Elizabeth Nabel and the NFL

First and foremost, I just want to state that I am continually adding more and more information to my Google Doc as it is the basis from where I will build my final presentation from.

http://www.si.com/nfl/2015/02/09/elizabeth-nabel-chief-medical-advisor

On to the main topic I would like to discuss today: Elizabeth Nabel and the NFL's new position of "Chief Medical Advisor"


The NFL is finally responding to the consistent beating it gets every year on its dealing with concussions. The chief medical advisor is stated to be "a new position created by the NFL to assist efforts to make football safer"


So what does the NFL do? They hire someone who just last week said she had "no intention of leaving our beloved Bringham"


Here is her responsibilities:

"to participate in the league’s medical advisory committees, identify areas for the NFL to enhance player safety, care and treatment, oversee the league’s medical policies and work “with players, medical personnel and others to continually update the league's healthy and safety guidelines."

For the first time in NFL history, there was an inductee to the Hall of Fame that was not able to receive his award. Instead, his (Junior Seau's) two sons accepted the award on his behalf. I found the NFL's tribute to him both heartfelt and disturbing. The NFL has every right to ignore the tragic event that occurred on May 2, 2012. Being inducted into the Hall of Fame shouldn't be marred with such a tragic event.

But when you think about it, maybe that is exactly what the NFL needs in regards to player's safety. The commercials that aired in this year's Super Bowl were much more morose and macabre than usual. That grabbed everyone's attention. Of course this may have been a result of all the domestic violence awareness the NFL is trying to promote. But than again, commercials like the "throw like a girl" one promoted social awareness to such social norms. However, there was not a single commercial about keeping the head out of the game of football. And in regards to Seau's tribute, there wasn't a single thing said about the events that lead up to his death. The NFL could have mentioned what happened and turned it around in a positive light to show all the work that they have done from then on to promote player safety to make sure a tragedy of this magnitude would never occur again. If there was anytime to really hit their viewers emotionally, it would have been now.

I make a big deal about Junior Seau because his case is probably the most important in regards to what can be done to help solve this crisis. Seau was a first ballot Hall of Famer. His death isn't like the one of Tupac or Biggie, in which their deaths may have played a role in bringing their music to godly levels in which nowadays the two are seen to be some of the best rappers alive. Seau was a plain beast on and off the field. He already made his name in the game of football as one of the greatest to ever lace up his cleats and play the game. You can't help but think about all the kids that grew up looking up to him. The same goes to players like Tony Dorsett. As much as some people hate on sports, the impact it has on our youth and to the American culture is undeniable. We look up to athletes because they represent our city, our state, our nation. And to see the same athletes that we once admired commit such tragic acts in which they themselves cannot even control can be detrimental to the surrounding people involved. Football is a "man's sport". You put everything you got on the field and you leave it there. But I can guarantee you one thing; nobody would ever set foot on a football field if it meant costing their entire life. Seau's kids may be too young to realize just how crazy their dad's death was in regards to everything football related. And most Americans see Seau as one of the greatest linebackers to ever play the game. This is a correct statement. At the same time, he was something more than that. He was a father. A husband. Football aside for a moment, there is now one more family that does not have a father.

http://webcache.googleusercontent.com/search?q=cache:iXmOyfW0rGoJ:www.researchgate.net/profile/Paul_McCrory/publication/5467854_Head_face_and_neck_injury_in_youth_rugby_incidence_and_risk_factors/links/0a85e535cf8792294c000000.pdf+RATE+OF+neck+injuries+rugby&cd=2&hl=en&ct=clnk&gl=us

^for next class

Tony Dorsett

http://profootballtalk.nbcsports.com/2015/02/10/tony-dorsett-on-living-with-cte-i-didnt-know-end-would-be-like-this-but-im-battling/

http://deadspin.com/tony-dorsett-on-cte-i-didnt-know-the-end-was-going-to-1684734846

http://espn.go.com/dallas/nfl/story/_/id/12300070/tony-dorsett-battling-cte-had-no-idea-end-was-going-this

A 3 time First-Team All American. Winner of the 1976 Heisman Trophy. The second overall pick in the 1977 NFL draft. A Super Bowl champion. One of the greatest running backs not only in Cowboy's history but in NFL history. A hall of famer.

Tony Dorsett.

CTE.

Need I say anymore?

One of the greatest players to ever grace the football field has been diagnosed with CTE, a disease that tortures a man's mind.

