Head injuries in contact sports have been a central topic of discussion recently, and rightly so.  Many athletes suffer numerous blows to the head, and only now are people beginning to discuss the repercussions.  Concussion research has improved in recent years, and as a result, scientists have found a degenerative disease called Chronic Traumatic Encephalopathy (CTE).  CTE has been found in many former professional football players after death.  This disease affects a person’s memory, motor skills, and emotional state.  CTE and many other things, such as athletes re-entering games after obvious head injuries, the process in which athletes recover from head injuries and many other issues are large factors that play into the current discussion of how the treatment of concussions should change.  The way in which concussions are diagnosed and treated at the amateur, collegiate, and professional levels of sports must change to protect athletes and their future.

A concussion is a type of traumatic brain injury that is caused by excessive force to the head, a fall with impact to the head, or any injury that jars or shakes the brain.  Concussions are graded as mild, moderate, and severe with each degree containing increasing levels of symptoms, which include temporary loss of consciousness, amnesia surrounding the traumatic event, difficulty concentration, and irregular sleep patterns.  CTE is mainly caused by multiple concussions, and this degenerative disease can largely impact a person’s life by severely damaging one’s memory, motor skills, and senses.  Many former NFL players who have committed suicide have been found to have had CTE.  The families of the former NFL players have allowed scientists to research the brains of the former players, and research has found a positive correlation between CTE and suicidal depression.  Scientists have said that these former professional athletes have experienced the phenomenon of not being able to live within their mental state because their brain has endured so much damage during their professional careers.  CTE is also commonly found in former boxers, military members, and recent studies have found the degenerative disease appearing among former soccer players.  Further implications tied with CTE include symptoms similar to those of Parkinson’s disease, which is a chronic, progressive disease which directly impairs someone’s motor movements.  Parkinson’s involves the malfunction and death of nerve cells in the brain called neurons, which send signals to receptors throughout the body.  This process allows for the movement of all parts of the body, and in the case of Parkinson’s disease, this process is hindered.  To think that a life-changing disease can stem from one or two hits to the head is staggering, but it is a scientifically proven fact.  So, whenever someone on the football field goes down with a concussion, it must be treated properly by the player, medical staff, and those directly involved with the athlete’s recovery process.

CTE is also associated with symptoms such as behavioral, personality, and speech abnormalities.  CTE can affect the area of the brain associated with speech in the left frontal lobe (Broca’s area), which can cause a speech impediment.  Furthermore, the degenerative disease can also affect the hypothalamus, which is the area of the brain associated with behavioral skills and personality.  Perhaps the most alarming symptom linked with CTE is disturbances in memory.  CTE causes a protein known as tau, which is also present in Alzheimer’s disease, to form around the blood vessels in the brain, which interrupts normal brain functions and kills nerve cells over time.  Once the tau begins to form on the nerve cells in the amygdala and hippocampus, one’s memory and emotional behavior are severely impaired.  The most high-profile NFL player to have suffered from CTE was Junior Seau, who had a 19-year professional career and was posthumously inducted into the Pro Football Hall of Fame in 2015.  Seau committed suicide in 2012, and his brain was donated for scientific research to determine if he had suffered from CTE.  Scientists stated that Seau did experience an extreme level of CTE which stemmed from head-to-head collisions spanning his near 20 years in the NFL.  In 2015, studies on former NFL players, who are now deceased, revealed that 87 of the 91 examined experienced CTE. (PBS.org) Furthermore, the Department of Veterans Affairs conducted a study which revealed signs of CTE in 96% of NFL players. (PBS.org) These numbers are astounding, and in order for the statistics to decrease, the NFL is faced with a difficult decision: change the rules of the game to lessen the amount or likelihood of hard hits to the head, or enforce harsher penalties to those who inflict the over-aggressive hits.

