concussions in professional footballmtopol/index_files/longreport.pdf · the nfl has consistently...

Concussions in Professional Football

Bradley Bernet

Taylor Fracassa

Jarett Margolis

Arley Sarner

Michael Topol

November 23, 2009

Prepared for

National Football League

1402 Washington Hts

Ann Arbor, MI 48109 (734) 647-9856

www.kines.umich.edu National Football League 280 Park Ave. 15th Floor New York, NY 10017 November 23, 2009 To Whom It May Concern, The purpose of this report is to inform you about the prevalence and severity of concussions in the NFL and what steps should be taken to ensure the safety of the players during and after their career with the NFL. Concussions are a very serious concern for professional football players. Suffering from numerous head injuries can lead to very serious long-term health issues such as depression and dementia. Currently, the league’s guidelines regarding head injuries are not in the players’ best interests. League officials should consider establishing a new set of rules to refer to when a player suffers from a head injury.

This report outlines current and past NFL players’ experiences with concussions. It includes research from a number of university studies that have looked at the brains of past NFL players who have suffered from many head injuries and how they differ from a normal human brain. The report also refers to opinions from many different NFL personnel such as a player, trainer, and team doctor. With the collaboration of studies and current news articles regarding head injuries, we have compiled a list of recommendations that we hope will act as a beginning to the changes the NFL will make to ensure the health of its players.

The report consists of a number of recommendations that can be useful to the NFL when it decides to make policy changes regarding head injuries. These recommendations include changes to the current rules, league-hired doctors, and increasing the awareness about concussions and their long-term effects. The report briefly goes over suggestions of rules that can be used as guidelines when establishing a new policy that will be implemented when a player sustains a head injury during a practice or game.

It is important that everyone involved in the NFL is knowledgeable about head injuries and what kind of effects they can have on current NFL players. The NFL should strive to increase awareness about this issue and look to increase the safety of its players. With this report, we hope to enlighten the NFL on the crucial issue of head injuries and persuade the league to make policy changes. After viewing this report, we will be available for any questions or comments you may have. Sincerely, Bradley Bernet Taylor Fracassa Jarett Margolis Arley Sarner Michael Topol

http://www.kines.umich.edu/

Bernet, Fracassa, Margolis, Sarner, Topol v

Table of Contents

Title Page .......................................................................................................................................... i

Letter of Transmittal ....................................................................................................................... iii

Table of Contents ........................................................................................................................... v

List of Illustrations......................................................................................................................... vii

Executive Summary ........................................................................................................................ ix

Introduction ..................................................................................................................................... 1

Background ...................................................................................................................................... 1

Problem ............................................................................................................................................ 1

Purpose Statement ........................................................................................................................... 1

Scope ............................................................................................................................................... 1

Current Studies ............................................................................................................................... 2

University of Michigan Institute for Social Research ......................................................................... 2

Dr. Bennet Omalu ............................................................................................................................. 3

The University of North Carolina Center for the Study of Retired Athletes ....................................... 4

Boston University .............................................................................................................................. 6

League Response to the Studies ...................................................................................................... 6

Statistics about Concussions in Athletes .................................................................................... 8

Past Players Experience with Concussions ............................................................................... 10

Kyle Turley ...................................................................................................................................... 10

Ted Johnson ................................................................................................................................... 11

Bernet, Fracassa, Margolis, Sarner, Topol vi

John Mackey .................................................................................................................................. 12

Mike Webster .................................................................................................................................. 12

Summary ........................................................................................................................................ 13

Congressional Hearings .............................................................................................................. 13

Interview with Various People Affiliated with the National Football League ........................... 16

Ken Montgomery ............................................................................................................................ 16

Dave Price ...................................................................................................................................... 18

Norman “Boomer” Esiason ............................................................................................................. 20

Tony Richardson ............................................................................................................................ 22

NFL Rules and Guidelines Regarding Injuries ........................................................................... 23

Resources for Players .................................................................................................................... 24

Opinions of NFL Personnel ............................................................................................................. 24

Changes to NFL Policy ................................................................................................................. 25

Rule Changes ................................................................................................................................. 25

League Hired Doctors ..................................................................................................................... 26

Increased Awareness .................................................................................................................... 28

Conclusion .................................................................................................................................... 29

Recommendations for NFL Policy Changes Regarding Head Injuries .................................... 30

Reference List ............................................................................................................................... 31

Bernet, Fracassa, Margolis, Sarner, Topol vii

List of Illustrations

Figure 1. Example of a Brain with CTE........................................................................................................4

Figure 2. Rates of Reported MCI & Memory Problems in Football Players ..............................................5

Figure 3. Rates of Alzheimer’s in ex-NFL Players vs. the General Population .........................................5

Figure 4. Rates of Diagnosed Depression in ex-NFL Players ....................................................................6

Bernet, Fracassa, Margolis, Sarner, Topol viii

Bernet, Fracassa, Margolis, Sarner, Topol ix

School of Kinesiology

To: National Football League

From: Brad Bernet, Taylor Fracassa, Jarett Margolis, Arley Sarner, Michael Topol

Date: November 23, 2009

Subject: Rethinking the NFL’s Position & Policy Regarding Concussions

PURPOSE

The purpose of this report is to inform the NFL on recent studies that show potential evidence that concussions

suffered by its players have long-term effects on their health and to provide suggestions for improving their policy

regarding this issue. This will increase the awareness associated with the game of football and better allow people to

protect their safety.

ESSENTIAL SPECIFICS

The NFL has consistently taken the stance of denying any connection between concussions suffered by NFL players

and long-term health problems these players experience. When looking at recent studies done by individual medical

groups and also at the stories of individual ex-NFL players, it appears that it is very likely that some sort of

connection does exist.

This report looks at five recent studies related to the issues. All of these studies have found higher rates of brain-

related disease (CTE, Alzheimer’s, dementia, depression) in ex-NFL players. A couple of these studies show higher

rates of these occurrences amongst NFL players who suffered more concussions during their career. This report

also concentrates on the stories of four specific NFL retirees, all of whom have suffered health problems that are

believe to be linked to the head traumas they suffered during their playing careers.

Due to growing public concern, Congress has decided to get involved in the issue, which has many sides. The main

groups involved are the NFL, NFL players (represented by the NFL Player’s Association), and team medical

personnel. All of these groups are worried with balancing safety concerns with their portion of the billion dollar

industry which is the NFL. This issue is also important because of the health implications for players in college and

Bernet, Fracassa, Margolis, Sarner, Topol x

amateur leagues, which generally follow the precedence set by the NFL. This report tries to get perspectives from all

sides of the issue to better understand what can be done.

CONCLUSIONS

The NFL should set a proper example for other football leagues at the professional, collegiate, and youth levels by

recognizing the results of the recent studies and the stories of former players that show evidence that head injuries

players suffer during their playing days may have lasting effects on their health.

RECOMMENDATIONS

In addition to acknowledging the possible connection between concussions NFL players suffer and health issues they

experience later in life, there are other measures the league can take to better approach the issue. Our proposals

will help the NFL will be more credible in its attempts to help protect the safety and well-being of its players, past,

present and future.

1. The NFL should, at the very least, acknowledge the possible connection between head injuries

players sustain in their playing days and health issues they have later in life, as is being shown in

recent studies.

2. The NFL should consider implementing some degree of mandatory sit-out periods to prevent

players from returning before they are fully ready which could cause them further harm in the short

term and in the future.

3. The NFL should consider implementing a system where doctors are not employed by individual

teams to avoid instances of conflict of interest.

4. The NFL should work to increase awareness of the potential long term health issues concussions

might cause in order to better protect the health of all football players, professional, collegiate and

youth.

