Tuesday, September 7, 2010

Achilles Revenge II: Brain Trauma and the Footballs

The accumulating evidence on head injuries and long term brain damage poses an immense problem for  American and European footballs. The problem arises because the contact initiated and the impact on the brain seems so woven into the pattern of the sport. Imagine soccer without headers (it is possible but won't happen: imagine football without head contact; impossible), but something must be done.

The awful injuries pose the question: should we change the sports to protect safety. The problem deepens because these are injuries that pose serious problems down the line; they are not immediate like ACLs or torn labra, but accumulate insidiously in increasing brain damage. Even concussions, where the sports are focussing, are only symptomatic of the long term costs.

For instance look at the pictures of two brains--a healthy brain and the poisoned brain of a 26 year old NFL wide receiver  Chris Henry. He had no history of concussions but after months of increasingly erratic behavior, he died attempting to jump on a moving truck driven by his fiance. Henry's brain  is shot through with the poisoned proteins. The  repetitive impact and the additive effect of  toxic proteins generated by the trauma was destroying his brain. The proteins like tau proteins create brain tangles and inefficiencies and degradation of connections. People suffer impaired cognitive reasoning long before dementia, alzheimers or Lou Gehrig's sets in.

Everyone focuses upon concussions because they seem immediate and can sort of be diagnosed and have some protocols for recovery. But as ventilator ridden Steve Smith writes from on a computer using eye movement:     "I have hit people 40 to 50 times every week in practice, not to mention 50 to 70 times on game day 16 days a year, not to mention camp every year." In a computer generated voice, Smith asks, "When is enough enough? You have the old-school owners that say, 'That's how you make them tough.' I'd love to see them get out there and hit heads with guys that are bigger than them."

Two answers are given for not changing. First, "this is the game" and "the game entails physical risk, that is what makes it the game and demands courage and skill of players." Soccer depends for some of its critical moves and scoring upon heading. Football grows from the organized directed violence of bodies upon bodies which require heads to be involved. Second, players now know the risk and play with informed consent; players accept the risk and get amply rewarded for playing.

Both answers are illusions. Games evolve and change all the time. I can quote you writers who declared the end of football and baseball, for that matter, when players were forced to wear protective helmets. The forward pass has been modified and formations have been outlawed in American football from the beginning when the killing machine single wing was outlawed. Soccer spends immense effort policing actions that can bring injury to its players. So rules to protect players from injuries make perfect sense to protect the integrity of the game; eliminate temptations to unfair play to "take players out;" and to protect the investment of coaches and teams in players. Even NASCAR which so depends upon crashes as an intrinsic aspect of its appeal constantly jiggers rules to keep even playing fields and build in protections for drivers.

Second, the informed consent argument makes little sense for three reasons. First, most elite players begin playing at very early ages, long before anything resembling real consent is possible. They are driven as much by parents as their own joy at the game. Later accolades, status and team loyalty motivate  them. None of this supports free informed consent for 12-20 year olds. The brain damage begins as early as high school age. Second, many of the players in both footballs come from poor or disadvantaged backgrounds. This is their way out, either to college or a lucrative career. They have few options except to stay in dangerous dead end worlds, so "informed" consent for 16 year olds trying to get out and often carrying the hopes of their family fails. Third, humans regularly as a species underestimate  future losses relative to immediate gains. The idea of a header or tackle leading to irreparable brain impairment in your fifties, is just too far away for the vast majority of folks, let alone athletes, to plan around. It seems a reasonable risk to a 19 year old or a 26 year old player seeking to build a nest egg or help companions win.

Not only does informed consent fail as an answer, but the nature of the injuries are not just physical. This is not about arthritis and limited mobility, this means the personality of the player changes or is destroyed. We are talking not about injuries but destroying the personality of the person who is asked to make the choice, not a knee, leg or shoulder injury. Too much is at stake, the very assumption of informed consent--having a whole and reasoned personality--is destroyed by the additive trauma of CTE.

New protocols on concussions are not enough. We need to change the games.


  1. There is no evidence that "Soccer depends for some of its critical moves and scoring upon heading." Heading may make watching the game more suspenseful and spectacular, but it is not inherently part of the game. Indeed, millions of kids play soccer every day without ever heading the ball. It is mostly the pressure to entertain audiences that drives players into heading. Heading started as a rule beating maneuver through a loophole in the laws of soccer. When hands were allowed to be used to block and drop the ball (Sheffield rules), there was no heading.

    1. I think you are referring to Cambridge rules. (http://www.soccer.mistral.co.uk/histrule.htm)