Here's a snippet about what Dorsett had to say to 1310 The Ticket in Dallas:

"I signed up for this when, I guess, I started playing football so many years ago," Dorsett told 1310 The Ticket in Dallas. "But, obviously, not knowing that the end was going to be like this. But I love the game. The game was good to me. It's just unfortunate that I'm going through what I'm going through.

This quote really hit me hard:

"I understand that I'm combating it, trying to get better. But, you know, some days are good. Some days are bad."

The same man that would make defenders miss left and right is now in this constant battle with himself. The only difference is that you can't juke your brain.

He never knew "that the end was going to be like this." The vast majority of current football players, at levels ranging from Pee Wee to NFL, don't know how "the end" will be for them as well. Probably the worst thing about my entire thesis presentation has been stories like this. Ever since I've started becoming aware of the situation, I've realized that this isn't a little problem. This is a huge matter to deal with. Bellini, Kosta Karageorge, and now Tony Dorsett. When I first learned about CTE I thought it occurred rarely even in football players. Now, I start seeing a more and more former athletes popping up with the disease. Concussions and Football: A Hidden Epidemic. The title of my thesis project makes more sense now than it ever has before.

Dorsett has describe the fact that his daughters are scared of him as "painful."

Dorsett made some very level headed remarks about the direction of the game of football:

"Dorsett said he doesn’t like all of the changes to the game that have been made in the name of player safety because they’ve changed the game from the one he played, but adds there’s “no question about” making those changes if they make life better for players. He also said that he’d still let his son (Anthony Dorsett played eight NFL seasons) play football knowing the potential downside, although he’d pay more attention to the physical toll that the game can take on those who play it."

I found this response to this comment about the whole situation regarding Dorsett to be extremely informative:

The comment:

These men are gladiators. They pay the physical price for the fortune and fame, and perhaps that's why we love them as heroes. It's important to keep in mind that their choices to sacrifice their bodies for this glory is indeed a choice; I have no sympathy for those living a life of privilege and excess that ultimately succumb to the consequences.

The response:

I gotta agree with these guys. Dorsett knew that there was a good chance of knee and other joint problems later in life due to playing football in the 70s and 80s. He knew that there was a chance he would suffer a spinal injury. If he was complaining about those issues you would have a case. 

CTE, or the liver issues suffered from guys who were pumped full of Toradol are completely separate issues. Not only were they not aware of these risks, the NFL in later years did everything possible to keep the players and the public from being aware of these risks.

February 6, 2015

I watched Kim Gorgens Ted Talk on protecting the brain from concussions, especially the youth brain.


Thinks to take note from the video:

A car accident at 40 miles per hour produces 35 G's of  force

A heavyweight boxer punching you in the head produces 58 G's of force

A tackle at the high school football level can produce over 100 G's of force, enough to cause a concussive force

High school athletes are 3 times more likely to sustain a concussion than their college aged peers and it takes high school athlete longer to recover from concussions

The more concussions that one has, the higher chance for a repeat concussion to occur.

3 step play that she proposes:

Study Up - learn about concussions
Speak Out - let legislators know what us, the constituents, want
Suit Up - wear a helmet


I listened to a short segment about football and ethics that was discussed last Tuesday at the Perot museum here in Dallas. Melani Ismail, wife of former Cowboys running back Raghib Ismail. spoke candidly about the emotional ride her life has been due to her husband's injuries. She talked about how she always steered her son towards playing basketball instead of football, but this year changed as her son took an interest in playing the sport his dad mastered. Former Denver Broncos receiver Nate Jackson was present, alongside Nahshon Ellerbe, a TCU senior and running back who will be playing football and studying at Rice next year.

Jackson had this to say about what he dislikes about the way football is played in the NFL:

“I think one of the biggest problems right now is that the players never have a say, whether it’s their own bodies, the medical health care stuff or the media stuff,” Jackson said. “So not only are their bodies controlled, but their minds are controlled.”

We see how the media controls players, dictating what they can and cannot do. This was made especially evident with all the Marshawn Lynch 'interviews" that occurred throughout this year. If you are not doing what the NFL wants, even if you are one of the best players in the entire league, then you will pay a hefty price, both figuratively and literally.

Ismail had this to say about football:

“I think football is a violent sport by nature. You have bodies flying around full speed, but it’s not a sport for violent people,” he said. “So, if you’re a violent person – if you have violent intentions – don’t pick up a football and think that’s going to be your way out.”

