Sports Injuries and Dementia

I have not written recently about my work with the Boston University Alzheimer’s Disease Center, but our Advisory Board ended up making a suggestion that eventually resulted in Boston University getting funded to undertake research that led to the findings that are now in the headlines of every sports page and in discussions on every TV and radio sports talk show. I am speaking about the discussions about the National Football League’s decision to issue a directive to officials, teams, and players that particularly “vicious” hits will be punished with player suspensions as well as penalties.

I commend NFL Commissioner Roger Goodell for having the good sense to address this issue decisively, although, as I will point out, the BU research findings are potentially far more transformational for contact sports than the commentators about the findings have communicated. What is most interesting, and, to some degree, saddening, is the fierce resistance of many players and commentators to an action that will benefit the players and the sport in the longer term.

The Boston University Research Findings

I have gotten to know two of the researchers in the BU Study, Dr. Robert Stern and Dr. Ann McKee. I have particularly worked closely with Dr. Stern, who is the co-chair of the clinical studies and trials program in the Alzheimer’s Disease Center. The research he and Dr. McKee have published makes a number of key findings:

• The dementia that many athletes experience, sometimes well before old age, is not Alzheimer’s Disease, but a condition brought on by chronic traumatic encephalopathy (or “CTE”), which creates the conditions for dementia, but has a different source of progression from Alzheimer’s Disease.
• Most important, CTE does not result from a single concussive event, but from the cumulative effect of many violent impacts on the brain, many of which would not be diagnosed as concussions. While the NFL and other sports are to be commended for their proactive approach to managing athletes who sustain concussions, the problem is more widespread. Indeed, it is entirely possible for an athlete to be victimized by CTE without ever having been diagnosed with a concussion.
• While the end result of CTE could be dementia, the effect on certain sectors of the brain even earlier in time might be damage to those brain functions that inhibit individuals from drug or alcohol addiction or prevent depression and/or suicide. Thus, many athletes who become alcohol or drug dependent, experience clinical depression, or even commit suicide long before old age may be victims of CTE.
• Because the root cause of CTE is cumulative and sub-concussive, it occurs in a wide range of contact sports, not just obvious contact sports like football and boxing. Ice hockey players, soccer players who use their heads to direct the ball, and baseball players who are hit in the head frequently with pitched or batted balls might also be CTE victims.
• Because not every athlete who has participated in, or been a victim of cumulative sub-concussive impacts has experienced dementia or the loss of brain function, there is much more work to do before researchers can figure out the whole puzzle.

What We Need to Do in the Meantime

There are many good things happening in sports management already as a result of these findings:

• The NFL has funded further research at BU, which has created the Center for Traumatic Encephalopathy to conduct the research.
• A number of sports, including football and baseball, are starting to keep people with concussions from returning back to active sports participation too quickly. I was pleased that the New York Mets and the Minnesota Twins kept Jason Bay and Justin Morneau out of action for the remainder of the 2010 season. This was particularly painful for the Twins, who could have used Morneau’s incremental and sizable contribution in the playoffs.
• There is more active dialogue about how to keep the intensity and attractiveness of these sports while reducing safety risks for participants.

The best article I have seen recently on this last subject appeared in William Rhoden’s October 24, 2010, column in the sports section of the New York Times, a column entitled “Hall of Famer’s History of Compassionate Hitting.” Rhoden profiled the story of Willie Lanier, a Hall of Fame middle linebacker from the Kansas City Chiefs from the late 1960’s to the late 1970’s, The gist of the article is that Lanier was fortunate to have had a concussion early in his career and refrained from being as reckless and violent for the remainder of his career as he could have been.

The most important insight Lanier gained and shared with his fellow players was that keeping people of high skill and quality playing, rather than injuring them, benefited everybody. If everyone successfully knocked the most skilled players out of competition for extended periods of time, there would be retaliation, and, over time, the quality of people competing would decline. Lanier also recognized, as has Mike Golic, of the Mike & Mike in the Morning show on ESPN radio, that, to some degree, the violent hits result because players have not learned how to tackle properly.

That being said, this is a difficult issue. Putting aside what I consider to be an overreaction of some players and commentators that the NFL risks turning tackle football into flag football, the legitimate issue is that football is a high-speed game played by abnormally large and strong men in which a traditional tackle may not always be possible in the context of a particular play. Moreover, as noted above, the real issue is not the occasional violent hit that results in a concussion, but the broader problem of cumulative sub-concussive impacts.

On the cumulative force problem, the NFL needs to look at a whole range of issues, including the 3-point stance, which creates more force at the point of impact for both offensive and defensive linemen, as well as the people they hit, and the equipment used in the game. The main equipment culprit is the current hard plastic helmet with the hard metal face protection system. The hard plastic helmet protects against certain blows to the head, although its absorptive capability is not as good as it could be, but it is a lethal weapon when aimed at the chest or head of an opponent.

The other equipment issue is the problem of the face protectors, which create both an opportunity for an opponent to grab and twist a player’s head and another hard object to plow into an opponent’s chest or head. One commentator mentioned that Joe Paterno of Penn State, the winningest college coach in the history of college football proposed that the NCAA and the NFL go back to the helmet used before face masks were made larger and harder.

This is not an easy subject to address. The economics of both college and professional football depend heavily on the excitement that the controlled violence football games present to viewers and participants. Eliminating violence is neither practical nor desirable, but controlling it so that it generates excitement without an accompanying risk to the long-term health of athletes is a more realistic goal. It is not a goal that will be reached quickly, but we are beginning a more productive journey because of the great work done by Boston University and other research institutions and the proactive response of the NFL.