Article Insects, us & the future

The concussion issue in sport

4,500 ex-players and their families are suing the National Football League (NFL) over the issue of concussion in the sport. The lawsuit was based on claims that the NFL covered up the severity of concussions on players, through the Mild Traumatic Brain Injury Committee, by denying scientific evidence which had been mounting up in the medical community. At the end of June, the NFL announced they had altered their offer to over 4,500 ex-players and their families from a £400m fund, to an uncapped fund. The deal will involve setting up a fund for medical checks for ex-players, covering medical expenses for those suffering from concussion related illness, and some money has also been set aside for research. The reasoning behind this change on the NFL’s part is their belief that the total for this will be below £400m initially planned and the optics of an uncapped fund making for better PR.

This whole episode within the NFL has been brilliantly covered by two documentaries, League of Denial and Head Games, Head Games being based on the book by Chris Nowinski. The issue first came to prominence in 2002 when Dr Omalu performed an autopsy on ex-NFL centre “Iron” Mike Webster and he was the first ex-NFL player to be diagnosed with Chronic Traumatic Encephalopathy (CTE) in his brain. CTE is a degenerative neurological disease found in people who have experienced repetitive brain traumas. It is a degradation of the brain due to repetitive hits to the head, leading to a build-up of tau protein within the brain. CTE can only be identified postmortem, however suffers show many of the signs of dementia; such as memory loss, confusion and depression.

This rumbled on for a number of years with ever increasing numbers of deceased ex-NFL players being found with CTE in the brain; Terry Long, Andre Waters and Tom McHale, for example. Throughout this, the NFL set up the Mild Traumatic Brain Injury Committee in 1994, led by Dr Elliot Pellman, a rheumatologist and the New York Jets team doctor. Eventually the NFL agreed to the settlement mentioned previously and have brought in new rules regarding concussion protocols and head hits as well. However as part of the settlement, the NFL accepted no liability for the injuries caused to former players, so it is hard to tell if they have truly turned a corner.

While it is hoped that the new regulations will help improve player welfare in the professional game, two autopsies undertaken in 2010 have the potential to change the game in a big way. Owen Thomas, 21, and Nathan Stiles, 17 and still in high school, were both found to have CTE in their brains. Thomas was reported to never having suffered a concussion during his playing career, which throws up the possibility that sub-concussive blows are what was responsible for their deaths. These blows, due to the everyday impacts during the game, are fundamental to the game and while a huge amount of research is still needed, if this prognosis is found to be accurate it could have grave implications for the way the game is played.

But this is only a NFL problem, right?

It could be argued that the NFL is one of the leading organisations when it comes to brain injuries. As will be discussed, rugby and soccer lag considerably behind. The deaths of Ben Robinson and Kenny Nuzum highlight this.

Fourteen year old Ben Robinson died as a result of second impact syndrome while playing rugby for his school in Northern Ireland in January 2011. Ben had suffered a concussion at the start of the second half but was not removed from the game, despite his coach attending to him a number of times. Throughout the rest of the half he suffered other blows to the head leading to him collapsing just before the end of the match.

Kenny Nuzum played club rugby in Ireland till his late forties, and at an inquest at the end of May, it was found that he was the first rugby player to have early onset dementia as a result of CTE. Nazum had played rugby before the laws of the scrum had legislated against the clashing of heads at engagement and had suffered numerous blows to the head throughout his career.

The concussion issues within rugby are documented in an article by Shontayne Hape, a former New Zealand rugby leaguer and English rugby union centre. Hape was forced to retire at 33 due to the numerous concussions he had suffered during his career, which has resulted in memory loss and aversion to loud music and light. His article perfectly encapsulates the casual manner in which rugby dealt with concussion. However with the introduction by the International Rugby Board (IRB) of the Pitch-Side Concussion Assessment (PSCA) it was hoped that this would be rectified.

The PSCA allows for a doctor to remove a player suspected of concussion for initially five minutes, now extended to ten, to perform a number of cognitive tests to determine whether a player has been concussed, replacing the protocol previously of the test occurring on the field. While removing the players suspected of concussion should be welcomed, allowing a ten minute window to assess the veracity of the concussion has provoked considerable reaction.

One vocal critic has been former IRB medical officer and member of the board for 15 years, Dr Barry O’Driscoll. He resigned his position in protest over the new protocol arguing that the IRB were trivialising concussion and asking for them to show what evidence the five minute test is based on. And it is hard to argue with his point of view, with the high profile cases in the last year of clearly concussed players returning to action; George Smith, Brian O’Driscoll and Florin Fritz.


Soccer does not escape from this either as shown in Head Games with Cindy Parlow, a US soccer international who retired in 2006 citing post-concussion syndrome. In the interview she recounts how she has likely had over a 100 concussions and now is suffering from the effects from of this; headaches, stuttering and memory loss.

Despite a reduced chance of head collisions in soccer, players from the fifties and sixties have been found to have suffered later in life from repeated head trauma. Around the time when Cindy was at the peak of her powers, ex West Brom and England international Jeff Astle died from dementia. When his brain was examined later, it was found that CTE was present. A coroner found that his death was due to an ‘industrial disease’ from heading the ball.

Events in the last year have also demonstrated that the governing bodies of soccer have not got a handle on the concussion issue. In the Premier League last November, Hugo Lloris suffered a concussion towards the end of the Tottenham Everton match, however he was allowed to conclude the final twelve minutes of the match without being removed from play.

This was outdone during the recent World Cup match involving England and Uruguay. With a half hour left, Álvaro Pereira took a knee to the head from an English player. It was clear from watching on television that he had been knocked out cold, lying prone on the ground for a number of minutes while being put in the recovery position by his team minutes. He was attended to by the team doctor and eventually came around. But as the doctor indicated for a substitution, he reacted angrily and refused to leave the pitch. He disgracefully was allowed to continue for the rest of the match with some of his clearances appearing to become more and more desperate towards the end of the match, admittedly a judgement from afar on my part.

This was followed by a number of other instances of concussed players playing on, Javier Mascherano against Holland, which the media largely ignored after his man of the match performance. And Christopher Kramer, who played on for fifteen minutes in the World Cup final itself. FIFPro, the players union, released a number of statements calling on FIFA to “conduct a thorough investigation into its own competition concussion protocol”. FIFA have disgracefully, a standard position for FIFA, not commented on this situation yet.


While various drug scandals seem par for the course in sport, particularly in American sports, parents, I feel, will be less inclined to have their children go out and play American football or rugby if they know there is a serious chance of brain injury in later life. NFL and baseball are still popular despite the numerous drug scandals which have involved the two sports. However, there is a subtle difference between choosing to take performance enhancing drugs to gain an advantage, compared to unwittingly suffering a deteriorating brain injury.

The final section of Head Games covers child safety in these sports and raises some interesting points. We know that children suffer brain trauma easier than adults and that it takes longer for them to fully recover. This, coupled with inferior medical training at youth teams across every sporting code is a cause for concern. This is an area where parents need to educate themselves in the signs of concussion. In the various documentaries, it is clear that some of the parents interviewed do not take this issue seriously and have no qualms in letting their son or daughter continue playing or not take the required rest because it was ‘only a bang to the head’.

This may seem like scaremongering when you think of NFL’s dominance of the American sporting landscape but this hasn’t always been the case. Boxing, horse racing and baseball have all held that title in the last hundred years, it can change. This is why officials of these sports need to get involved in actively making their sports safer for all; harsher punishments in the NFL and a complete overhaul of the concussion rules within rugby, because in ten years’ time it may not be an issue. Either the sports will have cleaned up their games or kids will eventually be stopped from playing them.

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