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Concussions and other types of repetitive play-related head blows in
American football have been shown to be the cause of chronic traumatic
encephalopathy (CTE), which has led to player suicides and other
debilitating symptoms after retirement, including memory loss,
depression, anxiety, headaches, and also sleep disturbances.
The list of ex-NFL players that have either been diagnosed post-mortem
with CTE or have reported symptoms of CTE continues to grow.
1 Concussions in the National Football League
Concussion protocol process
1.4.1 Preseason evaluation
1.4.2 In-game identification
1.4.3 In-game evaluation
2 NFL litigation
2.1 A league of denial
2.2 Federal NFL concussion litigation
Kansas City Chiefs
Kansas City Chiefs concussion lawsuit
2.4 Cook County, Illinois Riddell concussion litigation
3 Concussions in college football
4 Concussions in other leagues
4.1 Canadian Football League
4.2 Arena Football League
4.3 Youth football
4.4 Concussions in high school football
5 Prevention efforts
5.3 Youth football
6 Screening procedure
7 Recovery efforts
8 See also
10 External links
Concussions in the National Football League
See also: list of NFL players with post-concussion syndrome
A concussion, from the Latin word concussio, is a frequent injury
among football players. Concussions occur when the head is subject to
a large impact force, resulting in a minor brain injury. There has
been a growing concern about concussions since the early 1900s. In
1906, a Harvard student athlete died from a head injury and the team
doctors released a report titled "The Physical Aspect of American
Football" in the Boston Medical and Surgical Journal describing the
type, severity, and number of injuries the team sustained in the 1905
The NFL first began to review the subject formally in 1994, then NFL
Paul Tagliabue approved the creation of the Mild
Traumatic Brain Injury (MTBI) Committee with the stated goal of
studying the effects of concussions and sub-concussive injury in NFL
players. Tagliabue appointed rheumatologist Elliot Pellman to chair
the committee. Pellman's appointment was met with harsh criticism,
because he is not a neurologist or neuropsychologist and often
admitted ignorance about head injuries. The concussion data
collected by the league from 1996 to 2001 has been shown to understate
the actual number of diagnosed concussions by ten percent. The league
legal representation has been shown to have had ties to the tobacco
industry legal defense. [importance?]
The same year, the National Institute for Occupational Safety and
Health (NIOSH) reported a statistically significant increase in the
risk of neurological disorders such as amyotrophic lateral sclerosis
(ALS) in retired football players, which furthered public knowledge
about the risk of long-term neurocognitive disease related to repeated
head impacts. Despite the NIOSH study, Pellman and the MTBI
Committee drew their own conclusions that continued to contradict
these findings and those of other organizations. Biomechanical
engineers and neurosurgeons informed the Committee that the helmet
safety standard at that time was insufficient to minimize the risk of
The MTBI Committee began studying the nature of tackle plays resulting
in concussive impacts and developing its own biomechanical analysis of
the effect of these forces on the brain. It started publishing
study results in 2003 that stated there were no long-term negative
health consequences associated with concussions sustained by NFL
players. A six-year study by the Committee concluded that, "Players
who are concussed and return to the same game have fewer initial signs
and symptoms than those removed from play. Return to play does not
involve a significant risk of a second injury either in the same game
or during the season."
Other organizations continued to publish study results that linked
repeated concussions and long-term health problems contrary to reports
by the MTBI Committee. A 2003 report by the Center for the Study of
Retired Athletes at the University of North Carolina, for example,
found a connection between numerous concussions and depression among
former professional football players. Further, the Center's follow-up
study in 2005 associated both brain impairment and
with retired NFL players who had histories of concussions.
A 2004 doctoral dissertation by Don Brady examined NFL Players'
knowledge of concussions, studying both active and retired National
Football League Players' knowledge of concussions. Brady's findings
concluded: that many NFL players lacked accurate and essential
knowledge pertaining to various aspects of a concussion; that the
preponderance of credible experimental and clinical evidence
pertaining to the adverse effects of concussion indicates that the
brain is injured as a result of a concussion; that the altered cell
functioning and cell death along with subtle to more visible
neurological, neurocognitive, psychological, and other medical
problems reflect a diverse range of lifelong negative consequences of
a concussion / brain injury; and that sports team health-care
personnel need to focus primarily on the athletes’ health and
well-being, and not minimize an injury or primarily concentrate on the
players’ capacity to perform on the field. This expanded focus of
health care is necessary in order to avoid any real or perceived
conflicts of interest emerging in the concussion research, concussion
management and related return to play decision-making process.
During November 2014, Brady filed objections to the proposed NFL
concussion settlement offer. Brady sent a cover letter and detailed
objections on behalf of NFL retired players to the presiding US
district court judge, Anita Brody.
In addition to the studies that continued to contradict the work of
the MTBI Committee, renowned experts and sports journalists wrote
critical reviews of the Committee's studies. Robert Cantu of the
American College of Sports Medicine
American College of Sports Medicine noted bias in the committee's
extremely small sample size and held that no conclusions should be
drawn from the NFL's studies. In an
ESPN Magazine article titled
"Doctor Yes," Peter Keating criticized Pellman and the MTBI
Committee's work and argued that the "... Committee has drawn a number
of important conclusions about head trauma and how to treat it that
contradict the research and experiences of many other doctors who
treat sports concussions, not to mention the players who have suffered
More studies continued to associate repetitive head injuries with
neurological problems later in life. Kevin Guskiewicz, Director of the
Center for the Study of Retired Athletes in the Department of Exercise
and Sport Science at the University of North Carolina, analyzed data
from a 2007 study of nearly 2,500 former NFL players. He found about
11 percent of the study participants suffered from clinical
depression, with a threefold increased risk in former players who had
a history of three or four concussions. The following year, the
NFL commissioned the University of Michigan Institute for Social
Research to conduct a study involving more than 1,000 former NFL
players. The results reported that
Alzheimer's disease or similar
diseases appear to have been diagnosed in former NFL players vastly
more often than in the general population at a rate of 19 times the
normal rate for men ages 30 through 49. The NFL responded to these
results by claiming the study was incomplete.
