Writers of Pro Football Prospectus 2008

09 Oct 2013

"League of Denial": Five Takeaways

We've had a number of requests from readers for a discussion thread to discuss last night's PBS documentary on concussions in the NFL, "League of Denial." Here's a link to Patrick Hruby's article about the documentary on Sports on Earth, and a place to discuss. You can also watch the documentary for free on PBS's website.

Just a couple of short thoughts from me.

1) Obviously, the evidence that the league willfully tried to ignore the problem as evidence mounted for years is very, very strong. I'll let the courts figure out what the league does or does not owe past players; I'm more concerned with what happens to the game going forward.

2) At a certain point, a contact sport is a contact sport. What about other contact sports? I'm curious to see a similar study for hockey players to see how much difference there is in issues of head trauma. Hockey players are generally smaller, but they hit each other at even higher speeds.

3) Furthermore on the issue of a contact sport: I say this all the time when it comes to penalties for defenseless receivers and the like. You cannot legislate against the laws of physics. At a certain point, no matter how many rules we pass to try to make the game safer, tackle football is going to involve physical contact. That not only means contact that happens even when players are trying to avoid such contact. Remember that the concussion which cost Kevin Kolb his starting job in Philadelphia came when his head hit the ground, not another player.

Posted by: Aaron Schatz on 09 Oct 2013

82 comments, Last at 15 Oct 2013, 12:43am by akn


by Aaron Brooks Go... :: Wed, 10/09/2013 - 12:49pm

I think even #1 is overblown. The NFL certainly wasn't early, but to say it was late is a bit disingenuous, too.

It's not like the NCAA or the NHL was beating down that door, and they have the same problems. And even hockey is well ahead of rugby, field hockey, and lacrosse on this issue -- rugby still denies it has a problem.

by Independent George :: Wed, 10/09/2013 - 12:53pm

Except they went way beyond being slow; they actively sought to discredit any and every physician who even suggested a link between CTE and the NFL.

by Revenge of the NURBS (not verified) :: Wed, 10/09/2013 - 1:49pm

Yes, "ignore" is not really the right word. "Obstruct" might be better, although I think that carries additional legal meaning, which is outside my realm of expertise. In any case, they did more than just ignore.

by Aaron Brooks Go... :: Wed, 10/09/2013 - 2:28pm

I actively seek to date supermodels.

I'm more interested in whether or not they had any power to actually do so. "Didn't give them money" is different from "sought to stop them."

by Tim Wilson :: Wed, 10/09/2013 - 6:49pm

Seems like you have not seen the film.

by Aaron Brooks Go... :: Wed, 10/09/2013 - 7:29pm

I haven't. But I've met a fair number of these guys, and was active in this field in this time-period.

by GeneNgamu (not verified) :: Mon, 10/14/2013 - 5:02am

Rugby has had a mandatory 3 week stand down for concussions since 1992

by GeneNgamu (not verified) :: Mon, 10/14/2013 - 5:04am

Rugby has had a mandatory 3 week stand down for concussions since 1992

by Dwelker (not verified) :: Wed, 10/09/2013 - 12:53pm

I work with investigative journalists regularly on exposing workplace conditions from the labor union side of the equation. This NFL pattern of behavior in reaction to workplace injuries is standard operating procedure for the boss. Not surprising when Tagliabue was a staff attorney during the time he oversaw the "deny and delay" strategy as presented in the program.
Tagliabue returned to Covington Burling law firm and here is his bio from their web site (I looked but not too hard to find a more descriptive version of exactly what his early pre-NFL career was):

Paul Tagliabue uses his experience as chief executive and board member of the National Football League, major businesses and nonprofits to advise clients on matters of organizational structure and governance, develop strategic risk mitigation approaches and assist in managing unfolding crises.

Mr. Tagliabue chaired the U.S. Olympic Committee’s Independent Advisory Committee in 2009-10 to assess the committee’s governance structure and management responsibilities. In undertaking such assignments, Mr. Tagliabue works closely with firm colleagues who have special expertise in corporate, legislative, regulatory and international legal issues.

Mr. Tagliabue serves as a leader of Covington’s Strategic Risk and Crisis Management initiative. Covington lawyers represent some of the world’s most sophisticated clients in cutting-edge technology, white collar defense, litigation, transactional, government affairs, international and life sciences matters. The group is anchored by senior lawyers who have had operational and management responsibility for high-risk, high-profile situations and crises and have successfully navigated through these issues.


For my own curiosity, I will have to look into what the NFLPA did in that period because the film chose to not highlight the union or individual union reps point of view.

by PatsFan :: Wed, 10/09/2013 - 1:46pm

To me the more interesting question is what will happen on the lower levels. If the research keeps on pointing where it seems to, especially with respect to the effects of repeated, unavoidable-due-to-the-nature-of-the-game, sub-concussive blows, what does that mean for the levels of football where minors play?

