Rashaan Salaam's Death Officially Ruled Suicide

I wrote a more detailed post about Rashaan Salaam and his recent death a few weeks ago, but I wanted to write a brief follow up in response to new information on the situation. The Boulder County coroner's office formally ruled former running back Salaam's death a suicide earlier today. The autopsy revealed that Salaam shot himself in the head, and was under the influence of alcohol and marijuana at the time of death.

In observance of Salaam and his family's Muslim faith, his family declined to have his brain examined for the degenerative disease CTE. Nevertheless, his brother stated that Rashaan had "all the symptoms" of the disease, including memory loss, problems with vision, and depression.

Why Ladarius Green needs to Retire

Pittsburgh Steelers tight end Ladarius Green is currently in the NFL concussion protocol after sustaining a concussion in last week's game against the Cincinnati Bengals. He's officially listed as "questionable" on the Steelers injury report, and there's a lot of speculation as to whether he'll be good to go for Sunday's rivalry matchup against the Baltimore Ravens on Christmas Day.

He won't be.

I promise you.

See, this shows how disconnected the media and even a lot of coaches are from the concussion crisis. Looking at this situation in a vacuum, then maybe I could see how you'd think that Green could be back in a week. But any research at all of Green's concussion history reveals that this situation is much more complex than the media is making it out to be.

I actually thought about writing an article on Green a few months ago, because I saw this coming from a mile away. It's easy to make that claim in hindsight, but as a Chargers fan I knew that Green was walking thin ice and would be for the rest of his football career. Green, who spent the first four years of his NFL career in San Diego before signing with Pittsburgh this offseason, suffered a concussion in 2014, and two concussion in 2015. The two concussions he suffered last season occurred within one month of each other, and I noticed a visible difference Green's play style after returning from his second. He was primarily used as a receiver instead of as a a blocker, and he rarely tried to break tackles after the catch or sell out for contested passes. I'm not criticizing his play, and it was pretty apparent that he was playing with hesitation on the field.

If that's not enough evidence that Green never really recovered enough to be back on the field, his rocky off season should have drawn much more concern. He underwent ankle surgery in March of this year, and signed with the Steelers in the same month. But come optional team activities (OTAs), Green was absent. Green also missed Steelers training camp practices. When different sources within the Steelers organization and close to Green were asked about his absences, different answers arose. Green was reportedly complaining of recurring headaches, a common symptom of Post-concussion Syndrome (PCS), but the Steelers organization officially commented that Green was being held out of practice to continue his recovery from his ankle surgery. Later, Green's agent told NFL.com that Green's ankle was fine, but he wouldn't comment on why Green was being held out of camp.

As a I wrote about with De'Anthony Thomas' situation last season, NFL teams will often designate concussions as other injuries on official reports, especially if symptoms are long-lasting. Obviously I can't say with certainty that this is what happened with Green early on in the season, but the evidence in indisputably there.

Green missed the entire preseason and was placed on the Physically Unable to Perform (PUP) list to start the regular season. He missed the first nine weeks of this season, and played only five full games this year before sustaining another concussion. He won't return this Sunday, we won't return this season, and to be honest, I don't think he should ever return to football. It's an extremely unfortunate situation and my heart goes out to him and his family, but at this point he needs to look out for his long term health. The ice he's walking is only getting thinner.

Cam Newton Continues to Get Targeted

On Monday night against the Washington Redskins, Cam Newton took a shot to the head while sliding at the end of a short run play near the sideline. The hit, put on by Redskins linebacker Trent Murphy, was not penalized during the game, a decision that was lamented by the announcers of the game and has since been criticized by many analysts, coaches, and even former officials.

Walt Coleman, the head official for the Monday night matchup, denied any wrongdoing after the game. It's an eerily similar situation to that of week 8, where Cam Newton expressed discontentment with the officiating in a game against the Cardinals, where Newton took a hit late in the knees that went unpenalized. Coleman and his crew were also the officials for that game, and the NFL's post-game review of the hit determined that it should have been penalized. 

I understand the difficulty of this situation on NFL officials. For the most part, penalties inherently only benefit one side of the ball, so there will always be anger and criticism coming from the other side. When it comes to player safety, however, we're all on the same team in understanding the value of penalizing unnecessary blows to the head, especially to defenseless players. Hopefully the national attention of this ongoing story of Cam vs the Officials will create an atmosphere of more equal treatment off all players by officials.

Seau Foundation Donates to UCSD

On Wednesday, the Junior Seau Foundation and the University of California, San Diego announced that the foundation will be donating 250 thousand dollars in an endowment fund to support UC San Diego's research of traumatic brain injury. The donation will be used to finance a faculty fellowship, as well as the Junior Seau Foundation Lecture Series, which will bring groups of K-12 students to campus to learn about TBI and its risks.

After committing suicide at the age of 43 back in 2012, the hall of fame linebacker and San Diego native was discovered to have the degenerative brain disease CTE. His neurological decline and death were heavily discussed in League of Denial and other popular books on football and TBI, and the discovery of CTE in Seau's brain really brought the disease into the national spotlight.