On September 30, 2014, researchers with
Boston University announced
that in autopsies of 79 brains of former NFL players, 76 had tested
positive for CTE. As of January 2017, that number had grown to 90
out of 94. A study published in The Journal of the American
Medical Association in July 2017 showed that 110 of 111 former NFL
players whose brains were examined were found to have suffered from
In October 2009,
Roger Goodell and the NFL Concussion
Committee were called before Congress to defend their policies against
allegations of neglect. Goodell provided testimony, but was
unable to answer many questions, as none of the primary authors of the
league's research, Ira Casson, David Viano, or Elliot Pellman were
present. As a result of this incident and pressure from the
NFL Players Association, the NFL released a comprehensive overhaul of
the league concussion policy in November and December 2009. The
policy expanded the list of symptoms that would prevent a player from
returning to a game or practice on the same day their injury
With continued pressure to protect players, the NFL began preventing
players knocked unconscious by a concussion from returning to a game
or practice, a policy that applied to
Detroit Lions running back
Jahvid Best in 2009. Various players have filed lawsuits against
the league for the concussions, accusing the league of hiding
information that linked head trauma to permanent brain damage,
Alzheimer's disease, and dementia. Some teams chose not to
draft certain players in the
NFL Draft due to their past concussion
history. According to an Outside the Lines report, the head impact
telemetry system (HITS) was in question by the League, although Kevin
Guskiewicz, a professor at the University of North Carolina, said the
system is functional. The technology could detect and measure the
impact of blows to the head in real time during a game, but no such
measurement exists in the league at this time. Former Pittsburgh
Steelers receiver and current NBC Sports analyst
Hines Ward stated the
use of the system would be "opening a Pandora's Box," and that the
data recorded by the system could be used by team owners to give
players lower salaries.
In November 2011, the Cleveland Clinic Center for Spine Health created
an online study released by the
Journal of Neurosurgery in which
various football helmets were compared with each other via crash test
dummies. It was also found that leather helmets provided similar
results to modern helmets, and in some cases, the leather helmets
proved to have superior protection against concussive blows. However,
the leather helmets did not provide as much protection against skull
Concussion protocol process
When a football player sustains a concussion in the NFL, they are
required to go through the concussion protocol the league has in place
by the NFL Head, Neck and Spine Committee:
Before the NFL season starts, all players and coaching staff of an
organization are required to be educated on concussions and the
importance of promptly reporting any concussion symptoms. All players
in the league are also mandated to take a baseline neurological and
physical exam. The baseline neurological exam is either a computerized
or paper and pencil exam that will test different brain functions. The
exam tests attention span, memory, language, speech skills, reasoning,
planning, and organizational skills. The results of this test are used
as a baseline if a player suffers a head injury at any point
throughout the season. The preseason physical examination allows
the team physician and athletic trainer the opportunity to review and
answer any questions the player might have. This also gives the
physician and athletic trainer the time to go over any previous
concussions, discuss the importance of reporting any symptoms of a
concussion, and explain the concussion protocol that is in place for
the current season.
Current NFL concussion protocol creates positions in each
organization's medical staff who are specifically charged with
identifying and diagnosing concussions. One of these roles involves an
unaffiliated neurotrauma consultant who work with other team
physicians and athletic trainers to conduct evaluations. Another
position involves athletic trainers who are positioned in the booth at
every game to spot potential concussions in players from both teams.
These spotters review film throughout the game that could possibly
result in concussions and are capable to call "medical timeouts" to
relay that information to the medical personnel on the sidelines so
that further evaluation can be conducted. These spotters have been in
use since the 2011 season.
If a player shows to have a concussion or concussion symptoms, it is
mandatory that the individual be removed from the game. If the player
is diagnosed with a concussion, they are prohibited from re-entering
the game or practice that day. According to the league's protocol,
signs of a concussion include: loss of consciousness, lack of balance,
holding head after contact, absentmindedness, lethargy, confusion or a
visible facial injury in combination with any of the other factors. If
the medical staff rule the player clear from a concussion, then the
video of that hit must be reviewed before the player can re-enter the
game or practice.
After a concussion has occurred, the player must be monitored and
examined on a daily basis in a training room by the team medial staff
until fully cleared from concussion. Along with the continuous
examination prior to a concussion, the player must meet standards that
are in place by the league in order to return a game or contact
practice. The player may not return to football activities until he
has returned to his baseline cognitive function. Next, the player must
go through a graduated exercise challenge, followed by a gradual
return to practice and play. If player is feeling any setback or post-
concussion symptoms, evaluation then starts from the beginning.
Finally, the team doctor and an unaffiliated neurotrauma consultant
must both clear him for return to play.
