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. 

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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.