The Hardest Hit: Concussions and Football
by Zaid Safiullah
Concussions are brain injuries caused by a high-impact collision to the head, whether from tackling, blocking, or diving. The impact force of the collision shakes the brain inside the skull, which in turn disturbs normal brain function and equilibrium. Our brain is surrounded by cerebrospinal fluid that cushions it from everyday jolts and bumps, much like a shock absorber. But when one experiences a force greater than what our brain cushion can withstand, our brain can hit the skull – a concussion.
If the brain is bruised, one may suffer the common symptoms of persistent headache, nausea, vomiting, lack of motor coordination, blurred vision, and ringing in the ears. Thankfully, the cure for the common concussion is simple: doctors recommend seven to 10 days of rest and relaxation. In that time, the bruised brain tissue can heal.
Case studies of 12 deceased NFL players performed by the Center for the Study of Traumatic Encephalopathy in Boston show the more severe implications of concussions. Researchers found that concussions could cause permanent brain damage and chronic traumatic encephalopathy (i.e., brain disease), which could contribute to depression. In some cases, like that of San Diego Chargers’ Hall of Famer Junior Seau, it may even have contributed to suicide.
In January 2013, Seau’s family released the results of this study and brought the dangers of concussions into the limelight. Although the saga of Seau is one recent case of traumatic brain injury, it certainly is not the first. Countless football stars have fallen victim to undiagnosed brain disease. So the question remains: is the glory of an illustrious sports career worth the risk? Furthermore, what are sporting associations like the NFL doing to minimize risks for its players?
According to Dr. Stan Herring, a team physician for over 30 years with the San Francisco 49ers and the Seattle Seahawks, the Baseline Test is the first concussion assessment tool used. This test is used to routinely evaluate an athlete’s cognition, memory, balance, and reaction times, among other indicators of physical and mental health. It considers 65 points of analysis, including a recall of five previously dictated words.
The Automated Neuropsychological Assessment Metrics evaluation, originally developed by the Army as part of their baseline health profile, is also performed.
Before the Baseline Test can be validated, two doctors unaffiliated with the NFL must authenticate it. All together, these tests culminate in a comprehensive analysis that provides reference information for team physicians to use when diagnosing brain injuries.
When a high-impact collision like a hard tackle or a dog pile occurs, the NFL may employ a sideline concussion assessment as a follow-up safety protocol. If injury is suspected, a sideline physician will screen players for brain trauma by following a checklist similar to the baseline examination. The results of the sideline test are then compared to the baseline evaluation. Any decrease in results regarding memory, reaction time, or other cognitive function, could be indicative of a concussion. If a player’s results indicate decreased brain function, he will be asked to recall five words and answer basic questions like location, date, and the opposing team’s name.
If a player’s sideline scores are significantly lower than his baseline scores, and the attending team physician suspects a concussion, the player is immediately taken off the field and into the locker room. There, he undergoes more testing by team doctors and trainers. He repeats the Baseline Test to see if more serious action must be taken; this might include hospitalization or further assessment by the team’s neuropsychologist. Each concussion is different. Recovery time can vary from two to six weeks, depending on the player and the specific nature of his brain injury.
Players fearful of temporarily losing their job, or being permanently replaced, could be inclined to withhold pertinent diagnostic information to mislead the team physician and trainers. The NFL hopes the clinical exams that are administered combat these possibilities. To gain insight into the athlete perspective on the game and related injuries, I interviewed former University of Pittsburgh safety Steven Valenza.
“It’s all part of the game,” Valenza responded, when asked about sports injuries like concussions. He had suffered a concussion playing high school football. Valenza continued to explain that injuries like concussions are considered part of the sport – a risk that players take in order to be competitive.
Valenza also affirmed the reality of withholding information when being assessed for brain injury: “If you aren’t able to play because of an injury, there will be someone else that will.” Many high school athletes vie for competitive scholarships to the school of their dreams, and riding the bench for a few weeks can drastically affect their chances of securing such an award.
But what was interesting was the power the coaching staff holds in making playing decisions. “It’s the coach’s final decision whether a player is fit to play or not, but they often take the advice of the trainer,” said Valenza. This implies that a player who may not be 100 percent can still play, if his coach says so. Valenza agreed that this is a dangerous imbalance of authority that allows the coach to sacrifice the health of a player for a chance at improving the team’s record.
It was not until the end of Valenza’s football career that he realized the health risks he had subjected himself to. “If you have big dreams, you’ll do what it takes to achieve them, no matter the cost.” Although he is not taking these risks anymore, there are many high school, college and professional athletes that are. Their safety should be valued more than their statistics.
With all the safety precautions and protocols aside, it is the responsibility of the player to advocate their health concerns. Withholding such information can have dire consequences, including untreated brain disease. At the end of the day, quality of life is far more important than wealth and accolades, and slowly but surely professional sports are turning to protocols that put player health first.