A league of denial
The NFL spent years trying to deny and cover up any link that emerged
connecting head injuries sustained while playing football with
long-term brain disorders. The NFL Mild Traumatic Brain Committee,
first formed in 1994, reported in December 1999 that the number of
head injuries had remained "remarkably the same over the course of
four years." The committee went a step further in 2004 when it
suggested in an article published in Neurosurgery that "NFL players
have evolved to a state where their brains are less susceptible to
injury." Two months after that, MTBI publishes another article that
concludes "Players who are concussed and return to the same game have
fewer initial signs and symptoms than those removed from play. Return
to play does not involve a significant risk of a second injury either
in the same game or during the season." However, when Dr. Bennet
Omalu examined the brain of former Pittsburgh Steeler Mike Webster, he
discovered a new brain disease, which he called Chronic traumatic
encephalopathy, or CTE. He outlined his findings in a scientific paper
published in Neurosurgery in July 2005. The NFL's MTBI committee
wrote in May 2006 that the article be retracted. Dr. Omalu instead
wrote a second paper in the same magazine, this time about former
Pittsburgh Steeler Terry Long (American football). Dr. Ira Casson,
who was then co-chair of MTBI, denied in a televised interview that
there was any link between head injuries sustained playing in the NFL
and long-term brain damage. His repeated denials won him the nickname
"Dr. No." In September 2009,
The New York Times
The New York Times published an
article of an NFL-funded study stating that former players are 19
times more likely than the general population to have dementia,
Alzheimer's or other memory-related diseases. The NFL's spokesperson,
Greg Aiello, publicly said, "the study did not formally diagnose
dementia, that it was subject to shortcomings of telephone
surveys." Two months later, Aiello told
New York Times
New York Times reporter
Alan Schwarz that "it's quite obvious from the medical research that's
been done that concussions can lead to long-term problems." It was
the first time any League official had acknowledged a link between the
Things got worse for the NFL when investigative reporters Steve
Fainaru and his brother Mike Fainaru-Wada learned from an anonymous
source that the NFL Retirement Board had awarded "disability payments
to at least three former players after concluding that football caused
their crippling brain injuries - even as the league's top medical
experts for years consistently denied any link between the sport and
long-term brain damage." One of the cases was that of Mike
Webster, who filed a claim in 1999. In 2005, three years after his
death, his family received $1.8 million from the Retirement Board.
"That same year," write the Fainuru brothers, "the NFL published the
10th installment in its series on concussions research in the medical
journal Neurosurgery. The paper, whose authors included three members
of the League's [MTBI], asserted that chronic brain injury 'has never
been reported in
American football players.'"
Since Aiello's admittance, the link between head injuries in football
and long-term brain damage have become more accepted in the NFL In a
roundtable discussion with the
U.S. House of Representatives
U.S. House of Representatives Committee
on Energy and Commerce, Jeff Miller, the NFL's senior vice-president
for health and safety, admitted that "there is a link between
football-related head trauma and chronic traumatic
encephalopathy." However, public relations issues continue to
plague the League. A report from the Democratic members of the House
Committee on Energy and Commerce said that "the NFL rescinded a gift
National Institutes of Health
National Institutes of Health (NIH) for concussion research
when it learned the study's findings would be detrimental to the
league's image." The N.F.L had tried to funnel the funds it gave
to the NIH towards its own studies. The League rejected the
To mitigate the public relations (PR) nightmare, the NFL has taken
several steps to better assure player safety and bring awareness to
head injuries in football players of all ages. Several rule changes
took place between 2007 and 2014. NFL commissioner Roger Goodell
issued a memo in December 2009 to all 32 teams stating that a player
who sustains a concussion cannot return to play if he shows signs or
symptoms, such as inability to remember assignments or plays, a gap in
memory and persistent dizziness. This move changed the 2007 rule
saying a player cannot return only if he has lost consciousness.
Additionally, new rules regarding "crown of the helmet" tackles have
been installed where a runner or a tackler cannot initiate forcible
contact with the crown of the helmet outside the tackle box so as to
protect players' heads. Lastly, the NFL and
USA Football launched
the Heads Up Football initiative, which "emphasizes a smarter and
safer way to play and teach youth football, including proper tackling
and taking the head out of the game." A mobile application was
also launched with help from the CDC where information about
concussion protocols and player health and safety can be easily
reached by parents and coaches.
The PR issues surrounding the NFL's cover-up of concussions are far
from over, and it is too early to tell how and to what extent these
events will impact the NFL or football playing. Robert Boland,
professor of sports management at
New York University
New York University and former
college football player says, "In the short-run, [the NFL] is still
thriving," but downward trends in youth football players shows that
future generations "might have less of an intimate attachment to the
sport." Boland says this in light of
Pop Warner football
enrollment dropping by 9.5 percent between 2010 and 2012, likely
linked to the high-profile concussion problem.
Federal NFL concussion litigation
In April 2011, attorneys Sol H. Weiss and Larry E. Coben from the
Philadelphia law firm of Anapol Weiss filed a federal lawsuit on
behalf of Ray Easterling,
Jim McMahon and five other players.
Thousands of former NFL players have since filed lawsuits against the
League after suffering repeated concussions throughout their careers.
The multidistrict litigation (MDL) titled In re: National Football
Concussion Injury Litigation (MDL 2323) was filed on
January 31, 2012 in the United States District Court for the Eastern
District of Pennsylvania. Judge
Anita B. Brody presides over the
matter. The master administrative long-form complaint, filed by
Plaintiff's Co-Lead Counsel Sol Weiss and Christopher Seeger on June
7, 2012, alleges the League "... was aware of the evidence and the
risks associated with repetitive traumatic brain injuries virtually at
the inception, but deliberately ignored and actively concealed the
information from the Plaintiffs and all others who participated in
organized football at all levels." The master complaint argues the NFL
knew or should have known players who sustain repetitive head injuries
are at risk of suffering "... early-onset of
dementia, depression, deficits in cognitive functioning, reduced
processing speed, attention, and reasoning, loss of memory,
sleeplessness, moods swings, personality changes, and the debilitating
and latent disease known as
Chronic traumatic encephalopathy
Chronic traumatic encephalopathy ('CTE')."