In the National Football League, the process by which players recover and return to what is called ‘active status’ is the concussion protocol.  Recently, there have been many critics of the NFL’s concussion protocol because of its seemingly lenient requirements for athletes to return to the field of play after suffering a hit to the head.  The NFL concussion protocol is as follows: “There are at least 29 medical officials at every pre-season, regular season, and post-season game.  Within these 29 affiliates, there are a group of unaffiliated neurological consultants (UNC).  There is one UNC on each sideline, and they work with the medical staff of each NFL franchise to evaluate and diagnose concussions, and they must provide explicit approval for a player to return to the field of play.” (2016 NFL Rulebook) The NFL’s goal of implementing the UNCs is to have a team of experts who have no affiliation with the National Football League so that they do not take in the competitive implications of the game.  Previously, there was a medical staff associated with each NFL franchise who made the decisions on whether a player should return to the game or not, and this system was often cheated because the medical staff could have an affiliation with a specific franchise and take in the competitive implications of the game by taking a player off the field or keeping him on the sideline.  The players should not be able to manipulate the neurological test which is given on the sideline, and every day after the concussion is diagnosed until they are fully recovered. This implementation into the concussion protocol is a very good move by the league, however, the NFL has undergone a Congressional investigation, which has found that the league tried to influence concussion research by selecting specific doctors with ties to the NFL in order to skew the findings of the research.  Prior to this, the NFL agreed to donate tens of millions of dollars toward concussion research which was to be overseen by the National Institutes of Health, but the NFL wanted the findings to conclude that concussions were not as harmful as everyone thinks so that they would not receive so much criticism regarding their lack of attention toward concussions.  These actions are the side of the NFL that fans do not like to see; people want to see the league improving its precautionary measures to benefit the players, which in turn, benefits the fans and the franchises.  NFL Commissioner, Roger Goodell, has rejected the link between football and CTE during the recent speculation surrounding the NFL’s actions, or lack thereof towards players re-entering games after suffering concussions.  Fans have not accepted Goodell’s rejection of the connection between the two, and this has brought protests for new leadership in the NFL.  However, the question still has not been answered, what must change within the sport of football to protect players to a better effect?  The National Collegiate Athletic Association (NCAA) has implemented a rule into the sport of football that states, “No player shall target and make forcible contact to the head or neck area of a defenseless opponent with the helmet, forearm, hand, fist, elbow or shoulder. This foul requires that there be at least one indicator of targeting.  When in question, it is a foul.” (2016 NCAA Rulebook). This is the new rule put into the college game by the NCAA official rulebook for the 2016 season.  It also says that any player who does enforce excessive contact to the opponent’s head or neck should be ejected from the game.  This is a big step for the sport of football, and the NFL should take notes from its inferior level of the game.  

Concussions are extremely harmful and life-changing injuries that carry serious immediate and long-term threats.  When the brain is jarred within the skull, the tissue is damaged.  If this happens repeatedly, then the person’s memory, speech, and motor skills are all affected.  This is the basic overview of how CTE progressively worsens with time after someone suffers multiple hits to the head.  Dr. Maryse Lassonde says, “Concussions lead to attention problems, which we can see using sophisticated techniques such as the EEG. This may also lead to motor problems in young athletes.” (Medical News Today) Dr. Lassonde refers to the medical test called an EEG (Electroencephalogram), which measures the electrical activity in the brain.  An EEG has been proven to reveal brain trauma so that people can receive proper treatment immediately.  Experts, such as Dr. Lassonde agree that proper treatment cannot be delayed when it comes to an injury such as a concussion because any hindrance of treatment is putting the person at risk for serious health issues in the future.

On the collegiate level, student-athletes have the responsibility to perform in the classroom and on the field, and not all college athletes have professional careers in their future.  In fact, about one percent of college athletes sign a professional contract, so if a student-athlete suffers a concussion, and it is not properly treated, then their future health could be severely damaged.  For example, if a Division II college football player suffers a concussion, and his chances of signing an NFL contract are slim to none, then this injury must be treated properly.   If the player or the medical staff rushes the recovery process so that he can return to the playing field, then the athlete’s future is at risk.  By improperly rushing the recovery process, the player is being put at risk of further brain damage if they suffer another concussion, and this could seriously impair their potential ability to perform in the working world.  