Athletes need to be aware of the risks the sport poses and need to understand that the game isn't for everyone. When your on the field, nothing crosses your mind except the game that's taking place. You won't think about your health or your body, you only can focus on the game of football. And, honestly, that's very frightening. Nobody wants to play with a level of cautiousness because that hurts performance. But wouldn't playing with a level of cautiousness insure more time to have the ability to perform? I think that is a pretty good trade off to make. 

I also watched Junior Seau's, Hall of Fame special on his career 

February 4, 2015

Friday will mark exactly 2 months from when my thesis project will be due. Exciting.

http://www.sciencedirect.com/science/article/pii/S0969996114003325

It's about damn time. What exactly am I talking about? Science Direct's February medical journal on Neurobiology of Disease was released just a few days ago (February 1) and within the journal was a whole section dedicated to....:

Neuroinflammation and brain atrophy in former NFL players: An in vivo multimodal imaging pilot study

This is HUGE news. When football is easily being transported into the medicine world than you know a heightened awareness is surrounding the entire medical field. Most medical journals are very structured and only those with a very sophisticated knowledge in medicine can take interest and understand what is being discussed. So this article within the journal is a breath of fresh air. 

Here are some of the highlights gleaned out from the article:

Former NFL players were imaged with positron emission tomography (PET) to study a marker of neuroinflammation. 

Several brain regions showed signs of neuroinflammation in former NFL players.

Hippocampal atrophy was also observed on magnetic resonance imaging (MRI) of the same players.

If interested, here is the entire abstract which is easy to follow and provides a greater insight into the topic:

Abstract

There are growing concerns about potential delayed, neuropsychiatric consequences (e.g, cognitive decline, mood or anxiety disorders) of sports-related traumatic brain injury (TBI). Autopsy studies of brains from a limited number of former athletes have described characteristic, pathologic changes of chronic traumatic encephalopathy (CTE) leading to questions about the relationship between these pathologic and the neuropsychiatric disturbances seen in former athletes. Research in this area will depend on in vivomethods that characterize molecular changes in the brain, linking CTE and other sports-related pathologies with delayed emergence of neuropsychiatric symptoms. In this pilot project we studied former National Football League (NFL) players using new neuroimaging techniques and clinical measures of cognitive functioning. We hypothesized that former NFL players would show molecular and structural changes in medial temporal and parietal lobe structures as well as specific cognitive deficits, namely those of verbal learning and memory. We observed a significant increase in binding of [¹¹C]DPA-713 to the translocator protein (TSPO), a marker of brain injury and repair, in several brain regions, such as the supramarginal gyrus and right amygdala, in 9 former NFL players compared to 9 age-matched, healthy controls. We also observed significant atrophy of the right hippocampus. Finally, we report that these same former players had varied performance on a test of verbal learning and memory, suggesting that these molecular and pathologic changes may play a role in cognitive decline. These results suggest that localized brain injury and repair, indicated by increased [¹¹C]DPA-713 binding to TSPO, may be linked to history of NFL play. [¹¹C]DPA-713 PET is a promising new tool that can be used in future study design to examine further the relationship between TSPO expression in brain injury and repair, selective regional brain atrophy, and the potential link to deficits in verbal learning and memory after NFL play.

http://hub.jhu.edu/2015/01/26/nfl-players-concussion-research

This is thesis class so you won't see my discussing colleges like some of my fellow classmates would do (throwing some shade, all in good fun), but Johns Hopkins must come up in my research because a Johns Hopkins study of retired NFL players has shed new light on concussion related brain damage, and, to no surprise, the research provides further evidence of potential long-term neurological risks to football players who sustain repeated head injuries. 

Jennifer Coughlin is an assistant professor of psychiatry and behavioral studies at JHU and she states: 

"That may mean individuals are able to make more educated decisions about whether they're susceptible to brain injury, advise how helmets are structured, or inform guidelines for the game to better protect players."

.^ Once again, the basis of my entire thesis project.


Links for next class: http://www.ted.com/talks/kim_gorgens_protecting_the_brain_against_concussion

http://keranews.org/post/players-and-families-talk-nprs-michel-martin-about-footballs-ups-and-downs

February 2, 2015

First off, what a Super Bowl. It had everything you could ask for: a close well fought game that game done to the last second, an amazing halftime performance, and even a concussion.

