PALO ALTO, Calif. — Deep inside a gym on the campus of Stanford University, Dr. Jamshid Ghajar tinkers with virtual reality goggles that will determine within a minute if its test subject (me) has head trauma.
Starting this season, the SyncThink eye-tracking system — the goggles are attached to a monitor that records and prints the results of an eye following a circular path — has been on the sidelines for Stanford University football games.
It’s part of a growing movement within the sports and medical communities. After years of neglect — in some cases, denial — football teams are looking at everything from new-fangled helmets and neck contraptions to injury-risk monitoring systems, shock-absorbing turf and mandated spa days.
Most of the solutions are probably a year or two away, which means concussions will remain a scourge at the professional and college levels. The average career of an NFL player is six years, the league says.
The disease has ravaged the lives of former professional and college football players, and reinforced the violent image of the NFL, both on and off the field. (A forthcoming Will Smith movie, Concussion, recounts the sordid history that led to more than 4,500 players suing the league for hiding the dangers of concussions.)
“Tech is taking us in interesting ways to reduce risk on head trauma,” says Jack Swarbrick Jr., vice president and director of athletics at University of Notre Dame. Swarbrick is leading an effort with the NCAA to catalog the concussion histories of high school athletes.
The link between head trauma in football players and chronic traumatic encephalopathy (CTE), a degenerative brain disease, was discovered by Bennett Omalu, the forensic pathologist played by Smith in the movie, in the early 2000s.
The NFL, which fought Omalu’s findings initially, has since changed elements of the game and sunk tens of millions of dollars into efforts to cut down on brain trauma risk. In April 2015, the NFL settled the players’ lawsuit for $765 million (for comparison, the NFL makes $11.1 billion in annual revenue.)
“We’ve taken action to apply medical research and technological advances, as well as rules changes, culture shifts, and changes to the training of players,” to reduce concussion risk, says the NFL’s senior vice president of health and safety policy Jeff Miller.
BROKEN PLAYERS, DEATH AT AN EARLY AGE
Junior Seau, one of the NFL’s best players for nearly two decades, had a degenerative brain disease when he committed suicide last May, the National Institutes of Health told The Associated Press on Thursday. (Jan. 10)
The league’s moves have come too late for generations of former football players hobbled by blows to the head and neck, leading to excruciating pain, depression, dementia and, in several cases, death. After Hall of Fame linebacker Junior Seau fatally shot himself in 2012, an autopsy showed he had CTE.
“I gave my body and, to some extent, my brain to the league,” says Bill Romanowski, 49, a Super Bowl-winning linebacker for the San Francisco 49ers and Denver Broncos who says he was concussed more than 20 times during a 16-year career.
“The game is so hard, so intense, so violent,” says Romanowski, who acknowledges he “saw stars” in the more than 300 games he played in in the NFL.
Hall of Famer Frank Gifford, who died in August, suffered from a concussion-related brain disease, his family disclosed in November.
In pursuit of equipment that would reduce the chances of head injuries, football organizers have spared no expense, although the results have been mixed. Most efforts have centered on making a “concussion-proof” helmet that absorb blows from every conceivable angle — in particular, the back of the head and neck.
There is no holy grail to minimize head trauma, Ghajar says, but there are encouraging steps. The Brain Trauma Foundation, which developed SyncThink, is looking into a device for the neck that would significantly reduce the whiplash-like effect a hit has on the head, leading to many concussions. But such a device would require approval from federal regulators and is several years away from commercial use, Ghajar acknowledges.
Army Research Laboratory is developing a tether that looks like a cord that connects under the chin of a helmet. It helps reduce severe head movement after a hit. Start-up Viconic Sporting is working on an plastic underlayer system that fits beneath turf to provide extra cushioning for sometime next year. And the University of Washington and start-up VICIS are developing a new football helmet with “impact-absorbing structure” material, due in early 2016. It is expected to be used in pro and college games next year. All three technologies were funded, in part, by the NFL.
