Warfare vs. Fanfare: The National Football League’s Concussion Crisis and a Proposal for Reform

Introduction

The fact that participation in athletics causes between 1.6 and 3.8 million concussions annually in the United States (Daneshvar et al., 2013. p. 1) has brought traumatic brain injury (TBI) to the forefront of discussion in professional football. As a result of this discourse, the question of how to improve player protection, has dominated the ongoing concussion debate between neuroscience researchers and National Football League (NFL) executives. This debate is necessary because, while NFL executives and a small group of concurring scholars insist that football and the concussions that follow are not injurious to the athletes who partake in the sport, other neurological experts counter that the consequences from concussions present long-term consequences such as cognitive impairment, memory difficulty, depression and even Alzheimer’s disease. Therefore, NFL administrators believe that miniscule changes, if any at all, need to be made to increase player protection, while leading neurological experts believe that a plethora of changes to football are needed to heighten player protection and resolve the concussion dilemma. Furthermore, as players are becoming bigger, faster and stronger alongside a league that is turning into a battlefield rather than a playing field, more needs to be done to ensure the safety of the players because with an increase in speed, size, and force comes an increase in the already high number of head impacts. By doing more to protect players from these harmful impacts that could potentially derail the rest of their lives, league executives, researchers, and fans alike will be able to rest assured that players are being afforded the best chance of a lengthy and healthy career, as well as a productive and high quality of life after the league. Another reason this research is pertinent is that with the possible implementation of my suggestions (which will be detailed later), America’s favorite sport could be on its way to casting aside the shadow of deceit and mockery that covers it and ushering in a new era of safe, yet entertaining, play.

My view most resembles that of the neurological scholars. While I don’t share all their views, I concur that substantial modifications need to be introduced to the NFL to improve player protection. Despite it being easy to say that lowering the number of concussions a player receives will lead to a better life, stating exactly how is comparatively harder. What are the best methods for lowering the number and severity of concussions in the NFL, and how should these methods be implemented? To answer these questions, I will first provide an overview of the current critical debate among NFL administrators and neurological experts on the current state of concussions. Secondly, I will explain where I stand in that debate and the solution that I believe can help better protect players from concussions and their short and long-term effects.

Critical Debate about Concussions in the NFL

In the debate on concussions, two sides clearly emerge. On the one hand, some neuroscientists, such as doctors Daniel Daneshvar and Lawrence Robbins, argue that major changes need to be made to better protect players from traumatic brain injuries and the resulting consequences. On the other hand, NFL executives and scholar Dr. Frank Conidi contend that football is not as dangerous as recent scholarship makes it out to be and that minute changes in rules and protective equipment are all that is necessary in order to improve player protection. The NFL maintains that the aftermath of concussions is exaggerated by scholars who want to cast a bad light on the NFL and its practices. My view is that significant changes need to be enforced in the NFL to increase player protection including: making players take more responsibility for their safety, establishing new rules, redesigning helmets and uniform policy, and increasing coach and player education.

In “Helmets and Mouth Guards: The Role of Personal Equipment” (2013) Daneshvar et al. analyze the role of personal safety equipment on concussion prevention and encourage new rules that would inhibit spear tackling (tackling in which the player is picked up and dropped on his spine, head, and/or neck) and limit contact in practices to lessen the amount of danger a player is exposed to (p. 10). As an example, John Gagliardi (St. John’s University), the winningest collegiate football coach of all time, has banned tackling in practice since 1956 and continues to dominate Division III football (Robbins & Conidi, 2013, p. 2). Daneshvar et al. (2013) point out the shortcomings of helmets in their article saying, “the primary concern [of helmet manufacturers and designers] was the helmet’s response to the most acutely severe . . . impacts, rather than its response to wide range and types of forces that could result in concussion” (p. 3). In short, this means that helmets are designed to combat skull fractures and other superficial injuries, which have immediate symptoms, instead of concussions whose symptoms are latent and may not have prompt physical indications (Robbins, 2013, p.2). These findings support Daneshvar et al.’s opinion that major reforms need to be made to increase player protection and support my view point that helmet reform is a necessary component in improving player safety.

