In February 2010—before the suicides of football’s Dave Duerson (2011), Javan Belcher (2012), and Junior Seau (2012)—Deborah Blum, a University of Wisconsin professor, published an Op Ed about football safety in THE NEW YORK TIMES entitled, “Will Science Take the Field?” She began her essay with a quote from an article published in THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION:
“There is a very definite brain injury due to single or repeated blows on the head or jaw, which cause multiple concussion hemorrhages. … The condition can no longer be ignored by the medical profession or the public.”
That quote is from October 1928.
The JAMA article wasn’t the first concern expressed about safety in football. More than 20 years earlier—in 1905—18 players died from injuries suffered on the field (15 high school and 3 college players, pro football didn’t exist then), an outcome that precipitated a national conversation about abolishing the game. President Theodore Roosevelt got involved. He called for reform, voicing his concern about football violence during a Harvard University commencement address that year.
He got his way. In December 1905 representatives from over 50 colleges and universities met in New York City. They changed football’s rules with safety in mind, banning the dangerous “flying wedge” and legalizing the forward pass, among other things.
Courtesy: Bleacher Report
Over a century later, football safety is still a matter of national concern. In 2013 President Barack Obama talked about football during an interview with THE NEW REPUBLIC. The President said he’d “think long and hard before allowing his son to play.” And while he noted that professional players are “well paid, have a union, and are grown men,” he raised other questions, particularly about college play: “You read some of these stories about college players who undergo some of these same problems with concussions and so forth and then have nothing to fall back on. That’s something that I’d like to see the NCAA think about.”
Unfortunately, his words were prelude to tragedy. Just a few months later, in May 2013, Cullen Finnerty—star quarterback on the three-time Division II national champion Grand Valley State University football team—died mysteriously after disappearing in the Michigan woods.
What Duerson, Belcher, Seau, and Finnerty have in common—and football great Mike Webster before that—is Chronic Traumatic Encephalopathy (CTE), a progressive, degenerative brain disease. According to Boston University’s Center for Study of Traumatic Encephalopathy CTE “triggers progressive degeneration of the brain tissue.” It “can begin months, years, or even decades after the last brain trauma or end of active athletic involvement.” Among its many manifestations are “memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.”
The anguish of CTE has been widely chronicled recently in books, articles, and film, most notably by BU’s Christopher Nowinski’s in his book, HEAD GAMES, and in Steve James’ acclaimed film documentary with the same title.
But the question Dr. Blum posed in 2010 (about the role science might play in this matter) is not only still relevant, it’s central to making progress on addressing the causes and implications of CTE—especially with what science has revealed in the last several years.
What many thought would be the most direct route in football—building a stronger, more absorbent helmet—hasn’t yielded expected results. The proble m is straightforward: at issue isn’t fitting a helmet to the skull because it’s the brain within the skull that needs to be the focus of attention. So it’s not surprising that new helmet designs don’t offer more protection from concussions. In fact, there also aren’t major differences across brands, even over time. Consequently, older and new designs work about the same.
And what makes CTE a particularly ornery disease is that research reveals that many athletes are at risk, not just football players, by engaging in everyday play—including the types of activity that were thought to be outside the bounds of the disease. Regular contact—even jostling of the head—can cause brain injury due to what’s called “brain slosh,” especially when it’s repeated over extended periods of time.
Athletes in certain sports, most notably football and hockey, are certainly more at risk because of the nature of those games. However, research and clinical practice is showing that athletes in other sports—one’s not previously interpreted as “contact”—are susceptible to CTE, including baseball. Witness the impending ban on slides into home plate as mandated by Major League Baseball, a policy certainly influenced by Ryan Freel’s suicide in late 2012. Freel, well known for his aggressive style of play, was diagnosed (through autopsy) with CTE.
And women may be especially at risk even though there is no direct evidence to date of gender-bias associated with CTE. However, as Dr. Peter Pressman noted recently in an article published in ABOUT.COM NEUROLOGY, “women have a more prolonged recovery from concussions than do men.” This brings into the picture concerns about women participating in sports, including soccer and basketball.
Where might science go next in research on CTE? One direction was discussed recently in a fascinating article published in THE NEW YORK TIMES. In it Gregory D. Myer, Director of Research in Sports Medicine at Cincinnati Children’s Hospital, discusses the potential application of “biomimicry” as a means to address CTE.