I'm going to try to finish talking about all the links I wanted to discuss last class today, then from there I will start working on my final presentation and product.

http://www.denverpost.com/broncos/ci_27243298/nfl-concussion-protocol-hit-players-safety

key things to point our from this article:

1. "Per rules, players diagnosed with concussions must go through a mandatory return-to-play process involving observation, comparison to preseason baseline cognitive testing and physical exertion. Before resuming practice, a player must be cleared by the team doctor and an independent neurological consultant." - this has only been recently implemented. Before only the team doctors had to clear the player, which could result in a biased tendency to return the players back to the game. This is a great step in the right direction.
2. "The protocol is on the right path. As a player you have to do something to help yourself too. I tried to do my best on the test to make it even harder to get back on the field," said Anderson, who also made another change to help himself after getting his concussion. "I changed my helmet to a more padded one. When I get hit, I might get another one, but I feel a lot better with this helmet." - Players determine there baseline results. If the test isn't taken seriously, then concussion protocol is just thrown out the window. 

One thing I have now looked into is neuromuscular mouth guards. To my surprise, mouth guards are not mandatory in football. There isn't any scientific proof that mouth guards protect against concussions but they have been linked with prevention and I believe this should be more of a precautionary measure that must be taken. Only the QB or the signal caller of defense should possibly be allowed to forgo a mouth guard because of their crucial need to talk to their teammates. However, if everybody was to use mouth pieces, would it even out the playing field and make everything still as fair as possible?

http://usatoday30.usatoday.com/sports/2009-11-16-neuromuscular-mouthguard-cover_N.htm

The above article talks a lot about the positive reasons as to why a neuromuscular mouth guard should be used. 

http://www.pbs.org/wgbh/pages/frontline/sports/football-high/poll-wealthy-college-educated-less-likely-to-want-kids-to-play-football/

"In one recent poll, a majority of Americans said they expect football to be just as popular in 20 years, but 50 percent said they would not want their son to play the game. Joining the chorus of those worried about children playing football is Mike Ditka, the legendary coach of the 1985 Super Bowl champion Chicago Bears, who in an interview this month on HBO’s Real Sports with Bryant Gumbel said, “I think the risk is worse than the reward. I really do.” - that's right. People don't want their children playing the game of football anymore,especially those that are college educated or wealthy. Football could end up being a game played by those that are less affluent and less educated.

http://www.swsportstech.com/shockbox_football_helmet_sensors.html

I mentioned shockbox helmets a long while ago, but I'll bring them up again on the basis that it is another possible solution to fix the concussion crisis and my job is to find every possible thing that could help reduce the concussion rate and make the game safer.



http://www.buzzfeed.com/lindseyadler/youth-football-brain-disease-suicide#.dxLJ08VloQ

Very said story about a high school football player who suffered from CTE at a young age and committed suicide. Awareness is key. Do you really want to be aware of the ramifications that sustaining a concussion can cause after it occurs? Of course not. How can you tell someone that football can lead to serious brain damage if they are already six feet under?


Next class I need to watch a Ted talk Michelle sent to me. I am now keeping a google drive document to help sort out all the information I will be presenting on April 6th. 

January 29, 2015

Great news. I have confirmed with my judges a time slot for my presentation: April 6th and 11:45. I have sent this information forward to Mr. Correa.

Back to my research:

http://www.pbs.org/wgbh/pages/frontline/sports/nfl-sees-a-drop-in-concussions-but-problems-linger/

"Through the first 13 weeks of the season, a total of 96* concussions have been disclosed on team injury reports, down from 115 at the same point last season and 128 in 2012. At the current pace, teams are on track to report at least 122 concussions, a drop of nearly 20 percent from a year ago."

For once, good news is appearing. Concussion rates are actually down at the most competitive football level, something to be very happy about.

Dr. Cardenas, one of the doctors who sits on the head of the NFL's Neck and Spine committee, stated:

“In large part [drop in concussion rates] because of some of the intervention targeting of another athlete with the head is illegal,” Cardenas said. “The number of contact practices during the season has been reduced.”

Cardenas's quote is evidence that the widespread, stringent regulation placed in 2010 to make the game safer has been doing its job. I believe that even more can be done to reduce the concussion rate, the basis of my thesis project.

Cardenas has also commented on the player's pulling themselves out of games more than ever before:

“I’m really witnessing a culture shift where the athletes are taking better care of themselves"

Some problems are still lingering however:

"But despite the progress, the league continues to struggle with instances of players remaining on the field after a concussion. The NFL’s concussion protocol requires teams to sideline any player suspected of having a concussion, keeping them off the field for the rest of the game. According to the protocol, players must then pass a series of medical tests before they can return to play."

I've already talked about Jahleel Addae and how he returned to a game after suffering a concussion early on in the first quarter. One thing I have yet to talk about is concussion baseline testing. At the beginning of the year, players are made to take a baseline test to measure, if they ever have a concussion, there cognitive abilities. However, one huge issue with this is that many players a purposely doing poorly on there baseline tests that way they could pass concussion protocol easier. 