I think it's great that UC San Diego is using the donation for research and education alike. Obviously there's a lot of problems that exist as a result as a result of the concussion crisis in football, but the silver lining is that there are many solutions, too. An epidemic of this proportion can only be solved by a multi-front approach, consisting of awareness, education, prevention, research, and treatment. Having programs like what the Seau Foundation and UC San Diego are putting in place can accomplish all five of those methods.

RIP Rashaan Salaam

On December 5th just before 9pm, Rashaan Salaam was found dead in the parking lot of Eben G. Fine Park in Boulder, Colorado. The public park is located less than two miles away from Folsom Field, where Salaam starred as a running back for the CU Boulder Buffaloes football team around 20 years earlier. No foul play was suspected in his death, and Salaam's mother told USA Today that the Boulder Police department had found a suicide note. He was 42.

Salaam was awarded Heisman Trophy in 1994 and rushed for a school-record 2,055 yards while leading the Buffs to an 11-1 record and a victory in the Fiesta Bowl against Notre Dame. His professional career never lived up to expectations, as he battled injuries and drug use while bouncing from team to team in the NFL, XFL, and CFL.

As a former high school player from San Diego, I'd heard of Salaam well before the tragic news of his passing hit the national spotlight. He actually played for one of my school's main rivals, and it's inspiring to know that a player could go from a small high school to being named the best college football player in the entire country. It was an incredibly sad moment to hear of Salaam's passing, and one of the first thoughts that popped into my head was how similar this situation was to that of Junior Seau.

Both Seau and Salaam were born in San Diego and grew up in rougher areas of the county (Salaam in Skyline and Seau in Oceanside), and both were outstanding high school players in San Diego (Salaam actually still holds the county's record for career rushing touchdowns with 105). They both went on to have incredible college careers and made it to the NFL, and both unfortunately committed suicide in their early 40s. As is one of the most well-documented cases of the disease, Seau was diagnosed post-mortum with Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease caused by repeated blows to the head and discovered in many other former NFL players (I'll be writing a blog post or two on CTE in the near future). A major symptom of CTE is depression, and the nature of Salaam's death makes me fear that he may have had the disease, too. I'm sure Chris Nowinski and other folks over at the Boston University CTE center are already in the process of contacting Salaam's family to have the brain examined.

Unfortunately, CTE can only be diagnosed by looking at the brain post-mortum, and without his family's consent we'll never know if Salaam suffered from the disease. But as ugly a reality as it is, I think the diagnosis might give his family some solace in knowing what he was going through in the later years of his life, and it would increase the public's understanding and familiarity with the disease.

My condolences go out to Rashaan Salaam and his family. He was a true San Diego legend and one of the best running backs to ever play the college game. He won't be forgotten.

NFL: Not For Long

It’s a commonly known fact that many pro athletes go broke in just few short years after retiring from their respective sports. In fact, Sports Illustrated Magazine has estimated that 80% of NFL players go bankrupt in their first three years of retirement. That’s right: in three years, four out of five retired NFL players are bankrupt.

A couple years ago, Forbes Magazine published an article giving some explanations as to why this trend occurs. To summarize the article, they essentially argue that widespread bankruptcy of retired NFL players can be attributed to five main factors:

• Lack of experience with financial planning
• The need to financially support family members and friends
• Divorce and associated legal fees
• Not understanding how quickly careers can end
• Lack of preparation for a second career

The article also provides some recommendations to players should do to prepare for the transition to post-football life, and I agree with the majority of the article. What I disagree with, however, is that players don’t understand that any given play can be career-ending. In fact, I think the fact that so many players are aware of this fact is a key problem in the NFL’s concussion crisis. It incentivizes them to play through concussions, literally risking their lives, in order to maintain financial stability.

In her book Throwaway Players, Gay Culverhouse, former president of the Tampa Bay Buccaneers,  Culverhouse mentions that the average career of an NFL player lasts only four seasons (I will be writing a review on Throwaway Players soon). It’s a common adage that NFL really stands for “not for long,” and for every player that has a career that last a decade or longer, there is another player that got cut as a rookie. Because of these short careers, Culverhouse argues, even when ignoring the passion that players have for the game or the commitment they have to their teams, it makes economical sense that a player will continue to play through injuries, such as concussions, because he knows that he only has a limited amount of time to earn money for himself and his family before his career is over.

Of course, it’s easy to point out problems and much harder to find solutions to them. As the Forbes article mentions, the NFL Player’s Association (NFLPA, essentially the players’ labor union), has programs for  NFL players on financial education and has referrals to recommended financial planners. These efforts are valuable, and hopefully will only grow as awareness of NFL player bankruptcy increases. I think what is also important is strengthening the health insurance that the NFL provides retired players.

Much of Culverhouse book centers around what can be done to help former players dealing with injuries, especially TBI, who are unable to reenter the workforce after retiring from the NFL. As I said earlier, I will be writing a review of this book soon, so stay tuned.

