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.

Pay to Maim--Making Football Players Felons

Football is a violent game; the violence powers its structure and attraction. I have written at length about how this violence requires greater moral discipline from players and coaches than any other athletic endeavors. The game grows from the disciplined application of force against other human beings. In its normal practice within rules, the sport almost guarantees elite college and professional players will have shorter life spans, physically disabled futures and, worse, more than a few will lose their personhood to the depredations of brain injury.

Grown physically large men unleash focused aggression upon each other to block, tackle, run, pass, and catch. The level of force they inflict with this aggression would destroy most of us physically if we were not wearing weaponized armor and superbly trained. Only the tightest self and peer discipline among players and coaches keeps the game intact. Its intensity, ferocity and energy resembles a fusion reaction barely contained by internal forces. It can easily destabilize and explode into something worse, where the game becomes criminal assault.

The key here as with uniformed services lies in intention. The infliction of violent force upon another human being must serve a distinct and limited purpose to be defensible. If I tackle someone to stop the run, that fits with the norms and defensible approach to the game. If I a ball or cause a fumble, that fits. If I block someone hard within the rules, that fits. All this skilled and fierce force hurts, but if serious injury occurs, it is not intended but flows from another action—to block tackle, run, strip within the context of the game. These rules and intentions keep the game from being criminal assault.

Criminal assault occurs when a person  physically attacks or asserts force against another human being with the intent of maiming or injuring them so they cannot go on in their life role. It lies in the intent to injure and harm. Criminal assault that occurs because a person is paid to hurt someone involves a more heinous crime than one that involves passion or loss of control. So intentional maiming or injurying for money involves moral and criminal assault.

Now we know the New Orleans’ Saints turned football into criminal assault.

"The league’s investigation determined that this improper “Pay for Performance” program included “bounty” payments to players for inflicting injuries on opposing players that would result in them being removed from a game," NFL said in a statement. “Commissioner Goodell will determine punishment." "The players regularly contributed cash into a pool and received improper cash payments of two kinds from the pool based on their play in the previous week’s game," NFL said

Now we learn that a largely player financed fund provided bounties to players on the NFL New Orleans Saints over the last three years. $1,000 for a knock out and $1,500 for a cart off. 25 players over three years earned their reward.  A coach administered the fund, the head coach sanctioned it by his silence.

The sheer physical dangers of modern football are well known, and now the deeper dangers of later life crippling or loss of personhood from brain injury.  Football regimes from peewee through high school, college and professional are developing regulations that try to reduce the inevitable damage. The NFL union finally gained significant medical attention in the latest NFL.

Let's not romanticize football. It is hard, harsh and can be physically ugly. Long ago it lost any pretense to sportsmanship and coaches from Vince Lombardi to Bill Belichick mock the notion of football sportsmanship.

What scares me the most, the players did this to themselves. The players contributed the money and egged each other on. As mentioned, the “inmates are running the asylum.” It lets us know the reason why you need outside regulation rather than relying upon 24-28 year old aggressive males caught upon a culture to make rules. As Gregg Williams the coach who arranged it admits "It was a terrible mistake, and we knew it was wrong while we were doing it.”

They knew it was wrong! They knew they were maiming their compatriots, this is insane. The money is actually a pittance given the modern salaries but taken seriously for its symbolic importance. They were doing this at the same time retired football players are committing suicide as their brains disintegrate from damage sustained in the game.

Pay to maim moves a very violent sport from controlled violence with intent to win under the rules to rewarded felonious assault. It makes football players criminals.

Now football culture and media attention thrive on the big play and big hit. College players wear stickers on their helmets celebrating big plays. Replays go over it and controlled executed aggression can take on its own fearsome beauty. Even now old defensive players grumble about taking the football out of football, and Mike Golic talks on the ESPN about how this is blown out of proportion.

I am sorry, it is not. You do not violate the basic code of the sport, even one as elastic of footballs, by paying people to purposely injure, damage or maim other players.

Every football player has been injured, often many times. Every football player knows their career can end in a nano-second. A critical unwritten code permits players to play hard but not play to injure or maim,

Pay to maim violates the moral code and justification for football as a game or sport in at least three different ways.

1. 1)   It disrespects the moral core of the game. The players intend to injure individuals for pay. They unleash their controlled violence not to pursue a designed play. The players act to injure or end the careers of other players,
2. 2)   It destroys mutual respect among players. It turns fellow players into enemies rather than opponents. The moral structure of sport depends upon that distinction. While football spawns Rex Ryans of the world who think you have to hate your enemies to be effective players, athletic competition requires this distinction. This is even more important in a league where players move contantly and often end up playing with their opponents the next year.
3. 3)   It violates the contract players make with themselves. No one expects deep rationality from 22-27 year old males embarked on football careers. They all claim to “know” the risks, but no one that age can understand the risk to their future selves and personhood posed by physical disability. They enter the game expecting to risk unintentional injury. They do not expect other players to play or be encouraged by coaches and rewarded to wound them so that they cannot play the game.

Everything about this stinks. Too bad the NFL does not have the power of the NCAA to vacate victories or take away championships because this deserves that treatment. Remember the Saints got to the Super Bowl by injuring Curt Warner and Brett Favre, now we  know why and how.

Careers should end for doing this. The fines should be immense. Suspensions should be long term. Football has to keep pushing on its culture. Even as players push back against Commissioner Goodell, this represents a classic case of needed regulation to protect players from themselves and protect the culture from its worst tendencies. 

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.