Robbins, a neurologist and headache expert, first takes an extremist view on how to better player protection in his and Conidi’s article, “Stop Football . . . Save Brains: A Point Counterpoint Discussion.” Robbins (2013), asserts in the first line of the article: “We should eliminate tackle football before age 18” (p. 1). Robbins believes this is a suitable suggestion because the victims of concussions are becoming increasingly younger, as young as high school and little league levels (Robbins, 2013, p. 2). However Robbins’ solution is not very realistic because prohibiting tackling presents problems of its own. Upon reaching age 18, most students are graduating or have graduated high school; therefore, the chance to play recreational football and be educated in the fundamentals of the sport have passed. Consequently, the athlete would not have had a fair chance to learn proper tackling techniques and would be at a disadvantage trying to play football at collegiate and professional levels. Also, if a player does not practice tackling until the age of 18, then he or she will not have the muscle power needed to play tackle football at the higher levels (Conidi, 2013, p. 3). Later in his article, however, Robbins (2013) deserts his extreme solution for a more reasonable view: that educating coaches, parents, and players about proper tackling techniques and promoting the reporting of concussions will serve as better precautions to increase player safety than his initial solution of banning tackling until age 18 (p. 2).

Conversely, Dr. Frank Conidi, a neurologist and pain specialist, supports the view that football, at all levels, is not exceedingly dangerous and that there is not a lot of support for some of the alleged consequences resulting from concussions. In his collaborative piece with Dr. Robbins, Dr. Conidi casts doubt on the consequences of concussions by questioning science and current research. Conidi (2013) questions the certainty of concussion research by saying, “The fact is that there is little to no class 1 evidence to support the notion that subconcussive events . . . result in permanent injury” (p. 3). Subconcussive hits can be defined as small blows to the head that do not register as immediate threats or concerns, but upon amassing a great amount of subconcussive hits, a concussion and/or other severe consequences could surface. The class 1 evidence of which Conidi speaks can best be defined as evidence taken from randomized controlled trials, or clinical trials that randomly assign subjects to a group (PCCRP, 2006, para. 5). Conidi implies that most clinical trials subjectively place their participants into groups instead of assigning them at random, which would be required for a true randomized survey. Conidi (2013) takes his questioning of science a step further when he undermines the legitimacy of research concerning concussion symptom management and the existence of Chronic Traumatic Encephalopathy (CTE) as a clinical disease, contending that clinical evidence to prove its existence is lacking (p. 3). CTE is a disease very similar to Alzheimer’s disease and was found in the brains of deceased football players such as Mike Webster and Junior Seau, who committed suicide, by neuropathologist Bennet Omalu in 2002. However, Conidi does not believe that there is a significant difference between the two diseases. Once more, Conidi reaffirms his belief that concussions are not a serious issue when he describes a study completed by Sonia Gysland and several other sports science researchers at the University of North Carolina at Chapel Hill. The study, which looked into the relationship between subconcussive impacts and neurological function, concluded that there were no significant changes in neurological activity from preseason to postseason (Conidi, 2013, p. 3-4). In the study forty-six collegiate football players completed a number of neurological tests pre and post season that measured for concussion effects and were then analyzed.

My own view is that a mixture of both on-field and off-field precautions need to be taken to increase player protection from concussions and consequential injuries. Though I concede that the perspectives of the NFL executives and research scholars offer distinct and helpful solutions, I maintain that the optimal solution to increase player protection against TBI and subconcussive hits would be to create a protection protocol that better protects the players by improving rules and regulations while also putting some of the responsibility for safety onto the players themselves. Some of the neurological experts and NFL executives may object that my view remains passively neutral because my solution does not completely align with either of their ideologies. In response, however, I would say that my view allows me to propose a holistic approach and provide a more complete protection plan than implementing either one of their solutions alone.

My Own View and Proposal
[The purpose of this section is to detail my opinion and the resulting proposal I developed to remedy the current concussion dilemma]

My own view closely resembles that of Daneshvar and Robbins. I believe that revamping the usual workout to include neck strengthening exercises, new rules, helmet redesign, and coach and player education will be the best solution to decrease TBI and increase player protection. Daneshvar (2011) proved in his article that majority of helmets are designed for the purpose of protecting against skull fractures, and the few helmets that manufacturers promote as protecting against concussions do not have enough clinical proof to support these claims (p. 3-4). Therefore, helmet redesign is a factor that I think will lower the number of concussions reported. If helmets are repurposed to go beyond their superficial function of skull protection and provide deeper intracranial support, their effectiveness in preventing concussions will increase. Coach and player education is another component of my proposal for change; better education for all involved on harrowing concussion consequences cannot help but to amend the concussion crisis. My solution calls for more than just coach and player education, however. It has been proven that the rotational acceleration of the neck that occurs during a head-on collision contributes heavily to the severity of a concussion (Daneshvar et al., 2011, p. 3-4). As a result, I believe that some of the responsibility for protection of players falls on the players themselves. Players should incorporate neck strengthening exercises into their workouts to decrease this rotational acceleration. In the following sections, I will explain in great detail the specifics of each of my suggestions.

