The Concussion Crisis

by Linda Carroll

  Many other players insisted that they couldn’t learn a new style of play, one that didn’t include using the head and body as a battering ram. The league decided to show them that they could. That week in the film rooms of all thirty-two NFL teams, players were forced to watch a league-produced video showing examples of flagrant hits that would no longer be tolerated—a highlight reel of helmet-to-helmet hits and of shots to the heads of “defenseless” receivers. The players’ response was similar to what you’d expect from a roomful of junior-high boys forced to watch Reefer Madness as a drug-education video. There were catcalls and wads of paper hurled at the screen. All that was missing were spitballs. As the video’s narrator warned that they’d now be disciplined for these kinds of hits, the players provided their own commentary, making cracks like “Did this guy ever play?!”

  All-Pro linebacker Brian Urlacher of the Chicago Bears spoke for many of them when he scoffed that the NFL should just issue flags instead of protective pads and rename itself “the NFFL—the National Flag Football League.” The union president, former All-Pro center Kevin Mawae, ridiculed the crackdown, saying, “The skirts need to be taken off in the NFL offices.”

  Perhaps more surprising was the response from sportswriters who were concerned that all the new rules were going to ruin the game they loved to watch and write about. William Rhoden, a columnist at The New York Times, the very newspaper that ran dozens of front-page stories alerting the public to the dangers of concussions, wrote, “A number of parents with young children are wringing their hands and saying they would never allow their children to play football. That’s precisely why there is a premium on those who do play football: it takes a rare breed to play this violent game at any level. Football has always been dangerous—and that’s why we like it, for the vicarious thrill of watching someone do something we would never or could never do.”

  There were some who saw it differently, who recognized the value of protecting players from themselves. Brad Wilson, a columnist for a small paper in Pennsylvania’s Lehigh Valley, put it this way: “There are a few fans, one would like to think a minority, who view football as a bloodsport and will decry the new rules and changes they cause as wimpy and only good for sissies. These are the same people who didn’t like it when Rome stopped feeding its criminals to the lions because it spoiled their day out at the Colosseum. These people can go watch ‘Saw’ movies and leave football for everyone else.”

  • • •

  After the NFL’s fall 2010 crackdown in the wake of what became instantly infamous as Black-and-Blue Sunday, concussions increasingly seeped into the public consciousness and conversation. No matter where people sided on the concussion debate—whether with the reformers striving to make contact sports safer or the traditionalists fighting to preserve the fabric of rough-and-tumble games—it was getting harder and harder to ignore the impact that head injuries have on our brains and our favorite pastimes.

  Concussions had entered the vernacular everywhere from the sportscasts that entertain us to the video games that enchant our children. It was indeed a sign of the changing times when Madden NFL, which through its first two decades as America’s hottest-selling video game wowed nearly a hundred million kids with head-rattling hits even more exaggerated than anything seen in real-life games, announced in the spring of 2011 that its next version was being redesigned to stress the seriousness of head injuries, the urgency of sidelining concussed players, and the responsibility of teaching safer tackling techniques.

  Although the public hadn’t fully absorbed the message about the menace of head injuries, at least Americans were finally starting to recognize that concussions are indeed injuries to the brain.

  All the concussion talk certainly was weighing heavily on Dave Duerson’s mind that February night when he penned a chilling suicide note in block letters: PLEASE, SEE THAT MY BRAIN IS GIVEN TO THE NFL’S BRAIN BANK. He proceeded to aim a revolver at his chest rather than his head and shoot himself through the heart so that his brain could be preserved for science. Duerson had suspected that all the head blows he’d absorbed through his eleven-year NFL career as a hard-hitting safety were responsible for his downward spiral from a two-time Super Bowl champion and successful businessman to a bankrupt fifty-year-old battling memory loss, impulse control issues, and mood volatility. It surprised no one three months later when BU’s Center for the Study of Traumatic Encephalopathy revealed that Duerson’s brain evidenced the same trauma-induced disease previously found in the autopsies of more than twenty former NFL players. In becoming what Time magazine called “football’s first martyr,” he left this legacy for all those suffering in silence: a sword of Damocles that must now haunt everyone who’s ever sustained repeated concussions or absorbed multiple head jolts, from the Dave Duersons to the Dave Showalters.

  And it wasn’t just America’s most popular sport being threatened by the ticking time bomb of head injuries. Less than three months after the NFL’s Black-and-Blue Sunday, the NHL found itself facing a concussion flashpoint of its own.

  At the epicenter was hockey’s supreme superstar: Sidney Crosby, the sublimely skilled center hailed as the second coming of Wayne Gretzky himself. Whether leading the Pittsburgh Penguins to the Stanley Cup or Team Canada to the Olympic gold medal, Crosby has been the face of hockey ever since his 2005 NHL debut. By missing the entire second half of the 2010–11 season due to concussion symptoms, he would also become the face of an injury that threatens anybody who plays contact sports.

