This is an important scientific conversation. But perhaps even more important is the cultural conversation around concussion. After all, this is a sport in which an NFL player named Russell Allen, in a 2013 game with the Jacksonville Jaguars, took a big hit to the head and suffered a stroke on the field. Even more concerning was that Allen refused to come out of that game; he didn’t want to lose his starting job. (He eventually did lose his job, when the Jaguars released him four months later.) This play-through-it mentality is simply part of the fiber of this ruthless sport. As Sills stood before the group of neuroscientists and athletic trainers, he essentially admitted as much. The data that the NFL compiled on head injuries compelled the competition committee to adopt a rule before the 2018 season that penalized any player for lowering his head to initiate a hit on an opponent with his helmet. No sooner did the preseason games begin in August 2018 than the cries came from fans and players alike about these restrictive new rules. “A lot of people described that as the end of football, said it would be unwatchable, said it would be the worst thing that ever happened,” Sills said. Plenty more people said it would be the most significant and positive rule change the NFL ever made. The outcry quieted to an occasional murmur; players and fans adapted, as they always do.
As emotional as major rule changes can be—They’re sissifying football!—they are essential to the sport’s survival. For decades, the NFL’s own entertainment arm, NFL Films, released wildly popular VHS tapes that glorified these types of hits. The films had names like Big Blocks and King Size Hits, Bone Crunchers, and Thunder and Destruction. Most of the plays in these videos would result in flags, perhaps in ejection, today. “No one watches those videos [of big helmet-to-helmet hits] today and says, ‘Wow, that’s a great hit,’ ” Sills said.
Those “king size” hits, however, may not even be the central issue facing football. Big helmet-to-helmet hits can be legislated out of the game, or at least minimized, as the NFL has attempted to do in recent years. But what about repetitive subconcussive impacts that football players in certain positions, specifically on the offensive line and defensive line, experience on every single play? These head impacts are smaller, but they build up over time. The truth is, scientists don’t have a great understanding of risk factors for how CTE develops. The majority of CTE cases have extensive exposure to both repetitive subconcussive head impacts as well as multiple instances of concussion. The prevailing hypothesis now among scientists is that players who experience those repetitive subconcussive head impacts carry more risk for developing CTE and more severe CTE than those having a history of concussion. In other words, having thousands (or even tens of thousands) of smaller impacts to the brain during a career might be more dangerous than a few massive impacts to the brain. This is what becomes the biggest threat to the future of football. It may be difficult to take the big head impacts out of the game, but it can be done. It feels nearly impossible to take smaller head impacts out of the game. America is addicted to the National Football League. But would America’s addiction be transferred to the National Flag Football League?
The frontier of concussion research may determine that future. And part of that future is currently being worked on in a drab concrete office building in an industrial park near Minneapolis. Prevent Biometrics, founded in 2015, believes that to solve the concussion problem, we must first accurately measure impacts to the head. The company invented a smart mouth guard that does just that. There have been attempts to make head-impact monitors as part of the helmet, or embedded in skull caps, or as sensors attached to the skin, or implanted on headbands. The problem was that in high-impact collisions, these monitors would move around and the accuracy wasn’t good.
Since upper teeth are rigidly connected to the human skull, any skull impact can be extrapolated accurately by measuring force felt in the teeth. The Prevent Biometrics mouth guards are equipped with a flexible circuit board embedded with a battery, a microprocessor, Bluetooth capabilities, and LED lights (which illuminate when a worrisome head impact is detected). This mouth guard doesn’t measure or diagnose concussions. It measures head impacts. The sensors measure how much the teeth moved, then they triangulate that data to show how much the center of gravity in the head moved. Through an app, a coach or trainer has the ability to monitor head impacts in real time. Players who’ve experienced too many head impacts or a particularly hard hit can be red-flagged quickly. A head impact lasts .02 seconds, or twenty milliseconds. That’s a tenth of a blink of an eye: Far too quick to diagnose from observation only. The mouth guard serves like a blood pressure monitor for head impacts.