Strengthening of Neck Muscles: Revamping the Usual Workout
[In this section some exercises to decrease rotational acceleration and concussion severity will be discussed]

My first suggestion puts some responsibility directly on the shoulders of the players, literally. Daneshvar (2013) concluded that neck muscles and their strength directly relate to the severity of a concussion by way of rotational acceleration (p. 3). Therefore, ensuring the strengthening and balance of neck muscles and not monopolizing all efforts on popular mirror muscles such as the biceps, triceps, abdominals, and quadriceps will help to reduce the amount of rotational acceleration and, logically, concussions. Some exercises for strengthening neck muscles and reducing rotational acceleration include shoulder shrugs with dumbbells, dumbbell press, and lateral pull-downs (this exercise requires a specific workout machine) (Barton, 2013, para. 11).

New Rules
[In this section I will use unnecessary roughness as an example of why new rules are needed, introduce and refute a possible counterargument to the establishment on new rules, and lastly, make a plea for the lessening of brutality in practices]

New rules are crucial to improving the protection of players. Unnecessary roughness, for example, is explicitly defined in The NFL Official Rulebook in Rule 12, Section 2, Article 6, but as for a general definition to be used in this article, the term is fairly self-explanatory (NFL, 2013, p. 67): using the foot or leg to strike/tackle an opponent, tackling a runner out of bounds, tackling a receiver or runner after the play has ended, and/or using any part of the helmet to ram or spear an opponent are all examples of unnecessary roughness. As of now, the only penalty for these actions, including the last example of using the helmet as a weapon, is a loss of 15 yards and an automatic first down (a major detriment in the sport) for the opposing team. However, if individual players were to be suspended for unnecessary roughness instead of punishing the team as a whole, I believe there would be a decrease in unnecessary roughness calls and illegal tackles as a whole. I say this because player suspension directly interferes with players’ livelihoods. Players are more likely to play by the rules if it means, as individuals, they will lose money instead of just 15 yards as a team. Therefore, to stay in the game and make money, players will be less willing to partake in extraneous play and more willing to perform within the guidelines.

Opponents of imposing new rules, including NFL executives, football fans, and some players, argue that rules increasing punishment for abrasive tackling will weaken the level of intensity and manliness of the game and that imposing such rules likens the professional game to flag football or child’s play. However, form tackling (traditional tackling with the head up and spine upright) that does not impose excessive force was acceptable at the debut of the sport and should be acceptable now, when the sport is experiencing a substantial amount of controversy. Form tackling does not lower the masculinity of the game. In fact, players who use correct tackling techniques and produce immaculate and forceful tackles should be deemed most masculine because they’re playing the safest and still achieving the same result as someone who uses unnecessary force.

Prohibiting erroneous playing habits is not the only change that needs to be made as far as the rulebook is concerned in order to fix the concussion problem. The NFL also needs to do a better job to limit the brutality of practices. Currently, the NFL restricts the number of padded practices a team can have during a week in the pre, regular, and post seasons (NFLPA, 2011, Article 24, Section 1). But, even if full pads are not being worn, players will always wear helmets during practice. This leads to an irresistible temptation for players to butt heads with their helmets during practice. If pads are not being worn players won’t tackle each other because of the increased danger, but they will continue to collide helmets because that’s where they are seemingly protected. But this sense of security is indeed false, which leads to my next point.

Helmet Redesign
[This section consists of an explanation of the design shortcomings of football helmets, practices that affect the helmet selection (and protection) of players, and finally, a discussion of Riddell’s dominance in the NFL]