Bernet, Fracassa, Margolis, Sarner, Topol 1

Introduction Background

The National Football League (NFL) has always been known as the sport where enormous men collide with

each other at high speeds. The most revered players are often those who strike fear in other teams

because of their hard hits. Just like the big hits, concussions resulting from the hits have been a part of the

game for a long time. Players have traditionally missed the remainder of the game if they suffer a

concussion, but are usually cleared to play the next week; sometimes they miss a couple weeks because of

lasting symptoms, but other times they may return later to play in the same game if they are medically

cleared to do so. The NFL has always taken the stance that concussions suffered by their players do not

have long-lasting effects on their health.

Problem

Recent studies show evidence of possible connections between the head injuries former NFL players

suffered while playing and health problems they experience later in life, including Alzheimer‟s, dementia,

depression, mood disorders, and more. The NFL has produced some programs to help players with some

of these health issues, but they continuously attack the validity of the studies being done and refuse to

acknowledge any direct correlation between problems these ex-players experienced and the head injuries

they suffered during their playing days.

Purpose Statement

The purpose of this report is to further inform the NFL about the dangers of concussions and their long-term

effects based on individual cases and medical studies. This report also contains recommendations for

possible changes to NFL policy regarding treating head injuries.

Scope

This report will look at five studies conducted to ascertain the lasting effects of brain injury. This includes:

two studies done by research groups at the University of North Carolina, one looking at a concussion‟s

connection to depression later in life, and one looking at concussion‟s connection to Alzheimer‟s later in life;

the research by Dr. Bennet Omalu, who first diagnosed the disease chronic traumatic encephalopathy

(CTE), which results from blows to the head; a study by Boston University that further looked into the


prevalence of CTE in former NFL players; and most recently, a study released by the Institute for Social

Research (ISR) at the University of Michigan regarding the overall well-being of former NFL players.

Interviews were also conducted with people connected to the NFL to gather different opinions on the issues

relating to head injuries in the NFL. Those interviewed include two people on the medical staffs of NFL

teams, a former All-Pro NFL player, and a current player who is a member of the Executive Committee of

the NFL Players Association (NFLPA).

Current Studies

“Single incidents of concussion or head injury with loss of consciousness is a fairly well-established risk

factor for subsequent Alzheimer‟s disease that shows up in big epidemiological projects… Typically, head

injury is found to roughly double the risk for developing dementia.” This is a statement from Greg Cole, a

professor of medicine and neurology at the UCLA David Geffen School of Medicine (Reinberg, 2009), and

while this is a commonly accepted statement in the medical community, the NFL has consistently denied

any connection between its league, known for bone-crushing hits, and any lasting effects of head injuries

incurred by its players. There have been a few independent studies conducted in recent years to explore

possible correlations that exist between football head injuries and the future health effects.

University of Michigan Institute for Social Research

A research team from the University of Michigan Institute for Social Research (ISR), composed of David R.

Weir, James S. Jackson and Amanda Sonnega, recently conducted a study at the request of the National

Football League (NFL) and its Player Care Foundation. The purpose of the study was to learn more about

retired professional players, more specifically about their health and well-being.

The study was conducted by interviewing a random sample of 1,063 retired players on the phone. Players

had to have played at least three years in the NFL to be eligible for the survey. Questions in the survey

were derived from the National Health Interview Survey, which is the primary telephone-based survey of

disease prevalence in the United States. This allowed comparison between the retired NFL players and

other men of the same age who didn‟t play professional football. The samples from the NFL were also

weighted to better compare to the general population (This is done to correct for phenomena like the

proportion of African Americans in the NFL being higher than the proportion of African Americans in the

general population).


One section of the survey looked at the mental health of retired football players, including the prevalence of

depression, anger, and dementia. Cases of depression were slightly more prevalent in NFL retirees,

especially younger ones.

In looking at dementia, retirees were asked if they had ever been diagnosed with “dementia, Alzheimer‟s

disease, or other memory-related disease.” In cases where players were unable to answer for themselves,

a proxy reporter (generally the wife) was used in the interview. The results showed that 6.1% of players

age 50 and above had received a dementia-related diagnosis, five times higher than the national average

of 1.2%. Players between the ages of 30 and 49 had received a dementia-related diagnosis at a rate

(1.9%) 19 times higher than the national average (.1%).

The group that conducted the study acknowledged some of the limitations of the study, including:

The only information gathered was if the retirees had ever been diagnosed with a memory-

related disease, the researchers did not actually diagnose the disease themselves.

It is possible that athletes, for whom personal health and fitness was a major aspect of their

career, have greater knowledge and awareness of health compared to the general public.

Athletes might have more access to medical care to be diagnosed for disease than the

general public.

Dr. Bennet Omalu

Mike Webster was a player for the Steelers in the 1970‟s and 1980‟s, and even though he never suffered a

recorded concussion in his career, Webster experienced dramatic personality and mood changes in

retirement. He died at the age of 50 from a heart attack. Dr. Bennet Omalu, a neuropathologist who was

working as a medical examiner in Pittsburgh when Webster died, was able to determine the cause of

Webster‟s death, but was un able to determine the cause of his personality and mood changes.

He eventually got permission to continue studying Webster‟s brain, which looked normal to the blind eye

according to Dr. Omalu. But after microscopic analysis, Dr. Omalu found something that he had never

seen before. Comparing Webster‟s brain to that of a non-football playing person of around the same age,

Dr. Omalu found an accumulation of brown staining in the brain, as shown in Figure 1. These stains were

caused by the accumulation of tau protein, which is an abnormal substance that can develop in the brain

after multiple blows to the head. It can kill off brain cells, which will ultimately lead to cognitive dysfunction,


and sometimes even dementia. Dr. Omalu says

that it is rare to find a buildup of tau protein in the

brain of a 90-year-old, let alone someone who is

50. He named this new disease chronic traumatic

encephalopathy (CTE).

Since this discovery, Dr. Omalu has gone on to

study the brains of seven other former NFL players

who died. He has found similar results in every

case. He discovered that all patients shared

symptoms such as memory loss, insomnia, alcohol

use, drug use and the loss of the ability to engage

in complex mental functioning.

Dr. Omalu believes that one of the causes for these diseases is the helmets being used in the NFL. Not

that they are not well made, but that they give the players a false sense of security that they can use their

heads when hitting other players. When a helmet makes contact with something, it will suddenly stop along

with the skull, but the brain will continue forward to hit the front-inside of the skull and often back to hit the

back-inside of the skull.

Dr. Omalu also points out that even though a player, like Webster, may never have been diagnosed with a

severe concussion, the accumulation of multiple collisions per game over the extent of a career can have a

cumulative effect. (Bashir, 2009)

University of North Carolina Center for the Study of Retired Athletes

The University of North Carolina at Chapel Hill, along with the NFLPA, created the University of North

Carolina Center for the Study of Retired Athletes (CSRA), which “is investigating the spectrum of physical

and mental challenges these retired athletes face” (Center for the Study of Retired Athletes). They have

published two studies regarding the lasting effects of head injuries in retired NFL players. In a study

published in 2005, the CSRA found an association between recurrent concussions during a player‟s career

and then cognitive impairment, including mild cognitive impairment (MCI) and self-reported memory

problems.

Figure 1. Image of a normal brain (left) compared to

the brain of a person suffering from CTE (right).

(Bashir, Oct. 2009)


The study was conducted by having 2,552 retired

players answer a general health questionnaire and

then 758 of these players answered a second

questionnaire that focused on memory problems. Of

the people surveyed, 61% reported suffering at least

one concussion during their playing days while 24%

suffered at least three. Those players who suffered

three or more reported concussions were five times

more likely to have been diagnosed with MCI and

three times more likely to self-report memory

problems than those players who did not suffer

concussions.

