The NFL’s Battle with Concussions and Severe Injuries

by Scott Kacsmar

The Tom Brady injury scare took the NFL news feed by storm on Wednesday. Fortunately for New England, it was nothing serious. Not as fortunate were the dozens of players who already suffered a significant injury, including Jeremy Maclin, Bryan Bulaga, Dennis Pitta, Michael Crabtree, Percy Harvin, Danario Alexander, Dan Koppen, Victor Butler, Jared Veldheer and Plaxico Burress. At least 55 players have had a season-ending injury already. (Actually, that number has likely increased by the time you read this.)

Did I mention we only just kicked off the second full week of preseason games?

Based on a research study by Dr. Jesse David of Edgeworth Economics on data from the NFL Players Association, there were 265 concussions in the 2012 season (from training camp through the Super Bowl) after 266 in 2011. Is one fewer concussion progress? The total was 270 in 2010.

Injury prevention, especially in regards to head injuries, has never been a bigger issue in the NFL than it is today. The league has taken new measures to ensure safety is the top priority, as a failure to do so could result in catastrophic losses for the business through lawsuits. Past transgressions have already resulted in over 4,500 former players suing the league for not doing enough to prevent head injuries.

Clinton Portis is the latest to join the suit. He estimates he sustained 10 or more concussions in his career. The fact that many went undiagnosed is the major problem the NFL has to fix going forward. Limiting the number of concussions should not be the first goal as proper treatment for all concussions becomes the real objective.

Concussions and Kickoffs

A mild traumatic brain injury (MTBI), also known as a concussion, may be the key element of study for player injuries right now. The NFL’s rule change on moving kickoffs to the 35-yard line in 2011 was expected to cut back on the number, but we see overall that concussions are fairly consistent for the last three seasons, which is the time in which reporting them has become more common.

There’s no denying we have fewer concussions on kickoffs now, as the total went from 35 in 2010 to 20 in 2011, but this is more about the rise in touchbacks and lack of returns. While a player can still get a concussion on a touchback, it’s usually not going to provide as much violent contact as a real return.

Here is the data on kickoffs related to touchbacks and concussions going back to 2004. Please note the percentages are rough estimates as the concussions include the preseason and playoffs while the kickoff data is for the regular season only in each season. I should have realized this in a similar review I wrote a year ago. However, since the number of kickoffs have remained fairly consistent over time, using this estimate for each season is still reasonable.

The 26 MTBIs on kickoffs gave last year the highest (estimated) rate per kick return since 2004. The rule change does not make for a safer kickoff, it just means fewer will be returned. There have been over 1,100 touchbacks in each of the last two seasons.

Some of the past concussion rates wre no doubt misleadingly low as players were less likely to have reported a concussion years ago. We will need more years of data with the new kickoff rule to study this better.

We did not receive data on which 2012 kickoffs included the 26 MTBIs. Seven happened in the preseason (including practices) and two were in the playoffs. Without the proper data to see which types of kickoffs resulted in the concussions, we will only speculate on the rise from 2011.

One could theorize kickoffs may be more dangerous now since some return specialists need these opportunities to earn their roster spot. It's a fair speculation to think they may be more willing to return a kick that’s eight yards deep in the end zone. When you do that, you better get to the 20 or a special teams coach will be in your ear for a bad decision. So what we have is a player running harder than ever to get out of his end zone and make something happen.

It is no coincidence the 2011 season had the highest kick return average (23.8) in NFL history and the 2012 season ranked third (23.6). (Stats at Pro-Football-Reference.

Kickoffs aside, the overall number of concussions remains in that 265-270 range. What has changed is the time missed from them. In 2012, players missed an average of 16 days after a MTBI. The average was as small as four days in the medieval times of 2005.

Clearly concussions are handled with more care now. Rookie wide receiver Ryan Swope recently retired after suffering the fifth concussion of his football career in Arizona’s OTAs. Not many players in the past would have ended their dream before it began, but concussions aren't meant to be taken lightly. Knees and triceps will heal, but the brain is serious business. The league and many retired players are learning that the hard way.

The Rise of Severe Injuries

Speaking of serious injuries, in 2012 players suffered 1,496 severe injuries -- measured by missing at least eight days or requiring surgery. That is the highest total in the study, which goes back to 2004, and the frequency of severe injuries only continues to rise.