In April 2012, Easterling was found dead from a self-inflicted gunshot
wound in his home. An autopsy report concluded Easterling's brain
had evidence of CTE, a degenerative brain disease associated with
frequent blows to the head.
One month later, former
San Diego Chargers
San Diego Chargers player
Junior Seau also
died of a self-inflicted gunshot wound, and a brain autopsy showed he
suffered from CTE.
Like Easterling and Seau, an autopsy of Bears safety Dave Duerson's
brain after he committed suicide earlier that year revealed he also
suffered from the same degenerative brain disease.
The autopsy results following these players' suicides heightened
existing concerns regarding the connection between player deaths and
Bennet Omalu has identified CTE in the
autopsies of former players Mike Webster, Terry Long, Justin
Strzelczyk, Andre Waters, and Chris Henry. One of the
difficult issues facing doctors is attempting to identify mental
health effects from concussions during the lives of former players
rather than after their deaths. In April 2012, a group of former
Pro Football Hall of Fame
Pro Football Hall of Fame inductees Randy
White, Bob Lilly, and
Rayfield Wright (among other retired players
from around the league)—filed a lawsuit against the NFL, again
accusing it of ignoring a link between concussions and brain
In August 2012, the number of players involved in suits against the
NFL increased to 3,402, and the League sued three dozen insurance
companies in an attempt to force them to cover the costs of defending
claims of not protecting players. However, Travelers ultimately sued
the League on August 21 in a lawsuit called Discover Property &
Casualty Co. et al. vs.
National Football League
National Football League et al., New York
State Supreme Court, New York County, No. 652933/2012. The company
provided liability coverage for the League's merchandising arm (NFL
Properties), and the insurer also pointed out that the above-mentioned
lawsuit has allegedly 14 counts against the League, while only two
against NFL Properties.
After quarterbacks Jay Cutler,
Michael Vick and
Alex Smith sustained
concussions in Week 10 of the 2012 season, the National Football
League Players Association (NFLPA) reiterated their plans to have
independent neurologists on the sidelines at every game. The
2013-14 NFL season involved an independent neurological consultant per
team on the sideline of every game.
Concussion guidelines released
by the NFL in 2013, mandated a four-stage protocol for concussions,
including examinations, treatment and monitoring prior to a return to
play. In March 2013, the League proposed a rule to reduce
concussions by making it illegal for a ball carrier or tackler to
"initiate forcible contact by delivering a blow with the top crown of
his helmet against an opponent when both players are clearly outside
of the tackle box." However, the proposal was met with criticism from
players like running backs Matt Forte,
Emmitt Smith and Marshall
A federal hearing was held on April 9, 2013 in Philadelphia to discuss
the League's motion to dismiss the lawsuits brought on behalf of more
than 4,500 former players On July 8, 2013, Judge Brody ordered
representatives of both sides of the litigation to explore a possible
settlement in the litigation. Judge Brody ordered a report on or
before September 3, 2013 regarding the results of the mediation.
A proposed settlement was reached in the litigation on August 29,
2013. Under the agreement, the NFL will contribute $765 million to
provide medical help to more than 18,000 former players. Retired
players who suffer severe neurological conditions such as Alzheimer's
and amyotrophic lateral sclerosis (ALS) diseases in the future will
also be eligible to apply for medical help. In addition, $10 million
will fund brain injury research as well as safety and education
The settlement says it should not be interpreted as a statement of
legal liability on the part of the NFL.
The settlement, which is projected to protect retired players for
nearly 65 years, will compensate injured former players who need
immediate help and will provide baseline assessments and medical
benefits to those who are symptom-free or beginning to show signs of
"I think it's more important that the players have finality, that
they're vindicated, and that as soon as the court approves the
settlement they can begin to get screening, and those that are injured
can get their compensation. I think that's more important than looking
at some documents," attorney Weiss said.
The settlement also allows a player diagnosed with CTE the eligibility
to up to 4 million dollars in compensation. This has been met with
criticism of the settlement's structure as it only applies to players
diagnosed before the settlements preliminary agreement and disallows
those diagnosed after the approval of the deal in July.
Kansas City Chiefs
Kansas City Chiefs concussion lawsuit
On December 3, 2013, five former NFL players filed a lawsuit against
Kansas City Chiefs
Kansas City Chiefs organization: former Chiefs players Alexander
Cooper, Leonard Griffin, Christopher Martin, Joe Phillips, and Kevin
Porter. They wish to know what the Chiefs knew about concussions and
when they knew it.
This lawsuit is unique and different from the thousands of lawsuits
previously filed against the NFL. These players are not suing the NFL,
and are instead suing the Chiefs.
From 1987 to 1993 there was no Collective Bargaining Agreement
established in the NFL. With no existence of a CBA in these years,
players who played during this time for the Chiefs can sue the team
for many of the same reasons the NFL has been sued. The $765 million
settlement in August 2013 between the NFL and former players only
protected the NFL. "I think all of our clients were disappointed,"
McClain said of his clients reaction to the settlement with the
NFL. The players currently suing the Chiefs have all opted-out of
the settlement from the previous mediation with the NFL.
A law unique to Missouri allows certain former NFL players to sue the
individual team. The current Missouri law states that employees can
sue employers in civil court if the employees declined worker's
compensation. The Independence attorney for the five ex-Chiefs, Ken
McClain said, "The lawsuit is allowed in Missouri after a state
workers' compensation statute was amended in 2005 to exclude cases of
occupational injury that occur over an extended time."