Figure 2 shows this relation between the prevalence of MCI and self-reported memory loss in retired

players and how many concussions they had. The

study did not find a correlation between

concussions and Alzheimer‟s disease, but did

observe earlier onset of the disease than the

general American population, as shown in Figure

3. (Guskiewicz, et. al, 2005)

The CSRA also published a study in 2006 that

found a potential connection between recurrent

concussions in NFL players and an increased risk of

depression later in life. The research was done at the same time as the memory study, using the same

sample of ex-players and using questions on the same questionnaires. The results showed that 11.1% of

respondents had been diagnosed with clinical depression.

The rate of depression in players who had suffered one or two concussions was 1.5 times higher than in

those who did not suffer any concussions, and the rate was three times higher in players who had suffered

three or more concussions. These increasing rates are illustrated in Figure 4. (Guskiewicz, et. al, 2006)

Figure 2. Chart showing rates of reported MCI and

self-reported memory problems by how many

concussions the player suffered during their career

(Guskiewicz, et. al, 2005)

Figure 3. Graph showing Alzheimer's rates in NFL players compared to the US male population (Guskiewicz, et. al, 2005)


Boston University

The Center for the Study of Traumatic

Encephalopathy at Boston University found

severe brain damage in six former NFL

players (Lemke, 2009). The Boston

University group looked at cases of CTE in

retired NFL players. CTE, which is common

in boxers, can only be diagnosed after a

person has died. Of the seven brains they

looked at, six showed cases of CTE. All six of

these people were between the ages of 36 and

50 when they died; the one person who did not have CTE was only 24 when he died. One of the bodies

that they looked at was that of Tom McHale, who played in the NFL from 1987-1995 and died in May of

2009 at the age of 45. After retirement, chronic pain led to McHale abusing pain killers, which caused

lethargy and depression. He started using cocaine to offset these effects and eventually went through

three stints in drug-rehab before ultimately dying of a lethal combination of oxycodone and cocaine. His

wife says that McHale never had a diagnosed concussion in college or the NFL, but researchers believe

that brain damage could have played a role in his self-destructive behavior. Some of the symptoms that

they noted that are common with brain damage are: lack of insight, poor judgment, decreased

concentration and attention, inability to multitask and memory problems. The researchers believe that had

he lived, McHale probably would have had full-blown dementia by the time he was 60 years old (Schwarz,

Jan. 2009).

League Response to the Studies

According to Alan Schwarz of the New York Times, “The NFL has long denied the existence of reliable data

about cognitive decline among its players.” Dr. Ira Casson, a co-chairman of the NFL Concussions

Committee, has been the most vocal in these denials. In reference to the ISR Study, the NFL claimed that

the four limitations of the study (no disease is physically diagnosed) make the results inconclusive. Even

Figure 4. Table showing rates of diagnosed depression in

retired NFL players grouped by how many concussions they

have suffered. (Guskiewicz, et. al, 2006)


though the results reflect those of recent similar studies, the NFL also points out that they have not been

published in a peer-reviewed journal (Schwarz, Jan. 2009).

When Dr. Omalu published his findings in the prestigious academic journal Neurosurgery, the NFL

assembled a committee of doctors to demand the retraction of the findings. But the journal approved of the

work Omalu had done and did not retract the findings (Bashir, 2009). In response to the Boston University

study, the NFL once again refused to comment on the results because they had not appeared in a peer-

reviewed scientific journal, “It‟s very hard to react to things and to case studies that are not presented in

appropriate, scientific form and have not gone through peer review… I think there is not enough scientific

evidence to say that there is (an association between head injuries and the NFL)” (Schwarz, Jan. 2009).

Jeff Pash, NFL Executive Vice President for Labor is also vocal in defense of the NFL, saying, “There are a

great many people who have played football and other contact sports for many years and at high levels

who do not appear to have suffered these types of deficits. Whether it‟s President Ford or major business

leaders, whether it‟s people on television.” But Dr. Daniel P. Perl, the director of neuropathology at the

Mount Sinai School of Medicine has a rebuttal for this claim, saying, “Let‟s say 20 percent are susceptible

to something – 80 percent are not going to show anything, but if 20 percent have what should otherwise be

a very rare condition, and that could be the case here, you can‟t rely on the 80 percent to suggest there is

no problem.” So even though the national averages for head injuries are low in NFL players and the

general public, you cannot ignore that the rates for the NFL players are still much higher than that of the

general public (Schwarz, Jan. 2009).

The NFL is currently conducting its own study, headed by Dr. Casson, which is looking at 120 retired

players; it is expected to be released within the next year. Congress has criticized the NFL for having Dr.

Casson lead the research because of his well-vocalized stance on the issue (Lemke, 2009). The NFLPA

recently asked the league to remove Dr. Casson from the league‟s committee on concussions because

they believe he is biased on the issue. NFLPA assistant executive director George Atallah said, “We‟ve

expressed some serious concern about his ability to continue in his role. Because of the historic comments

that he‟s made with respect to discrediting independent research on the subject of concussions and the

long-term impact of football on players.” (NFLPA Wants Concussion Expert…, Nov. 2009)


Statistics about Concussions in Athletes

Injuries happen every day in sports, but the number one undiagnosed sports-related injury is the

concussion. In fact 90% of concussions go undiagnosed because the person suffering from the concussion

doesn‟t know that they suffered one (Pasquarelli, 2007). It is important for an athlete to see a doctor if they

sustain any head injury because the facts about the results of head injuries are overwhelming.

It is important to be knowledgeable about concussions at a young age because statistics show that the

earlier in life a person suffers a concussion, the worse the repercussions are later in life. This is because

younger people have a far less developed brain than adults and their brains are damaged more easily upon

impacts, particularly the types of impacts seen in high school football. According to Alan Schwarz from the

New York Times, 50% of all high school football players have suffered a concussion and of those players,

35% have suffered from more then one concussion within a single season. Many of these concussions go

unreported because high school players are afraid to tell their coaches; they don‟t want to appear weak or

let down their teammates or miss games.

Although it is very important to protect young athletes from concussions, they are not only seen in high

school. At the college level, as well as the professional level, concussions are a reoccurring issue. In fact, it

is estimated that 19% of college athletes who participate in a contact sport suffer from at least one

concussion in a single season (Hairopoulous, 2009). This is significantly lower than seen in high school

students for many reasons. One of the reasons that college players have a lower rate of experiencing a

concussion in a single season is because college football players are much more skilled with proper ways

to tackle and block. Also, college football players‟ brains and bodies have matured a lot more from high

school. Although this number is lower it does not fully account for the amount of concussions that happen

at the college level. According to Quiana Burns of ABC news health, 85% of concussions at the collegiate

level go undiagnosed because of the intense pressure put upon players to perform under any

circumstance.

Once a football player has reached the professional level it is assumed that they have suffered from a

handful of concussions ranging from severe to mild. In fact, in a recent study done by the NFL Players

Association, 61% of players suffered severe concussions during their career in the NFL. Of these players

73% claimed never to be sidelined and continued to play after a sever concussion. From this study by the


NFL Players Association they also found that 30% of players suffered from three or more concussions and

15% of these players had suffered from five or more concussions within their NFL career. Overall, 51% of

players reported in the study claimed that they had been knocked unconscious at least once from a football

hit resulting in a concussion.

