can't be designed. Take some of the material they use in space shuttles where factoring in these variables is literally life or death. There has to be a super light thin padding out there in there aerospace world that could be used as well. Factoring safety in at all costs regarding rules changes is a must as well. But you will never be able to eliminate head trauma in football. That is why advancement in helmet design and materials must be a priority and investment in all levels of football.
    1. FrzzerBwler's Avatar
      Been wondering for a while if concussions might be what ends our love affair w/ football.
      Remember when boxing prize fights were popular?
      How much has Ali's Parkinsons Disease diminshed boxing's appeal.
      Is a modified racing helmet the answer? Or would the appearance be to much for some? Believe the NFL has looked at it but do not know what came of it.

      Cris mentioned liability, is it only a matter of time before the league is defending itself in a disability or wrongful death suit?
    1. darvon's Avatar
      There can be a lot of modifications in helmet design to reduce concussion and neck trauma. First step is data. Accelerometers in helmets at college and pro level need to feed into a common database public for medical research.

      Then engineers can prioritize the problems, make design tradeoffs and crank out some new helmets.

      I also think there needs to be a uniform G rating, overwhich any player is sidelined for the day. But I am guessing here. It may be that 3 20g impacts are worse than one 40g one. Or that side impacts are 2x worse than front impacts.

      1) Get a whole bunch of data. Make it easy for everyone to use.
      2) Prioritize and state the problem(s).
      3) Design some new safety gear.


      We have just begun Step 1. Let's see if we can complete it.

      Let's see if by the end of this year, there are public databases of Real Time Accelerometer data. That will be difficult, but it has to be done first, before any other step.

      Which teams and schools will be contributing to a central database of hits? Which helmet manufacturers will have accelerometers that generate data in a common format? Will all manufacturer's use a common telemetry format, so the players can choose among helmets? Will the players be forced to use an accelerometer helmet?
    1. wxwax's Avatar
      Great post, Chris.

      I worry that the NFL's sudden about face on concussions, from stalling to taking the issue seriously, is more about PR than it is substantive change.

      I hope I'm wrong.
    1. FootballFan's Avatar
      Quote Originally Posted by darvon View Post
      There can be a lot of modifications in helmet design to reduce concussion and neck trauma. First step is data. Accelerometers in helmets at college and pro level need to feed into a common database public for medical research.

      Then engineers can prioritize the problems, make design tradeoffs and crank out some new helmets.

      I also think there needs to be a uniform G rating, overwhich any player is sidelined for the day. But I am guessing here. It may be that 3 20g impacts are worse than one 40g one. Or that side impacts are 2x worse than front impacts.

      1) Get a whole bunch of data. Make it easy for everyone to use.
      2) Prioritize and state the problem(s).
      3) Design some new safety gear.


      We have just begun Step 1. Let's see if we can complete it.

      Let's see if by the end of this year, there are public databases of Real Time Accelerometer data. That will be difficult, but it has to be done first, before any other step.

      Which teams and schools will be contributing to a central database of hits? Which helmet manufacturers will have accelerometers that generate data in a common format? Will all manufacturer's use a common telemetry format, so the players can choose among helmets? Will the players be forced to use an accelerometer helmet?
      Agreed, discussed this before, I'm not sure where the articles and websites linked are to be found. The key is getting the data, and then starting to look for the relationships with actual injuries. I think it was you that posted the army and auto industry stuff. Protective helmet design is not unique to sports. The military spends a ton of taxpayer money on safe helmet designs, as I'm sure the auto racing industry does as well - (well - not taxpayer money for them!)

      The biggest obstacle in getting something like this going though - is the simple question - what do you do if you don't like the results?

      Is the NFL, and society in general all the way down to pee wee, willing to accept the results and make a change in the game, a fundamental change - if it turns out that the vast majority of head trauma that occurs in a normal play of the game turns out to be very dangerous? Or are they just going to have every player sign waivers?

      I think that before anything like these kind of studies, which are the only way to do it right and find out for real what's going on - for that to actually happen and have any legitimacy to it - that question needs to get answered in public first.
    1. Cris Collinsworth's Avatar
      Quote Originally Posted by Winter View Post
      Loved the article Chris! But as far as doctors go, there is only one way for there to be a legit "player" doctor, and it will be a headache.

      First you would need every player on the team to agree on using one doctor. Second you would need to install in their contracts a portion to be taken out to pay for said doctor. It can be done, but this would be the only way to effectively remove the "Team" from the picture of responsibility. Any ideas as to if the players would accept such a proposition?


      I have always wondered why they don't use extra foam or something in the back of players helmets. Possibly reshape them some, but most of the concussion impact doesn't come from the initial blow, but the smashing to the ground creating the whiplash scenario like you stated. Surely something can be created to slow the heads motion inside the helmet.
      Doctors probably don't get paid to do it. They get other rewards in marketing.
    1. Cris Collinsworth's Avatar
      I am going to ask Dr. Pomeranz to show everyone what brain damage looks like and how it progresses. He has MRI images that make it all too clear.
    1. Darren83's Avatar
      CC:

      Thank you for this most relevant post.

      Have read a lot on this topic over the last few seasons, as concussions and specifically CTE, are at the forefront of my mind when I watch games.