I actually think that's where the biggest existential threat to the NFL will be -- some combination of

  • * Parents not letting their children play
  • * Schools dropping the sport because their insurance carriers force them to
  • * Pop Warner/etc. leagues shutting down because they can't get insurance
  • * And perhaps eventually, state laws prohibiting/restricting minors from playing tackle football

If that happens it will eventually have a huge effect on the NFL player pool in addition to over time disposing people to think of NFL games the way many people of think of boxing now, all of which will be a strong "nichifying" force on the NFL.

by dmstorm22 :: Wed, 10/09/2013 - 2:15pm

Out of your four bullet points, I think only #2 (school's dropping the sport) and I guess #4 (though I feel #4 would never happen) would pose any serious threat. Youth (Pop Warner) football participation is really low compared to other sports like baseball, soccer. Already, parents don't like their pre-teen kids playing football. Many people in the NFL today started in high school. Football we be fine anyway since the supply of football players is way, way more than the demand. If you reduce the pool of college players by 50% (which is really dramatic), that still leaves a ridiculous amount of people. Quality of play will drop and because of that so could national interest, but I think people are way overexaggerating the problems football faces.

by Turin :: Wed, 10/09/2013 - 3:15pm

By the time players get to the NFL they've had 5-10 years of training, if HS football starts to disappear that number will drop substantially. Even assuming the quality of available athletes doesn't change, their skill level on entering the NFL would be quite a bit lower than it is today. Look at all the freak athletes who've failed to make active rosters, success in the NFL isn't just about physical ability.

Make no mistake, if liability concerns force high schools to cut football programs, the NFL is doomed. They'll go from a large, skilled talent pool to a small, unskilled talent pool. It'll be a slow death, but fans who grew up watching Brady/Manning are going to eventually lose interest as the game gets slower, simpler and less exciting.

by dmstorm22 :: Wed, 10/09/2013 - 3:42pm

I said the most serious concern is high schools cutting it. I don't think pop-warner leagues having to shut down is nearly as serious, though.

by Aaron Brooks Go... :: Wed, 10/09/2013 - 4:03pm

I wonder if that's actually true.

We're already seeing the effect of 7-on-7 leagues on QB and WR development. The only really enormous effect will be on linemen, and our course, on defensive players. But the NFL is already trying to legislate those guys out of existence, so what difference will it make?

by akn :: Wed, 10/09/2013 - 7:48pm

Let's not forget that concussions demonstrably affect younger players greater than older players, including lower concussions thresholds and longer time to recovery. Our brains continue to make substantive growth-related changes until about age 24. It's no coincidence that epidemiological research shows that being under the age of 24 is a significant risk factor for concussion (along with other factors as well, of course--female, history of prior concussions, history of prior neuro/psych issues, etc.).

Among organized sports, football has the highest rate of impacts per unit of playing time, and the highest rate of concussions per impact. Parents are becoming more and more aware of this, and it no doubt plays a role in what they will allow their kids to participate in.

by Aaron Brooks Go... :: Thu, 10/10/2013 - 9:59am

"the highest rate of concussions per impact"

That one is probably going to be cheerleading. Cheerleading doesn't have many injuries, but they tend to be spectacular when they do occur.

by akn :: Thu, 10/10/2013 - 6:47pm

Girls Cheerleading (high school): 0.06 - 0.094 concussions/1000 exposures
Boys Football (high school): 0.33 - 0.60 concussions/1000 exposures
Boys Football (college): 0.37 - 0.61 concussions/1000 exposures
Girls Soccer (college): 0.41 - 0.63 concussions/1000 exposures

I was wrong, girls soccer has the highest rate, but the rate of exposures/playing time is way lower than football.

by akn :: Thu, 10/10/2013 - 7:22pm

Actually just found a better source. Surprisingly, girls hockey (high school) has the highest rate, at 0.91 concussions/1000 exposures. Still very low exposure/playing time, however.

Boys football accounts for up to 75% of high school/college sports related concussions. Among girls, soccer accounts for up to 50% of concussions in high school/college.

by tuluse :: Fri, 10/11/2013 - 12:01am

Are girls more susceptible to concussions, or are they just going hard out there while the boys are protecting their weakling brains?

Or do girls just have better reporting?

by akn :: Fri, 10/11/2013 - 7:10pm

It's not completely clear. The leading hypotheses are a smaller head mass/neck mass ratio (weaker neck muscles can't cushion rotational forces as well), slower reaction times (less time to brace for impact), and better self reporting.

by Aaron Brooks Go... :: Mon, 10/14/2013 - 11:10am

"smaller head mass/neck mass ratio (weaker neck muscles can't cushion rotational forces as well)"

I think you meant that the ratio is larger, not smaller.

by akn :: Tue, 10/15/2013 - 12:43am

Brain fart.

by theslothook :: Wed, 10/09/2013 - 3:27pm

I'm optimistic that the technology will get better. The NFL has vast sums of money for research, both in terms of better helmets, better protective gear, maybe better scanning to prevent repeat concussions, etc.

by Go pats (not verified) :: Wed, 10/09/2013 - 4:42pm

The technology already is better, for instance, players do not wear the most "safe" helmet that exits out there. The NFL can fine players for not wearing their socks correctly but does not mandate the most safe equipment available. Also eliminating a lot of contact during pracrtice, especially for players in pop w, high school and college, where they undergo hundreds of collisions (especially linemen) prior to even getting to the NFL, would go along way to making the game safer. Also mandating the safest equipment in schools and college.

The NFL should be ashamed for the way it acted over the last 15 plus years. Also, where the hell was the players union????? If anything demanded a work stopage, player safety should have been first and foremost no?

I really feel for the hundreds of players and their families who have really been affect very badly by this.

Just my $0.02.

by akn :: Wed, 10/09/2013 - 8:01pm

"Safe" is a loaded phrase. To claim that one helmet is more safe than another in regards to concussions is a very difficult thing to prove, and I haven't seen anything in the medical literature that shows good evidence for one helmet over another. After disentangling business interests and affiliations, everything must be taken with a pretty sizable grain of salt.