Link to Forbes article:

http://www.forbes.com/sites/leighsteinberg/2015/02/09/5-reasons-why-80-of-retired-nfl-players-go-broke/#4d86ff1e4e36

Luke Kuechly

Some folks might remember the picture that went viral around national media sources back in August of a Syrian boy injured by an airstrike in Aleppo. The shocking image really served as symbol of all the atrocities happening in Syria, evoking much stronger emotions and attention with one face than would 1,000 news articles and reports.


On November 18th, America received a similar image.


Luke Kuechly, middle linebacker for the Panthers and arguably the best defensive player in the entire NFL right now, was shown tearing up while being carted off the field after suffering a concussion.

This image is what football's concussion crisis is. It's not numbers. It's not statistics. It's not fantasy points. It's scary, inconvenient reality that was shoved in the face of a national audience during that game.

If you watch the hit that Kuechly takes from Saints running back Tim Hightower when he went down, you'd probably never guess that Kuechly suffered a concussion on the play. He was hit at the bottom of his facemask, not directly on the shell of his helmet, and the hit didn't seemed to be abnormally forceful or unexpected. While the replay was showing, the announcers speculated that he may have suffered a knee or leg injury. Even I, knowing his concussion history, thought that his injury was most likely an ACL tear. It wasn't until after Kuechly was carted off the field and examined in the locker room that the announcers found out and reported that he'd suffered a concussion.

Seeing an elite and well-respected player and person like Luke Kuechly crying after suffering a concussion is heart breaking. He missed around a month recovering from a concussion last year, if and when he steps on the field again, he's putting himself at an enormous risk.

I don't know what else to say except that I hope he gets well soon and I hope that this image makes more people aware of the impact that concussions have. I think we're at the point that anyone who watches football, even very casual fans, is aware that concussions in football exist. The next step is making people aware of the gravity of concussions.

Steelers Establish TBI Research Foundation

Earlier today, the Pittsburgh Steelers President Art Rooney II announced the creating of the Chuck Noll Foundation for Brain Injury Research. The foundation is named after sports brain injury advocate Chuck Noll, Steelers head coach from 1969-1991, and administrator for the team for two decades after that. The Steelers are supporting the foundation with an initial contribution of $1 million, and the Foundation's Board of Director will include Merrill Hoge, current ESPN commentator and former Steelers running back who retired over concerns about football-related concussions. The medical advisory panel will include Dr. Julian Bailes, Dr. Regis Haid, and Dr. Joseph Maroon. These are names are all familiar if you've read League of Denial, by Mark Fainaru-Wada and Steve Fainaru (review on that book coming soon), one of the most popular books on the NFL and TBI.

It goes without saying that it's great to see people within the NFL making major efforts to help alleviate the concussion crisis overtaking the sport of football. The foundation's creation comes at an especially apt time, as Dallas Cowboys owner Jerry Jones made some statements yesterday (in addition to other past statements) denying the link between football and brain trauma. I'm going on a tangent here, but it honestly blows my mind that there are still people within high places in the NFL who deny that CTE exists or that it is caused by football. Of course, there are debates within the field about how prevalent CTE is and what its underlying causes are, but those discourses are lead by medical doctors, not wealthy businessmen who clearly have vested interests that override the science. At the risk of alienating people politically, it's a lot like the global warming "debate."

Anyway, this move is an applaudable move by the Steelers and a great example of how the NFL, a multi-billion dollar industry, can start investing more of its own money to fund research on TBI.

About Concussions

Concussions are often called an invisible injury, and this assessment is true in more ways than one. Obviously concussions as injuries are often overshadowed by tears and fractures in training rooms and doctor's offices, but a large part of this categorization is that many concussions occur without a loss of consciousness or with symptoms that manifest hours or days later. So what is a concussion?

To put it simply and unscientifically, the brain sits inside the not completely snuggly, but is rather floating in cerebrospinal fluid, which provides a barrier between the interior wall of the skull and the surface of the brain. When a strong amount of force, such as a blow to the head, impacts the skull, the brain will essentially slosh around within the skull before resettling. This movement causes the brain to make contact with the surface of the skull and suffer swelling, axonal damage, and metabolic disruption. This damage can cause a whole host of symptoms.

Here are some common symptoms of concussion:

• Headache
• Blurry Vision
• Nausea or Vomiting
• Dizziness
• Lethargy
• Balance problems
• Sensitivity to light
• Sensitivity to noise
• Depression
• Mental fog
• Anxiety
• Confusion
• Irritability
• Difficulty thinking clearly
• Difficulty concentrating
• Difficulty recognizing play calls
• Aphasia
• Disruption in normal sleep patterns
• Loss of Consciousness

(Source: CDC)

As an athlete, it's important to know the signs and symptoms of concussion not only to know when to remove yourself from play and get proper rest/treatment, but also to recognize symptoms that may arise in a teammate who is attempting to hide them, doesn't recognize them, or is simply too disoriented to remove himself from play.