Many football players begin their football careers in high school and end their career at the professional

level. Throughout their career they suffer many injuries many of which include head injuries, more

specifically concussions. The high occurrence of injuries in football has led many players in the NFL to

retire early and later have serious medical problems after retirement. In the study done by the NFL Players

Association they found that 49% of the former players had numbness or tingling; 28% had neck or cervical

spine arthritis; 31% had difficulty with memory; 16% were unable to dress themselves; and 11% were

unable to feed themselves. Also 8% were officially diagnosed with Alzheimer‟s disease. According to this

study, all of these medical issues were connected to the many head injuries that they suffered throughout

their football career. It has also been found that players who had sustained three or more concussions were

three times as likely to develop clinical depression and five times more likely to develop mild cognitive

impairments compared to players who had not suffered concussions. (Hadhazy, 2008)

An estimate of 500 deaths from sport-related traumatic brain injuries is reported each year (Gavin, 1999).

With this it is important to better understand the proper ways to handle a concussion. If the concussion is

very mild, a player may be allowed to return to play after 15 or 20 minutes, but if they have memory loss or

lose consciousness they should not be able to return to play for one to two weeks. A player who returns too

early could suffer from “second impact syndrome,” which can be fatal. A second blow to the head, even a

minor one, can cause a loss of control of blood flow to the brain. It is important that an athlete gets cleared

by a doctor before returning to their sport after a concussion. Treating the brain by resting, sleeping,

protecting it from additional impact and abstinence from alcohol are the most efficient ways to recover from

a concussion (Harmon, 1999). This knowledge is important in order to prevent complications that

concussions cause and avoid their potential long-term effects.


Past Players Experience with Concussions

Former NFL players are struggling from post-concussion effects during their post-career life. CTE, brain

damage, and dementia have become common brain related illnesses among retired players, as the result

of the concussions and hits suffered during their high school, college, and NFL playing career. Some of the

toughest players to ever play the game now face altered personalities, diminishing memory, mood swings,

depression, and degenerative motor control due to the toll of hits their brain has endured while playing

football. The results have been terrifying and heart wrenching.

Kyle Turley

Former NFL lineman Kyle Turley is feeling the effects from the concussions he suffered while playing

football and is suffering the effects of brain related illnesses at an alarmingly young age. Turley played in

the NFL for nine years as a member of the New Orleans Saints, St. Louis Rams, and Kansas City Chiefs.

He was known for his extremely physical style, but he never considered himself a player with a loft of head

injuries. (Silver, 2009)

In August of 2009, two years after retiring and at the age of just 33, Turley collapsed at a club for several

seconds with no apparent cause or warning. Shortly after, while battling vertigo, he began to vomit

uncontrollably; his wife rushed him to a hospital. After being admitted to the emergency room, Turley fell in

and out of consciousness for the next several hours. Turley‟s visit to the hospital was life threatening:

“I was having a full-on seizure-type-thing…I was on a table just flipping around like a fish; I was

fully conscious and knew what I wanted to say, but I couldn‟t speak. Realistically, if I hadn‟t gone to

the hospital, my kidneys could‟ve shut down and I probably could have died” (Silver, 2009).

Doctors have not given him a conclusive cause of the episode he experienced that night – or of the

migraine headaches, dizzy spells, and disorientation which have followed – but doctors believe that Turley

is feeling the effects of head trauma suffered during his playing career. (Silver, 2009)

Ever since that night, Turley has evaluated all the hits he has taken while playing football and times where

medical personnel and team officials did not properly protect him after he experienced the effects from a

concussion.


While playing with his first team the New Orleans Saints early in his career:

“I got out of bed one day and ran into a wall. My wife had to drive me to practice … and told [the

team] what was up, [and] all they did was put me in a room, put the lights out and say „lay down

and go to sleep.‟ I was puking all over the place, in and out of consciousness – I probably could

have died. At the end of the day, they called my wife and had her pick me up, and that was it”

(Silver, 2009).

Turley recalled having many of these episodes and recalled that the team‟s medical official never told him

to see a specialist, get any tests, or even figure out if any of his episodes were treatable. (Silver, 2009)

Turley suffers from vertigo, which is treatable, but experts fear that he is on the road to contracting CTE,

the degenerative neurological condition that has contributed to deaths of former NFL players. A big

complaint Turley has, which he referenced before, is that “team physicians are employees of the club, they

have the team‟s best interests at heart, and that‟s having your best players on the field, regardless of

whether that‟s in the best interests of the player” (Silver, 2009). Turley is a person who rarely drinks,

doesn‟t smoke, and leads a healthy life. But, his post-concussion syndrome effectively threatens the rest of

his life. (Silver, 2009)

Ted Johnson

Former three-time NFL Super Bowl winning linebacker Ted Johnson was known for his hard-hitting style of

football. In one game, Johnson tackled an opposing player so hard, the other player‟s helmet cracked in

half (Simon, 60 Minutes, CBS, 2009). By Johnson‟s estimates, he suffered over 50 concussions throughout

his playing career (Simon, 60 Minutes, CBS, 2009). Today, Johnson suffers from depression, dementia,

and brain damage due to post-concussion syndrome. There were times where Johnson would be in the

game with blurry vision and see three of one player. Johnson would continue to play just hoping to hit the

right player. He continued to play because at the time, players did not know how dangerous it was. Now

Johnson is feeling the full effects from playing with those concussions. After retiring, there was a year and a

half period where all Johnson would do is “be in bed with no contact with anyone, curtains drawn, I would

get up to go eat, then go back to bed” (Simon, 60 Minutes, CBS, 2009). Johnson only retired five years ago

and turns just 37 years old in December.


John Mackey

One of the most famous former NFL players to suffer from post-concussion syndrome is former Super Bowl

winning tight end John Mackey. Mackey played nine years with the Baltimore Colts and one with the San

Diego Chargers before retiring in 1972. He is known for his memorable 72-yard touchdown reception with

the Colts in Super Bowl V and has been credited for revolutionizing the tight end position in football.

Unfortunately, Mackey has lately become the poster-boy for former NFL players needing medical support

for brain related illnesses resulting from concussions. Mackey, now 68 years old, suffers from severe

dementia, which has no cure. He first showed signs of dementia in his early 50‟s, 20 years earlier than

common dementia sufferers. He lives in an assisted living center where he gets the attention he needs. His

wife visits him every day in order to jog his memory, which is completely deteriorating. Mackey barely

remembers anything from the past and his days in the NFL, struggling just to remember that he played for

the Colts. Mackey‟s battle with dementia has taken a very large toll on the family economically, which led

Mrs. Mackey to plead with the NFL to get financial support to help her husband. As a result, the NFL

created the 88 Plan in 2007, named after John Mackey‟s number, which gives retired NFL players up to

$88,000 in financial support per year to help with medical costs. The 88 Plan is just the start to helping NFL

alumni in their battle to overcome post-career medical problems and will soon develop into something

bigger as more and more former NFL players begin suffering from post-concussion syndrome. (Simon, 60

Minutes, CBS, 2009)

Mike Webster

One of the most severe cases of post-concussion syndrome is former Pittsburgh Steelers center “Iron”

Mike Webster, the subject of Dr. Omalu's first study regarding CTE. Webster, who died just after his 50th

birthday from a heart attack, was revered for his hard-nosed play, gentle personality, and humor. He went

to the pro-bowl nine times and won four Super Bowl titles. Webster was idolized in Pittsburgh and a hero to

his family. However, after he retired at the age of 38, he underwent a major personality change

experiencing severe mood swings, violent behavior, and rapid memory-loss. Webster destroyed

memorabilia and smashed items around the house. His family “noticed he wasn‟t there for birthdays…he

was forgetting to come home at night…he would disappear for days, weeks on end” (Bashir, Sherwood, p.

