The future of football and the wave of brain injuries

We’ve been here before, historians remind us, and we have the pictures to prove it: late-nineteenth-century newspaper and magazine illustrations with captions like “The Modern Gladiators” and “Out of the Game.” The latter of those, which appeared in Harper’s Weekly in 1891, describes a hauntingly familiar scene, with a player kneeling by his downed—and unconscious—comrade, and waving for help, as a medic comes running, water bucket in hand. It accompanied an essay by the Yale coach Walter Camp, the so-called Father of American Football, whose preference for order over chaos led to the primary differentiating element between the new sport and its parent, English rugby: a line of scrimmage, with discrete plays, or downs, instead of scrums.

What is old is new

Camp viewed football as an upper-class training ground, not as a middle-class spectator sport. But the prevalence of skull fractures soon prompted unflattering comparisons with boxing and bullfighting. Another image, which ran in the New York World, depicted a skeleton wearing a banner labelled “Death,” and was titled “The Twelfth Player in Every Football Game.” Campaigns in Chicago and Georgia to outlaw the sport were covered breathlessly in the New York dailies. That was in 1897, “the peak of sensationalized football violence,” as Michael Oriard, a former offensive lineman for the Kansas City Chiefs who is now an associate dean at Oregon State University, explains in “Reading Football: How the Popular Press Created an American Spectacle.”

…What was missing from this picture was the effect of all that impact on the brain. You got your “bell rung,” they used to say. You’re “just a little dinged up.” This was not merely macho sideline-speak; it was, as recently as a decade and a half ago, the language of the N.F.L.’s leading doctors. Elliot Pellman, who served until 2007 as the Jets team physician, once told a reporter that veteran players are able to “unscramble their brains a little faster” than rookies are, “maybe because they’re not afraid after being dinged.”

Chronic traumatic encephalopathy, or C.T.E., is the name for a condition that is believed to result from major collisions—or from the accumulation of subconcussions that are nowhere near as noticeable, including those incurred in practice. It was first diagnosed, in 2002, in the brain of the Pittsburgh Steelers Hall of Fame center Mike Webster, who died of a heart attack after living out of his truck for a time. It was next diagnosed in one of Webster’s old teammates on the Steelers’ offensive line, Terry Long, who killed himself by drinking antifreeze. Long overlapped, at the end of his career, with Justin Strzelczyk, who was also found to have C.T.E. after he crashed, fatally, into a tanker truck, while driving the wrong way down the New York Thruway….

…The fastest running on a football field often occurs during kickoffs and punts, when some members of the defending team are able to build up forty or more yards of head-on steam before a possible point of impact…. One proposed reform that I’ve heard about would involve removing this element from the game, through automatic fair catches, or at least neutering it, by shortening the distance travelled by the kicking team. The most frequent head-butting on a football field, meanwhile, occurs at the line of scrimmage, where linemen often begin in what’s known as a three-point stance: crouching and leaning forward on one hand, and then exploding upward in a meeting of crowns. Another suggestion: banning the stance and requiring linemen to squat, sumo style. And then, more important, there’s simply teaching proper tackling technique. As one recently retired player put it to me, “Instead of telling a kid to knock the snot out, you say, ‘Knock the wind out of him.’ ”

“The reality is you’re going to need about twenty fixes that reduce risk by a couple of percentage points each,” Chris Nowinski said. “There’s still going to be four downs. Still going to be a football. Still going to be eleven guys on the field—and touchdowns. Other than that, everything’s in play.” . . .

…How many of the men on the field in the Super Bowl will be playing with incipient dementia? “To me, twenty per cent seems conservative,” Nowinski said. C.T.E., as of now, can be observed only with an autopsy. The ability to detect it with brain scans of living people is at least a couple of years off. “It’s not going to be five per cent,” Nowinski went on. “The reality is we’ve already got three per cent of the brains of people who have died in the last two years confirmed, and that’s not alarming enough to people. What number is going to be the tipping point? People are O.K. with three per cent. They may look sideways at ten per cent. Maybe it needs to be fifty per cent.”

That’s from a piece from this week’s New Yorker, by Ben McGrath. Not much new is covered on this subject; indeed, much of it is giving deserved credit to the New York Times’s Alan Schwartz, who has made this subject his personal question. But it’s a worthy reminder of the serious risks inherent in our favorite sport and which we are only just beginning to understand.

I’ve written about this subject before, and I am still sure that the brain-injury/concussion problem remains the most serious threat to football, and it will not be resolved by tweets from Greg Aiello, the NFL’s spokesman. Yet — and this may sound harsh — I don’t really care about the risks to current NFL players. Like professional boxing, no one can, with a straight face, say that they don’t understand the risk of playing such a dangerous, high speed collision sport, and they are all compensated handsomely for it. (I have more sympathy for older NFL players who played before high salaries and before these risks were well understood.) Indeed, I think the NFL as spectator sport will continue to survive through more “Black and Blue Sundays” or even serious injuries like paralysis, potentially even a live-on-the-field death. Some quick cuts to show Roger Goodell solemnly addressing “the problem” with fines and rule changes will be enough to placate the masses and change the narrative on ESPN back to who will rally for the postseason.

But the more serious threat to football — and the one I care about more than whether a very narrow class of high-profile, high-risk, high-reward professionals are making a bad judgment by playing the game — is whether the evidence shows that amateur football can cause lasting, long-term brain damage. The big stories will come out of the NFL and, to a lesser extent, major college football, but if in ten years it can be demonstrated that four years of high school football significantly increases the risk of brain injuries and long-term disorders, then football really will have no future.

And yet… as McGrath observes, maybe it’s not just football — maybe it’s sport in general, or simply us:

In fact, reading the Concussion Blog exposes you to a steady drip of news that is not so good for your anterior insula, the part of the brain associated with worry. Rugby, lacrosse, baseball: concussions are seemingly epidemic everywhere. The problem with having access to better information about the risks we all take is that most leisure pursuits start to seem inherently irresponsible. What are we to do about skiing, bicycling, sledding?

“Hockey, by the way, has a higher incidence of concussions than football,” Dr. Maroon told me. This is true of women’s college hockey, at least, which doesn’t even allow body-checking. (Women, in general, seem substantially more prone to concussions, and explanations vary, from weaker necks to a greater honesty in self-diagnosis.) … Hockey may now have a concussion crisis on its hands, with the N.H.L.’s best and most marketable player, Sidney Crosby, having been blindsided during the sport’s annual Winter Classic; attempting to play again, four days later, he was drilled into the boards, and he hasn’t played since. I play hockey twice a week myself, and was once concussed, or so I now believe, while skating outside, on a frozen pond, without a helmet.

Troy Polamalu suggested soccer as an alternative for squeamish fans. But soccer players collide sometimes, too (Taylor Twellman, a forward with the New England Revolution, recently retired because of ongoing symptoms from a neck injury sustained in 2008), and the ball is harder than you think. The g-forces involved in most headers are equivalent to minor car crashes. “Twenty-five years from now, I wouldn’t be surprised to see everybody on a soccer field wearing some kind of headgear,” Michael MacCambridge said.

To err is human, or so it seems.