The National Football League and Brain Injury
Catharine Farnan, MS, CRRN, CBIS and Sandra Eggleston, CRRN, CN, Rehabilitation Unit
Thomas Jefferson University Hospital, Philadelphia, PA
2010 Brain Injury Association of Pennsylvania State Conference
reasoN For coNcerN IN THe “aNNuaL League’s sTraTegy To reduce BraIN
INTroducTIoN BaTTLe oF aTroPHy” INjury rIsk
As football fans we watched last season as numerous players were sidelined with Fox Sports Senior Writer Alex Marvey termed the preparation for the season as the Changes in NFL Rules
concussions and head injuries. This uptick in press reporting of head trauma in “annual battle of atrophy.” Medically, Dr. David Cifu, in 1984, identified a repetitive head In December 2009, the NFL announced it would impose its most stringent rules to date
professional football players piqued our interest in this topic. injury syndrome called second impact syndrome (SIS) (Cifu, Steinmetz, and Drake, 2008). for players exhibiting signs of concussion so that they be removed
Dr. Cifu explained that an individual sustains a second head injury before the symptoms from the game or practice and barred from returning to the game
of the first head injury resolve. Factors that may increase the risk of a poor outcome with
aBsTracT a repetitive head injury include: a previous head injury, headache, balance disorder and
the same day. Some fear that players will have more incentive
to lie about their symptoms. In 2007, the NFL mandated
In this celebrity focused world in which we live, recent headlines of NFL players acquiring visual, motor or sensory changes, persistence of symptoms from a previous head injury too that every player undergo neurological testing in the
brain injuries have received much press. This poster will examine the National Football and memory and thought processing difficulties (Cifu, Steinmetz, Drake, 2008). As this preseason to establish a base line against which results
League’s (NFL) players’ concerns and strategies the football league would like to see in phenomenon and its cumulative effects were studied over time, another term, chronic can be compared when concussion occurs during
place to minimize this injury. This poster will examine the risk of professional football traumatic encephalopathy (CTE) emerged and was given to the degenerative condition the season. NFL Commissioner Roger Goodell
athletes for acquiring brain injuries. This poster will also examine the NFL’s concerns of caused by the brain damage to the football players (Rozenman, 2010). has advocated for new funding for concussion
the long term effect of sustained head injuries. A Boston University School of Medicine study found that all 11 former football players research and new practice techniques that will
showed evidence of CTE, and that repeated concussions in football have long term effects reduce head trauma.
and can lead to dementia at a younger age (Rozenman, 2010). A University of Michigan
HIsTorIcaL PersPecTIve inquiry found a higher than normal number of memory related diseases in former players
Helmets Evolve
In the early 1900’s the helmetless game of professional football led to the deaths of players (Rozenman, 2010). The science behind helmet technology and
such that then President Theodore Roosevelt told the league to “fix it” and helmets became the changing technology required to test
part of the game. them for brain protection continues to evolve
NFL PLayers’ coNcerNs and may further lead to minimizing risk of
As far back as 1928, the sport of football was noted to brain injuries in the professional football player. It
make an impact on athletes’ brains. Dr. Martland wrote in One of the major concerns for the professional football players is the cumulative is a science whose study is ongoing.
The Journal of the American Medical Association an article effect of the concussions. Every time a player has another concussion the damage
titled “Punch Drunk.” This classic article examined via to the brain increases. Return to play policies and safety of the helmets are also
autopsy, the brains of former NFL playe rs who suffered concerns. Former NY Giants George Martin, now head of the NFL’s Alumni
from profound dementias. Dr. Martland identified that Association, said most players have the following safety related concerns:
small cumulative hemorrhages lead to scarring in the brain
• there should be a greater emphasis on injury prevention through rule
coNcLusIoN
tissue and dark nerve cell clusters. It is such fibrous scarring The body of evidence continues to grow for professional football players linking
changes and better protective equipment;
that we now know to be associated with dementias like
• there should be easier access to quick diagnoses and treatment; cumulative chronic concussions and brain injuries to neurodegenerative dementing
Alzheimer’s and Parkinson’s diseases (Martland, 1928).