Will every concussed person experience every symptom on this (non-exhaustive) list? Most likely not. But I wanted to put the whole myriad of symptoms together in one list to show how many ways a concussion can impact a person's life, and how many different ways there are of recognizing if a person has suffered a concussion. It's unfortunate, but every brain injury is different. Every last one.

A Farewell to Punting?

David Romer, an economist at UC Berkeley, published a study in 2005 titled "Do Firms Maximize? Evidence From Professional Football," which analyzes how effective punting is as a strategy in football. Now, obviously this study is around 11 years old as I'm writing this, but punting is still a strong part of the game, and it doesn't seem to be going anywhere, so it might be worth revisiting.

Ray Guy, the sole Punter in the Pro Football Hall of Fame

Rommer studied NFL data of punts from 1998 to 2004, To summarize the main conclusion of the study, teams should never punt if they are within four yards of the first down markers, regardless of what yard line they are on. Without getting into the economic and statistical analysis of punting vs going for it (which I don't claim to understand), I still think there are obviously situations where punting is vital; if you're backed up in your own red zone and it's fourth down, your primary concern is booting the ball as far away from your endzone as possible, not failing to convert and having your opponent get the ball 30 feet away from the goal line. But more importantly, special teams is widely understood to be one of the most dangerous aspects of football, and eventually it might be worth removing it entirely from the game, especially at lower levels.

The NFL may agree to an extent, at least on kickoffs. This year, the NFL changed the staring point after a touchback from the 20 yard line to the 25, (theoretically) encouraging more kick returners to let balls bounce out of the endzone for a touchback, rather than attempting to make a return and risking injury for themselves or the other 21 players on the fields. Of course, this rule change backfired, because while returners may be more likely to settle for a touchback if they get an extra 5 yards out of it, NFL coaches and kickers are not so keen.

PDF of Dr. Romer's study:
http://eml.berkeley.edu/~dromer/papers/PAPER_NFL_JULY05_FORWEB_CORRECTED.pdf

Cam Newton: "I Don't Feel Safe"

Earlier today, the Panthers beat the Cardinals at home and gained their much-needed second win of the season. Outside of the victory, though, what has drawn a considerable amount of attention are Cam Newton's comments post game.

As I've written about before in this blog and as has been commented on quite a bit by different sports media sources this season, Newton's been the victim of many big hits that have gone uncalled. Previously, Newton has always seemed to hold a stance of frustration yet humility when asked about these hits, expressing the unequal treatment of different players around the league by officials, but also understanding the risks he puts himself in by using his legs as a fundamental part of his game. However, today, Newton was again asked about hits he took during this week's game, and he let loose some of his frustration over missed calls by the officials. Click the link below to watch the press conference. Newton's commentary on officiating comes around the 5 minute mark.

It's one thing for Newton to comment on how the lack of calls makes the game less fun, especially when other quarterbacks are getting penalties in their favor on the same type of hits Cam takes. But for Newton to express his desire to meet with NFL commissioner Roger Goodell, because, as he describes, "in games, I do not feel protected by the officials," shows how serious this issues has become to him. Newton, who suffered a concussion in week four against the Falcons, stated earlier this month how his injury forced him to reflect on how certain aspects of his game make him more vulnerable to big hits than most NFL quarterbacks are.

Although it's unfortunate that all this has been happening to Cam, it's beneficial for the health of football as a whole, because it increases awareness of head injuries and of the importance of protecting players. I'm looking forward to see if Newton really does meet with Goodell at the end of the season.

An (Unscientific) Analysis of Frontline's Concussion Data

A few days ago, I posted a link to Frontline's online NFL concussion application. If you haven't checked it out, I encourage you do to so. It allows you to sort by season, team, position, and individual player when looking at concussion data from the 2012-2015 seasons.

Click this link to visit the website: 

http://apps.frontline.org/concussion-watch/#positions_2015

I've been milling around the application data, and I noticed a few trends that I thought were interesting and strong enough to point out.

1st, it seems that defensive backs and receivers are the positions most likely to suffer concussions. Looking at the 2015 data, cornerbacks are especially susceptible, and the comparison between the corners and interior linemen (defensive tackles, offensive guards and centers) is pretty striking. Thinking about it, though, it makes a lot of sense-- although linemen may be experiencing more contact on a play-by-play basis, cornerbacks and receivers bring much more acceleration and momentum into hits. Defensive backs have a much larger space to work with than linemen do, and thus collisions will often be lined up from 10 or 15 yards away, resulting in harder hits. Additionally, again due to the large amount of space, collisions can come awkward and unexpected angles, leading to head injuries.

