A New Era of Pro Football

The era of concussion awareness has dramatically transformed the social and legal landscape surrounding the gridiron. Concussions – traumatic brain injuries – were hardly part of the public discourse less than a year ago.

In Dr. Elliot Pellman’s words, they were just “an occupational risk.” Now, there isn’t a day that goes by that we don’t hear about the long-term effects of concussions.

The scientific information players are equipped with provides them with a decision: should I continue to play football knowing that one day I will probably have dementia or CTE?

The overwhelming answer is yes, and, of course, the majority of middle-aged men would unequivocally risk brain damage for a couple million bucks.

The public’s interest in the concussion discussion was on display this week in the “controversy” surrounding Robert Griffin III’s return to play after suffering a “mild concussion.”

Regardless of whether you thought he should have returned or not, the fact that people were talking and arguing about it, shows that we as a society are becoming increasingly aware about the risks of concussions.

Unlike the current players, I’m not so sure the pre-2009 NFL players had an opportunity to make an informed decision about the neurocognitive risks of professional football. Whether this was due to the lack of science or whether the NFL concealed this from the players, will be a question for the jury – if the concussion lawsuits survive several pre-trial hurdles.

In order to appreciate the differences between professional football now and what it used to be, you don’t have to look back very far.

In the early 1990s, Al Toon was one of the first players to retire due to concussions. Similarly, after suffering second-impact syndrome and nearly dying, Merril Hoge was forced into retirement. Back then, getting your “bell rung” was handled like a jammed finger – players played through it because they were not informed that concussive and subconcussive blows could have permanent, neurocognitive effects.

In 1994, then-Commissioner Paul Tagliabue formed the Mild Traumatic Brain Injury Committee with the specific task of studying concussions in professional football. The Committee was led by Dr. Elliot Pellman, a rheumatologist; Dr. David Viano, a biomechanical engineer; and Dr. Ira Casson, a neurologist. Over the next 15 years, the Committee created a series of several controversial studies that refuted the link between concussions and neurodegenerative diseases (e.g. dementia, Alzheimer’s, ALS, CTE). In the Committee’s most controversial study, published in Neurosurgery, the authors made four conclusions that could, eventually, cost the NFL billions of dollars in the NFL Concussion Litigation.

First, “it can be concluded that mild TBIs in professional football are not serious injuries.”

Second, in regard to the often-times deadly second-impact syndrome the Committee found that “[i]t is possible that this syndrome does not truly exist in this population of athletes.”

Third, in dismissing Dr. Cantu’s various grades of concussions and the necessity to hold concussed players out until they are asymptomatic, the authors found that their study “supports the suggestion that such arbitrary return-to-play guidelines may be too conservative for professional football.

And fourth, “[t]he results of this study indicate that many NFL players can be safely allowed to return to play on the day of the injury after sustaining a mild TBI.”

Shocking, I know.

But, I’ll leave it to the plaintiffs’ lawyers, and their experts, to tear apart these studies in court. In the meantime, I’ll use the NFL’s subsequent remedial conduct to shed some light on its, arguably, flawed pre-2009 approach and how the NFL concussion protocol has evolved into its modern form.

After taking a tongue-lashing by Congress, the NFL did a complete about-face.

In December 2009, Roger Goodell sent out a memo to all teams summarily stating, a player who has a concussion shall not return to play on the same day. A few weeks later, the NFL’s spokesman, Greg Aiello, told the New York Times, “It’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems.” The NFL also accepted the resignation of the members of The Mild Traumatic Brain Injury Committee, and its flawed studies were flushed down the toilet.

Players used to have a say in whether they were allowed to return to play. After suffering an obvious concussion, Wayne Chrebet was examined by the Jets’ medical staff – none other than Dr. Pellman – prior to returning to play. Dr. Pellman told Chrebet on the sidelines, “This is very important. You can’t lie to me. There’s going to be some controversy about going back to play. This is very important for you, this is very important for your career. Are you okay?”

With a wink and a nod, Chrebet convinced Pellman, and Pellman happily agreed, that he could return. In hindsight, Chrebet said, “It was just stupid, trying to get back out there, just me trying to convince them and myself that everything was all right.”

It’s difficult, and perhaps unfair, to blame players for wanting to return to play. Not only is their job and future earning potential at risk, but they also are not thinking clearly (i.e. temporary dysfunction of the brain). This is why the decision is, according to the NFL’s protocol, no longer in the player’s hands.

If a player is suspected of having a concussion, he must go through the NFL sideline assessment test. Once it is determined that a player has a concussion, the John Madden Rule applies, he must immediately be removed from the field and taken to the locker room where he is examined by the medical staff. And, under no circumstances, is the player allowed to return to play that same day.

Before a player is allowed to return to practice, he must pass daily neurological exams and be cleared by an independent neurologist and the team’s doctor. A great example of the protocol working as advertised involved Matt Cassel and RG3. Both suffered a concussion during Week 5 and were immediately removed from the field. Cassel still had concussion symptoms and therefore was not allowed to play in Week 6. On the other hand, RG3 was asymptomatic, cleared by an independent neurologist, and allowed to return to practice.

This brings me to my final point. There is a clear contrast in the way the NFL handled concussions pre and post-2009. From Day 1 at the Rookie Symposium players are educated about head injuries and the daunting statistics that likely await them in life after the game. Players like Calvin Johnson, who readily admit to playing through concussions, appreciate the risk, and rightfully so, have determined that the award (i.e. million-dollar contracts) outweighs the cost of someday suffering from dementia or CTE.

Frankly, I don’t mind Calvin Johnson’s attitude — it likely represents the mindset of the majority of current players. Although Tiki Barber’s recent article is well intentioned, I think he completely misses the mark. How is RG3 setting a bad example when the decision to return to play wasn’t up to him? Hell, if the decision were up to RG3, he would have returned to play during the same game – he still won’t admit he had a concussion.

Again, this decision was solely within the control of an independent neurologist and the Redskins. Each individual is different – blanket guidelines yield to a doctor’s judgment. More importantly, with plaintiffs’ lawyers breathing down the necks of the NFL, no independent neurologist would be willing to place his/her license on the line if RG3 were not ready to return.

Tiki Barber, without saying it, almost comes across as equating steroids with concussions. If Tiki’s comments were in the context of steroids, they would be spot on. Steroid intake is obviously within an individual’s control, and the cheaters that took it should be chastised for setting a bad example to the youth.

But, professional football players should not be called out for being cleared by a neurologist. Moreover, the inherently violent game of football and the daily brain bashing that comes with it is not a good example for the youth, period, but that argument is a lost cause.

We will never be able to take concussions out of the game. What we can do is continue the dialogue and maybe, just maybe, place some trust in the NFL’s concussion protocol.

No system is perfect and we may, unfortunately, see more incidences where players look concussed but somehow are returned to play. At the end of the day, the fatally flawed system of football’s past has been put to bed, and the new era of professional football — independent neurologists and informed players — is here to stay.