Tuesday, January 21, 2014

The Concussion Battle the NFL Must Win

The NFL battle to protect the brains and mental health of players is proceeding on a wide front. One of the most critical is occurring right now on the sidelines. It is a medical and political and symbolic battle that the NFL must win.

So far 15 players removed from games for concussions during the 2014 playoffs. The 2014 NFL playoffs reveal the violence and quandary the NFL faces as it pushes to minimize long-term brain damage. First the NFL realizes the very popularity of the game grows from its combination of violence, beauty and intelligence. Second, its motives are mixed with fear of liability coupled with a slowly dawning stewardship for the long-term health of its players.

At best all the efforts from regulated contact in practices to limiting head to head hits will only make an inherently dangerous and violent game marginally more safe. In the first six games of the playoffs, ten players were kept out by concussion protocols. Two players flouted the protocols ignoring doctor’s orders. Three of the lost players clearly affected the outcome of the games. But the NFL must continue to create a hard and fast line on concussion. It will not be easy.

The games remind everyone how ruthlessly violent the game remains and will continue to be. As the Grantland summary put it, “the most violent teams won.” Players will continue to get bigger and stronger and faster. Aggressive and violent play will be rewarded. Technology may or may not minimize damage to the heads.  CTE Chronic traumatic encephalography will continue to sneak into the lives of thirty and forty year old men long before their time and steal their souls. Football has a cost far beyond that to knees, arms and backs. Now we know it even if the committed fan base and veterans live in denial.

The attempts to change the game is putting huge stress on the autonomy and professionalism of all concerned. The referees are doing an admirable and hard job taking the brunt of anger for creating the common law norms for the new safety rules. Coaches are reluctantly but effectively, when they choose, integrating new techniques into the coaching. The fact that not only “normal” physical injuries are removing players but now concussions are placing immense stress on team doctors where an inherent conflict of interest can exist between being employed by a team and trying to protect the safety of a player. This is amplified when the coach and player both want to get the player back into the game. The entire culture of sport and football especially praise and reward players who “play through the pain” and return to the game for the sake of the team.  

The NFL has to win this battle for the long term welfare of the players.

The interesting point is how many players and veterans resist and attack these changes. Richard Sherman, the smart, brash and aggressive corner of the Seattle Seahawks dismissed the concerns by saying, “if you don't like it don’t watch it.” He’s wrong. The stakes are too high for the players, the league and the future players.

Two major sets of reasons exist to set these clear lines and get concussed players off the field immediately.

First, militantly diagnosing concussions and not letting NFL players return sends a powerful message to young players, parents and lower level coaches. Only if NFL players are forced to stop playing will high school coaches and institutions force their own players to stop play. Only if the NFL players force players off the field because of concussions will mother and fathers sit up and think harder about their own children. Only then will young players understand that ruining your mind and judgment is not the way to become a long term sucesssful athlete.

The symbolic power of these actions will ripple down and impact adults and high schools and colleges to take this far more seriously. This is no longer about having your “bell run” and returning. Although NFL commentators snidely mentioned, “we would have returned to the game with that kind of hit.” Almost universally explayer commentators belittle the new rules and getting people off. They glorify players like the Saints Kennan Lewis who animatedly argued with his coaches to get back on the field. But then these commentators still have minds to make coherent arguments, bring on Steve Young or Tony Dorsett and ask them.

We are only learning about the pervasive nature of concussions on people and their cumulative impact. The underdeveloped and less protected brains of young players makes it even more important to protect their brains.

The battle will need relentless support from the league. Roger Goodell will continue to be attacked for efforts to make the game safer. The older players and veterans lead by cheerleaders like Mike Golic on Mike and Mike in theMorning will continue to defame Goodell. Ex-players with access to microphones will bemoan how the changes will dilute the power and majesty of the game.

Veterans, at least the ones not beginning to suffer from brain damage, will rail against how efforts to minimize intentional helmet to helmet or helpless player hits somehow undermines the “integrity” of the game and forces players to throttle back and play with less aggression or skill. This syndrome exists everywhere, "we had it so much harder." To be honest they veterans may have and now we know that they were being having their brains traumatized and many of them are now suffering for it. I find it odd that they are not willing to get out of their own mind set of wanting to replicated their initiation rites of toughness and protect the future from what they own colleagues are now suffering. 

They will even mock the efforts like the comment during when game when Chris Collingsworth states, “When I was playing football, he would be back in the game. The doctors now are taking a much stronger approach to this issue;”—this is in a league where 7 percent of the all players have season ending injuries—7 percent have season ending injuries!!

This resistance makes no sense. The game has always evolved and players relearn skills all the time. These are the same voices who would have opposed the early twentieth century outlawing of the flying wedge and other formations after 14 players were killed in one year.