“It’s a whole new approach to helmets, with a brand-new engineered structure that reduces head trauma” in football, lacrosse and hockey, says VICIS CEO Dave Marver, who has spent 25 years in the medical technology field.
A medical team (general doctor, neurosurgeon, orthopedic specialist, sports medicine doctor) patrols the Stanford sideline during games and practice, monitoring the field for signs of injured players. A spotter high above the field does the same.
NFL RULE CHANGES
The NFL’s Miller points to 39 rules changes over the last decade to reduce injuries on kickoffs, protect quarterbacks and wide receivers, and punish head-hunting defenders. The changes, he says, reduced concussions 34% in regular season games from 2012 to 2014.
In 2013, the league launched its Head Health Initiative, a four-year, $65 million collaboration with General Electric and Under Armour to detect and treat traumatic brain injury. The program includes $40 million to develop next-generation, brain-imaging technology.
Another arrangement, in which the league donated $30 million to the National Institutes of Health in what was the single largest donation the NFL had made in its 92-year history, is designed to focus research on brain trauma.
Miller says the league is closely monitoring developments at universities, the Department of Defense and start-ups in the areas of equipment, eye-tracking devices and hyperbaric chambers, oxygen-infused containers that can accelerate the healing process.
NO CLEAR-CUT DEFINITION
Concussions have proved to be elusive to the medical community because there is no clear-cut definition. “I count about 40 (definitions). It is a real struggle … in identifying someone who has diminished ability,” says Ghajar, who founded the Brain Trauma Foundation and is considered one of the leading experts in the field. “There are 5,000 studies on the topic, and maybe 11 are good.”
The signs for head trauma can be anything from headaches and blurred vision to memory loss, dizziness or a player being knocked out. Sometimes, as in the case of a Notre Dame player, there were no signs of a concussion until the day after the game. The danger is that an impaired player is much more susceptible to additional concussions that deepen the injury.
Will Smith tells the story of Bennet Omalu, a forensic neuropathologist under pressure from the NFL to hide the truth about concussions after discovering football-related brain trauma in a player.
Medical researchers haven’t conclusively proven that playing football causes CTE.
“We know what we signed up for, but the worrisome part is not knowing how many times your bell was rung,” says Terrence Wheatley, 30, a former defensive back for the New England Patriots, Jacksonville Jaguars and Buffalo Bills. He suffered his first concussion, he says, while playing football in the eighth grade.
“The amount of pressure to perform is immense,” says Wheatley, now director of the Dallas Cowboys’ football academy. “I did what I had to do. I played with a broken foot, broken wrist, concussion. I didn’t want to lose my spot (to another player).”
As in the infamous case of Mike Webster, a Hall of Fame center for the Pittsburgh Steelers who is patient zero for CTE, the effects of some many hits on the field didn’t manifest until late in his career and his post-football career. He died at age 50 in 2002 after experiencing dementia. Webster’s cause of death has not been released at the request of his family. The Steelers originally said Webster died of a heart attack before it recanted the statement.
“Concussions are hard to define, and it’s hard to solve a problem when you don’t know what it is precisely,” Ghajar says. “In fairness to the NFL, this is the issue it is tackling.”
Indeed, the problem may be deepening as players get bigger, stronger and faster in an era of spread offenses that create more open space on the field and more high-speed collisions, says Stanford’s Scott Anderson, director of athletic training at Stanford.
But, so far, it remains to be seen if the dangers of football will dissuade participants. Although participation in Pop Warner football for youngsters dipped 9.5% from 2010 to 2012, it has dipped just 2.2% in high school, according to the National Federation of State High School Associations.
Former player Romanowski says it’s too late for his generation of players to avoid the lingering after-effects of head trauma, but the attendant attention to the topic might “force the NFL to do something.”
“There are not a lot of answers yet,” says Wheatley, an advocate, like Romanowski, of hyperbaric chambers for injury recovery. “We need to ask more questions — players and parents.”
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