Graphic from 2015 Data

Another trend I noticed in the data was that quite a few players suffered multiple concussions in the course of one season. Of these 11 players, all except two of them missed more game time after their second concussion than they did after their first. I charted out the data below:

As you can see, players missed an average of 1.0 games recovering from their first concussion of the season, but missed an average of 2.7 while recovering from their second. Additionally, five of the 11 players suffered their second concussion during their first game back from their first concussion. I've highlighted these players on the chart. The two players who suffered concussions that were season-ending, Andrew Hawkins and Joe Haden, both suffered their second concussions during their first games back. 

A few obvious conclusions and lessons can be drawn from this small sample size of data. Primarily, long-term health concerns put aside, it makes no sense for a player to return to game play unless he is completely healthy. Obviously I can't speculate on how the these players, especially the ones who immediately suffered a second concussion, felt physically going into their games. I'm sure at least a few of them felt entirely normal. But clearly, there needs to be some better sort of gauge on whether a player is truly recovered before he is sent back to play. The NFL is notorious for its use of pain killers, which could be a factor in this situation.

Trump Spews Ignorance on Concussions

Republican presidential candidate Donald Trump gained news attention and public backlash in the last week for his comments on concussions and the NFL. Click on the image below to view the video from a political rally in Florida. 

After a woman passed out at the rally, Trump commented: "The woman was out cold and now she's coming back. We don't go by these new, and very much softer, NFL rules. Concussion? Oh, oh! Got a little ding on the head? No, no, you can't play for the rest of the season. Our people are tough."

Trump's comments were met with tremendous backlash by many current NFL players, such as Giants tight end Larry Donnell and cornerback Buster Skrine.

Lisa McHale, director of family relations at the Concussion Legacy Foundation and wife of the late NFL player Tom McHale, who was diagnosed with CTE postmortem, commented, "It’s not really surprising that a man who came out publicly believing that he knows more than our top generals about ISIS would think he knows more about concussions than the world-renowned researchers who are studying the issue.” Obviously, this is not a political blog, and traumatic brain injury is certainly a problem in society that should transcend any political divide or agenda. Nevertheless, I can't help thinking that Trump's comments are indicative of a larger trend of ignoring established facts and tradition in order to promote some farcical notion of toughness or know-how. 

One of the first steps in any nationwide problem is spreading awareness and giving people access to complete and reliable information. That's the goal of this blog, and that's the only way we can stop the archaic and barbaric notions of head injury that still seem to be held by Trump and other people.

Frontline Concussion Watch

For those who haven't seen it, the PBS series Frontline has an application on its website that tracks all disclosed NFL concussions each year, and makes it easy to sort concussion info by season, team, position, and individual player. I've posted the link below. The info collected by Frontline is only based on weekly NFL injury reports, and thus does not include concussions suffered in the preseason or, obviously, concussions that went unreported by teams (see my blog "Beating Around the Bush" for further commentary).

Click this link to visit the website: 

http://apps.frontline.org/concussion-watch/#positions_2015

The application has data from the 2012-2015 seasons. I'm hoping that the site will eventually track the data from the 2016 season, but I'm not sure if it normally collects week-by-week, or just posts everything at the end of the season. 

NFL Fines

Late last week, Pittsburgh Steelers star receiver Antonio Brown received a fine of $24,309 for twerking in the endzone after scoring against Kansas City in the Steelers' 43-14 victory over the Chiefs. Among other comments denouncing the fine, Brown said:

"I don't think excessive celebrating should cost more than hitting guys in the helmet -- $24,000 for a guy scoring touchdowns and having fun is more than a guy getting hit in the head, targeting with the helmet."

Of course, it's clear that twerking unexpectedly in front of a national audience is different than just "having fun," and I don't condone Brown's behavior. His point, however, is an important one. Part of mending the concussion crisis in football is not just placing in rules that disallow deliberate hits to the head of defenseless players, but also making sure that players are strongly incentivized to not break these rules.

Antonio Brown brings in a Touchdown against Kansas City

Last month, I posted about the penalized hit that Darian Stewart laid on the helmet of Panther's quarterback Cam Newton (who is currently out with a concussion suffered from a different hit). Stewart was fined only $18,231 for the hit, about 25% less than the fine given to Brown.

Obviously there's already a system of penalties, fines, and suspensions that the NFL uses to punish players who commit various violations of the game's rules. But if the NFL really wants to show that it is attempting to crack down on hits to the head in the game, these deterrents must be significantly larger than those of other penalties. If Stewart, for example, was forced to sit out for a couple games, rather than pay fine that amounts to a drop in the bucket of a multi-million dollar NFL contract. Unless players are truly incentivized not to break the rules surrounding head injuries, there is no effective way of helping prevent these hits from occurring.

Beating Around the Bush

If you watched this week’s Thursday night matchup between the Bengals and the Dolphins, you saw Cincinnati cornerback Josh Shaw leave the game after taking a huge hit to head from Cincinnati safety George Iloka in the fourth quarter while the two teammates were attempt to make a tackle. Shaw remained on the ground for the entire commercial break, but was able to walk off the field after several minutes under the guidance of training staff in order to be medically examined.

