Hurting the head

Why NFL injuries keep getting worse

[Via The Crosscut Blog]

The latest cover story for Time magazine is, ahem, particularly well-timed. My snail-mail version arrived the day before the NFL Pro Bowl game and on the eve of the excesses of Super Bowl week.

The story is ostensibly about football injury but focused almost exclusively on concussions: injuries suffered when the skull abruptly stops but the encased brain continues moving and is damaged by cranial impact. Sensible reforms are offered by author Sean Gregory and others.

It’s a story of Northwest interest if only because it quotes from the anecdotes of a young Port Angeles player and also notes the Zackery Lystedt Law, passed last year in Washington state. The law requires that young athletes suspected of sustaining concussions sit out football until licensed medical providers trained about concussions clear them to play. Interviewed is Seattle attorney Richard Adler, a primary designer of the law.

The author of the not-oppressively lengthy piece dwells almost exclusively on head trauma. The fact is that myriad other injuries are incurred as part of the spectacle of football, the nation’s fan-fave sporting attraction.

A few years ago I asked a well-known, Seattle-bred athlete and decade-long NFL player to recite for me briefly the injuries he incurred during his pro years. He started with the top of his body and eventually, about 10 minutes later, had worked his way down to the ankles (sprained) and toes (broken). Then he observed that football would continue to get more dangerous if only because of the inevitable consequences of physics: bigger, faster athletes in constant contact.

The thought of this occurred to me an hour after finishing the Time article, as I met with parents of a prized high-school player thinking about coming to the University of Washington and becoming a major in the Department of Communication, where I teach. He was among perhaps two-dozen potential recruits. Virtually all of them appeared as big and perhaps as strong as guys I see in the Seahawks locker room, even though the visitors obviously are all still in high school and no doubt getting bigger and faster all the time.


The article discusses Dr. Ann McKee’s research, which I have mentioned before. She has been studying the brains of Alzheimer’s patients. She got a brain of a recently deceased football player. Staining revealed a pattern that was completely different from Alzheimer patient brains.This is what led to her current research.

Be sure and watch the video.You can download the PDF of the research report at her lab website. As you can see, this is very recent work and, in the case of football players, quite disturbing in its current focus.

We have expected boxers to suffer from this. So much so that we have the term punch drunk to describe it. Not so for football players. It is hard to know if this is a more recent problem only because the size and speed of modern football players have crossed some sort of momentum threshold.

Or perhaps there is some sort of genetic factor, predisposing some people to massive tau bundles if they get hit, while sparing others. The McKee paper seems to indicate that there might be, although the numbers are very low. The Apolipoprotein allele E4 may play a role. 50% of the brains McKee examined had at least one copy of this particular allele, whereas it is only found in 15% of the normal population. One football player actually had 2 copies of this allele. Maybe people carrying this gene should be discouraged from playing football. We just do not know enough yet to be sure.

The problem of concussions really seems to crop up in offensive and defensive linemen, who get thousands of sub-concussive hits a season. These are the ones who sustained so much damage that their cognitive processes were impaired, resulting in obvious external changes in their behavior. Here is how former NFL lineman Kyle Turkey describes it:

Lately, I’ve tried to break it down,” Turley said. “I remember, every season, multiple occasions where I’d hit someone so hard that my eyes went cross-eyed, and they wouldn’t come uncrossed for a full series of plays. You are just out there, trying to hit the guy in the middle, because there are three of them. You don’t remember much. There are the cases where you hit a guy and you’d get into a collision where everything goes off. You’re dazed. And there are the others where you are involved in a big, long drive. You start on your own five-yard line, and drive all the way down the field—fifteen, eighteen plays in a row sometimes. Every play: collision, collision, collision. By the time you get to the other end of the field, you’re seeing spots. You feel like you are going to black out. Literally, these white explosions—boom, boom, boom—lights getting dimmer and brighter, dimmer and brighter.

Tau protein was originally associated with Alzheimer’s and where most of the original research was done. But in Alzheimer’s the tau protein is mixed up in other masses, such as b-amyloid protein. In fact, there is some indication that the real start of the disease process starts from abnormal tau protein bundles.

In these concussive brains, only tau protein bundles can be seen, yet some of the symptoms resemble Alzheimer’e. These Tau bundles have not been seen in normal people. I wonder if there are other groups, ones where concussions are common, that might be worth looking at: wrestlers, cheerleaders, soccer and rugby players. Does post-concussion syndrome have any connection with tau? Some forms of tau can be found following head trauma but we do not yet understand just why.

The research seems to indicate that it is the cumulative effects, not simply getting hit once or twice, that are a problem. But we just do not know for sure. The only way to visualize the damage by Tau protein is post-mortem. Researchers are hopeful that advances in neuroimaging will provide a useful test.

The Zackery-Lystedt Law is a nice step in the right direction for protecting young athletes. I would imagine that fewer people would choose to be a lineman or linebacker if they knew that even a small number of concussive events increased their changes of developing dementia 5-15 fold? That by the age of 45, they might not remember their children’s names?

Football is an amazing sport but we are currently selecting for a form of it that does not seem sustainable, at least for the lives of those that play the game. Football has always resonated with the same sort of thrill that Roman gladiatorial events provided. Except that we were much more civilized and advanced, providing a highly complex manifestation of brutal physical combat, but with safety measures that did not require the deaths of the participants.

Now we are finding out that the safety measures may not have been complete enough. I would expect that we will find ways to enhance them rather than simply ignore the consequences. These videos are mainly of quarterbacks and receivers but it may be the linemen who suffer the most.

[Listening to: Presence of the Lord from the album “The Cream of Clapton” by Blind Faith]
Image(added in 2015): Erik Drost