• medical treatment for retired players should not lead to financial ruin; disorders. Research so far indicates this population’s risk seems to be higher with
• more comprehensive studies are needed to assess extent of the problems. Alzheimer’s disease, depression and cognitive impairments as noticed more so
rIsk For BraIN INjurIes A 2003 University of North Carolina study found that NFL players who suffered multiple when they retire and as they age. As advocacy and awareness of traumatic brain
So one question is--are professional football players more at risk today to acquire brain concussions were three times more likely also to suffer clinical depression and that injuries and secondary impact syndrome become more widely recognized, it is
injuries? We answer that the risk is inherent to the game especially as force becomes more chronic pain may also play a part in that. Twenty five hundred retired NFL players who critical that players, coaches and staff are educated about them. NFL changes
dominant. Risk will always be present. It is estimated that a professional football player’s had at least three concussions during their careers had three times the risk of depression to rules to recognize brain injuries and safer helmets are ongoing. Restraint to
average length of time in the League is 5-7 years. It is estimated that professional football (McConnaughey, 2007). A follow up study showed NFL players suffering concussions had when return to play is required can be helpful in reducing injuries. Continued
players average approximately three concussions in their playing years. In 2000, a survey five times the rate of cognitive impairment and suggest that they were almost 40% more
comprehensive research is needed in this field. As healthcare providers, caring
of 1,090 former NFL players reported 60% had suffered at least three or more concussions. likely to suffer Alzheimer’s (Fendrich, 2009).
for those with brain injuries, in our opinion, we must also strive to be diligent
(The New York Times, 2010) These are the ones reported. A little more than a generation
ago only a handful of the players were 300 pounds. Not so today. The average weight of Since 2007, the NFL’s 88 Plan, run by the players Union and League, spent more than $7 advocates of brain injury prevention.
an NFL offensive tackle in 1985 was 281 pounds and, in 2006, the average weight was 318 million to reimburse medical expenses of former players with dementia (Schwarz, 2010).
pounds. It is estimated that there are about 160 concussions in the NFL every year.
References
Guskiewicz, K.M., Marshall, S.W., Bailes, J., McCrea, M., Cantu R.C., Randolph, C., Jordan, B.D.(2005). Association between McConnaughey, J. (2007). NFL head injuries studied. Retrieved April 3, 2010 from: http://www.seattlepi.com/football/318108_
recurrent concussion, mild cognitive impairment and Alzheimer’s disease in retired professional football players. Neurosurgery, concussion01.html
57 (4), 719-724.
Fendrich, H. (2009). NFL concussions: players fear, hide brain injuries. The Huffington Post. Retrieved March 15, 2010 from:
Guskiewicz, K.M., Marshall, S.W., Bailes, J., McCrea, M., Harding, H.P. Jr., Matthews, A., Mihalik, J.R., Cantu, R.C. (2007). http://www.huffingtonpost.com/2009/11/18/nfl-concussions-players-h_n_362928.html
Recurrent concussion and risk of depression in retired professional football players. Medicine and Science in Sports and Exercise,
39(6), 903-909. Schwarz, A., The New York Times. (2010). Before dementia assistance, help with NFL application. Retrieved March 1, 2010 from:
http:www.nytimes.com/2010/01/22/sports/football/22eckwood.html
Markland, H. (1928). Punch Drunk. JAMA, 91 (15), 1103-1107.
Rozenman, E,. The Philadelphia Inquirer. (2010).Two minute warning for a dangerous game. Retrieved April 15, 2010:http://
Cifu D., Steinmetz, B.D., Drake, D.F. (2008). Repetitive head injury syndrome. Retrieved April 1, 2010 from: http://emedicine. www.thephiladelphiainquirer.com/2010/01/08/sports/football
medscape.com/article/92189-overview
The New York Times. (2010). Concussions and head injuries in football. Retrieved April 21, 2010 from: http://www.nytimes.com/
info/concussions-in-football/
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