After an examination, Shaw was determined to have suffered a “stinger,” the colloquial term from what is medically referred to as cervical cord neuropraxia. The injury, a result of a blow to the neck or shoulder area, causes a jolt and stinging sensation to travel down one or both of the affected individual’s arms, and can also lead to numbness, weakness, and or a burning sensation in the arms. I’m here to question whether Shaw suffered a stinger on that play.

As I’ve said before, I have no medical training. Even if I did, there’s no way to diagnose such an injury just by seeing it on a TV screen (I’ve been looking for a video of the hit online, but I haven’t found anything). However, unless I’m misremembering, the bulk of the blow seemed to be taken the side of Shaw’s head, not his neck or shoulder. Given the way that he froze up immediately after getting hit, fell to the ground, and stayed there for several minutes, I think it’s possible that Shaw also or instead suffered a concussion on the play. You’re likely wondering, “if they medical staff had thought that Shaw suffered a concussion, why would they diagnose him with a stinger? What incentive would an NFL team have to misdiagnose head injuries?” To answer these questions, I will first provide you with some other examples of questionable diagnoses and descriptions of injuries within the past couple years.

On November 22nd, 2015, Kansas City wide receiver and running back De’Anthony Thomas suffered a concussion. He was out of games and practices for around three weeks. The Chiefs planned to have him play in their December 27th contest against Cleveland. The day before the game, however, the Chiefs organization announced that Thomas would not play due to a “non-football related injury.” During a press conference after the game, Kansas City head coach Andy Reid said that Thomas was dealing with “personal issues” that forced him to miss the game. Thomas missed the remainder of the season for reasons that Reid specifically described as “not concussion-related.” However, around a month later, Thomas posted the following tweet on his Twitter account:

Thomas is still on the Chiefs roster, and though he not is not listen on any injury report or reserve list, he has yet to appear in a game so far this season, around 10 months after suffering his concussion against the Chargers. Another questionable example of questionable labeling of injuries is actually one that is currently ongoing, involving Chargers offensive lineman King Dunlap. Dunlap, who has suffered four diagnosed concussions since 2012, including one last year, missed last Sunday’s game, and continues to be out of practice, due to what Chargers head coach Mike McCoy had described as “migraines.”

Now, although migraine headaches are often used synonymously with other kinds of headaches, the two terms are not truly interchangeable; the National Institute of Neurological Disorders and Stroke specifically states: a migraine is not the same as a normal headache. Most people have headaches from time to time. These are usually tension headaches. Migraines, though, are sudden and strong, pounding headaches on one side of the head.

Given Dunlap’s concussion history, McCoy has been asked by the media whether Dunlap’s migraines are concussion-related, to which he replied, “this is not linked to concussions.” Once more, I know very little about medicine, and I haven’t examined King Dunlap’s medical records. I also know that headaches, especially migraines, if that is truly the type of headache that Dunlap is experiencing, can often come on suddenly and without any apparent cause. However, to deny that concussions could have played any sort of role in Dunlap’s headaches seems shortsighted at best, and possibly deliberately misleading.

These two examples of Thomas and Dunlap, are just two random ones that happened to come to my mind in the past hour. I’m sure they are other examples that I don’t know about going on right now, and many many others that have occurred in recent years.  

The difficult question to answer in this saga is why some NFL teams are possibly not disclosing true information about concussions. As is often the case when no other cause is immediately apparent, the answer is likely economic. Every player on an NFL roster obviously has a large monetary value-- for a large amount of them, we’re talking 7 or 8 digit salaries every year. When trading players, teams will obviously be offered less money or other incentives for a player who has a lengthy concussion history. This fact makes sense; teams looking to add players to their rosters want players who have had few injuries in the past and have a high probability of being healthy and staying on the field. It gives them more bang for their buck.

A player also wants to earn the biggest contract he can from teams interested in him, so he is not very motivated to disclose the unrecorded details of his medical history, either. When looking at two identical players, one who dealt with “migraines” or “personal issues” last year, and the other who suffered a “concussion,” obviously the former is going to be more desirable because he seems like he did not deal with injury, whereas the latter did.

Whether some NFL coaches are deliberately lying about head injuries and whether their incentives are economic or otherwise, I obviously cannot say. I’m giving a very rough hypothesis in this entry, but the more important issue is to simply recognize that what shows up on an injury report or comes out of a coach’s or player’s mouth might not always tell the full story.

Information on Stingers:https://www.ncbi.nlm.nih.gov/pubmed/19691361
Information on Migraines: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024778/

Tonight, I Applaud Ed Hochuli

One of the major stories of last Thursday night's NFL game was of Cam Newton remaining on the field and not undergoing concussion protocol after sustaining multiple hits throughout the Panther's 20-21 loss against the Broncos. The media and countless fans vocally criticized the NFL's actions during the game, it's likely that last week's failures influenced referee Ed Hoculi's swift actions tonight as he forced Buffalo Bills quarterback Tyrod Taylor to be removed from play after Taylor sustained a hit to the head by multiple Jets players.