From a medical perspective, safety and efficacy (in the FDA sense of those words) is evaluated by clinical trials. For drugs, you start with cells in a petri dish (phase #1), move on to animal models to determine lethality (phase #2), then humans in controlled settings to determine side effects and efficacy (randomized controlled trials, or phase #3), and finally humans in real world, uncontrolled settings (post-release surveillance, or phase #4). Studies on the safety of helmets and other equipment are largely based on controlled, simulated impacts with dummies ("phase #2") and post-release monitoring in uncontrolled environments ("phase #4"). Nothing has come even close to a randomized controlled trial. So from my perspective, calling one helmet (or mouthguard, shoulder pads, etc) more safe than another is just marketing.

Concussions are biomechanically acceleration/deceleration injuries. Better materials/designs only go so far in mitigating that fundamental fact. It's still one large body moving at high speed imparting acceleration to another body.

by tuluse :: Wed, 10/09/2013 - 8:23pm

akn, you rule

by N8- (not verified) :: Thu, 10/10/2013 - 11:34am

I doubt that a helmet considered "safe" or "safer" is even effective at all if the player wears it so casually and loosely that it practically falls off upon contact. The number of helmets falling off during games is going up every year. I believe it is a reaction to the TV crews showing some "tough guy" running the field without a helmet and how manly he is. It should be against the rules.

How about a study of a helmet full of dreads reduces the likelihood of concussions, or increases it due to improper helmet fitting? I'm sure it sounds like a joke, but I'm serious...

If you don't wear your seatbelt correctly, it can kill you. If you put your infant in a rear-facing child seat in the front seat, it can kill the baby when impact occurs. Isn't it the same with helmets? If worn carelessly, they probably increase the likelihood of brain damage, especially since the wearer assumes he is protected.

by Special J :: Wed, 10/09/2013 - 4:43pm

Well, so far, the Ravens spent as much on Joe Flacco's signing bonus as the whole league has on concussion research.

by Danish Denver-Fan :: Wed, 10/09/2013 - 3:46pm

At some point a contRact sport is a contRact sport as well. I know I know, players may have not known what they signed up for, and the NFL may have withheld some of that informmation. But at a certain point, and I don't know if we're at that point yet, players are signing a contract to do something everyone knows is extremely dangerous.

by tuluse :: Wed, 10/09/2013 - 5:11pm

I think the point is, it was not known how dangerous it was.

In highschool I had a teacher who played football when he was in highschool (would have been the late 70s I think). In that era concussions were literally treated like a joke. He had one in a game and ended up walking to the other team's bench after a play. The response was to laugh at how silly that was. Not to think "maybe bashing your brain about is a bad idea".

Getting one's "bell wrung"* was right of passage for decades, and this is just in highschool.

*Since you're Danish, I'll explain. It means getting hit so hard in the head your ears have a ringing sound like church bells.

by Danish Denver-Fan :: Wed, 10/09/2013 - 5:30pm

Yeah yeah i came off a little harsh there. My point was that in the long term, once this kind of information is available, there's a limit to the number of precautions the league is morally obligated to take, if that makes sense...

by Sisyphus :: Wed, 10/09/2013 - 5:08pm

The concussion problem has any number of issues that have really been hashed out and some of them may never be clear.
1) The lack of practice of proper tackling technique. Once you get out of high school, and even there it doesn't happen often, tackling is not practiced. The lack of technique has led to players thinking the highlight reel hits are tackling. Spearing was never taken out of the rule book but it was (and still is) a pretty rare penalty call. (I am encouraged that I think we are seeing more in the way of form tackling in the past few years than in the previous couple of decades.)
2) Performance enhancing drugs, particularly HGH have an impact on injuries in general. Some of these players are clearly NOT as naturally big as they end up and have likely used chemical enhancement as part of their training regimen. (It seems from an outside view that in some cases their bodies have developed to a place where their physical framework cannot support the muscle/tendon demands, another injury concern.) Size does matter in these collisions and the PED problem adds to this issue.
3) The tough it out mentality of players (and coaches and teams) has been a huge contributing factor to keeping hurt guys playing. This is where the changes are most likely to help the fastest and where using independent neurologists on the field is mandatory if the NFL is serious about protecting players from their coaches, teams, and especially themselves.
4) The form of the game will change somewhat but it has before and it has survived and even prospered. It seems that every time there is a change in the rules or interpretation someone claims it is ruining the game. The football we watch is very different from what I watched in the 50’s as it was in the 70’s and also in the 90’s; it has not seemed to have lost many followers in that time.

by PatsFan :: Wed, 10/09/2013 - 5:24pm

People need to remember there are two kinds of problems going on (or appear to be going on).

One kind of problem is actual concussions from big hits, bad tackling form, etc. This is the obvious-to-the-viewer problem and is also the one that the most can probably be done about -- emphasize better tackling form, institute/make more severe penalties for improper tackling, etc.

The other kind of problem is the (for lack of a better term) "everyday", "normal" blows that the OLmen and DLmen incur as a matter of course during the game and in practice. It's not clear to me what can be done about that without radically changing line play.

by Tim Wilson :: Wed, 10/09/2013 - 7:00pm

Excellent insight. Most of the CTE research over the past 5 years, since the public attention kicked off in earnest with Gladwell's New Yorker article, indicates that it is the latter (frequent, consistent blows to the head over time) that poses the most danger to longterm brain function and CTE issues, not the big highlight reel hits. These repeated blows also are thought to make players more susceptible to concussions, although I don't believe that's been conclusively proven. And it's even worse when you build it up starting in high school or even earlier.

And as you say, I don't know how you guard against that in the current version of this sport.