Just as important as flagging vulnerable brains on the field will be the reams of accurate head-impact data that can be combined with clinical results and sent to researchers. One of the most stunning parts of the infancy of concussion research is that experts have little idea exactly how many sport-related concussions occur in the United States annually. Estimates range from 300,000 to 3.8 million. Put another way: We don’t know within an order of magnitude how big a problem concussion really is.
Unfortunately, all this—the hundreds of millions of dollars for concussion research, the massive media and political attention, the cutting-edge biomedical technologies—doesn’t mean paradigm-shifting results are coming anytime soon. As exciting as it can be when you hear people like Allen Sills talk about improvements over the past several years, that excitement gets quickly tempered when scientists talk about how long it will be until this research can actually make a major difference. “It wouldn’t shock me,” Adam Bartsch, the chief science officer at Prevent Biometrics, said, in a statement echoed by every serious scientist I’ve spoken with, “if we’re at the start of a thirty-year learning curve.”
Zac Easter’s journal, July 12, 2015
Therapy is going all right, cognitively I’m still slow and physically my dizziness doesn’t seem much better . . . My emotions still just seem fucked up. I’ve been stressed w/ all this stuff and I don’t really feel like doing much. Been sitting around the house a lot and its hard for me to want to go out and do much. Its just easier for me when I avoid everyone. I wish there was a magic pill for me. I do just get sick of living this life and I try to stay motivated but its all self motivation from brain tremors. Everything I’m motivated to do has still yet to be accomplished. I wish I could put a finger on what is wrong with me. Its either from the concussions or Im just bat shit crazy. Im tired of feeling emotionless or too many emotions. Im trying to find a new hobby but nothing really quite makes me want to do it. Tomorrow I meet w/ Spooner about everything to me, there’s just NO way those concussions didn’t change me. I think I might just donate my brain and let them figure it out. I talked with my boss today and he understands why I cant work. IDK I might have to go on medical disability for right now. Every day has been a struggle for years. Hopefully this will stop. I want to be like everyone else.
The next day was the last time Zac met with Spooner. After that, he just quit. Gave up. Lost hope. Spooner never heard from him again, and he didn’t hear anything about what happened to Zac until five months later, when he got a call from another doctor who’d been working with Zac. It was a call that stopped Spooner right in his tracks, that hit him in the gut harder than any hit he’d experienced on the football field. “You don’t like to fail as a doctor,” Spooner would later say. “It pissed me off—God, what did I miss?”
Despite everything, though, Spooner would still love football. During his sports medicine fellowship at Camp Pendleton, he’d be on the sidelines at Chargers games, learning as much as he could. Junior Seau had retired a couple of years before, but he was still the most revered Charger of all time, and the stands were filled with fans wearing Chargers jerseys emblazoned with Seau’s number, 55. Spooner also worked as a sideline doctor on Friday nights at Oceanside High School, the same high school Seau had attended, just a few miles southwest of Camp Pendleton’s main gate. It was on May 2, 2012, less than a year after Spooner compl
eted the navy fellowship, when he heard the news that shocked the football world: Seau had shot himself in the chest at his beachfront home in Oceanside. Almost a year later, Seau’s family released the findings from the National Institute of Neurological Disorders and Stroke, to whom they had donated his brain. Seau’s brain had tested positive for CTE.
A few years later, after Spooner’s tour in Afghanistan, after he joined a medical practice in a Des Moines suburb, his nine-year-old son announced to his parents that he wanted to play football. Spooner knew about the scientific studies that indicated playing tackle football before age twelve can be tied to an increased risk of brain problems later in life. And he’d read about former NFL players who recently joined up with the Boston-based Concussion Legacy Foundation for a new parent education initiative, Flag Football Under 14, that dissuades parents from allowing their kids to play tackle football before age fourteen.