However, there are many proponents for the NFL, and they claim that the league is protecting its players to the utmost level by providing the safest, newest, and most innovative equipment in the game today.  Football helmets are always evolving as equipment companies are constantly discovering new ways to lessen the impact on the players’ heads.  No helmet can prevent a concussion, but new materials are being placed in prototype helmets which are being used in youth football.  Helmet manufacturing companies such as Riddell, Schutt, and Xenith are putting more padding on the inside of their helmets to absorb the impact on the skull.  These are positive actions by major manufacturing companies, but no equipment can fully prevent a concussion.

NFL referee, Walt Anderson, says, “What the NFL has done is take a very proactive stance.  Goodell is very serious about this. We're going to be a very proactive in doing what we can to strike an appropriate balance.” (NFL.com) Anderson recognizes the NFL’s actions to protect the players, and he also says that referees will penalize hard hits to the head or neck area when in doubt.  It is important that the referees understand the implications that come with the game of football, and the new rules that the NFL has implemented helps the referee’s decision making process.  Of these new rules in the NFL, the “defenseless player” rule is the most important when it comes to the protection of the players.  This rule states, “It is a foul if a player initiates unnecessary contact against a player who is in a defenseless posture.” (2016 NFL Rulebook) The league office implemented this rule in 2010, and it says that any player who is unable to avoid a hit from an opponent (defenseless) must be protected by the laws of the game by a flag being thrown on the player who enforced the hit.  This was the NFL’s biggest move regarding concussions and player protection when there is forcibly strong contact to the head or neck area.  Recently, the NFL announced a $100 million initiative towards concussion research.  While announcing this plan, Commissioner Goodell spoke on what he believes is an improving situation within the NFL, “We will continue to take a hard look at any aspect of the rules that can make the game safer for our players. We have made 42 rules changes since 2002 to protect our players, and we will make further changes as we study the effectiveness of those rules in preventing injuries and continue learning from the data.” (NFL.com) Goodell states that the league has implemented 42 rule changes in the past 15 years to protect the players to the greatest effect, and he says that the NFL is interested in learning about the ways to prevent further injuries.  This is a promising statement from the man in charge of the largest professional sports league in the United States, so maybe the NFL is heading in the right direction.

Many current and former NFL players have spoken out on the issue of concussions and CTE, and they all come to the same consensus: Play through it.  Former Jacksonville Jaguars running back and NFL rushing yards leader in 2011, Maurice Jones-Drew said, "The bottom line is: You have to be able to put food on the table. No one's going to sign or want a guy who can't stay healthy. I know there will be a day when I'm going to have trouble walking. I realize that, but this is what I signed up for. Injuries are part of the game. If you don't want to get hit, then you shouldn't be playing." (ESPN.com) Jones-Drew feels that doing his job, which is to stay in the game is more important than his health because he must provide for his family, and the only way he can make money and earn a new contract is by playing, not sitting on the sidelines.  He is putting his family before himself, which is an admirable value, but professional athletes such as Jones-Drew must be aware of the potential health issues that come with the risk of playing through such a serious injury.  By making this seemingly unselfish decision, Jones-Drew is potentially hurting himself in the long run.

Many things must be reassessed by the National Football League regarding the way in which they handle, diagnose, and treat concussions.  Penalties could be implemented, rules could be altered, and equipment can potentially be improved, but one thing that cannot happen is the NFL ignoring what is going on within the game of football.  Coincidentally, that is exactly what is happening within the league; Commissioner Goodell persistently denies that there is a link between brain damage and football, and this is no starting point for change.