Look how quickly college basketball players adopted to new rules on hand checking this year. No one has accused the NFL of becoming namby-pamby Along with 7 percent having season ending injuries, 10 percent suffer concussions each season. New skills, new training will be integrated. Professional football players are some of the most ferociously disciplined athletes in the world with their endless balancing of violence, aggression and skill and team cohesion. They will learn and adapt.

The other argument lies in the claim that these are mature and informed 22-year old adults who can give "informed consent" to risk loss of brain function and self-conscious freedom. I buy this to an extent, but believe society has the right to take certain decisions away from people. Every set of safety regulations designed to minimize the threat of long term injury to workers is based upon the same set of concerns. Many jobs such as coal mining are inherently risky and dangerous but organizations and government have the right to limit some of the more predictable and egregious threats. This protects the workers and it protects the liability of the companies. The risk matrix of an occupation is legitimate concern for society and law.

The NFL concussion settlement depended upon the claim that prior players did not know the full danger to themselves and that the NFL hid the dangers. Now that claim will not work and young players proclaim their willingness to risk their self-awarenss and freedom of choice at age 23.

I do not believe that risking the physiological foundations of personality and free choice linked to one’s brain should be fully respected by many players. I think institutions can accept at face value the willingness to risk one’s future capacity to exercise judgment and free will. This decision may make sense but does not possessess unlimited respect or deference from me or the league or the union.

Many of the most important decisions have in fact been bargained by the union. The level of contact in practices has been limited and other restrictions lower the average exposure to head trauma. It is now clear from data that repetitive injury can be as potentially dangerous as concussive trauma. These hidden but vital changes could be one of the most important long-term impacts and will be critical to migrate to colleges and their own practice schedules. Individual players have neither the incentive nor ability to negotiate their safety issues as individuals—they have too much at stake to maximize their gains in a very short career; they will take the risk.

In addition players who have been concussed are simply in no position, even if they think they are, to make the decision. The more we understand about the neural and traumatic impacts of a concussion the more we know that players, even if they seem to be, are not fully cognizant and not in their “full faculties.” They have significant and unpredictable. In addition significant cognitve and physical exertion aggravate concussions and hurt. In college schools are now stopping concussed athletes from taking exams until they have recovered under protocols.

The new NFL protocols embody the best available concussive diagnoses but also build in the need for quiet and rest afterwards to ensure diagnosis but also fast and safer recovery. To work the league needs clear and absolute lines and absolute authority with no compromises given to the doctors.

Beleaguered coaches, overactive owners and desperate players all have conflict of interests about wanting the players back in the game as soon as possible. Even team doctors have implicit conflicts even with clear protocols. Teams can fire them and get more pliable doctors, so the doctors have their own potential conflict of interests against their professional autonomy and judgment..

Above all the players want to play. They love the game; they feel obligations to their teammates. In the playoffs the stakes of loyalty and winning and money and fame rise.

Each player also plays one injury from oblivion. The stories are infinite and real. A player such as Alex Smith of the 49ers has to sit from a concussion and never returns to play when Colin Kaepernick takes his place. It happens enough to be a real and constant threat. Players play for money and worry about being replaced with the “next one up” mentality. Injuries in professional football are so regular and recurring it feels more like the military with “next one up” and the utter Replaceability of everyone at a second’s notice.

Team doctors perform the original baseline examinations at the start of training camp. The doctor has a clear cognitive and neurological baseline for each player. When they perform the protocol that takes up to 15 minutes, the doctors measure memory, concentration, balance and recall as well as baseline knowledge. The existence of the baseline makes the protocols stronger.

People, myself included, worried that the team doctors can be compromised given that they depend upon the team for their salary and this creates a conflict of interest which can pit their medical judgment against the need for the team to have a player return as fast as possible. Now every game has an unaffiliated neuro-trauma expert on the sidelines as a second pair of eyes and double check. This gives much greater weight to the doctors and medical independence of judgment.

The NFL is doing this for mixed motives. Obviously they want to avoid another law suit. They want to head off a cultural and government reaction against the violence that effectively segregated off boxing from the wider culture. At the same time the league wants players to have full and rich lives as they age and not just during the heyday of their careers, which normally last from 23-28. I can live with mixed motives to do the right thing especially when the league has to push back against the short-term self-interest of owners, players and coaches to make this happen.

The society may ultimately leave football behind as it has boxing for all but a strange and corrupt minority. But until society changes or liability costs destroy college and high school football, the game with its violence and beauty and intellectual wizardry will continue.

This is only one battle on a wide front to try and at least minimize the worst long-term damage from football to players—stealing their mind and personality. Even these efforts face opposition and mockery from those who should know better. But the NFL has to perservere and we as fans should support it.

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