1). Webster‟s life was disintegrating in front of everyone‟s eyes. He started “living out of a truck, used a

taser gun to ease his back pain and put Super Glue on his teeth” (Bashir, Sherwood, p. 1). His family and


friends did not know what to think of his behavior, especially coming from a player who “was never known

to have suffered a single documented concussion during 17 years of pro football” (Bashir, Sherwood, p. 1).

As previously discussed, the family agreed to have his brain studied by Dr. Omalu after his death. After

looking at Webster‟s brain, Omalu discovered the CTE in his brain, which leads to cognitive dysfunction

and dementia. All the minor and major hits suffered by Webster resulted in his demise at an early age

(Bashir, Sherwood, p. 1).

Summary

Former NFL players from the early days of the league and the recently retired are feeling the full effects of

brain related illnesses as a result of concussions experienced in their playing days. Players are suffering

from incurable diseases like dementia, brain damage, and CTE and are slowly seeing their lives deteriorate

right in front of them. Quality of life for these players has all but been destroyed and it has taken its toll on

family and friends as well. Looking at these past players now, the NFL needs to further research the

situation in order to prevent current and future NFL players from suffering the same fate as theses past

players.

Congressional Hearings

Recent studies linking brain related injuries to hits suffered by players in football have been a hot topic in

the United States. Rules that do not protect players enough, biased team doctors, and a nonchalant

attitude towards concussions have exposed the country to the dangers of playing football. Congress has

taken note of these studies having heard personal horror stories of past NFL players suffering from

dementia, CTE, and depression, and as a result held Congressional hearings to address the matter with

the NFL.

For the Congressional hearings, Congress summoned medical experts, former players, former and current

team officials, and NFL Commissioner Roger Goodell. The Congressional committee wanted to get to the

bottom of the correlation between head injuries and post-concussion syndrome and discuss the concern

that the league does not do enough to provide care for former players suffering from debilitating brain

injuries.


Representative John Conyers, the Democratic Chairman of the House Judiciary Committee, stated: “surely,

an $8 billion a year industry can find it within its budget to make sure players are adequately protected and

that any victims of long-term brain disease are fairly compensated” (CNN, 2009). Goodell responded to

Conyers by citing multiple policy changes implemented during his tenure as Commissioner to better protect

players‟ safety. More notably, Goodell noted an increase in pension benefits and the creation of the NFL‟s

88 Plan in 2007, which provides up to $88,000 a year to former players suffering from dementia,

Alzheimer‟s or Parkinson‟s, regardless of cause (Associated Press, 2009). Goodell stressed “since

becoming commissioner, [he] can think of no single issue which [he] has devoted as much time and

attention” than to the well being of all the members of the NFL family. (Associated Press, 2009)

With the new collective bargaining agreement negotiations coming up in the next year, questions arose

about the state of the 88 Plan and other measures meant to support past players‟ medical bills and

treatment. Goodell without hesitation declared that “[the NFL] will not reduce or eliminate funding for these

agreements…medical considerations must always come first…[the NFL] is changing the culture of [the]

game for the better.” (CNN, 2009)

NFL teams‟ medical staffs have become a very controversial topic recently as players and non-NFL

affiliated doctors have noted that team-employed doctors put the interests of the teams first instead of the

players. Gay Culverhouse, former President of the Tampa Bay Buccaneers, testified at the hearing stating

that players are too easily encouraged to play with concussions and that team doctors are pressured to

allow players back on to the field before they are ready (Lemke, 2009). Culverhouse believes “you can‟t

leave it in the hands of the team physician to make the decision” because doctors cannot fully serve the

best interests of players‟ health being employed by the team (Lemke, 2009). This is evident by the case of

former Pittsburgh Steelers running back Merril Hoge, who was once cleared to play only five days after one

of his many concussions. Hoge now states that he is losing the ability to read, is suffering from depression,

and is unable to recognize his family (CNN, 2009). The assumption by many inside and outside the NFL

has led to the discussion of having league appointed doctors determine when a player should be cleared to

play, to eliminate the pressure and biases that NFL doctors face.

A large portion of the Congressional hearings brought to light the recent studies conducted on brain injuries

in the NFL. Conyers cited the University of North Carolina study which found that players who suffered


multiple concussions were three times more likely to suffer clinical depression than the population as a

whole (CNN, 2009). In addition, Conyers referred to the other UNC study that showed NFL players

suffering concussions had five times the rate of cognitive impairment, and retired players were almost 40%

more likely to suffer from Alzheimer‟s disease than the population as a whole (CNN, 2009). Lastly, Conyers

referenced a University of Michigan study released this year that documented that more than 6% of former

NFL players over the age of 50 reported receiving a diagnosis of dementia, five times higher than the

national average (CNN, 2009).

Doctors who testified at the Congressional hearings differed on their interpretations of the studies. Dr.

Robert Cantu, who works at the Boston University of Medicine, testified that there “is a serious public health

problem today resulting from repetitive head trauma too often experienced by NFL players” (CNN, 2009).

Cantu studied the brain injury CTE in a former NFL player‟s brain. He firmly stands by the correlation

between football-related concussions and brain problems later in life. (CNN, 2009)

Dr. David Weir, a University of Michigan researcher is not convinced yet that the link is factual. Weir cited a

previous NFL-sponsored study he conducted that showed 96% of NFL retirees reported no cognitive

impairment or dementia (CNN, 2009). He believes “those numbers may or may not indicate an elevated

risk from a career playing football…we can‟t draw a conclusion and no responsible scientist would do so”

(CNN, 2009). Dr. Andrew Tucker, the head team physician for the Baltimore Ravens, noted that “[he]

doesn‟t think it is wise to indict the care being given today‟s players based on reports [from players treated]

a generation ago” (CNN, 2009). Tucker has seen the evolution in the culture of the NFL and mentions that

doctors and athletes take concussions far more seriously today than they did 10 or 15 years ago. (CNN,

2009)

While the Congressional hearings did not result in any immediate changes to NFL policy, it was important

to bring the discussion of brain related injuries suffered in football to the national spotlight. Clearly, more

studies need to be made to further gather information on head injuries in football and brain-related

diseases. Hearing from the NFL Commissioner, medical experts, former players, and team doctors was

very beneficial for all parties and hopefully will spark further change regarding the safety, protection, and

treatment of current and former NFL players.


Interviews With Various People Working in the National Football League

This section of the long report displays copies of interviews that were conducted through email. The people

interviewed have all worked with the National Football League in different ways. The interviewees range

from team medical staff director, to head athletic trainer, to retired player and current sports commentator,

and finally to a member of the National Football League Players Association executive member.

Ken Montgomery

Ken Montgomery is currently the head medical director for the New York Jets; Montgomery has been a

member of the medical staff since 2000. Dr. Montgomery was also the team orthopedist for the New York

Islanders, as well as a member of the Molloy College sports medicine staff. He was a credible choice to

conduct an interview with because of his hands on experience with concussions in the NFL as well as his

overall experience in dealing with sports medicine.

1. Can you explain what a concussion is?

In simple terms it is a minor traumatic injury to the brain that can be manifest with subtle or

obvious abnormalities in cognitive function…the ability to process information, make decisions. It

can also have an impact on balance and coordination.

2. Can you explain post-concussion syndrome?

While most signs and symptoms of concussion resolve quickly (within a few days to weeks), their

are times when more subtle findings may be persistent, and even permanent. These can include

inability to concentrate, depression and chronic fatigue.

3. How do you personally feel about the controversy with the NFL and player concussions?

I think that the attention given will ultimately end up being a positive motivator to encourage team

physicians to be more conservative with players with even low grade symptoms. While most

players recover quickly after concussion, there are times when players are allowed to return too

soon, and this can lead to long-term consequences. We are getting better at this.