Spooner and his wife tried to talk their son out of football—Why not soccer? Soccer would be safer! But it was not as easy a parental diktat as you would think. All their son’s friends were playing football. Spooner wanted his son to have the same social experience that he’d had in his own childhood. He didn’t want to protect his son so much that all he did was stay in the house and play video games. So in third grade, his son played in a flag football league that had the boys wear soft-shell helmets, a slightly more aggressive version of flag football that focused heavily on fundamentals. In fourth grade, his son was supposed to play flag football in full pads—one season to get used to the equipment—then by fifth grade, he would move on to padded, tackle football.
The potential consequences of football wore on Spooner. Plus his son was small compared with other football players. For a year, he kept hammering home to his son the risks of football, but he wanted his son to make the decision on his own. Finally, the boy decided to play soccer instead. Spooner knows soccer is a sport with substantial concussion risk, with headers and plenty of incidental contact. But U.S. Soccer banned headers in youth soccer in 2016, and Spooner took solace in the fact that soccer concussions tend to be freak injuries, as opposed to in football, with concussions and subconcussive hits seeming to be a natural part of the game.
Still, his son could have decided on football, and Spooner would have lived with that.
“We should have a healthy fear of concussions and treat them appropriately,” Spooner said. “But I’d hate to have them feared so much that we start keeping kids from being physically active and from enjoying things like sports.”
“Here’s the thing,” Spooner continued. “I don’t want to put my kid in a bubble. I want him to experience what it’s like to be on a team. That’s a powerful experience, whether it’s a football team or a military squad or whatever team you’re on. He knows there’s a chance he could get hurt. Parents and coaches know there’s a chance [kids] could get hurt. No guarantees. I know it can happen with anything, but something about the football stigma even has me spooked. If he got a concussion [in football] and it’s a bad one, I may regret it. But if everyone is educated on the risks, and there are significant benefits, and if the vast majority of people who go through it have vast benefits, I’m just going to let it go. See how it goes. It can happen in soccer. It can happen on your bike. It can happen any other place. Sometimes you gotta trust fate, I guess.”
Spooner has another son, a tough kid a few years younger than his firstborn. Spooner knows the family is going to have this same discussion and this same concern. The doctor isn’t sure which way the choice will go.
Eight
The Reckoning
Zac Easter’s journal, June 30, 2015
The past week I’ve been stressed out from not getting enough sleep and the Wellbutrin makes me feel weird. I took it for a while and stopped once I noticed it was giving me insomnia and actually making me depressed. I’m still going to speech therapy and PT. Dr. Spooner is also sending me to a mental health psych because I might be a little mentally ill. Personally I wouldn’t be surprised. I’ve been to the Dr. so many damn times over my life and they always say my head is fine. So maybe I’m missing a screw lol. IDK I’m open to going down that path and figure it out. I just know I can’t sustain the life I’m living so I’m willing to see anyone at this point. I’m tired of having to eat healthy, work out several times a day, or use drugs/alcohol to feel normal around people. If only people could see the world through my eyes and see the mental battle I fight every day. Only God knows whats it like because he has been the only one to guide me through the light of darkness and into the brightness of the future. I had quite a few thoughts of suicide over the past week, but I told that Zac to go fuck himself. I’m not giving up and I know God is still on my side watching my back from letting my mind slip into temptation. Either way this weekend should be fun. Fourth of July is usually a nice [break] from reality for me.
The summer of 2015 was filled with stops and starts for Zac. There were moments of hope when he felt on top of the world, when he felt one of these doctors would finally lead him to that magic pill. He recorded his emotions and his coping strategies, and when he was feeling at his highest, he’d scribble down aspirational lists of his life goals. To his family, he’d often pretend that everything was normal, doing things like going to a gun show with his dad and his younger brother, Levi, and showing up for family meals. But there were also deepening moments of despair; at one point, he sat down at his computer and started typing out a suicide note. One night, he even resolved to kill himself. “Thank god I was to drunk one night and passed out while doing it,” he wrote. At the gun show, he attempted to tell his dad and younger brother what was going on inside his brain. “It was awkward when I tried telling them a little about whats wrong w/ my head. I ended up dropping it.”