Another alarming and lingering problem is that the full story about concussing are almost never told. One-third of all concussions are left out of the injury report. When roughly one-third of head injuries are left off the list, there can be no check on who the missing names are, how quickly they’re returning to play, or whether the injury marks a repeat concussion for the player.

Here is the reasoning why this occurs: "Much of the gap can be explained by the way injuries are publicly reported. For example, teams don’t release injury reports until Week 1 of the regular season, meaning most concussions from training camp are left off the list. Likewise, it’s unclear how many concussions go unreported when an injured player’s team has a bye week and the player recovers before his next game. In that case, the player would not go on the injury report.Teams also stop releasing injury reports after their final game of the year. That means there is no public record of any injuries from the final regular-season game for the 20 teams that don’t make the playoffs. The same is true for playoff teams as they’re eliminated from postseason play"

http://www.denverpost.com/broncos/ci_27243298/nfl-concussion-protocol-hit-players-safety

http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/what-weve-learned-from-two-years-of-tracking-nfl-concussions/

http://www.pbs.org/wgbh/pages/frontline/concussion-watch/#players_2014

http://kjzz.org/content/31693/white-house-concussion-summit-hits-home-arizona

http://www.sciencedirect.com/science/article/pii/S0969996114003325

http://hub.jhu.edu/2015/01/26/nfl-players-concussion-research

January 27, 2015

I emailed my two judges, Dr. Rossetti and Dr. Cook, the final presentation schedule.

I'm looking at recent news in my field to understand the direction the concussions crisis is headed. I finally found clarification with the NFL's concussions lawsuit.

 In August 2013, the NFL and players reached a $765 million settlement in all lawsuits over allegations that the NFL did not warn ex-players of the dangers of concussions despite prior knowledge of the harm that could come from head injuries. Players could choose to opt-in or opt-out of the settlement by Oct. 14, 2014.

So the settlement was reached in August of 2013 and the monetary value was constantly tinkered with up until maybe July of 2014 when $765 million was the set number. Players than had the option of opting in or out of the settlement. Opting in would mean receiving a fixed amount of money from the guidelines in the settlement. Some families have decided to opt out on the basis that their injuries deserve more compensation (individual lawsuits).

This is a quote I found very interesting and alarming by Houston Texan's owner Bob McNair:

“It was about protecting the brand," McNair told GQ. "Do we want the brand attacked on this for the next ten years? Or do we want to go ahead and take the high road? In effect, we don't think most of these concussions referenced even occurred in the NFL, but we're not going to complain about it."

"Take the high road"?! How is giving money to the thousands of NFL players who have suffered from brain damage "taking the high road"? He is completely right about how the settlement was all about "protecting the brand." Roger Goodell and the NFL will do everything in its power to protect the game of football in its current form.

I watched a video by SI titled "Have concussions stalled football's popularity at the youth level?"

http://www.si.com/more-sports/video/2015/01/20/concussions-stalling-football-popularity

I'll list some key facts from the video below:

1.  The head of the Texas Youth Football association said they had a 35% increase in youth football enrollment 
2. Participation nationwide, however, participation is down\ (one Texas league was gone)
3. Mike Ditka, NFL legend, would not let his son play football
4. Discussion now on how young is to young to play tackle football

I watched this AWFUL video about this one youth league called "Friday Night Tykes".

http://www.hollywoodreporter.com/news/friday-night-tykes-coach-injured-767445

In the video, these youth players play with aggression and anger. The running back for one of the teams was tackled hard and went down to the ground in what to me looked like a concussion. The coaching staff literally said to the injured player "You alright" "Get up" "Don't quit on my now". So instead of caring about the player's safety, the coaches cared about the game. The opposing team's coach told his players to "keep sticking it to him" in reference to the injured player, that way they could render him a complete non-factor. This is just disgusting, and I will take this information into account when I write up my proposed changed to youth football legislation. Plain awful.


Next class I'll be looking into these articles:

http://www.pbs.org/wgbh/pages/frontline/concussion-watch/#players_2014

http://hub.jhu.edu/2015/01/26/nfl-players-concussion-research

http://www.sciencedirect.com/science/article/pii/S0969996114003325

http://kjzz.org/content/94028/nfl-concussions-down-20-percent-2014-season

http://www.denverpost.com/broncos/ci_27243298/nfl-concussion-protocol-hit-players-safety