Head to head

Why we need to talk about brain damage in American Football.

Put away your swimming costumes, no need to worry about burning or freckling as autumn is well and truly here, if the rain hadn’t already tipped you off. With autumn or should that be fall, in keeping with the American theme begins a new American National Football League season, full of hope and endless questions and predictions. Will the Falcons avenge last season’s shock Superbowl loss? Will Odell Beckham Jr. break the 2000 yards receiving mark? However, perhaps the most important discussion topic on the table at the moment is that of how the sport deals with concussion or, more specifically, with CTE or Chronic Traumatic Encephalopathy? There is an undeniable link between concussion and CTE, which is a problem that must not be underplayed; the side effects suffered by those diagnosed with CTE include excessive rage, depression and advanced dementia. It is clear, then, that something must be done to drastically reduce the rates of concussion experienced by professional football players.

 

This issue is hardly a new one; take, for example, the case of the St. Louis Rams’ quarterback, Case Keenum, who sustained a head injury in a game against the Baltimore Ravens but was allowed to continue playing and was only diagnosed with a concussion after the game was finished, an injury that then ruled him out for the following two games. In fact, the problem became so bad that the NFL introduced strict new rules before the start of the 2016/17 season with huge fines, as well as potential loss of draft picks, for those teams who failed to remove concussed players from the field, where previously there had been no sanctions. Coupled with radical new advancements in the testing and diagnosis of concussive incidents a new method of diagnosis will be trialled in Premiership Rugby this year, using saliva samples from players suspected of sustaining head injuries, that will reveal the extent of such injuries instantaneously and with laboratory accuracy   and the sport seems to be on the path to truly tackle the issue.  

 

Yet, last season, the first with such regulations in effect, saw no significant decline in concussion rates. There were 244 reported concussions in the league last season, and whilst this was a decrease of 31 on the previous season, it was an increase from the lowest numbers of recent years, 206 in 2014. What this means, in its simplest terms, is that in 2016 there was one concussion approximately every 1.5 games, undeniably an epidemic. However, one might argue that taking a sample solely from last season, the only season thus far to see these regulations in effect, is to take far too small a sample size. The simple fact is that last year saw a decrease in concussive incidents, albeit a modest one, and that once this season is out we will have a more representative sample size from which to draw conclusions.

 

This is true. It is probably too early to draw any meaningful conclusions on the effectiveness of the league’s concussion regulations, especially with potentially game-changing testing developments only in the trialling stage. However, intuitively, there isn’t any reason why the numbers should decrease significantly enough over the coming years for us to definitively conclude that the regulations have succeeded. This is for the simple reason that the regulations aren’t aimed at reducing the numbers of concussions but merely at more successfully identifying such cases and removing the affected players. If the franchise is serious about eradicating CTE, then it is clear that what is needed is not just a more effective identification of concussion but a full-scale change in the tackling rules and perhaps the removal of the contact element of the sport entirely.

 

This may seem like an overreaction, but it’s not. Tackles that result in concussions are rare; with an average of just over 100 tackles per game and a concussion occurring every 1.5 games, that means about 1 in every 150 tackles results in a concussion. However, studies have emerged over the last 18 months that have linked CTE not just to such “big hits”, but also to more common, “sub-concussive” tackles. Such tackles also have a far wider scope: whereas concussive tackles are usually reserved for quarterbacks and wide receivers, almost every player throughout the course of the game will suffer sub-concussive hits.

 

In the most recent and most comprehensive study of former league players, the Journal of the American Medical Association concluded that 110 of the 111 players tested were found to have suffered from CTE. Moreover, unlike concussion, CTE cannot be diagnosed immediately: in fact, it can only be diagnosed posthumously, meaning that there is no way of assessing if a player is developing CTE and then sidelining him for an appropriate period.

 

Thus there seems to be only one conclusion: the game must be altered sufficiently to protect its players from life-changing brain damage. If this includes the removal of the contact element of the game, so be it.

 

On the surface, it seems obvious why the league has resisted such wholesale change; the league’s revenue passed $13 billion (€11bn) last year, with the average team worth almost $2.5 billion (€2bn) and regular viewing figure of 16.5 million viewers per game. From a financial perspective, the one undoubtedly most important to those running the game, there must be a temptation to adhere to the old adage “if it ain’t broke, don’t fix it”. Brain injury, one might argue, is an accepted risk for those who make their fortune playing the game, and that to change the game so as to safeguard against it could potentially ruin the sport beyond repair.

 

It would be churlish to suggest that such drastic changes to the rules of a sport could never affect its popularity; there is indeed a chance that such changes may significantly damage the global standing of the league. However, this is far from an inevitability. Take, for instance, Formula 1 racing. When Ayrton Senna died after crashing at the San Marino Grand Prix in 1994, there was agreement that the long-held belief that such risks were simply part and parcel of the sport was no longer acceptable. There was, and continues to be, a concerted effort made to improve the safety of the sport, even at the expense of those things considered to be part of the DNA of the sport, such as refuelling at pit stops or, even, from next year, the open cockpits said to be the defining feature of such racing.

 

Yet, the 2016 F1 season drew 400m viewers worldwide, making motor sport once again being the most-watched sport on the planet. In fact, the NFL’s 16.5 million viewers per game in 2016 was an 8% decrease from the previous season, so perhaps the time has never been better for the powers that be to shake-up the game. Either way, one thing is clear: the league owes it to the sportsmen of the future to act decisively to reduce the risk of brain injury.

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