After his twenty-fourth birthday in June, when he revealed the depth of his brain issues to his parents, his mother did everything she could to save him. She insisted on going to some of his therapist appointments. When she was there with him, Zac would get angry and embarrassed. He hated talking in front of his mom about his emotions and drug abuse and how much he had struggled just to get through school. When the therapist asked about things like abusing Adderall to get over his social anxiety, Zac’s face got flushed. His heart raced. The doctor noted Zac’s anxiety at his questions, and he backed off.
Every time he left these appointments, Zac felt lost and confused. One time, he walked into the parking lot and for several minutes couldn’t find his car. “I drove home in one of those trances I get in and damn near almost hit a car and took a bunch of wrong turns,” Zac wrote in his journal. “Shits starting to get fucked up for me. IDK . . . I’m going nuts lol.”
Zac was sleepless and on edge; too much Adderall will do that. Again and again, he pledged to quit, but he kept coming back to it. When some buddies invited him to Lake of the Ozarks in Missouri for a weekend of partying, he declined: “I just feel super avoidant and I don’t feel like being around anyone.” Instead of hanging out with friends, he’d stay in his room and masturbate for hours; hypersexual behavior can be a complication associated with head injuries. While his friends were at the lake, Zac finally relented with a girl who’d been bugging him to hang out. (Ali and Zac had been in this hybrid intense-but-casual semi-relationship for months, but they weren’t official—so why not?) The girl came over to his place, and they had sex all night. “It was nice to just fuck for like 5 hrs and not think about my brain,” Zac wrote. “Overall the sex was great and was a nice release from the normal jerking off every night . . . Fuck it. Pussy was nice.”
The next day, Zac went to his parents’ house for dinner. He was exhausted—he had been up with the girl until 5:00 a.m. and awoken at 8:00 a.m.—so he popped a few Adderall. As soon as he walked into his parents’ house, his mood shifted to anger. One reason was that his brother Levi was having friends over, and Zac didn’t want to be around them. More urgently, though, his medical records had been mailed to his parents’ house, a
nd they had looked through them. “I kinda tried to be ok about it but inside I wanted to freak out and I felt like its not their problem its mine,” Zac wrote. “I know they just want to help. I honestly feel like its not their business to know about all my problems. I still feel insecure about letting them know.” He told his mom that he didn’t want her to attend his doctor appointments anymore, and that he had signed a document saying health-care information couldn’t be released to anyone but him. She thought Zac was hiding something. “I kind of snapped a little and told her its just whats best for me.” He hated that his problems were putting more stress on the family. So he made up an excuse to leave and drive back to Des Moines.
Back home, he couldn’t sleep, so he jacked off until 6:00 a.m. He woke up a few hours later to go to lunch with his grandparents. He was late. His eyes were bloodshot. Zac barely spoke during the meal. It was awkward: “I felt anxiety and depressed the whole time,” he later wrote.
As Zac walked out to his car, his younger brother, Levi, followed him. He asked if Zac was OK. He asked if he was still taking his antidepressants. “If you need to talk,” Levi told him, “just call me.”
“I told him Im ok and it’s just I haven’t slept much lately,” Zac wrote in his journal. “Really I want to tell someone that I’m a wreck inside.”
Zac drove home and popped some more Adderall. He stayed up all night researching concussions on his computer.
“I need to keep control of what I still can in my life,” Zac wrote. “I also hate how I feel like I might snap any moment on someone . . . I’m willing to do whatever it takes to get help. I just hope I’m not fully loosing my mind.”
Love, Zac Page 17