  It is a cautionary tale that highlights the consequences of failing to take head injuries seriously. During the NHL’s annual New Year’s Day spectacle on a makeshift outdoor rink built over the very Heinz Field gridiron where the Pittsburgh Steelers illuminated football’s concussion crisis, sixty-eight thousand spectators and millions of TV viewers watched Crosby get flattened by a blindside shoulder to the head, struggle to his feet, and then skate slowly, dazed and doubled over, off the ice. That wooziness should have been enough of a red flag to automatically sideline him for the remaining twenty minutes of play. Instead, shaking off what he dismissed as just common neck soreness, he played on without missing a shift and started the Penguins’ next game four nights later despite a feeling of fogginess that sneaked up on him gradually. His brain was still foggy late in the second period when he was rammed into the boards by an illegal blindside check, slamming his head against the glass. It wasn’t until he reported feeling headachy and sick after finishing the game that he was finally sent to the University of Pittsburgh’s renowned concussion clinic for evaluation.

  Even then, the diagnosis, “mild concussion,” and the prognosis for his return to play, “about a week,” minimized the seriousness of the head injury. With Crosby’s headaches and other symptoms persisting much longer than expected, doctors waited ten weeks before clearing him to resume even light skating; and when his noncontact workouts triggered a recurrence of the concussion symptoms five weeks later, they ordered him to stop all physical activity. The Penguins’ medical personnel, still stinging from widespread criticism over not taking the New Year’s Day hit more seriously, were now taking no chances in the aftermath of their team captain’s first diagnosed concussion. By season’s end, Crosby had been disabled for four months and had resigned himself to the specter of a long roller coaster of recovery and rehab from a scary injury that was threatening his brilliant career at the age of just twenty-three.

  It took the loss of hockey’s transcendent star to spur the NHL into taking action. Late in the season, the league toughened its head injury protocol to require that any player who shows signs of concussion be removed from the bench and examined by a team doctor for fifteen minutes in a quiet room away from the ice. At the same time, the Crosby controversy—coupled with the finding of CTE in two NHL retirees notorious for their aggressive style—poured gasoline on the smoldering debate over whether all head hits should be banned. Crosby himself joined the growing chorus of prominent voices criticizing the NHL w
hen it failed to discipline either player who’d blindsided him and calling for a prohibition on all head hits once and for all.

  “How much damage is it going to take before we finally wake up and we make those changes?” wondered Pat LaFontaine, the Hall of Famer whose forced retirement had inspired him to become a vocal advocate for concussion awareness. “I pray it doesn’t mean somebody doesn’t get up off the ice to realize this is a serious problem.”

  As important as those types of changes would be for the pros, they are all the more imperative for the kids.

  • • •

  The YouTube video got hundreds of thousands of views: Two eight-year-old boys are charging toward one another in a tackling drill as a female voice yells “Go! Go!” They lower their heads and ram into each other, helmet to helmet, with a sickening crack. The boy carrying the ball is knocked flat on his back and begins to cry and writhe in pain as a coach casually walks over.

  The video encapsulated everything that is wrong with the way we play sports in America. We glorify the big brain-rattling hits, cheering the players who deliver them and rewarding the coaches who teach them. We entrust our children to coaches who would blithely unleash two eight-year-old heads on one another without a thought to the vulnerability of the developing brains inside the helmets.

  Inevitably, people who want to keep the game the same will suggest that the problem can be solved with better helmets. But that’s just wishful thinking. Helmets can’t protect a brain during a collision any better than a shell can protect an egg yolk if the egg is shaken back and forth. Like the yolk, the brain slams around in its “shell” when the head suddenly accelerates or decelerates. No matter how sophisticated the design of a football helmet, nothing can prevent the brain from being damaged by the shaking. The only way to protect athletes’ brains is by changing our culture of concussions on every level from the pros all the way down to the peewees.

  We need to educate not just the athletes—millions of whom aren’t old enough yet to make informed decisions—but also the parents, the coaches, and everyone else involved with youth and school sports. Only through education and information will Americans come to accept the reality that concussions are indeed traumatic brain injuries.

  • • •

  America needs a hero, a celebrity willing to step forward and speak for all the millions suffering in silence with brain injuries that they prefer to keep hidden for fear of being stigmatized.

  Troy Aikman, America’s Quarterback himself, would have made an ideal spokesman after multiple concussions forced him to retire at age thirty-four. To the millions of kids looking up to him as a role model, he could have told a cautionary tale about the dangers of playing through concussions and offered a heads-up about the urgency of managing them safely. Instead, as a leading broadcaster on the NFL’s network telecasts, he chose to send a different message—by minimizing them and insisting that they must be accepted as a risk inherent in the sport. Even after the NFL finally accepted the need for safety reforms under withering media and political pressure in 2009, Aikman seemed less concerned with the long-term effects of concussions on the players’ brains than with the long-term impact of the increased awareness on “the game of football as we know it.” In the face of the mounting scientific evidence exposing football-related dementia among NFL retirees, he pointed out that he has no cognitive deficits in his forties and focused not on that vulnerability but on the trickle-down effect on the sport. “I wonder what the impact of the concussion studies will have at the grassroots level,” he wrote in his Sporting News magazine column. “If you’re a parent and you hear repetitive contact in football could cause long-term health issues, are you inclined to let your 10-year-old son participate? And if fewer kids are allowed to play, what effect will that have on the NFL 10 or 15 years from now?”