4. Have you ever felt pressured to okay a player to go back on the field knowing medically it was

not the best decision?

There are multiple pressures that can be felt. The coaches obviously want their best players on

the field ASAP. Players themselves may also want to return to the game, and claim that they are

fine, even when they still have deficits.


5. Do you feel being hired by a team, as a team trainer/doctor leads you to have a conflict of

interest to the team, instead of the individual player’s health?

There is always a conflict of interest that is present. The bottom line is that we must be there to

protect our players, get them back onto the field as quickly as it can be safely done. In sports

medicine (even with our HS and college players), we are always trying to push the envelope. As

long as we do this with the best information, and the best intentions, with the players input in the

process, we can minimize that conflict of interest.

7. Do you feel league hired doctors would be more beneficial to a player’s health?

I am not sure that would be any less of a conflict of interest. Perhaps a medical staff hired by the

Players Association would be less likely to push the envelope, and would protect the players more,

at the expense of the team…but then who would pay for those medical personnel.

8. What is the protocol in dealing with a player suffering or who has suffered a concussion?

Every team will have a different protocol. Ours consists of 3 sections.

Part one- adequately respond to a verbal cognitive test (days of the week backward, serial

sevens backwards, remembering 3 unrelated objects after 5 minutes (red, block, Broadway).

When they are symptom free and can answer all the questions correctly…

Part 2- when part one is normal, they will do an exercise stress test on the sidelines and if they

remain symptom free (no headache, nausea)…then

Part 3- the players position coach gives him a few plays and sees if he understands the

plays…if he does, he is cleared to return.

9. Can you tell me about the situation with Wayne Chrebet, a player who went on the injured

reserve after a game with post-concussions syndrome?

He developed recurrent symptoms, with less and less trauma required in subsequent events to

cause a concussion. A simple fall to the ground was all that was required as the season

progressed. He was therefore placed on IR.

10. Do you think a neurologist should be present at all games as a member of a team’s medical

staff due to the game relying on heavy physical contact?

I think that if a thorough evaluation (like the one I described) is performed, a neurologist is not

required. They should be consulted, however, for all injuries that take more than a short period of

time to resolve.


11. Have their been more head injuries recently due to the increased violence and intensity of the

hits in the playing of game?

I don‟t have the statistics on that but I suspect it is the case. There have been several new rule

changes this season that have been meant to decrease that risk (no hitting the QBs helmet etc).

12. Do you think having a mandatory two-week inactivity, as it is in rugby, would benefit

players with a head injury?

Every situation is different. Using sweeping rules may not be wise. What if a teams star QB or

receiver “gets their bell rung”, and is functioning clearly without symptoms after 10 minutes? If this

player is required to take two weeks off, that could prevent them from playing in a Super bowl

game or playoff game.

13. What do you think can be changed in the game either in equipment or rules in order to

reduce the amount of concussions that occur?

Many rule changes are already in effect this year for that reason. There are always modifications to

equipment, but I am not sure any helmet or pad will eliminate concussion in this violent sport.

(Ken Montgomery, personal communication, November 8th, 2009)

Dave Price

Dave Price, currently the head athletic trainer for the Kansas City Chiefs, has been with the NFL for now 29

seasons. He was previously with the New York Jets where he was present during the concussion issues

Wayne Chrebet suffered. Being the head athletic trainer “he is responsible for all aspects of the Athletic

Training Department, including the evaluation, management, treatment, rehabilitation and prevention of

athletic injuries,” as stated on the Kansas City Chiefs website.

1. Can you explain what a concussion is?

A concussion is a direct blow to the head causing the brain got be moved and contacting its

protective structures. It is a contusion of the brain.

2. Can you explain post-concussion syndrome?

This is after a player has a concussion and does not clear up with the symptoms. Continued

symptoms classify post concussions syndrome.


3. How do you personally feel about the controversy with the NFL and player concussions?

There is no controversy – concussions happen and we feel we take the best care of them and treat

them properly. At issue is the long term effects of concussions. More study is needed.

4. Have you ever felt pressured to okay a player to go back on the field knowing medically it was

not the best decision?

Never – the player‟s health is always the most important thing, what happens more is that players

pressure you to go back too quickly after an injury.

5. Do you feel being hired by a team, as a team trainer/doctor leads you to have a conflict of

interest to the team, instead of the individual player’s health? Do you feel league hired doctors

would be more beneficial to a player’s health?

No, each team‟s medical staffs are set up differently but all the three teams I have worked with in

the past put players‟ health, safety, and long term care first.

6. What is the protocol in dealing with a player suffering or who has suffered a concussion?

We have a long established protocol in dealing with concussions – it is too in depth to summarize

but there are 3 grades of concussions, when either has happened a player that has lost

consciousness never returns to play that day; any player with retrograde amnesia never returns to

play that day. Also days after a concussion a player never returns to the field for practice or games

unless he has a negative MRI-CT scan, negative neuropsych test (returned to normal baseline

from initial test) and has no symptoms for the past 3 days.

7. Can you tell me about the situation with Wayne Chrebet a player who went on the injured

reserve after a game with post-concussions syndrome?

I cannot comment on particular players injuries due to HIPPA Health Care Directives.

8. Do you think a neurologist should be present at all games as a member of a team’s medical staff

due to the game relying on heavy physical contact?

That would be good, but more importantly is to have an emergency room physician who has

experience with head trauma on a daily basis. A neurologist may not have enough experience with

sport related injuries to the head.


9. Have their been more head injuries recently due to the increase violence and intensity of the

hits in the playing of game?

No, there is just more sensitivity to it and more publicity when injuries happen. Players are bigger

and faster, but helmets have also been improved for protections. Also the way we care for

concussed athletes has improved.

10. Do you think having a mandatory two-week inactivity, as it is in rugby, would benefit players

with a head injury?

No, there should not be such a rigid standard for all MTBI-concussions – more mild traumatic brain

injuries are minor and only require 3-5 days of rest before return – others need more than 2 weeks.

11. What do you think can be changed in the game either in equipment or rules in order to reduce

the amount of concussions that occur?

Nothing, concussions and head injuries will always occur in contact sports. A standard of caring for them is

the most important part of caring for athletes. Head to head contact should never be tolerated.

(Dave Price, personal communication, November 14th, 2009)

Norman “Boomer” Esiason

Boomer Esiason is an ex-NFL quarterback and currently a sport commentator. Boomer played college

football at the University of Maryland, as well as professional football with the Cincinnati Bengals, the New

York Jets, and the Arizona Cardinals. He was also awarded the honor of MVP in 1988, in addition to

participating in the Pro Bowl four times. Currently, Boomer works as a sport commentator for CBS Sports

on a show called NFL Today. He also has a morning radio talk show called Boomer and Carton in the

Morning, with WFAN.

1. What do you know about the incidence of concussions among players?

Concussions are commonplace these days due in large part to the amount of press coverage they

receive. Since diagnosis in now better-understood concussions are given serious concern due to

long-term problems that retired players are facing.

2. Have you ever suffered a concussion? If yes, how long were you sidelined and not playing and

do you feel this was enough time away from the game?

I‟ve had three concussions that were properly diagnosed. In 1987, 1989, and 1995. I only missed

one game in both 1987 and 1989. In 1995 while playing for the New York Jets I missed 5 games


and was entered into a concussion study. The first of it‟s kind. I feel that I was treated correctly

after the last one due to the violent nature of the hit. I was free of all concussion symptoms at the

time and was ready to resume playing. As far as the previous two are concerned, I don‟t remember

(not a joke) the circumstances surrounding them. It was too long ago.