Click here to watch the hit

As the announcers mention, the hit was audible from quite a distance from the field and can be heard in the audio of the video. Unlike Newton after getting hit by Stewart last week, Taylor seemed to be cognizant after the getting hit, and he returned to his feet soon after the blow of the whistle. Nevertheless, Ed Hoculi stepped into the Buffalo huddle, removed Taylor from play, and physically walked him to the Bills sideline where he could be evaluated for symptoms of concussion, much to Taylor's chagrin. 

Hochuli's actions may go relatively unsung, but they were undoubtedly brave and heroic. I'm extremely certain that Hochuli was nervous about his decision, especially given a close game between two rival teams, and hearing boos from the home crowd as their quarterback is removed from the game, not to mention Taylor's physical resistance to Hochuli's actions. All in all, Taylor was checked, cleared, and back out on the field after only a few plays. 

I sincerely hope that fans, players, coaches, medical staff, and most importantly officials around the league take a moment to understand and appreciate Hochuli's actions. We can learn a lot when things go wrong with concussion protocol, such as they did in Denver last week, but we can learn even more when they go according to protocol, like they did tonight. It's easy to criticize poor decisions, but it's more difficult to recognize and applaud good ones. And tonight, Ed Hochuli made a great step towards implementing the concussion protocol on a consistent basis. 

An Introduction: The Curious Case of Chris Borland

The 2014 season was a fairly lackluster one for San Francisco. Coming off a strong 2013 campaign with a 12-4 regular-season record in addition to two playoff wins, the 49ers finished the 2014 season at .500, failed to make the playoffs, and averaged only 19.1 points per game.

On the defensive side of the ball, one of the only promising glimmers in an otherwise dreary group was linebacker Chris Borland, a rookie out of the University of Wisconsin-Madison who was an All-American in college, and finished his first NFL season with over 100 tackles, 1 sack, and 2 interceptions. He was undoubtedly one of the most impact rookies in the league, and sat at the foothills of what by all accounts looked to be a long and successful professional career. Yet on March 16th, 2015, Borland announced his retirement from the NFL, citing concern over the effects of repetitive head trauma.

It's interesting and commendable enough that Borland, only 24 at the time, would decide to walk away from a career he'd spent his entire adolescence and college years building up to. What's more peculiar, however, is Borland's outlook on the future of football. In an interview with ESPN several months after his retirement, Borland stated "I don't dislike football. I love football," and yet also described the sport as "kind of dehumanizing... like a spectacle of violence."

Regardless of your personal opinion on Borland's decision or your views on the sport of football, it's undeniable that a great schism is on the horizon for the sport that has become a central component of the American identity. How will public perception of football shift in coming years? What changes can and will be made to the sport? What will new medical discoveries reveal? These questions and more will be examined throughout the course of this blog.

Chris Borland attempts to tackle Seahawks running back Marshawn Lynch on November 27th, 2014

NFL Opening Game

Tonight, the Carolina Panthers traveled to Denver in hopes of gaining revenge after an embarrassing loss in Super Bowl 50 at the hands of Broncos quarterback Peyton Manning, linebacker Von Miller, and the rest of Gary Kubiak's team. Quarterback Cam Newton, the reigning MVP and captain of the Panthers offense, exhibited his skills as both a runner and a passer, as per usual. Ultimately, the Broncos sealed victory in a close 21-20 finish after a missed field goal by Panthers kicker Graham Gano missed wide left.

What many media outlets have been discussing the past few hours, however, is not just the close finish to the game, but the hard hit that Cam Newton took with less than a minute left in the game. 

Click here to watch the hit

You can clearly see Broncos safety Darian Stewart lead with the crown of his helmet, and his contact with Cam Newton turns Newton's head around 90 degrees. In addition to getting hit directly by Stewart's blow, Newton also takes another hit to the head when he goes horizontal and slams into the ground. 

Stewart's hit, whether intentional or not, was certainly illegal, and he was penalized on the play. I suspect he will also, for what it's worth, receive a fine from the NFL¹. But my real concern is the fact that Newton clearly took a hard shot to the head right in front of a referee (let alone a national audience of millions), grabbed his head, was on the ground for over 20 seconds before getting back on his feet.

The referees, coaches, players, team trainers, team doctors, and the NFL's "independent concussion specialists," who are supposed to be present at every game, all saw what you and I saw on that video, and yet no one stepped up. Cam Newton wasn't tended to by medical staff while on the ground, he didn't go through the NFL's concussion protocol, he didn't even miss a single play. I'm not a medical professional, and I obviously cannot definitively say whether Newton suffered a concussion on that play. But for him to go through no concussion protocol whatsoever? That's a clear violation by the NFL of it's own policy, and it's completely unacceptable.

Look: I understand that when millions are watching a prime time game between two exceptional teams and the losing team has the ball and is within one point with 40 seconds remaining, the last thing that anyone wants to do is remove a star player like Newton from action. I understand that if one of the team doctors or a referee were to remove Newton from play, he or she would receive unbelievable scrutiny for the next few days, or possibly longer, from fans and possibly from the Panthers organization. But a player's health, especially when it comes to the brain, is much bigger than football.