The amendment of the 2005 law is set to be changed at the end of
December 2013. Martin and McClain have both encouraged former players
who are eligible to join the lawsuit before their window of
On December 1, 2012, Jovan Belcher, current member of the Kansas City
Chiefs, shot and killed his fiancée, Kassandra Perkins, before
committing suicide in the Arrowhead practice facility parking lot. On
behalf of Belcher’s and Perkin’s daughter, lawyers have filed a
wrongful death lawsuit against the Chiefs. Belcher’s mother has
filed a similar suit accusing the Chiefs of ignoring Belcher’s cries
for help as he complained of concussion like symptoms. The first
occurrence came against Jacksonville in 2009 where Belcher was knocked
unconscious and failed to receive adequate treatment. The second
occurrence was against the Bengals in November 2012. The lawsuits
allege, Belcher "suffered what should have been recognized as an acute
concussion." However, one lawsuit continues, "despite exhibiting
obvious symptoms, Decedent was never removed from play for evaluation
and recovery." The lawsuits also claims Belcher exhibited signs of
CTE, including changes in his mood and behavior.
On September 30, 2014, it was announced that the brain of former
Kansas City Chiefs
Kansas City Chiefs player, Jovan Belcher, contained neurofibrillary
tangles of tau protein; which is associated with Chronic Traumatic
Encephalopathy. The tangles were distributed throughout Belcher's
hippocampus, an area of the brain involved with memory, learning and
emotion. If the findings of CTE come to be true, Belcher’s daughter
and mother are eligible for up to $4 million under the National
Football League’s current Collective Bargaining Agreement.
Cook County, Illinois Riddell concussion litigation
On March 11, 2016, the family of deceased San Diego Charger defensive
Paul Oliver (American Football) sued helmet-maker Riddell along
with its related corporate entities, in the Circuit Court of Cook
County, Chicago, Illinois. Shortly thereafter, NFL hall of fame
running back and Super Bowl champion Paul Hornung, represented by The
Brad Sohn Law Firm and Corboy & Demetrio, filed a related case
against these defendants. Now, some 100 former professional players
have sued Riddell in the consolidated litigation in Cook County, which
alleges Riddell to have conspired with the NFL in creating false
science. Riddell's attempt at the same federal labor preemption
defense attempted by the NFL failed. The NFL remains subject to
discovery in this case, even though it is a non-party.
Concussions in college football
Self-reported concussions among NCAA student athletes
Women's Ice Hockey
Men's Ice Hockey
The NCAA, like the NFL, has been criticized for its handling of
concussions, with numerous players having retired from football due to
concussions, or have filed lawsuits against the association for
failing to protect student-athletes from concussions. In 2011,
former players Derek Owens and Alex Rucks filed lawsuits against the
association for failing to cover the players' safety. Both Owens and
Rucks claimed that they had suffered brain trauma which could have
been prevented. In 2012, the
Southeastern Conference and Big Ten
Conference began work on preventing concussions, and appointed
University of Mississippi
University of Mississippi Chancellor Dan Jones to evaluate and review
existing research and various diagnoses from past analyses. In
2009, an NCAA panel created and recommended a rule that prevents an
athlete from returning to a game after he/she has sustained a
concussion. The panel also had recommended for an athlete to be
sidelined after any concussion-related injury until he/she has been
cleared by a doctor. Under the new plan, all student-athletes must
sign statements saying that they will report all signs and symptoms of
concussions to their coaches. In addition, all athletes must have
baseline cognitive testing while the post-injury cognitive testing is
strongly recommended. The athletes diagnosed with concussions must be
removed from sports for a minimum of one day and can only return when
decided by a team physician.
There's been less focus on college players who don't go on to play
professional sports, but I think you'll see that getting more
attention and go down to people who play it at every level. From time
to time we have all had concerns of what we ask student-athletes to do
and what the long-term health may be.
University of Mississippi
University of Mississippi Chancellor Dan Jones
Concussions in other leagues
Canadian Football League
In the 2010 season for the Canadian Football League, there have been
50 reported concussions; 44.8 percent of players reported having a
concussion or concussion-like symptoms, 16.9 percent had confirmed
that they had a concussion, and 69.6 percent of all players who
suffered from concussions that year suffered from more than one.
However, the average of 0.59 concussions per game is lower than the
0.67 recorded by the NFL in 2010. The league eventually started a
concussion-awareness program with the help of Football Canada,
Canadian Interuniversity Sport
Canadian Interuniversity Sport (CIS), the Canadian School Sport
Canadian Football League
Canadian Football League Players Association (CFLPA),
Canadian Football League
Canadian Football League Alumni Association (CFLAA), and the
ThinkFirst program. The league eventually pointed out eight
Team physicians and therapists are to use a SCAT2 (a medical
protocol), to diagnose concussions and preventing athletes from
playing until they have been cleared to play.
All players are to be submitted to IMPACT, which is a form of
cognitive testing, during training camp.
All player concussion assessments in the CFL are to only be used by
team physicians and therapists.
All coaches and players will receive educational items to aid in
recognizing signs of a concussion.
Administrators are to report a change from the expectation that a
player returns to the game to one that encourages players to be honest
The formation of certification programs that teach coaches how to
recognize the symptoms of concussions.
The formation of training programs for coaches that emphasize that
players should never use their helmets to tackle.
A new rule in the amateur football rulebook was implemented that
requires officials to report suspected concussed players to the
coaching or medical staff during games.