This is why the NFL is probably in more trouble with this issue than the NHL (mentioned in an above post). I would actually think that soccer, especially at positions like stopper/sweeper and forward where you see a ton of headers, would have similar concerns, but haven't heard as much concern there.

by akn :: Wed, 10/09/2013 - 8:21pm

The research in no way shows sub-concussive hits as the primary risk factor for CTE and other chronic issues. The evidence is just not there, as it is impossible to collect. How do you catalog all the sub-concussive hits a player accumulated over the years and relate that to an autopsy finding at death? A lot of researchers hypothesize that sub-concussive hits are big contributers, but only indirect evidence supports that belief (most autopsies showing CTE are of linemen, for example). Only retrospective studies are available to determine risk factors for CTE, and those are largely limited to cataloging the number of confirmed/diagnosed concussions a player had. That doesn't provide very strong evidence in the medical community. And because the NFL was so neglectful at keeping good concussion records before the late 90s, it complicates CTE research even further. I've studied those Pellman articles published in Neurosurgery--they are pretty shoddy.

Right now, most agree that the more confirmed concussions a person has, the higher the risk of CTE. Most also agree that the more sub-concussive hits a person suffers, the higher the risk for concussion. So that's an indirect link, but it's pretty weak evidence. It doesn't mean it's not true--just that it's really hard to collect the appropriate data for that kind of conclusion.

Repeated blows are not only a risk factor for concussions, several sub-concussive blows (without any one big hit) can lead to a clinically valid case of concussion itself, especially when they occur without a lot of time between those hits. This happened to Jay Cutler when he was sacked 9 times in the first half a few years ago against the Giants. Remember, concussions are defined by the clinical characteristics observed in the patient, not a catalog of they number/type of hits that person took.

by Tim Wilson :: Wed, 10/09/2013 - 9:47pm

Sorry, I'm probably playing a little fast and loose with my causation claims, at least by scientific standards. This is all from top-of-mind recollection, but I believe in some studies cited in the New Yorker piece or soon after, the brains of a very small number of high school and college age football players who died prematurely (non-football or brain related…car accidents, etc.) were studied, and they showed CTE, despite never having been diagnosed with concussions. The hypothesis of the scientists involved was that it was driven by years of subconcussive blows to the head.

Now, as you say, this is hardly medically conclusive. These players may have had concussions that went undiagnosed, and even if they didn't, such a small sample can't tell us anything firmly meaningful. Your last point, though, is what I was trying to get at—concussion symptoms and eventual CTE are likely not just caused by the big hits the NFL (and the willing media) have focused their PR battle on. There are hundreds and hundreds of subconcussive but still significant blows to the head for an NFL player every season, particularly for linemen and running backs, and the cumulative effect of that trauma could end up driving more brain impairment and long term symptoms than the "single hit" concussions that a lot of the discussion is focused on.

My point here is not to say that this is absolutely medically true or not. My point is that it certainly seems POSSIBLE that it is true (perhaps even likely), and if it is, then I don't see how the NFL (or high school football, or college football) guards against that type of trauma while still resembling the game that we see played today.

by jontemple :: Thu, 10/10/2013 - 9:13am

I agree that the level of peer-reviewed research on the topic of sub-concussive blows and their link to CTE is not up to snuff right now, and that it may be years before it is--if ever. It's hard to retrospectively quantify this sort of thing, and a prospective study is going to be in an ethical gray area--at best.

If researchers start monitoring players who routinely undergo subconcussive blows and begin to detect that we are underestimating the damage undergone by these blows, it will be difficult to continue such studies in good conscience. To reach significant sample sizes and time durations to show any conclusive results will also take a lot of time. This is all hypothetical, however. I am a pharmacy student, and, while I reed a lot of peer-reviewed medical research, my expertise does not lie in neuroscience.

I think the NFL realizes that now is their time to strike in the PR battle. They likely suspect (I would be extremely surprised if they didn't, anyway), as you and I, that subconcussive blows are a massive problem for CTE. On the other hand, they have this massive money-maker and are tasked with defending their market position. Just like any other unethical big business in this country, the truth matters little.

All the posturing they have done about "big hit" rule changes and superficial concern about players' health post-retirement is just that--posturing. If they can get it in your average American's head that "big hits" are to blame and they can be alleviated, then they will consider this a win. Their true fear, I believe, lies with this more sinister unavoidable subconcussive blow business. They'll fight tooth and nail to never let that come to light.

by Aaron Brooks Go... :: Thu, 10/10/2013 - 10:03am

To be fair, what was officially a "concussion" changed in 1997. Prior to that, nearly all scales required frank loss of consciousness. A "ding" was considered a sub-injurious event.

It's somewhat disturbing to see what was thought of concussions in the 1950s. Some of those would be considered comas today.

by akn :: Thu, 10/10/2013 - 7:07pm

There's no official definition of "concussion." Several medical societies have offered their opinion on what a concussion is, and they largely agree, but there have been major modifications well before and and well after 1997. ICD9/10 codes (what we bill on) have also changed several times over the years. The largest recent consensus was the Zurich panel in 2009, but there have been changes/updates as recently as 2012. And that doesn't even include all the confusion around trying to grade concussions.

Pellman, in his "research" published about concussions in the NFL in the late 90s/early 2000s, used a 1993 definition that is pretty obsolete (even though he was publishing as late as 2011).

by Aaron Brooks Go... :: Mon, 10/14/2013 - 11:13am

I was using the AAN's 1997 decision, which seems to have been the bellwether that started the modern concussion awareness.