Total injuries went down from a whopping 4,493 in 2011 to 3,126 in 2012. The big reason for 2011’s bloated number was the 3,113 minor injuries (fewer than eight days missed). With stricter rules in reporting injuries, teams followed suit. Fast forward to the next season and it’s only natural to see some slacking off in that department as minor injuries fell to 1,630 in 2012.

But the perplexing part here is trying to figure out why severe injuries continue to rise. Yes, the "bigger, faster, stronger" principle could be part of it as players get more freakishly athletic as time goes by. It may go deeper than just that though.

"Treatment is more extensive," said Dr. David, who has analyzed injury information for three seasons. "So what appears 'severe' (longer time out of the game; more surgery) is actually just longer treatment for injuries that actually are not objectively worse than they used to be." However, the number of ACL injuries, often a season-ending injury, is increasing.

The NFL would like to believe the game has been made safer through changes to equipment and rules and that the increase in severe injuries is the result of better treatment. So far, data analysis does not support that, but more changes are coming to the league.

New Protocol Should Lead to More Reported Concussions

From the Saints’ Bountygate scandal to the suicide of retired star Junior Seau, whose brain had chronic traumatic encephalopathy (CTE), the NFL certainly had to fix its image problem when it comes to knockout shots and headhunting.

The league is clearly not taking risks when it comes to safety with the head in focus. While players are now required to wear thigh and knee pads, a new type of Bane-like face mask that was gaining popularity with defenders like Robert Mathis was quickly banned this summer. NFL V.P. of officiating Dean Blandino cited some problems with the face mask: one was that it may actually encourage players to lead with their heads. Of course the NFL implemented the "Crown Rule" this offseason to further restrict players from using their helmet as a weapon. We also know now that when the helmet comes off, the play is whistled dead immediately.

The message is clear: Keep your heads up, players. However, we also know the action is played at rapid speed on the field and impact between these players will continue to cause injuries. Sometimes the head shot is unavoidable when an offensive player ducks at the incoming defender at the very last second before contact.

While making the number of concussions shrink would look good for the NFL, treating each case with a standardized procedure is the best approach. This season is the first time the league will use an independent neurotrama specialist instead of a team’s medical staff to oversee concussion protocol. So if Robert Griffin is feeling woozy after a hit this season, no one can blame coach Mike Shanahan for throwing him back to the wolves to serve Washington’s best interest.

Getting honest answers from players fighting to keep a job will be the next challenge. For example, Alex Smth’s tenure in San Francisco effectively came to an end after a concussion paved the way for Colin Kaepernick to lead the team to the Super Bowl. Think there may be some regret there by Smith, leaving one of the NFL’s most talented teams to head to the Chiefs?

There was a telling scene in the first episode of HBO’s Hard Knocks with the Cincinnati Bengals. Trainer Paul Sparling told wide receiver Marvin Jones he was done for the day of practice after getting his bell rung. As much as Jones pleaded he was good to go, Sparling told him he could not go back on the field because of the new NFL rules.

How many players, especially those barely hanging onto a roster spot, will admit to any symptoms now? That’s why it will be important for players sustaining big hits to be checked as soon as possible by the independent specialist.

More concussion checks should undoubtedly lead to more recorded concussions. If more minor concussions are found, then that could decrease the average time missed from them. Hopefully catching things earlier will help prevent future problems.

This is just my personal opinion, but I always believed that NHL star Sidney Crosby had such a long recovery from "a concussion" because he suffered one in the 2011 Winter Classic that went undiagnosed and quickly picked up another concussion after crashing headfirst into the boards just four days later. Crosby would not play again for over 10 months.

That’s one of the scariest things about concussions that result from contact sports. Once you have one, you are more susceptible to the next one, which will take even longer to recover from. So let’s nip it in the bud.

Thus far it has been a rough preseason for severe injuries. The 2013 numbers could be frightening at first glance, but if concussions go up, just remember that’s not necessarily a bad thing assuming the players are getting better treatment.

However, the players cannot have it both ways. They cannot lie about symptoms like in the past and still want to sue the league for not having their best interest. If a player’s feeling dizzy, he should get checked out ASAP. That may not be the manliest thing to do in a sport that promotes grit and bravado, but if the goal is to play as long as possible, then it’s the only smart thing to do.

If a teammate cannot understand that, then maybe he’s already taken too many unchecked blows to the head.