In 2012, ThinkFirst founder and
Toronto Western Hospital
Toronto Western Hospital neurosurgeon
Charles Tator led a study that was conducted by the University of
Toronto, which examined the brains of 20 former players with a history
of concussions, and compared them to 20 other players without a
history of head injury. A separate group of 20 without football
experience served as a control group. Also in 2012, the league and
Tator announced a partnership to work in a study that would perform
postmortem tests on former CFL players to look for signs of CTE.
Arena Football League
In the Arena Football League, despite the league's intense play, very
few lawsuits have been filed for concussions. The most notable lawsuit
against the league was a lawsuit filed by former
Colorado Crush kicker
Clay Rush in 2010, who claimed that he suffered from permanent brain
damage due to repeated blows to the head during games. Like the
NFL, the AFL prohibits players who suffered from concussions from
practicing. In 2008, during the original league's final season,
the "Shockometer" made its debut at two season-opening games (Dallas
Desperados vs. Georgia Force/
San Jose SaberCats
San Jose SaberCats vs. Chicago Rush) on
40 player helmets. The device is projected to sell for $30 if it is to
become available on the market. The players that were given the
device play positions that are suspectible to hard hits, such as wide
receivers, defensive backs, running backs, and linebackers. AFL
Players Association regional director James Guidry stated that the red
light doesn't mean that the player has a concussion, but as a warning
for team examiners to inspect the player. Guidry also said that the
device could be used to prevent players who do not want to show any
signs of weakness after sustaining any concussion-like symptoms from
continuing to play.
What happens in a game is much different than what happens in lab
situations. To be able to have a partner like the AFL that values this
project as much as we do is fantastic. We can learn an awful lot and
make this product as good as it can be before it's winding up on the
field in widespread use.
— Dave Rossi of
Schutt Sports on the Shockometer
Youth athletes make up 70% of football players in the United States.
Every year there are 23,000 nonfatal traumatic brain injuries stemming
from playing football that required an emergency visit to the
hospital. Of those visits, 90% of them are children between the ages
of 5–18 years old.
One of the first studies of its kind was performed during the Fall
2011 football season when researchers from Virginia Tech, receiving
permission from parents, placed accelerometers (which measure g
forces) inside the helmets of seven youth players. These seven players
were 7- and 8-year-old boys participating in a community youth league
who were chosen because they were expected to have high participation
and also because they wore at least a youth medium Riddell Revolution
helmet (enabling the accelerometers, battery, and wireless transmitter
to fit inside the helmet within the padding). That is, these seven
were not a random selecting of players. Rather, the purpose of this
study was to establish a baseline of what range of hits are generally
As way of comparison, a collision of 80g is a big hit in a college
football game of which there might be only six per game. And the range
of 80, 90, or 100g is generally where risk of acute injury and
concussion begins to occur (concussion being symptoms such as feeling
foggy or woozy and not necessarily loss of consciousness). An example
of a lesser force of 40g is heading a soccer ball, and even with blows
in this 30 to 40g range, it is not known whether these pose a
cumulative risk of injury.
This 2011 study measured a total 753 impacts among these seven players
with a median impact of 15g. It did, however, observe 38 impacts of
40g or greater, and six impacts of greater than 80g. Fortunately, none
of these youth players experienced a concussion. There is also a
concern that since many young players have less developed chest and
neck muscles than older players, almost every impact potentially acts
likes a surprise hit.
Virginia Tech doctor stated that reducing the number of higher hits
during practice sessions constitutes a real opportunity. Of the 38
impacts of 40g or greater, 29 took place during practice. And of the
six impacts greater than 80g, all took place during practice.
Concussions in high school football
Concussions are frequent in high school football. Football has the
highest rate of concussion among high school sports, with about 11
concussions occurring per 10,000 athletic exposures. About 50 high
school or younger football players across the country were killed or
sustained serious head injuries on the field since 1997.
Many concussions that occur during high school football often go
untreated and are not monitored. This is a big concern because
repeated trauma to the head, especially injuries with concussion like
symptoms, puts a young athlete health at serious risk. A 2013
study by Cincinnati Children's Hospital Medical Center found that,
despite knowing the risk of serious injury from continuing to play
with a concussion, half of high school football players would still
play if they had a headache from an injury sustained on the field.
Researchers surveyed 120 high school football players. Of those
students, 30 reported having suffered a concussion. More than 90
percent recognized the risk of serious injury if they returned to play
too quickly, but more than half of those aware of the risks responded
they would "always or sometimes continue to play with a headache
sustained from an injury," and only 54 percent indicated they would
"always or sometimes report symptoms of a concussion to their
coach." Another study found that 15.8% of football players who
sustain a concussion severe enough to cause loss of consciousness
return to play the same day. Due to the fact that only 42% of high
schools have access to athletic training services, there has been a
large debate regarding the risks that high school football players
Numerous efforts have attempted to identify potential concussions
quickly. Helmet shock data loggers and impact sensors help monitor
impacts a player receives. One example is a device created by Schutt
Sports during the Arena Football League's 2008 season known as the
"Shockometer"—a triangle-shaped object with adhesive on its side
that sticks to players' helmets. When a player gets hit by a g-force
which exceeds 98, a capsule with a green light in it will change to a
red light. Doctors have determined that a g-force of approximately 100
will increase the risk of a concussion, even though a quarterback that
gets sacked would normally register a g-force of 150 g. A possible
flaw to the Shockometer is that fan activity could accidentally
trigger the device. Riddell created the Head Impact Telemetry
System (HITS) and Sideline Response System (SRS) to help record the
frequency and severity of player impacts during practices and games.