Forget grading -- we're still trying to figure out what concussions are. =)

And don't get me started on whether or not blast-related MTBI is a concussion or not.

by akn :: Tue, 10/15/2013 - 12:41am

I would actually be very interested on your opinion of the differences between blast-related mTBI vs sports-related mTBI. I'm sure issue number one is the energy involved, but I'm wondering if there's any way to apply conclusions about one to the other. It's a lot easier to collect sport-related data.

by Sophandros :: Wed, 10/09/2013 - 7:24pm

I've been saying for a long time that football needs to adopt tackling rules similar to those in rugby. Penalize players who do not attempt to wrap up in a tackle. That will make that aspect of the game safer.

The technology will help with the hits that OL, DL, and FBs take--as long as the players use those helmets.

But at the end of the day, people need to realize that we can only reduce the risk of concussions, not eliminate it. And we can do that without "ruining the game".

Sports talk radio and sports message boards are the killing fields of intellectual discourse.

by Johnny Socko (not verified) :: Thu, 10/10/2013 - 3:18pm

Adopting the rugby tackling rules is such a fantastic idea. Why this idea doesn't gain traction is a mystery. It may not solve the CTE issues, but at the very least it would bring back the skill in tackling and the game would be more fun to watch (IMO).

by akn :: Wed, 10/09/2013 - 8:40pm

1) Tackling technique can probably play a role, but there's no research that supports that. Improving tackling technique remains a "weak" recommendation by medical experts. In the end, it's one big, fast moving body hitting another--technique only mitigates that so far.

2) Advances in PEDs have been far outstripped by advances in training technique and nutrition. Players may be getting too big for their bodies, but that can happen without chemical enhancement. The few studies looking at HGH as a PED are largely inconclusive about enhancing sports performance/training. Nonetheless, that doesn't stop athletes from trying it as a shortcut. You are right about muscle/tendon/ligament issues, however. Several experts have expressed concern that unbalanced development of muscle groups (such as the quads vs hammies) in an attempt to become more explosive have left athletes more vulnerable to sprains and strains.

3) Toughing it out mentality affects return to play. In the late 80s/early 90s, half of NFL players returned to play/full practice after concussive-like symptoms either the same day or the next day. As late as the mid 2000s, the average return to play time after concussion was between 4-6 days. Last year, it was 16 days. So there's progress being made.

4) Rules changes have absolutely had a positive impact (concussion-wise) on the game. Kickoffs were clearly the riskiest play in football by far. Now, the number of concussions from kickoffs have been dramatically reduced. Hits to unaware (defenseless) players are also at higher risk for concussion, since bracing for impact stiffens the neck and reduces head rotation after being hit. Rules changes to protect defenseless players directly addressed this. Finally, the number of concussions has actually gone up over the past few years, but the evidence indicates that it is because trainers/doctors/independent consultants are catching more of them rather than more actually occurring. All these changes may have come because the legal threat, but there's no doubt it's improving prevention of concussions and their complications. It remains to be seen if it has any affect on CTE and other chronic complications.

by Sophandros :: Wed, 10/09/2013 - 10:12pm

PEDs are the elephant in the living room for this discussion.

Sports talk radio and sports message boards are the killing fields of intellectual discourse.

by David :: Thu, 10/10/2013 - 5:32am

Agreed - or, more accurately, the lack of a comprehensive testing & appropriate punishment regime. The elephant in the room is the performance of AP & Ray
-Ray last season

by usernaim250 :: Thu, 10/10/2013 - 8:53pm

Amen on #4. I can't believe how on one of the few venues for intelligent discussion of the sport, the general tenor brings to mind defenses of bare knuckled boxing.

by Theo :: Wed, 10/09/2013 - 7:02pm

3) so? that Kolb hit the ground doesn't mean you should still try to limit hits to the head.

by Revenge of the NURBS (not verified) :: Thu, 10/10/2013 - 3:25pm

It means that concussions will never be completely eliminated from the game, which I think is the point Aaron was trying to make. Large people are slamming into each other at high rates of speed; concussions will occur. The number of concussions may be reduced through a variety of measures, but at the end of the day, there will always be concussions in football.

The NFL has undertaken an effort to reduce concussions, which is a good thing, but no success criteria have been defined. At what point has the NFL sufficiently "protected player safety"?

by Theo :: Fri, 10/11/2013 - 4:17am

Let's answer that question:
I think the league is going with the idea that they protect players from concussions enough if the rules are sufficient to eliminate the actions where concussions can be reasonably be expected; hits to the head when someone can't protect themselves.
The goal is not to eliminate concussions from football (you can't) but I think the League is trying to eliminate those actions where you can directly expect a concussion.

I don't know where Aaron was going for with points 2 and 3. But to me they looked like either fallacies/strawmans or even cognitive dissonance.

by Revenge of the NURBS (not verified) :: Fri, 10/11/2013 - 8:19am

That doesn't really answer the question though. It just changes the question from the definition of success to the definition of "where you can directly expect a concussion." With what probability? Even a full-on head-first spear (a.k.a. The Meriweather Special) is probably less than 50% likely to cause a concussion.

We obviously know that certain actions are more likely than others to cause a concussion, but we can't put a number on it. And even if we could, someone (I have no idea who) would have to establish the line of what "directly expect" means. 10%? 1%? .001%? There's a non-zero chance of concussion simply from falling on the ground (let alone being slammed into it).

by PatsFan :: Wed, 10/09/2013 - 8:46pm

This could be very interesting -- being able to diagnose CTE in the living. What happens if the union starts pushing for all players to get this test. And what happens if lots and lots of players test positive?


Earlier this year, UCLA researchers published a breakthrough study in The American Journal of Geriatric Psychiatry outlining a method of testing for CTE in living players.