3. Have you ever felt pressured to play when you did not feel ready after suffering an injury?

Most of the pressure comes from within. You feel obligated to play. You end up putting the

pressure on yourself to get back out on the field. There‟s nothing worse then being injured and not

being able to perform. You are also dealing with a sense of insecurity. One would think that a

professional athlete is secure in his ability, but that‟s often not the case. The money and adulation

are so great that an athlete is willing to put themselves back into harms way.

4. Does it make you nervous to continue playing the game with the new studies coming out and

the tie to Alzheimer’s disease and Dementia?

Yes of course it does. As I watch my generation and the generation that preceded me deal with

these issues I‟m concerned. However, I don‟t blame anyone for the decisions that I made on the

field of play. Playing the GREAT game of football has given me many opportunities. I‟ve taken

advantage of most of them. I‟m elated that the NFL and its players are taking this issue so

seriously. I‟m also hopeful that the NFL and it‟s players will continue to support retired players who

need the financial and medical help to deal with their current circumstances.

5. Have you seen any of your teammates or close friends in the game have their life change due to

a concussion?

Not anyone close to me. I have seen others who are suffering. Many of those players have been

documented in the press. The NFL put into a fund, $10 million dollars to help those players. I hope

that there will be more $$$$ and more studies.

6. Do you feel there is a need to make changes in the game to protect players’ health?

There have already been numerous rule changes to protect the players. Also, there have been new

helmet designs. But one must remember that this is a violent sport where very large men are

running into each other. Injuries will occur, it‟s a fact.

7. Do you feel the NFL is supporting your rights as a player, and has your best interests in mind?

The $$$$ are incredible and so are the opportunities. Today‟s players are treated so much better in

all aspects of their NFL career then we ever were. I feel strongly that the NFL is doing everything it


can to make the experience as safe as they can. Remember, the players don‟t have to play if they

don‟t want to. They choose to endure the risks to enjoy the benefits.

8. Do you feel there is a conflict of interest between the team hired doctors and the team therefore

compromising players’ health?

I always felt that the doctors had MY best interest in mind and never once did I feel my health was

compromised. Hell, even the team dentist was great to work with.

9. Do you think having mandatory two-week inactivity, as it is in rugby, would benefit players with

a head injury?

I believe that players should be held out a minimum of 4 games after the first concussion. If a

second concussion happens during the same season that player should be placed on injured

reserve for the remaining of the season. I feel this way because as I answered earlier, you must

protect the players from themselves.

(Norman “Boomer” Esiason, Personal Communication, November 11th, 2009)

Tony Richardson

Tony Richardson is a running back on the New York Jets as well as a member of the executive committee

on the National Football League Players Association.

1. What do you know about the incidence of concussions among players?

I know they occur.

2. Have you ever suffered a concussion? If yes, how long were you sidelined and not playing and

do you feel this was enough time away from the game?

Yes, 1 week, enough time

3. Have you ever felt pressured to play when you did not feel ready after suffering an injury?

No.

4. Does it make you nervous to continue playing the game with the new studies coming out and

the tie to Alzheimer’s disease and Dementia?

No.

5. Have you seen any of your teammates or close friends in the game have their life change due to

a concussion?

No.


6. Do you feel there is a need to make changes in the game to protect player’s health?

No, they made the changes.

7. Do you feel the NFL is supporting your rights as a player, and has your best interests in mind?

Yes.

8. Do you feel there is a conflict of interest between the team hired doctors and the team therefore

compromising player’s health?

No.

9. Do you think having a mandatory two-week inactivity, as it is in rugby, would benefit players

with a head injury?

No, every case is different.

(Tony Richardson, Personal Communication, November 14th, 2009)

After reading through the interviews, it is interesting to note that though some of the interviewees were

asked the same questions, it is compelling to see the differences in the answers based on their position

with a team and the NFL as a whole organization. While one trainer could not say a lot about a player‟s

experience, a player was allowed to openly speak, if he chose to do so, about his experience with

concussions and the game.

NFL Rules and Guidelines Regarding Injuries

Current NFL rules and regulations regarding injuries (mostly concussions and other head injuries) are not

based on the players‟ best interests. Common protocol usually demonstrated after a player sustains a head

injury includes:

1. A player should not return to the same game or practice

2. Players removed from games will undergo repeat testing to monitor recovery and decide when

they can return to play

However, most of these traumas go undiagnosed by team physicians and therefore proper treatment of the

injury does not occur. Usually, a player gets to determine whether or not he feels that he can and is willing

to play.


Resources for Players

Controversy over the players‟ decision of being pressured to determine whether or not he will play after an

injury has led to the development of a number of resources to assist players. These resources include a

hotline and informational pamphlets about sustaining an injury and their options.

Recently, an NFL sponsored hotline was established for players who feel forced to practice or play against

medical advice. This may seem like a useful tool for players, but the chances that they actually choose to

take advantage of it is slim. In most cases, players will choose to play through their injury regardless of how

they feel mentally or physically.

Pamphlets given to all players by the NFL are educational tools for players informing players about the

seriousness of head injuries such as concussions. The pamphlet discusses concussions in general and the

procedures used regarding treatment. The pamphlet also tries to reassure players that current research on

athletes with multiple head injuries does not result in any long-term effects. However, the pamphlet does

not mention that this “current research” is done by an NFL committee and no other outside research source

is cited in the pamphlets. It fails to tell players that other research done outside of the NFL has shown

increased risk for cognitive impairment, depression, and dementia in NFL retirees. The pamphlet also

excludes the numerous amounts of cases which show the increasing number of subconscious brain trauma

in past NFL players and its continued effects.

(How the Codes Deal with Concussion, 2009)

Opinions of NFL Personnel

Commissioner of the NFL, Roger Goodell, believes in and works to defend the league‟s current rules and

regulations regarding head injuries. At a congressional hearing concerning the health of past NFL players,

Goodell told lawmakers that the NFL is continuing to do all it can to keep the safety of its players as its

number one priority. Goodell said that he would be willing to restructure the current guidelines over the

controversial topic of long-term concussion effects. (Lemke, 2009)


Changes to NFL Policy

The issue concerning the football players and their tendency to sustain numerous head injuries during

game play has recently become very intense and controversial. We believe the first thing the NFL should

do is to formally recognize, based on recent studies and health problems faced by former players, that

there is at least a possible connection between head injuries players suffer and lasting effects they may

have. The NFL and Congress are currently working together to reach new solutions about proper

diagnosis, treatment, and care of players who suffer from any type of head injury. In order to do so, some

things are going to have to change regarding the rules and regulations currently upheld by the NFL. Also,

the NFL needs to focus on increasing awareness about the damaging long-term side effects of head

injuries. Some specific things that could be changed in the NFL to appropriately care for the players

include:

1. Rules changes

2. League hired doctors

3. Increased awareness

Rule Changes

The NFL should implement new rules regarding the diagnosis of head injuries from which many current

NFL players suffer. The current rules suggest that a player who experiences a concussion must sit out for

the rest of that game or practice in which the injury occurs. The league should adopt rules that are similar to

the International Rugby Board. Rugby, a very violent sport with much less padding than American football,

has certain rules that are enforced for players who suffer from any concussion. Some of these rules

include:

1. No players are allowed to return to the field if knocked out during a game

2. All Junior and Senior players who suffer from a concussion must take a three-week break

3. Players can return earlier only if a team physician AND neurological specialist says it is okay

(How the Codes Deal with Concussion, 2009)

The three-week period in which a player must sit out during practices and games applies even when a

player suffers from a mild injury or returns to a normal functioning level within a few minutes. One example

of this rule being implemented into real game play was when the rugby team captain of the “Crusaders”,

Richie McCaw, was ruled out of a very important match against its rival, the “Lions”. He had suffered from a


concussion in a match the week before and was then bound by the rules of the International Rugby Board

and forced to sit out for a three-week period. (Concussion Rules out McCaw, 2009)

Although many players and coaches may have problems with the lengthy three week sit-out period, this

international rugby rule may be used as an example for the NFL if they decide to change their current rules

regarding head injuries. It is inevitable that players will always want to get back to playing before they might

be ready and that doctors might feel pressured by these players, or their coaches and owners, to allow

them to play. It is the better interest of the players‟ short-term and long-term health that should remain the

number one priority in any sport organization.