Every HITS helmet features MX Encoders, which would automatically
record every hit. Eight NFL teams had planned to use the system in
the 2010 season, but it was ultimately not used. In 2013, Reebok
developed the Head Impact Indicator, which is a quarter-sized device
placed on a player's skull, which activates a red/yellow light if the
player is hit too hard. Similarly to Reebok's Impact Indicator,
Battle Sport Science has released the Impact Indicator 2.0. The Impact
Indicator 2.0 looks to increase long-term brain safety for all those
who play football. On February 3, 2013, the NFL and General
Electric partnered on a five-year, $50 million project to develop
technology to predict brain injuries, show injury severity and the
rate of recovery, and to create more protective material. There is
now another company that has taken on the responsibility of attempting
to limit the number of concussions in the game of football. Vicis, a
Seattle-based firm, has created a new unique type of helmet that is
very flexible due to the many layers that make up this new intricate
helmet. This helmet consists of four layers, beginning with the Lode
Shell. This layer absorbs the shock from the hit, which then leads to
the Core Layer contorting and bending in all directions. This
technology alleviates stress from the impact, which consists of all
the linear and rotational forces involved in the hit. The Arch Shell
exists directly under the Core Layer and is precisely designed to fit
a player's head shape. The last layer, the Form Liner, works with the
Arch Shell to apportion pressure evenly around the perimeter of the
head. Instead of measuring a player's head the conventional way by
taking the circumference, Vicis measures the length and width of the
head to get more accurate data. A better fit of the helmet allows for
the technology to work more advantageously.  Several NFL players
have tried this new helmet and have provided great feedback. Cliff
Avril from the Seattle Seahawks said, "You don't feel the thuds as
hard as they normally are." In the NFL's 2017 Helmet Laboratory
Testing Performance Results, the Vicis helmet finished first out of
the 33 helmets that could have been worn in 2017 NFL season.
Concussion-preventing technology continues to improve the safety in
the game of football. 
National Football League
National Football League has made numerous rule changes to reduce
the number of concussions suffered by players while making the game
In 2010, the NFL reworded the League's rules to prohibit a player from
"launching himself off the ground and using his helmet to strike a
player in a defenseless posture in the head or neck." Violations of
this rule only result in the imposition of a 15-yard unnecessary
roughness penalty. In the same season, the NFL mandated that once a
player loses his helmet on the playing field, the current play must
immediately be whistled dead.
Also in 2010, the NFL mandated that during field goals or extra point
attempts, defenders must line up with their entire bodies on the
outside of the snapper's body to protect the snapper while he is in a
position of vulnerability. Violations of this rule, however, result in
only a five-yard penalty for illegal formation.
The Competition Committee reviews all competitive aspects of the game,
including playing rules, roster regulations, technology, game-day
operations and player protection. The process for modifying or
adopting rules and regulations is systematic and
To reinforce the seriousness of the rule changes, in the middle of the
2010 season, Commissioner Goodell issued a memo to all NFL teams
stating that "more significant discipline, including suspensions, will
be imposed on players that strike an opponent in the head or neck area
in violation of the rules."
The most drastic step the NFL has taken to reduce head injuries was
the 2010 change to the NFL kickoff rules. To reduce what has been
referred to as one of the most violent plays in the game, the kickoff
was moved up from the 30-yard line to the 35-yard line. The NFL also
outlawed the use of the three-man wedge on kickoffs, while allowing
the two-man wedge to remain a legal play. Consequently, players on the
kicking team must now line up closer to midfield, reducing the amount
of space the players have in which to get a running start.
In 2011, the NFL also mandated that certified athletic trainers be
available in press boxes during all NFL games. These athletic trainers
assist medical personnel located on the sidelines in identifying
potential concussions because the symptoms are often difficult to spot
and assess from the field level.
On March 20, 2013, the NFL voted to introduce yet another new rule
aimed at player safety. Starting in the 2013-2014 season, if a running
back lowers the crown of his helmet while he is inside the tackle box
or while he is less than three yards downfield and makes contact with
a defender, the team will be given a 15-yard penalty.
After three years of declines in reported cases, the 2015 regular
season contained a spike in concussions even after making several
improvements the previous year. The total cases reported for the
practices, pre-season, and regular season was 271, a 31.6 percent
spike. The 2015 cases reported for regular season games was 182, a
58.3 percent spike.
In the 2016 offseason, the NFL implemented a new policy to their
concussion protocol. The NFL can now punish teams that do not follow
their concussion protocol by imposing a monetary fine or taking away
their draft picks. The first violation can be a fine up to $150,000
and the second violation can be a fine no less than $100,000 and a
possible removal of draft picks. In 2017, the Seattle Seahawks
were under much scrutiny for violating the NFL's concussion protocol
by allowing Russell Wilson to return to the game against the Arizona
Cardinals without the proper treatment. The Seattle Seahawks failed to
have Wilson cleared by a team doctor and an independent physician
before allowing him to return to the game. The NFL investigated
the incident, but has yet to officially address the issue or impose a
penalty on the Seahawks.
The Women's Football Alliance has come a long way when it comes to the
guidelines on making the game safer for its players.
from 2012 to 2017 they have since made it illegal to send a player
back into the game with suspicions of a concussion unless cleared by a
certified health official.
Return to play guidelines (RTPs), such as Washington State’s Lystedt
Law, have been legally mandated since 2009. All 50 states, including
Washington D.C, have now passed legislation to help reduce the number
of traumatic brain injuries in youth football.