By injecting a radioactive compound into the bloodstream of five retired NFL players, the UCLA researchers were able to identify the biomarkers of CTE in a routine positron emission tomography (PET) scan. The compound, called FDDNP, acts as a tracer by binding with the tau protein deposits associated with CTE. The radioactive chemical tracer then accumulates in the brain in various densities, which show up in clusters of different colors on the PET scan (low-density tau deposits glow blue, while high-density deposits glow red).

It’s essentially a visual map of tau protein deposits in the brain.

by akn :: Fri, 10/11/2013 - 7:20pm

FDDNF (fluorine-18, or light fluorine) isn't new. It's been investigated as a Alzheimer's disease marker for long time, but hasn't reached enough reliability to break into mainstream practice. It's not even the "best" compound--a chemical called Pittsburgh compound B (PIB) generally shows more promise. If PIB isn't currently being investigated for CTE, I'm sure it will be soon.

The other complicating factor is that many people have tau deposits on autopsy without suffering neurodegenerative disease. Maybe not at the levels and distribution that someone with severe CTE (or AD) would have, but enough that it could drive up false positives.

by Steve Wills (not verified) :: Wed, 10/09/2013 - 8:46pm

I'm thinking this issue is far more complex than we know. Instead of looking at blame, perhaps we should look at all possible ways to helpthose active and past players of all collision sports survive their chosen life styles.

One such way is looking at the way Omega-3 Fatty Acids play in helping and lessening the damage of head trama of boxing, football, hockey, etc.


by Yuri (not verified) :: Thu, 10/10/2013 - 10:22am

I watched the film. Here are my 5 takeaways to complement Hruby's (some assimilated from other reactions):

1) There is no smoking gun / "conspiracy" that can be proven. NFL research was shoddy and they obstructed independent research drawing "wrong" conclusions, but that's about as far as the accusation goes. I'd say most NFL insiders (perhaps not the lawyers occupying commissioner's office but certainly at least some of MDs involved on NFL side) genuinely believed that the risks are overblown. As a result of the film, I don't see huge damage to the league's image or changes in the way the game is played. One danger is removed--I don't think it's a coincidence that the retired players' lawsuit was settled before the movie aired.

2) Past players/head injury sufferers. What is the way to help them or is it too late? $ alone does not cure brain disease (See Steve Willis comment #30)

3) The key issue that NFL would argue is that the brains being examined for CTE are mostly of players who had life problems before their death (sometimes being ultimately manifested in suicide)--that's why their families send brains over for research. For the sake of argument, assume CTE->life issues link is clear. While I believe it, I did not see strong data on prevalence of CTE among ex-players vs general population (the film states that of course not everyone gets it but players get it at a rate of more than regular folks) _adjusted_ for effects of PED or any other significant factors (e.g., physical attributes of NFL player or "hitting the wall" with lack of life skills post NFL).

4) Really the most important question is what happens with the lower levels of football going forward. I have no idea. I was toying with the idea of letting my kids play Pop Warner, but now I am not doing it.

5) What about Congress (the ultimate x-factor)? Can anyone predict what they would do in this day and age?

by Dan in Philly (not verified) :: Thu, 10/10/2013 - 11:06am

Why is boxing and MMA ok?

by Revenge of the NURBS (not verified) :: Thu, 10/10/2013 - 12:43pm

Boxing and MMA are OK? Who told you that?

I guess, taking your question more seriously, if we are to look at boxing and MMA, we could go back to the idea of "knowing the risks". The term "punch drunk" has been known to boxers for a long time. Per Merriam Webster, the first known usage of that term dates to 1918. For a boxer to not know that brain damage is a risk, he'd have to know literally nothing about the sport.

Note that I'm not making a comparison to football here, only stating that it would be very hard for a boxer to credibly claim that he didn't know about the risk of brain damage.

by Dan in Philly (not verified) :: Thu, 10/10/2013 - 3:29pm

In a sport where the term "Getting your bell rung" is pretty common, it's hard to argue that players didn't know they were risking their health. If you contend that the long term hard of concussions are too damaging, why target football? Other sports, including boxing, MMA to name the obvious ones, but soccer, LaX, and any sport which risks contact have similar dangers.

While I'm all for raising awareness about the risks of football, I question why the most lucrative one is the one drawing the latest attention. I suspect the trail lawyers who got rich of the last settlement are behind it.

by Revenge of the NURBS (not verified) :: Thu, 10/10/2013 - 4:31pm

"If you contend that the long term har(m) of concussions are too damaging, why target football?"

To reiterate --
"Note that I'm not making a comparison to football here, only stating that it would be very hard for a boxer to credibly claim that he didn't know about the risk of brain damage."

Nevertheless, you may be correct that there's a money-grab aspect to this. It's certainly possible. In the case of a few players (like Pat White) who were in the concussion suit and then dropped out when they were offered a spot on an NFL roster, it's undeniable. Still, it's not particularly outrageous to point out that lawsuits generally are directed at those with money. There's no point in suing someone with no money.

But just to play devil's advocate (leaves and plays a game of Devil's Advocate at the Kwik-E-Mart), I wonder how one even could hypothetically sue "boxing". Who would you sue? Major league football IS the NFL. Major league basketball IS the NBA. There is no major league boxing. It's a mishmash of leagues and promoters, none of whom is fully responsible for safeguarding the sport. Same could be said of soccer. MLS is more established, but it's not the only pro soccer league, or even the most prominent one. Players jump from league to league constantly. There is no dominant rule-making entity to hold accountable.

by Andrew Potter :: Thu, 10/10/2013 - 5:22pm

Same could be said of soccer. MLS is more established, but it's not the only pro soccer league, or even the most prominent one. Players jump from league to league constantly. There is no dominant rule-making entity to hold accountable.


by akn :: Thu, 10/10/2013 - 7:04pm

When boxing or MMA net 10+ billion a year in revenue and produce Nielsen ratings that leave every other show on TV in the dust, then you'll see the outrage.

by QCIC (not verified) :: Thu, 10/10/2013 - 12:12pm

I would say 2 things on this issue that seem at odds.