Like Dr. Montgomery and David Price mentioned in their interviews, there are varying levels of

concussions, and thus, treatment varies. So instead of implementing a three week mandatory sit-out

period, the NFL may consider varying the length of inactivity based on the severity of the injury. Current

players, like Tony Anderson, might be opposed to this because they might view this as a rule that will cause

them to lose more time than they need to, but retired players, like Boomer Esiason, have the hindsight to

see that these rules could probably be beneficial in the long run. One problem that a mandatory sit-out

period could have is that it would discourage players from reporting the symptoms of concussions in fear of

being forced to sit out. There could also be the issue of doctors being pressured into giving a less severe

diagnoses in order to not lose a player to mandatory sit-out time; this brings up the idea of league hired

doctors.

League Hired Doctors

The reason why most concussion cases go misdiagnosed is a result of the doctors that examine the

players after they suffer the injury. After being hit and knocked out, a player is surveyed by a team

physician. These doctors are hired by the coach and paid by the team, which means their first priority may

be the team, not the player.

Gay Culverhouse, former president of the Tampa Bay Buccaneers, has recently spoken out publicly about

the issue of team hired doctors. In one interview she states, “…the team doctor is hired by the coach and

paid by the front office. This team doctor is not an advocate for the players. That doctor‟s role is to get

those players back on the field.” Culverhouse‟s statement implies that these doctors do not have the


players‟ best interest at heart because they feel pressure from the coaches to allow a player to continue to

play through an injury. Players also feel pressure to play because they refuse to inform the team doctor if

they have suffered a concussion because they are aware that a backup player will play in their spot.

(Smart Football, 2009)

A solution to this problem was proposed by former Wall Street Journal reporter Stefan Fatsis. Fatsis states

that, “the league and the players should jointly select and oversee of medical staffs... if you take away the

oversight role from the team; maybe the doctors and trainers won‟t worry about protecting their jobs”. By

instituting league-hired doctors instead of those that are hired by specific teams, doctors could focus more

on the health of the players. It would also encourage players to have more confidence in the doctors and

coaches.

There are many advantages to mandating league-hired doctors. Some of these advantages include:

1. By requiring teams to report every injury that occurs, the league can track trends and begin to

take preventative action.

2. Players best interests would be taken as a number one priority thus increasing players‟

confidence in their doctors.

3. Players would be more willing to reveal information about their injury because they would be

provided with a complete analysis of their injury and potential complications that could occur.

4. Doctors would no longer feel they are being placed in ethically uncomfortable situations

because they would no longer feel pressure from coaches.

5. Players could extend their careers because they would be in better health.

6. Doctors would be able to avoid lawsuits regarding malpractice based on theories that the

doctors‟ loyalty is with the team instead of the player.

7. Tension between doctors, players, and coaches would be alleviated.

As stated, players could feel more comfortable revealing injury information, but there also could be an issue

with players feeling the need to hide symptoms of injuries, especially to the head, if they are reporting to

league doctors (or as Dr. Montgomery suggested, NFLPA hired doctors) instead of team doctors, especially

if there are mandatory sit-out periods established. Both team doctors interviewed claimed that league-hired

doctors would not be necessary because they always act with the best interest of the players in mind, but


this is obviously a partial view on the issue. By instituting league-hired doctors instead of those hired by the

specific team, all parties would benefit. Doctors and players would no longer feel pressure to make

unethical decisions about the health of the players. Players would ultimately maintain better health and in

turn be able to lengthen their careers and improve performance on the field. (Norris, 2009)

Increased Awareness

Although the issue of concussions in the NFL has been brought up all over the media lately, there is still a

need to increase awareness about the dangers of concussions. Parents of high school football players and

current NFL players could benefit from increased awareness by learning the facts about concussions and

their long-term effects.

Most people do not know the actual prevalence of concussions. According to the Centers for Disease

Control and Prevention, 1.6 to 2.3 million sports-related concussions occur annually. This is an

overwhelming amount and people need to realize that this does not only happen at the professional level,

but accounts for 8.9% of all athletic injuries at the high school level according to the Journal of Athletic

Training. (Lukosius, 2009)

Some organizations such as the National Academy of Neuropsychology and National Athletic Trainers‟

Association have made efforts to begin to educate athletes, coaches, and parents about the severity of

concussions within the world of sports. (Campaign to Raise Concussion Awareness, 2009)

The NFL should change the content of the pamphlets given to players regarding head injuries. It should at

least acknowledge that that studies show a possibility that there might be lasting effects of the head injuries

sustained by the players during their careers. This is also important to set precedence in looking out for the

safety all football players at any professional and amateur level, because like Alan Schwarz of the New

York Times wrote, “The findings could ring loud at the youth and college levels, which often take cues from

the NFL on safety policies and whose players emulate the pros. Hundreds of on-field concussions are

sustained at every level each week, with many going undiagnosed and untreated.” Sean Morey, a player

for the Arizona Cardinals, adds that, “This is about more than us – it‟s about the high school kid in 2011

who might not die on the field because he ignored the risks of concussions.” (Schwarz, Sept. 2009)

When in doubt, sit them out.


Conclusion

Concussions have always been a part of the NFL and are now a controversial issue. This report found five

independent studies that showed possible connections between head injuries that players suffer during

their playing careers and health issues they have later in their life. We also looked at the cases of four

former NFL players who are now either suffering from health issues or are dead; it is believed that all four

of these men suffered lasting effects from the head injuries they suffered while playing football.

Congress has recognized the issues raised by these studies and recently held hearings regarding the topic.

NFL Commissioner Roger Goodell, retired NFL players, league-affiliated medical personal, and non-league

affiliated medical experts testified at these hearings. The main points of discussion were whether the NFL

was doing enough to protect its players, if team doctors had the players best interest in mind when

diagnosing injuries, if the NFL is providing enough financial support for ex-players suffering health

problems, and if there is a direct connection between head injuries players suffer while playing and health

issues they may have later in life (dementia, CTE, Alzheimer‟s…).

We also interviewed various people involved with the NFL, including current and former players and

members of teams‟ medical staff. These interviews gave us different perspectives on the issues brought up

in the report. We suggest that the NFL rethinks its current stance on not recognizing an actual connection

between the head injuries its players suffers and the long lasting health implications they may have.


Recommendations for NFL Policy Changes Regarding Head Injuries

In addition to acknowledging the possible connection between concussions NFL players suffer and health

issues they experience later in life, there are other measures the league can take to better approach the

issue. Our proposals will help the NFL will be more credible in its attempts to help protect the safety and

well-being of its players, past, present and future.

1. The NFLshould, at the very least, acknowledge the possible connection between head injuries

players sustain in their playing days and health issues they have later in life, as is being shown in

recent studies.

2. The NFL should consider implementing some degree of mandatory sit-out periods to prevent

players from returning before they are fully ready which could cause them further harm in the short

term and in the future.

3. The NFL should consider implementing a system where doctors are not employed by individual

teams to avoid instances of conflict of interest.

4. The NFL should work to increase awareness of the potential long term health issues concussions

might cause in order to better protect the health of all football players, professional, collegiate and

youth.


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