Senator Dick Durbin, from Illinois, introduced the Protecting Student
Athletes from Concussions Act on September 25, 2013 to the U.S.
Senate. This act would require athletes, parents, coaches and school
officials to be informed of the risks of mild traumatic brain injury
(mTBI) and it would also require the "when in doubt, sit it out"
policy to be used with athletes that have been suspected of having a
concussion and be removed from the field of play. A press release from
Senator Durbin stated that many major U.S. sports organizations,
including the NFL and NHL, endorsed the bill.
Coaches, youth and high school, now must be certified in the Heads-Up
Football program. If they aren’t certified in this program; they
won’t be able to coach. This a program that will try to top the
head-related injuries. As of 2016, most of the coaches in the United
States are certified.
Although the concussion crisis is major concern for families, recent
changes implemented to fight the concussion issue such as the Heads-Up
Football program and the growing efforts to educate coaches and
trainers about the severity of concussions have led towards a slight
increase in player participation at the youth level. In 2015, player
participation from the ages of 6-12 totaled at 1.23 million, compared
to the reported 1.216 million the year before according to the Sports
& Fitness Industry Association. It remains to be seen how
football's popularity will be effected in the coming years, but
increased concussion prevention at every level of the game should be
encouraging to families.
[dubious – discuss]
In September 2015, researchers with the Department of Veterans Affairs
Boston University announced that they had identified CTE in 96
percent of NFL players that they had examined and in 79 percent of all
As of February 2015, Gary Small and colleagues have been called into
question by the
FDA for their overzealous commercialization and
promotion of clinically unproven screening that fellow peer
researchers deem fit only for research and they have responded by
withdrawing related materials from their website.
To date, all screening procedures that examine football players for
brain damage have been post mortem. In 2013, Gary Small and colleagues
developed an in vivo chemical tracer that can detect tau protein build
up in living players. Small and his team invented this new chemical
tracer, 2-(1- 6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl
ethylidene)malononitrile, or FDDNP, that could be used in Positron
Emission Tomography (PET) scans. This new tracer measures for tau
protein and amyloid plaque accumulation in human brains; symptoms of
repetitive brain trauma among other things. Although tracers have been
developed to screen for the build-up of tau proteins in the human
brain, FDDNP is the first PET tracer that can be used in vivo in human
trials. FDDNP was originally developed in an effort to detect
Alzheimer’s in elderly individuals, thus the article was published
in the journal of the American Association for Geriatric Psychiatry.
However, because there are similarities between Alzheimer’s and the
effects of Chronic Traumatic Encephelopathy (CTE), FDDNP was used to
study the extent of brain trauma in consenting, retired NFL players.
Small and colleagues performed a controlled experiment on retired NFL
players and an equal number of control participants. Unfortunately the
sample size was very small as only 5 players of the 19 contacted were
eligible for the study. Though the sample size was small, a good range
of positions were represented (linebacker, quarterback, offensive
lineman, defensive lineman, and a center) and all players had played
in the league at least 10 years. The players had to be at least 45
years of age and currently exhibit symptoms of cognitive and mood
disruption. Control participants had to meet certain criteria as well
to ensure that they were as similar as possible to the NFL players in
order to eliminate any biases or confounding variables. Age, Body Mass
Index (BMI), years of education, and family history of dementia were
all selected as the selection criteria for control participants. All
participants received intravenous injections of the FDDNP tracer and
were tested over 4 weeks using PET imaging technology.
The injection of the FDDNP tracer was successful, and the results of
the study showed significant differences between the NFL players and
control participants. The NFL players had significantly higher FDDNP
signals than control participants, indicating a greater amount of tau
protein accumulation. The cortical regions of all the participants
studied showed no significant difference, but the NFL players had
FDDNP levels that were significantly higher in the caudate, putamen,
thalamus, sub thalamus, midbrain, and cerebellar white matter regions
of the brain as compared to the control participants. In
addition, a positive correlation was found between the number of head
injuries the players sustained and the levels of FDDNP binding. This
suggests that players with a more severe history of head trauma will
likely have significantly more accumulation of tau protein. This, in
turn, gives rise to the suggestion that a more severe history of head
trauma will result in greater deterioration of the brain, cognitive
functioning, and mood regulation.
The findings of the study were consistent with previous autopsy
studies of individuals with CTE. The important distinction to make,
however, is that the patients in Small’s study were not on the slab
and walked out after testing was completed. This is monumental in the
field of brain trauma and concussion research.
Concussions are proven to cause loss of brain function. This can lead
to physical and emotional symptoms such as attention disorders,
depression, headaches, nausea, and amnesia. These symptoms can last
for days or week and even after the symptoms have gone, the brain
still won't be completely normal. Players with multiple concussions
can have drastically worsened symptoms and exponentially increased
Researchers at UCLA have, for the first time, used a brain-imaging
tool to identify a certain protein found in five retired NFL players.
The presence and accumulation of tau proteins found in the five living
players, are associated with
Alzheimer's disease. Previously, this
type of exam could only be performed with an autopsy. Scientists at
UCLA created a chemical marker that binds to the abnormal proteins and
they are able to view this with
Positron Emission Tomography
Positron Emission Tomography (PET)
scan. Researcher at UCLA, Gary Small explains, "Providing a
non-invasive method for early detection is a critical first step in
developing interventions to prevent symptom onset and progression in
National Football League
National Football League controversies
Steroid use in American football
Health issues in American football
Concussions in sport
Concussions in high school sports
New Orleans Saints bounty scandal
League of Denial
List of NFL players with chronic traumatic encephalopathy
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