1) I think the extent to which this is portrayed as "new" knowledge in the media or in NFL circles is overblown. In hockey crazed northern Minnesota in the 80s, where my grandfather was a HS football and hockey coach, one of his main points of emphasis with me as a young hockey player was ALWAYS, where a mouthgaurd, strap your helmet, keep your head up, always avoid big hits. His explanation of why was always that too many large hits could leave you permanently punch-drunk and do serious damage. SO there was at least some awareness of these outcomes in these circles, and I would say throughout my hockey career his position was not anomalous. I would also point out that this is coming from guy who played college hockey in the 40s and 50s when the rinks had chain link fences, fans jumping onto the ice to fight with players was common, and where he got 25 broken noses in 4 years. So he was definitely not some shrinking lily.

Due to the above I am not sure all the "OMG I am shocked, shocked! that football is bad for you" is warranted. Seems like the reaction of a media that sells papers by sensationalizing things, and a legal system that thrive son silly lawsuits.

2) All that said, I don't see any reason you could not outlaw "hitting". So you can still tackle people, and bring them down with your arms. But you cannot use your weight and your shoulder into their shoulder/body to bring them down. This would be very similar to how men's league hockey works. There is no or only very light checking, but there is still a lot of pinning along the boards and the occasional scrape. But the overall impact on peoples brains drops to almost nothing and the game is really 95% the same. I think you could preserve 95% of football by just eliminating "hitting" and keeping "tackling". You might have to de-liberalize the passing rules a bit because it would be harder for the defense. But the league would probably see that as a feature not a bug in its quest for more and more points.

by Aaron Brooks Go... :: Thu, 10/10/2013 - 6:11pm

" So you can still tackle people, and bring them down with your arms. But you cannot use your weight and your shoulder into their shoulder/body to bring them down."

That's not rugby rules, by the way. Rugby uses all kinds of body weight and shoulder force. To the point where you see a higher rate of clavicle and compressive neck injuries.

by GeneNgamu (not verified) :: Mon, 10/14/2013 - 5:13am

It's illegal to tackle without your arms. You can't shoulder charge in rugby

by Boston Dan :: Fri, 10/11/2013 - 4:02am

"Due to the above I am not sure all the "OMG I am shocked, shocked! that football is bad for you" is warranted."


by Juvenal (not verified) :: Fri, 10/11/2013 - 11:17am

You say that is a straw man, but that is basically the reaction ESPN and the mainstream sports outlets have presented over the last decade.

by ClemsonMatt (not verified) :: Thu, 10/10/2013 - 3:52pm

People seem to focus on lack of a perfect fix meaning no measures matter. If the probability of long term neurological damage can be reduced from 50% to 10% (posterior generated numbers), even though all risk isn't eliminated the risk/reward calculation to playing football has been greatly changed.

Virginia Tech quantitatively evaluated helmets. I've also heard of helmets that go soft - Hard - soft being the optimal design for reducing acceleration. In addition, it's been shown that mouth guards reduce risk.

In practice Clemson is wearing foam mushroom caps.


Longer recovery times prevent recurrence.

Overall, there are always solutions. Defeatism annoys me.

by Aaron Brooks Go... :: Thu, 10/10/2013 - 6:13pm

Soft exteriors are a great way to protect the head at the expense of the neck.

by tuluse :: Thu, 10/10/2013 - 6:43pm

Hard helmets also eliminated skull fractures. Which is generally seen as a good thing.

by akn :: Thu, 10/10/2013 - 7:01pm

The first link you provide is based on dropping dumbbells on dummies with helmets, hardly strong evidence.

The second link is a theoretical design discussion with no real data to back it up.

As I said earlier in this thread, there's no good evidence, other than you should probably wear a modern helmet of some kind. It's not defeatism, it's pragmatism.

by usernaim250 :: Thu, 10/10/2013 - 9:11pm

No, it's defeatism. Pragmatism would be to experiment creatively to solve the problem rather than throwing up your hands.

by tuluse :: Fri, 10/11/2013 - 12:02am

I don't think he's suggesting we stop trying to make better helmets, but that there is no real evidence that certain helmets are better than others.

by Aaron Brooks Go... :: Mon, 10/14/2013 - 11:18am

The VT method is to replicate the impact ratios seen at a range of possible energy levels, as determined by 10 years of real-time player data, measure the linear and rotational accels that result, and determine the cumulative risk of injury based on the same data that went into the energy range analysis.

As far as human-based data goes, it's pretty compelling.

It's slightly more advanced that dropping dumbbells onto dummies.

by akn :: Tue, 10/15/2013 - 12:38am

The real-time player data is retrospective, which--as far as risk ratios are concerned--is a second tier level of evidence compared to prospective data. The only prospective studies on concussions I've seen published are on hockey players, but there was no accelerometer data collected.

by Eric (not verified) :: Thu, 10/10/2013 - 5:42pm

I haven't seen the film, but I follow articles on the subject. It blows me away that AFIK, nobody has actually done the leg work to see what percentage of ex-players have significant neurological impairment. This is a tractable problem. There's between 300-400 player retirements per year, (and fewer then that in years past when the league was smaller) so to get 50 years of data it's only a matter of tracking 18k people at the very outside down. What percent of these guys have trouble with daily living (as opposed to occasionally forgetting their keys) and how does that compare to the population as a whole.