For a variety of reasons, many players, maybe even most, will not remove themselves from a game due to a hard hit to a head. Some reasons why are obvious: in the moment, they care more about winning the game for their teams, and they don't want to be seen as weak or defeated. They might also not realize that they are concussed, due to a late onset of symptoms or due to confusion and dizziness that results from the injury itself. Additionally, a coach is unlikely to remove a player from action unless he is specifically told to do so by a doctor.

The responsibility, then, falls directly on the shoulders of the independent concussion specialists and injury spotters to step up, stop the game, and allow players to receive an adequate examination before returning to action. That's their one and only job. Now, I'm sure there's circumstances surrounding the situation that I don't understand. Maybe the coaches are ignoring the specialists. Maybe the specialists don't have access to the referees in the middle of a fast-paced game. Maybe players sometimes refuse to see the specialists and want to remain in the game. Whatever the reasons for failure were, on that type of hit with that type of attention drawn to it, there should be absolutely margin of error. Newton should have been attended to and removed from play immediately, and not allowed to return until examined by one of the independent concussion specialists present on the sideline. 

---

1 Fines are a common occurrence after illegal hits, yet the amount of repeat offenders continually receiving them reveals that fines don't contribute much to their prevention. Part of this ineffectiveness may be due to the relatively small fines given in relation to the multi-million dollar contracts players receive. More will be discussed in a later post.

Read the Sticker

Around the beginning of training camp every August, after the summer workouts of June and July have been completed, the playbook has been solidified, and the pads and helmets have been distributed to players, my high school coach would always have us kneel together one afternoon after practice, take off our helmets, and flip them around to spot the little warning sticker stuck to the backs.

If you pay close attention next time you see a game or practice, you'll notice that every football helmet (at least in the last 5 or so years), no matter the brand, no matter if it's worn by a peewee kicker or an NFL linebacker, has one of these stickers. Different brands have different wording or information on the stickers, but the message is essentially the same-- "WARNING: NO HELMET CAN PREVENT SERIOUS HEAD OR NECK INJURIES A PLAYER MIGHT RECEIVE WHILE PARTICIPATING IN FOOTBALL. Contact football may result in CONCUSSION-BRAIN INJURY which no helmet can prevent." You get the idea. They often also include common symptoms of concussion, and discourage unsafe or illegal tackling techniques, such as spearing.

Notice the warning sticker with black writing on the back of this Tennessee player's helmet

There's assumed risk with everything in life. Get behind the wheel, especially if you chose to drink and/or not wear a seatbelt, and there's a chance of serious injury of death. Jump in the ocean, and you're jumping out of the human environment and into one of sharks, jellyfish, and rip currents. These dangers are everywhere when one really looks for them, but they're remote enough and difficult enough to prevent that most people probably don't spend much time contemplating them.

Football is in a different category than that of these normal occurrences. Although I hate to juxtapose what I consider to be a a virtuous past time to vices, football really can be compared to smoking, drinking alcohol, gambling, etc; it's not a matter of if negative consequences will ensue, it's a matter of when they will ensue.

I respect and admire my high school head coach for 1000 reasons, and the fact that he forced us every year to read the warning sticker that often gets overshadowed by the glossy finish and colorful stickers on a football helmet is one of them. In many ways, that warning sticker's place on the helmet is an apt metaphor for the way the concussion crisis in football is often lost in a sea of excitement, adrenaline, and (in the case of professional football) the dollar bill. But it's imperative that players, wether they are 7 years old or 37 years old, pay attention to the sticker and what it represents. Next time you (or your player(s) if you're a parent or coach) go to strap on a helmet, make sure you know and understand the risk associated with the game. Read the sticker.

Labor Day/About This Blog

It's a pretty obvious and indisputable statement that football is a sport ingrained in the American ethos. National holidays during the season demonstrate this importance; Thanksgiving for many is a day of family football games in the park and watching the NFL after eating turkey and potatoes, and New Year's day is often celebrated by marathon of college football games. Labor Day is no exception. Today, I'm sure you are much more likely to find Americans with the day off of work at home watching college football than you are to find them at a labor march or rally.

What is also indisputable, though, is that there is a hidden underside to a sport that has captures the attention of millions of Americans throughout the fall and year round. The prevalence and severity of traumatic brain injury (TBI) resulting from the football is undeniable, and it's impact is only beginning to reach the surface level of our societal awareness.

This blog seeks to explore that underside, to engage and analyze the crisis occurring in a game that sits at the very heart of the American ethos. This blog will be a place of exploration, information, and speculation on the nature of football and its future. It will serve as a resource to those impacted by or wanting to learn more about TBI. Most of all, it will be always be a voice truth, no matter how inconvenient or how bleak that truth may seem. For, with a nod to a famous quote from the bible, it is the truth that will set us free.