The word biomimicry is drawn from the Greek roots—“of life” and “to imitate.” Biomimicry fuels human ingenuity by asking and answering: “Is there an example in nature for humans to model?” For example, the Wrights’ airplane design was inspired, in part, as they observed pigeons flying.
Courtesy: Business Insider
Enter the woodpecker. For a variety of reasons the woodpecker devotes a considerable amount of time to hammering wood using its bill. The bird pecks away without concern for damage to eyes, nose, and brain. The reasons for no-harm are many and complex—including brain size and its location in the skull—but the bottom line is clear: the animal’s skeletal structure and physiology well suits the task.
And woodpeckers aren’t the only animals that use their head as a tool. Bighorn males are called “rams” for a reason: they butt heads. This head-to-head activity is ad hoc, but repetitive; and the task would otherwise cause harm if it were not for a number of protective physiological adaptations. Among other things, blood flow in Bighorn Sheep is regulated while butting—from head to body and back again to head—with increased blood flow to the brain, which creates a “Bubble Wrap” effect, protecting the brain.
While there’s much more to the story in both cases, what’s intriguing about woodpeckers and rams—animals that use heads in a seemingly destructive ways, but without suffering head injuries—is the possibility of applying animal behavior to addressing a human problem related to sports activity.
In his article Myer discusses another “natural phenomenon” that may hold promise in the fight against CTE. Researchers at his institution wanted to know if there are any circumstances where concussion rates are lower than the expected norm. They found a circumstance—higher altitude. High school football players who play at higher altitudes have about a 30 percent reduction in concussion incidents. Higher altitude, Myer asserts, increases the volume in the cerebral venous system, which creates a natural Bubble Wrap surrounding the brain, a “snugger fit inside the skull.” That finding takes us back to the Bighorn Sheep example.
How these findings might influence the quest for CTE solutions is unknown at this point, but knowledge provides a foundation for innovation.
What makes this work important are the stakes involved. It’s almost inconceivable to think about the fall season without football or kids not being able to participate in sports for fear of long-term injury. But are those outcomes far-fetched? No.
The NFL found a short-term way to deal with CTE and related issues for its former players because it has the resources to do it—by negotiating a $765 million dollar pay out over 20 years “to compensate victims, pay for medical exams, and underwrite research.” The League’s estimated revenues for 2013-14 will be “north of $9 billion dollars” according to FORBES magazine’s Monte Burke; and Burke reports that Roger Goodell, NFL’s Commissioner, has his sights set on annual revenues of $25 billion in less than 15 years.
Other professional leagues may be able to compensate victims for CTE’s damage and the NCAA may be able to do that as well. But do we want to live in a society where sports participation and litigation go hand-in-hand? And what about local school systems, the “Y,” and all the other organizations that organize and offer youth sports programs? They can’t possible withstand litigation costs; and the nature of these institutions would inhibit them from putting youth at risk in the first place.
And how many parents will be willing to sign paperwork authorizing their children to participate an activity that may lead to mental incapacity, perhaps even suicide, later in life? What seemed to be a relatively simple solution just a few years ago—“We’ll have Johnny play soccer rather than football”—isn’t so simple today given what we know from research.
It’s a frightening thought—to have our sports compromised, if not taken away—but the possibility isn’t outside of the imagination. In response to the recent announcement that Tony Dorsett has signs of CTE this article appeared on a Georgia Tech sports site: “Is the end of college football coming to a university near you?”
In 1905 the crisis was caused by athletes dying on the field, but in 2014 there’s a ticking time bomb: with concussions today, there’s potential nightmare down the road. The numbers are frightening. The Medical Center Sports Medicine Concussion Program at the University of Pittsburgh estimates that 10% of U.S. high school athletes in contact sports will suffer a concussion this year; and the number of sports- and recreation-related concussions ranges between 1.7 and 3 million annually (300,000 football-related). These numbers are underestimates, though: half of all concussions either go unreported or undetected.
What Americans want their games and they want their games played safely. But, in today’s world, the sporting public can’t eat its cake and have it, too: the games are played with risk.
We need to resolve this matter. And, as wild as it seems, the woodpecker may hold the answer.