A lot of these guys have severe orthopedic problems which is a known cause of depression, as well as substance problems with alcohol or pain pills. They also frequently end up in money problems, especially compared to the image that they feel they need to maintain. Those are all big time contributors to suicide - teasing the impact of CTE (if any) out from that mess of factors is going to require research orders of magnitude more meticulous more then has been performed to date.

by bhauck :: Thu, 10/10/2013 - 6:08pm

I'm going to be really surprised if hockey has even a tenth as widespread the brain damage that football does. [Some made up large percentage] of hockey players probably don't get hit (regular, legal hits, not talking unusual stuff) as much in a year as a lineman on either side of the ball does in [some made up small number of games/practices].

The three NHL games last night had 36, 42, and 78 recorded hits. I'm not a football expert, but aren't there at least (# of lineman) x (# of snaps) + (# of tackles, sacks, and other hits) hits in every NFL game? That's, what, a few hundred?

by Eric (not verified) :: Thu, 10/10/2013 - 6:25pm

Well you are exaggerating the number of hits in football by quite a bit. Over half of plays are pass plays and most linemen on most of those plays do not get hit in the head. And if you are going to count a routine drive block as a "hit" I'm pretty sure you need to add some more hits to hockey, like guys fighting for a dropped puck. Also hockey has 5x as many games at the professional level, and my impression is there are many more at the youth level when people play on traveling squads and what not. A typical NFL player probably plays less then 300 games across all levels, I bet a typical NHL player plays more then 300 only counting professional games.

But more data is needed on the way head injuries occur across different sports. Like other people have mentioned, there's some evidence of damage from Soccer. More data about the injuries, more brain scans, more measurements of life outcomes, and more statistics to correlate all these things.

by bhauck :: Thu, 10/10/2013 - 6:56pm

Yeah, I don't have a great understanding of line play, but most of what I do know I've learned from the articles addressing football and brain injuries. One of the major things I've seen addressed over the last year or two has been that smaller and smaller contacts are believed to add up to major damage. Three years ago we were only worried about people who lost consciousness, now we think your routine jostling at the line is a slow march to damage. The head doesn't have to be the point of contact for the brain to rattle a bit.

So I don't think it's unfair to say a 350lb, super-athletic NT pushing into the offensive line as hard as he can to try and get into the backfield is a little different than two hockey players who are already tangled up using their shoulders and backs to try and lever an opponent away. If they're tangled because one of them came flying in, yeah, that's not good for you. But that's a relatively rare enough event in a hockey game that they count them. Relatively rare in this case is dozens of times a game spread over 40 players, but it's not happening multiple times every five seconds. Line play sets the structure of the game every snap, and a tackle is how most of them end. Hitting is the fundamental element of football in a way that it just isn't with hockey.

Sorry, I'm basically just rambling because I drank too much coffee this morning and now can't focus enough to work, and I'm nervous because my baseball team play an elimination game in an hour I'm going to have to rush home to only miss a third of. So you probably shouldn't take me seriously.

by Eric (not verified) :: Thu, 10/10/2013 - 7:56pm

Reading Muth is an excellent way to understand line play, if you are so inclined. If you read one of his articles, you will notice when pass protection is the topic, he talks a lot about sitting. That is the offensive linemen pull their heads away from the defense in a "sitting" position to avoid being pulled forward. Then he talks about punching - which is not allowed to the head. It does happen sometimes, but not super frequently. If an offensive lineman tried to use his head to pass block, most times he would quickly get defeated with a swim move.

For the defensive line's part, if you tried to strike an offensive lineman with your head on a pass rush, the man will gratefully hold the living heck out of you. When you bull rush, the most effective way (I found at least) is to try to grab inside and under the chest plate with both hands, then force that up into the OL's neck. It's unpleasant, but it's not a blow to the head.

Pass protection involves few enough blows to the head that most college camps I attended that were technically "non contact" would quietly do it off to the side, with no pads at all, full speed. At least with the kids they were trying to evaluate, if not the general population of local kids who were paying to be there.

So I'm pretty sure there are a significant number of hits of that magnitude that go into every hockey game without being reported. Probably not as many as football, but a significant number.

I agree that subconcussive hits are a concern, and running plays are a significant source of these. My best guess is that CTE turns out not to be a huge problem, but that nearly everybody has it - football, hockey, rugby, soccer.

by tuluse :: Fri, 10/11/2013 - 12:03am

He's also talked about using a headbutt as a form of blocking, so there is that.

by Eric (not verified) :: Fri, 10/11/2013 - 12:18pm

I'm gonna guess that was on a run play. Or he was saying it disapprovingly. Headbutting somebody deliberately on a pass block will get you defeated by a swim move a very unacceptably high percentage of the time.

by JMM* (not verified) :: Fri, 10/11/2013 - 9:32am

The goal in boxing can be stated as inflecting a concussion (knockout) in your opponent. The rules in boxing have changed over the years. More TKO's vs knockouts, ref's will step in as soon as it is clear that a boxer is in trouble vs the "old days" when a guy would be beaten till he falls. Also, if a guy is knocked out, he can't enter the ring for months. In the NFL, the practice was get 'em back in ASAP. Football is just catching up.

Also, it is possible to get a concussion without a blow to the head. An abrupt change in direction is enough to make the brain impact the skull with enough force to cause concussions. Improvements in helmets and rules can and should be done, but fast guys forcing other fast guys to abruptly change direction (say a hit in the chest) will still cause some concussions. We will get to the point where accelerometers will be in every pro helmet, at least to begin to determine the scope of the issue. Trying to solve this with the data collection we have now is futile.