  Troy Aikman, bemoaning how he and fellow Hall of Fame quarterback Steve Young had become “the poster boys for concussions,” wasn’t about to become a crusader for concussion safety. If only some marquee superstar like Aikman could have followed the example set by Harry Carson.

  During his thirteen seasons as one of the NFL’s hardest-hitting linebackers, Carson had caused countless concussions and sustained at least fifteen himself without ever reporting them to a trainer. He never connected them with the odd symptoms that dogged him through much of his Hall of Fame career—not even the depression so profound that once, while driving across the Tappan Zee Bridge on his way to Giants Stadium for practice, he had to resist the strong impulse to steer his car through the guardrail and into the Hudson River. It wasn’t until Carson began his second career as a TV commentator that the symptoms he’d played through became too noticeable to ignore: migraines, blurred vision, sensitivity to light and noises, short-term memory loss, concentration problems. He would be on air, live, and he’d lose his train of thought in mid-sentence. He found himself misidentifying players and teams, blanking on the names of interviewees in mid-question, mispronouncing words, stammering as he fumbled to retrieve them from his thesaurus-like vocabulary. Sure that he had a brain tumor, he finally consulted a neurologist two years after he’d retired from the NFL. The belated diagnosis of post-concussion syndrome explained the symptoms that cost him his broadcasting career and his first marriage.

  It also led to a new calling. In 1994, four years after he was diagnosed with a syndrome that was then just starting to force other NFL stars into early retirement, Carson was asked by the Brain Injury Association of America to promote concussion awareness. At a time when the concussion controversy was first emerging, Carson started by trying to educate former teammates and opponents. “Once I went public with this concussion thing, they were looking at me as being sort of brain-damaged, drooling and all this stuff,” he recalls, “but it is an injury just like one to your knee or hip.” That’s the message he delivers, passionately and eloquently, whenever he speaks to athletes, parents, and coaches at educational conferences.

  With a sensitive and soft-spoken manner belying the ferocity he brought to the football field, Carson makes just as effective a leader in the fight for retiree disability benefits as he had been as captain of the New York Giants’ first Super Bowl championship team. Still suffering post-concussion symptoms fully two decades after retirement, he worries about the future implications for his own brain and regrets whatever role the hits he delivered may have had in the dementia suffered by too many of his teammates and opponents. If he had known then what he does now about the long-term consequences of concussion, Carson doubts he ever would have played in the first place. When medical conditions forced his older son to give up football before an NFL tryout and his younger son to give it up before a major-college tryout, Carson was relieved rather than disappointed. “Every parent should sit up and pay attention,” he says. “When you look at the players who have played the game and are now dealing with serious neurological issues, you have to ask yourself, ‘Is it worth the risk to allow my child to play the game?’ ”

  America needs more Harry Carsons, sports stars willing to talk publicly about brain injuries that most sufferers strive to keep private. The famous among us need to be just as courageous as the everyday people who made this book possible by sharing their lives and struggles. If the most visible among us won’t talk about their invisible wounds, traumatic brain injury is fated to remain silent and hidden.

  Appendix I

  Concussion Symptoms

  All head injuries should be taken seriously. A concussion may be an invisible injury, but its symptoms and signs can often be spotted by parents, friends, coaches, athletic trainers, and others who know the head-injured individual. The following symptoms or signs of concussion may occur after a bump, blow, or jolt to the head:

  Observed Symptoms

  • Appears dazed or stunned

  • Vomiting or complaining of nausea

  • Confusion

  • Memory problems (difficulty learning new information)

  • Amnesia
(loss of memories from before and/or after the injury)

  • Any loss of consciousness

  • Difficulty with coordination or balance

  • Behavior or personality changes

  • Slowed thinking, reaction, speaking, or reading

  • Slurred or nonsensical speech

  • Seizures

  Reported Symptoms

  • Feeling dizzy, dazed, or lightheaded

  • Headache, neck pain, or a sensation of pressure in the head

  • Increased sensitivity to light or sounds

  • Feeling hazy, foggy, or groggy

  • Feeling sluggish, fatigued, or unusually tired

  • “Seeing stars”

  • Blurred vision or double vision

  • Ringing in ears

  • Mood changes (e.g., sadness, listlessness, irritability, anxiety, loss of motivation)

  • Difficulty concentrating, thinking, or making decisions

  • Sleeping longer than usual or having trouble sleeping

  • Loss of sense of taste or smell

  Sources: Adapted from the Centers for Disease Control and Prevention’s “Heads Up Toolkit for Youth Sports,” the “Sport Concussion Assessment Tool 2” developed and adopted in 2008 by the Third International Conference on Concussion in Sport, and concussion education articles published online by the University of Pittsburgh Medical Center and the University of California–Los Angeles Health System.

  Appendix II

  Resources for Patients and Families

  The following are some useful resources for information on traumatic brain injuries in general and concussions in particular: