Writers of Pro Football Prospectus 2008

13 Sep 2005

Injuries Contributed to Retired Player's Death

A disturbing story out of Pittsburgh, where former Steelers lineman Terry Long died from a brain inflammation that resulted, in part, from repeated head injuries suffered while playing football. Long, 45, died on June 7, a few hours after paramedics found him unconscious at his home. A contributing factor was "chronic traumatic encephalopathy" - also known as dementia pugilistica - a condition most often seen among career boxers.

Posted by: Michael David Smith on 13 Sep 2005

22 comments, Last at 16 Sep 2005, 12:39pm by Carl


by marc (not verified) :: Tue, 09/13/2005 - 10:02pm

quite frankly, anyone that doesn't realize that playing football, particularly for many years, is bad for the human body, is an idiot.

by Will Allen (not verified) :: Wed, 09/14/2005 - 2:47am

I am somewhat surprised that this isn't seen more often. The day may come when players are more closely monitored for the onset of chronic brain injury (I have no idea whether current imaging technology, such as PET scans, allows for this), and are forced to retire as a result.

by princeton73 (not verified) :: Wed, 09/14/2005 - 9:55am

Is it my imagination, or do the linemen from the 70's dynasty Stillers and the immediate aftermath teams seem to have a disproportionate number of these types of things happen to them

(I don't know why, either)

(maybe Haslett was right)

by C (not verified) :: Wed, 09/14/2005 - 10:56am

It's sad to see this sort of thing. Helmets are better now, but guys should put in as much padding as is possible. A few years ago, a lineman was wearing a "shell" outside his helmet. I wonder if the league should look at improving headwear.

by Vern (not verified) :: Wed, 09/14/2005 - 11:29am

Thus the recent emphasis on head slaps, leading with the head, and illegal hands to the face. In the 70's none of that ever got called. Every down was a boxing match.

by Carl (not verified) :: Wed, 09/14/2005 - 3:52pm

"I am somewhat surprised that this isn’t seen more often. The day may come when players are more closely monitored for the onset of chronic brain injury (I have no idea whether current imaging technology, such as PET scans, allows for this), and are forced to retire as a result."

There are several ways teams can monitor the condition of players' grapes. Most -- but not all -- teams now use computerized testing to chart mental deterioration from training camp to the Super Bowl.

Players can't return to the field until they pass the test. That simple. The Steelers pioneered this sort of detection. They count about 30-35 concussions per year, or about half the team.

Certain people are genetically predisposed to receiving head trauma and from suffering most terribly from it years later. These are the guys who end up with pugilists' dementia, Alzheimer's Disease, etc.

We can find out NOW who these players are. An unusual type of protein embedded in the genetic structure of a human cell, apolipoprotein E4, signals a greater risk of receiving a concussion.

But both the union and the teams don't want to do the screening. Why? Players fear they will be unfairly kept out of the league because they show a predisposition to frequent or severe brain trauma. And teams don't want to know because, if they play the guy and he gets seriously injured, they will face the inevitable lawsuit.

As for concussions in the earlier game, they happened, of course, but not either at the frequency or the severity of today's impacts. Why? Because of the nature of the game. In a slower, lumbering game of blocks and feints and rushes, the velocity before the on field impacts were reduced compared to today's pass-happy game of downfield explosions.

Not that these old school retirees, however, don't face problems related to the amount of head trauma they received.

Players who suffer five concussions in a career are three times more likely to experience depression as other men their age, and they carry increased risks for stroke and Alzheimer's disease, according to a landmark 2001 study of nearly 2,500 former pros conducted by Dr. Julian Bailes, a West Virginia University neurosurgeon and a leading expert on serious head trauma.

Bailes' research found that three of five retired NFL players had experienced concussions on the field, and 11 percent later suffered from clinical depression.

Seven of 10 players reported they didn't come out of the game after hurting their heads -- a practice that increased the risk of future concussions and could have killed them on the spot had they received another jarring blow, a rare phenomenon called "second impact syndrome."

by ABW (not verified) :: Wed, 09/14/2005 - 5:50pm

Carl, I know you've probably touched on this before, but what do you think of the "concussion reducing" helmets that were introduced a few years ago? Do they make a difference? Have they been widely adopted? Are there any studies going on to determine if they are reducing the number of concussions players receive? I linked to the manufacturers web page.

by Jerry (not verified) :: Wed, 09/14/2005 - 7:57pm

Re #3:

Is it my imagination, or do the linemen from the 70’s dynasty Stillers and the immediate aftermath teams seem to have a disproportionate number of these types of things happen to them

Long was actually with them in the '80s, not the '70s.

(maybe Haslett was right)

He was probably right about them using steroids, but that would have been the same for any offensive line in the league.

by MDS (not verified) :: Wed, 09/14/2005 - 8:30pm

One of the main reasons I posted this was that I knew Carl would have some interesting insight.

by Carl (not verified) :: Wed, 09/14/2005 - 8:33pm

ABW, I no longer play football. But if I did, I would wear either the Revolution or Schutt's DNA because the current research suggests that they better promote safety than the older products.

But any neurosurgeon will tell you there's no such thing as a "safe" helmet. The very act of using one implies that you are entering a workplace that's inherently unsafe. That you then use that same helmet to batter yourself and your opponents stupid might be a sign that you're involved in an unhealthy lifestyle.

The irony is that neither the NFL nor the NFLPA have worked together to mandate the wearing of the new helmets. It's strictly voluntary.

The problem is that many veterans remember the debacle of the 1999 Bike Athletic Co. Pro Edition helmet. Billed as a lighter model that would allow players to elevate their heads (thus avoiding head-down contact), it began to catch on with players throughout the league.

But then the NFL started a campaign to remove it from their locker rooms. Some players said that the NFL did this because the league has an exclusive marketing agreement with Riddell. The NFL said it was because its concussion committee research indicated that it didn't provide enough shell or cushion protection.

The problem is that players want either the league or the union to come out with something like a "Good Housekeeping Seal" for all equipment. They want to know what can meet minimal safety standards. They want to be informed workers.

Because of the fear of litigation, however, both the league and the union have balked at this.

Schutt's new DNA helmet has been popular with some teams, especially Cleveland, but the company doesn't release sales data.

You can tell if a player is wearing a Schutt helmet when you watch TV. It will be the helmet with a plain, white piece of plastic across the bill and not RIDDELL in red stencil across the front.

I believe the NFL earns something like 8 percent of GROSS revenues off the top from Riddell sales nationwide in exchange for the marketing deal. That might be a wrong or outdated figure, but it's what I've heard.

It's important to remember that (1) the helmet companies make very little money off of the NFL; (2) there is no way to tell how many players have switched from the old stuff to the new kit; and, (3) most of the football equipment used by all levels of play is dated.

Instead of the NFL market, the two companies concentrate their sales force on the 1.5 million high school and college players.

Most helmets used today were cutting edge in 1985. They haven't really improved over the past 20 years, except for the Revolution and DNA.

It's an even longer span for polyurethane pads, which date back to the 1960s and 1970s.

by ABW (not verified) :: Wed, 09/14/2005 - 11:41pm

Thanks Carl. It's really sad that advances that could be helping keep the players safer are being held up by fears of lawsuits. Perhaps what we need is some kind of independent board(industry or government sponsored and not affiliated with a league or players org) that could issue ratings for the various helmets. Giving a seal of approval might have too many legal hurdles, but maybe just some kind of rating that measures how much protection a helmet gives for a given amount of acceleration. I can't say I see that happening anytime soon though.

by Will Allen (not verified) :: Thu, 09/15/2005 - 12:02am

The Union, if it really is concerned about the well-being of players, should put this topic on the table for the next CBA; larger contributions to the pension fund, or a special fund set up for players forced out due to brain injury. Next, as painful as it may be, players should undergo extensive, continual, testing, and once enough concussions have been endured, or enough deterioration has been suffered, sorry, but it's time to find a new career. Is it possible for labor and management have enough foresight to have this happen? Don't hold your breath.

by Carl (not verified) :: Thu, 09/15/2005 - 12:04pm

Will, the topic is on the table, part of an expansion of the "benefits cap." The problem for both the league and the union, however, is trying to determine how many guys will be Terry Long or Mike Webster. Not every player is as likely to succumb to repeated, severe brain trauma as others are.

Interesting research at Virginia Tech is plumbing this data now. Some athletes can take an immense amount of G-force to the grape, whereas others are felled by what are comparatively light blows or whiplash.

One of the things you notice about, say, NFL linemen is that they've been self-selecting out for concussion risk from their Pop Warner days. The kids least likely to withstand the line mugging and punches don't make it to the next level.

The NFLPA, to its credit, is paying millions of dollars out of the CBA to research the effects of brain trauma. The NFL, working with NOCSAE and the helmet manufacturers, also has toiled to better design equipment, conceding along the way that it's probably not enough.

For those who follow the league, one of the saddest things to watch is the nearly crippled player going from camp to camp trying to catch on, one last time, to a team.

I know agents get a bad name in here, but ultimately it's usually the agent who steps in. I admire Leigh Steinberg for a lot of things, but one of them is his ability to tell a player, 'Listen, I don't care about the money. I don't think you can play. I talk with your doctor and he says that you will die if you keep this up. I refuse to represent you and I will do everything I can legally to make sure you don't die on the field.'

I know a lot of agents like that. They don't brag about this because it's probably not good for business. But there is a strong ethical streak that tells them they will do no harm to any client's health.

Steinberg continues to help many players, often down on their luck, long after they've left the game.

The tragic thing is that there's always a player that wants to hang on, and there's always a franchise that will let him try, regardless of the health implications.

If I could change one thing about football, it would be that. But to do so would be to change human nature.

by Carl (not verified) :: Thu, 09/15/2005 - 12:08pm

If I might pursue another line of thought for a moment, I will paraphrase the wisdom of the Cleveland Browns' equipment manager:

If you want players to quit using their helmets as weapons or tackling other players to jar loose their heads, then do one simple thing. Outlaw facemasks or helmets.

Ironically, while the helmet protects the skull and brain, it's been this vital piece of equipment that's allowed highly skilled and conditioned men to use it to ram their opponents and, generally, conduct themselves in a way on the field that would be highly lethal without the protection of foam and plastic.

You do NOT see the same number or severity of concussions in rugby, Australian Rules Football or even hockey. There might be a reason for that.

by Carl (not verified) :: Thu, 09/15/2005 - 12:53pm

"but maybe just some kind of rating that measures how much protection a helmet gives for a given amount of acceleration"

There is something like that. The National Operating Committee on Standards for Athletic Equipment (or "NOCSAE") has minimum standards for helmet design and construction. It's an industry-supported lab that tests new helmets.

Under their standards, nationwide gridiron deaths fell 74 percent between 1959 and 1990, and have continued to drop ever since.

The problem is whether NOCSAE has been testing (they drop helmets from high places) the right way. Were the simulations accurate in depicting actual game play?

The NFL said no, and convinced them to use the same testing equipment they designed to simulate on the field crashes.

But even the NFL's testing equipment has been controversial, and many neurologists have complained that it's too limited and fails to take into account many of the mechanics of field play.

And, again, there is no regulatory measure in place now that will force a professional player to switch. Trust me when I say that players are VERY reluctant to trade in equipment that's made them so succesful, often the same pads and helmets they wore in junior high!

In their public filings before they were bought out, Riddell estimated that possibly only one in 10 NFL players would wear the Revolution, despite the advice of trainers, equipment managers and doctors.

So, they have to pursue a longer business strategy. They have to "get" the kids when they're coming up. Or, at least, "get" the athletic directors, coaches and parents to really explore helmet purchases.

As for me, I don't have this choice. I return to OIF next month and the Kevlar helmet I'll use is the best one ever produced in modern warfare. It originally came out of research to improve the headgear for Navy SEALS, the same technology that went into Schutt's DNA.

I'm glad I'm getting rid of the old Kevlar, ring-around-the-skull net (I wore a similar helmet when I started playing football!) and picking up the new stuff.

I can't figure out why more players don't see it the same way.

by Jerry (not verified) :: Thu, 09/15/2005 - 7:33pm

There's some knowledgable disagreement on Terry Long (link on my name).

by Carl (not verified) :: Thu, 09/15/2005 - 8:05pm

Thanks, Jerry. I was going to post the Trib's follow up today.

I have the greatest respect for both Drs. Maroon and Wecht.

As a point of fact, however, I think both are right: (1) Maroon's records do not record an on-the-field concussion; (2) this would not be unusual.

Even today, according to the NCAA, 75 percent of all concussions are NOT reported to team doctors. In the old days of the NFL, without computerized testing like that pioneered by Dr. Maroon, I would imagine that far fewer were detected, even in a program as wonderful as the Steelers had.

Again, I can't say enough about how much I admire both of these physicians. I'm sure we're going to hear more about this as the story plays out.

by Carl (not verified) :: Fri, 09/16/2005 - 11:07am

Click on my name for an even better article (of course) from the Pittsburgh Trib.

Apparently, there was a letter in Long's medical jacket from the team doctor saying he had suffered "massive and concussive injuries" during a game against the Oilers in 1987.

Also: Long's family told coroner's investigators that Long frequently complained after games that he had been "knocked out.''

Pellman of the Jets says, "nothing to see here, people, keep walking to the exits. We'll have another study that most neurosurgeons will dispute."

by Jim A (not verified) :: Fri, 09/16/2005 - 11:59am

This was the first I've heard of Cyril Wecht's study of NFL concussions. A google search turned up nothing not referencing Terry Long's death.

Wecht is a prominent forensic pathologist who is probably best known for being a longtime vocal JFK assassination conspiracy theorist. In recent years he's written about high-profile pop culture crimes such as Laci Peterson, O.J. Simpson, JonBenet Ramsey, Kurt Cobain, and Ron Brown.

I also have a great deal for Wecht's work, but I wonder what the extent of his research on football injuries is.

by Jim A (not verified) :: Fri, 09/16/2005 - 12:11pm

Thanks Carl. The latest Trib article references a study in Neurosurgery by Omalu and Wecht, among others. Click on my name for the Abstract. It appears they only studied the autopsy of Mike Webster. Still wondering what other research Wecht and/or Omalu have done in this area.

by Jim A (not verified) :: Fri, 09/16/2005 - 12:21pm

The filter seems to be eating up my attempts to post a link to the medical article mentioned in Carl's link, but here's a quote from it: "relation to duration of years of playing football have not been sufficiently studied"

That refers to the study of Mike Webster by Wecht and Omalu.

by Carl (not verified) :: Fri, 09/16/2005 - 12:39pm

He's been studying it on and off for about a decade, Jim. For a much more comprehensive survey, however, I would refer everyone to the work done by Dr. Julian Bailes of West Virginia University and, formerly, the Steelers' neurosurgeon.

Sidebar: Dr. Bailes also played center for his college football team!

The 2001 study surveyed the medical histories of 2,500 former pros. The following year, a NCAA study of college football players found that 72 percent of concussions went unreported and, consequently, untreated.

A major, longitudinal study by the Center for the Study of Retired Athletes at UNC is currently doing exactly what the Neurosurgery article proposed.

I've written before about just how important the Center is to understanding brain injuries amongst NFL players.

By the way, the July report concerned Mike Webster, not Long. I hope people don't draw that conclusion.

What I've been wondering is whether Long carried the specific apolipoprotein E genotype that could predict future concussion risk.

Webster, as you know, carried the apolipoprotein E genotype E3/E3.