      Chris Nowinski, leader of the heroic effort in Boston to study the impact of football and brain injuries, believes players may ENTER the NFL with concussive and sub-concussive damage. This at a tender age when the brain is still in development. Once that player receives the tremendous impact of an NFL-caliber hit, it may be just adding fuel to the fire. As he said (and I paraphrase), "how come there are pitch counts in little league but nothing for kids with head injuries?"

      How often do we hear, "Johnny loves football; he loves to hit." This is unconscionable, given the evidence.

      It sickens me that Chris Henry was never even diagnosed with one concussion in his career, yet had CTE and tau protein developing on his cerebellum! A Wide Receiver! But in our 24-hour news cycle, here today gone tomorrow.

      Dave Duerson's story is even more outrageous. And people still doubted whether he was afflicted with CTE at time of death. Now we know.

      Aside from a token $1M donation to Nowinski's outfit, where is the leadership at the youth level on head injuries? Not some silly commercials with Arthur Blank and kids running around for an hour! Real leadership. Goodell should have spent last season travelling the country, speaking to youth leagues and high schools on this point. It's truly a matter of life or death.

      Frankly, I found it difficult to watch and analyze games in 2010 based on what I know about Chronic Traumatic Encephalopathy. How many players, our heroes, names on the backs of our jerseys, have it?

      I wish we never have to answer that question. Wishful thinking.
    1. FootballFan's Avatar
      Read more here - started this after the last concussion discussion.

      I hope the link works, if not - maybe the tech support around here can have seome to do

      http://footballpros.com/showthread.p...0390#post50390
    1. GoBigOrGoHome's Avatar
      Lots of quality info in the links in ^^^^^^^^^^^^^^^^^^^this^^^^^^^^^^^^^^^^^^^^^^^ thread.
    1. cml's Avatar
      I think the boxing reference in the initial post is particularly appropriate, Cris, because it seems to me that one of the risks football faces if it does not address the concussion issue aggressively is that it will go the way of boxing - a niche sport, but much less relevant.

      I'm just barely old enough to remember, but when I was little (the early 80s), boxing was on ABC's Wide World of Sports relatively regularly. I remember watching a replay of the Hagler-Hearns fight on TV. At the time, boxing was still one of the biggest sports out there. Steadily, however, boxing dwindled in popularity - and while there were a lot of different reasons for that, I think one of the biggest is that people saw what happened to Ali as he got older and were at least somewhat turned off as a result of that.

      Do I think football will have exactly the same result or be marginalized in the same way boxing was? No, but I'm sure boxing fans never thought their sport would be so marginalized, either. It just seems like the sort of thing that needs to be addressed early.

      As for how, I'm not a scientist or a doctor, but it seems like a combination of rules, teaching techniques, and equipment would have to be the method. I'm not sure any one approach would be sufficient. And I share the concern that the NFL might be focusing on just the rules because it's the easiest to do and makes them look the most concerned, regardless of the impact.

      I am worried that this may be the dominant story around football for a long time.
    1. Cris Collinsworth's Avatar
      I heard one NFL type talk about the fear that middle class soccer Moms would no longer let their children play football. It is not the past the NFL is worried about, it is the future.
    1. TheBMann's Avatar
      Great blog Cris. I wanted to reply to some of the ideas being expressed in some of the comments. I work for a helmet maker, although I won't say which one. But I want to give you the point of view from this side of the equation.

      Helmets were never designed to prevent concussions. They were designed to prevent violent, frequently catastrophic external head injuries, like skull fractures. To their original purpose, they're an unqualified success. But now that those injuries are virtually eliminated, the attention is now focused, quite naturally, on internal injuries, like concussions and MTBIs.

      But there's no such thing as a concussion proof helmet - at least not one that anyone would buy or wear. And there's the rub. Today's athletes want their gear lighter, stronger and faster. We have to strike a balance between what will protect them the best (which they won't buy) and what will sell (which we try to design to protect them as best as possible).

      To address one poster's thoughts: we are constantly looking into new materials from which to make helmets. But, again, we have to find the sweet spot of what will work great but cost an amount that people are willing to spend.

      In terms of the triple layered helmet, the real danger lies in two areas: weight and heat. More players die every year from heat related injuries than head injuries. So, as a helmet maker, we have to be equally devoted to the concept of designing a helmet that not only is as strong as a dinosaur but as cool as an ice cube. The triple layered helmet will weight dramatically more than contemporary helmets, because in order for that middle "foam" layer to do any good, it will have to to be of such thickness as to improve the protective performance of the helmet. It might be 3/4", 1" or even 1 1/2". That amount of padding - of any type - will significantly increase the weight, not to mention the addition of another shell. It's an interesting concept but one that is not realistic, given today's materials. That doesn't mean it won't ever work - but right now, it's not a tenable design.

      Helmets will not be the answer to the concussion problem. It will be, as you said, Cris, a combination of helmet technology, rules enforcement and better coaching and training that will eventually make this problem go away.
    1. darvon's Avatar
      Welcome Bmann.
    1. BuckeyeRidley's Avatar
      Welcome to Football Pros Bmann; THis whole thing is terrible. I hate to see a who appears to be a Good guy go this way. To ensure is death is not an oversight or in vain, I'm sure his family is going to fight in his honor for this type of study.