As helmets protect the brain, which is at the heart of the concussion discussion, shouldn’t it be mandated that they be the safest and most useful piece of equipment a player wears? As much as concerned fans and researchers wish this were true, it most certainly is not. Helmets are intended to protect against the impacts that cause skull fractures, but not necessarily against the blows that lead to concussions. The main reason for this is that designing a helmet to prevent skull fractures is easier than designing a helmet to prevent concussions because the injury is so superficial. Still, when designing a helmet to prevent subconcussive blows, it can be difficult to pinpoint which part of the head to protect. This is because the severity of concussions is heavily dependent upon the amount and type of acceleration the head experiences during a collision. When most helmets’ acceleration changes are measured, the data is measuring acceleration at the center of the head, but this is not where the most acceleration occurs. Instead, some researchers conclude that most acceleration takes place in the facemask area (Kis, Saunders, ten Hove, Leslie, 2004, p. 4). Impacts to the facemask cause the head to twist and accelerate, which is given the term rotational acceleration. And since it isn’t practical to place a lot of padding in a helmet’s facemask region because it will be uncomfortable and could affect an athlete’s ability to see, another way to lower the amount of rotational acceleration in the head must be created.

Even then, another issue arises: uniformity. NFL players are free to choose whatever helmet they’d like to wear as long as the helmet is National Operating Committee on Standards for Athletic Equipment (NOCSAE) certified (Borden, 2012, p. A1). This means that a player can choose a helmet that he or she thinks will look best on television but is not necessarily the most protective, or a player can continue to use the same type of helmet throughout his or her entire career even though the helmet’s design may have become archaic. Because players are able to use whatever certified helmet they prefer, even if a helmet that protected against concussions was designed, it doesn’t mean the players would wear it.

Not only does physical appearance affect how a player chooses his or her helmet, but the manufacturer of the helmet also plays a large role. Riddell, a helmet manufacturer, has the privilege of being the official helmet sponsor of the NFL, meaning that only Riddell logos are able to be seen on helmets in the NFL as seen in Figure 1. Thus, for players who prefer a Schutt (another popular equipment manufacturer) helmet, it may be harder for them to acquire such a helmet because a) it will be more expensive since Riddell offers teams helmets at a discounted price and b) the Schutt logo has to be removed and replaced with the team logo as seen in Figure 2. This dominating presence of Riddell not only affects players in the professional league, but it also affects those in younger leagues which is seen in my next suggestion (Borden, 2012, p. A1).

Coach, Player and Parent Education
[Coach, player and parent education is an integral part of my solution for increasing player protection, so the particulars of helmet and tackling education will be discussed in this section]

Where might Riddell helmets fit into coach and player education? It has to do with knowing what’s best for the player. If Riddell dominates as the NFL’s top helmet choice and is the only manufacturer of helmets to be advertised on a large scale, then coaches and parents are more apt to think that Riddell is the best option for their players without considering other options. But, if players in the NFL use helmets other than Riddell, then there’s cause to believe that players at younger levels of football would and should as well. For example, let’s say that Adams, a helmet manufacturer, produces a helmet that has been rated as the best helmet for children under the ages of 13 (Pop Warner/Little League level of play) by USA Football, football’s national governing body. The Adams helmet, though proven to provide the most protection for their children, will be overlooked by parents and coaches for a Riddell model because Riddell is a more popular brand. Therefore, the authority given to Riddell by the NFL, whether deserved or not, can interfere with the decisions of coaches and parents about which helmets to outfit their players.

Helmet awareness isn’t the only facet of education to be considered though. Heads-up tackling, or tackling without lowering the crown of the head should be taught at lower levels of play because heads-up tackling reduces the number of head hits a player receives. This way when a child participates in higher levels of play the traditional form of tackling will be ingrained and second nature. Because Pop Warner leagues are not regulated on a national scale, coaching styles and techniques vary greatly. If coaches follow the uniform guidelines of heads-up tackling, then more symmetry will appear across the nation in the way Little League football is played. These changes will follow into the middle school, high school, and collegiate levels of play as well.

Conclusion and Further Discussion

As the NFL continues its battle with researchers as to whether changes need to be made to better protect players against concussions and the magnitude those changes should have, I have come up with four suggestions I think would satisfy both sides. Strengthening neck muscles, imposing new rules, redesigning helmets, and increasing coach and player education are all components of my suggestion that I think will increase player protection and, therefore, decrease the number of traumatic brain injuries and concussions in football. On the one hand, the NFL would appreciate athletes being more responsible for their own health and helmet manufacturers being held to a better standard for designing helmets, but the NFL needs to work to increase helmet uniformity within the league. While, on the other hand, neurological researchers would appreciate adding new rules and penalties to the game and educating coaches, players, and parents on the dangers of concussions so that the number of concussions would decrease and an unfortunate dilemma can be amended. Even though my suggestions in no way completely resolve the concussion crisis, I do believe they provide a good start for further innovation and discussion.