Concussions, Brain Damage and the NFL

[Diomedes]

We all know that the NFL is about to hold a conference on the issue of concussions and the long term effect they have on mental health.  So far as I can tell, the NFL and the NFLPA would rather sweep this under the rug, but can't.  Roger Goodell sees that much, hence the conference.  I doubt much will come of it immediatly, but this isn't a passing topic.  Brain concussions ruin lives, so eventually I figure we'll see some changes in the sport.  I have no idea what they're going to do about it--aside from mandate that all players be tested for cognitive ability, which Goodell announced last month--but the writing is on the wall that change is coming.


From today's NYTimes.  Remember this guy Strzelczyk?  Died in a police chase a few years ago..well turns out his brain was a lot like Andre Waters'.

June 15, 2007
Lineman, Dead at 36, Exposes Brain Injuries
By ALAN SCHWARZ

WEST SENECA, N.Y., June 13 — Mary Strzelczyk spoke to the computer screen as clearly as it was speaking to her. "Oh, Justin," she said through sobs, "I'm so sorry."

The images on the screen were of magnified brain tissue from her son, the former Pittsburgh Steelers offensive lineman Justin Strzelczyk, who was killed in a fiery automobile crash three years ago at age 36. Four red splotches specked an otherwise tranquil sea — early signs of brain damage that experts said was most likely caused by the persistent head trauma of life in football's trenches.

Strzelczyk (pronounced STRELL-zick) is the fourth former National Football League player to have been found post-mortem to have had a condition similar to that generally found only in boxers with dementia or people in their 80s. The diagnosis was made by Dr. Bennet Omalu, a neuropathologist at the University of Pittsburgh Medical Center. In the past five years, he has found similar damage in the brains of the former N.F.L. players Mike Webster, Terry Long and Andre Waters. The finding will add to the growing evidence that longtime football players, particularly linemen, might endure hidden brain trauma that is only now becoming recognized.

"This is irreversible brain damage," Omalu said. "It's most likely caused by concussions sustained on the football field."

Dr. Ronald Hamilton of the University of Pittsburgh and Dr. Kenneth Fallon of West Virginia University confirmed Omalu's findings of chronic traumatic encephalopathy, a condition evidenced by neurofibrillary tangles in the brain's cortex, which can cause memory loss, depression and eventually Alzheimer's disease-like dementia. "This is extremely abnormal in a 36-year-old," Hamilton said. "If I didn't know anything about this case and I looked at the slides, I would have asked, 'Was this patient a boxer?' "

The discovery of a fourth player with chronic traumatic encephalopathy will most likely be discussed when N.F.L. officials and medical personnel meet in Chicago on Tuesday for an unprecedented conference regarding concussion management. The league and its players association have consistently played down findings on individual players like Strzelczyk as anecdotal, and widespread survey research of retired players with depression and early Alzheimer's disease as of insufficient scientific rigor.

The N.F.L. spokesman Greg Aiello said that the league had no comment on the Strzelczyk findings. Gene Upshaw, executive director of the N.F.L. Players Association, did not respond to telephone messages seeking comment.

Strzelczyk, 6 feet 6 inches and 300 pounds, was a monstrous presence on the Steelers' offensive line from 1990-98. He was known for his friendly, banjo-playing spirit and gluttony for combat. He spiraled downward after retirement, however, enduring a divorce and dabbling with steroid-like substances, and soon before his death complained of depression and hearing voices from what he called "the evil ones." He was experiencing an apparent breakdown the morning of Sept. 30, 2004, when, during a 40-mile high-speed police chase in central New York, his pickup truck collided with a tractor-trailer and exploded, killing him instantly.

Largely forgotten, Strzelczyk's case was recalled earlier this year by Dr. Julian Bailes, the chairman of the department of neurosurgery at West Virginia University and the Steelers' team neurosurgeon during Strzelczyk's career. (Bailes is also the medical director of the University of North Carolina's Center for the Study of Retired Athletes and has co-authored several prominent papers identifying links between concussions and later-life emotional and cognitive problems.) Bailes suggested to Omalu that Strzelczyk's brain tissue might be preserved at the local coroner's office, a hunch that proved correct.

Mary Strzelczyk granted permission to Omalu and his unlikely colleague, the former professional wrestler Christopher Nowinski, to examine her son's brain for signs of chronic traumatic encephalopathy. Nowinski, a former Harvard football player who retired from wrestling because of repeated concussions in both sports, has become a prominent figure in the field after spearheading the discovery earlier this year of C.T.E. inside the brain of Andre Waters, the former Philadelphia Eagles defensive back who committed suicide last November at age 44.

Tests for C.T.E., which cannot be performed on a living person other than through an intrusive tissue biopsy, confirmed the condition in Strzelczyk two weeks ago. Omalu and Nowinski visited Mary Strzelczyk's home near Buffalo on Wednesday to discuss the family's psychological history as well as any experiences Justin might have had with head trauma in and out of sports. Mary Strzelczyk did not recall her son's having any concussions in high school, college or the N.F.L., and published Steelers injury reports indicated none as well.

Omalu remained confident that the damage was caused by concussions Strzelczyk might not have reported because — like many players of that era — he did not know what a concussion was or did not want to appear weak. Omalu also said that it could have developed from what he called "subconcussive impacts," more routine blows to the head that linemen repeatedly endure.

"Could there be another cause? Not to my knowledge," said Bailes, adding that Strzelczyk's car crash could not have caused the C.T.E. tangles. Bailes also said that bipolar disorder, signs of which Strzelczyk appeared to be increasingly exhibiting in the months before his death, would not be caused, but perhaps could be exacerbated, by the encephalopathy.

Omalu and Bailes said Strzelczyk's diagnosis is particularly notable because the condition manifested itself when he was in his mid-30s. The other players were 44 to 50 — several decades younger than what would be considered normal for their conditions — when they died: Long and Waters by suicide and Webster of a heart attack amid significant psychological problems.

Two months ago, Omalu examined the brain tissue of one other deceased player, the former Denver Broncos running back Damien Nash, who died in February at 24 after collapsing following a charity basketball game. (A Broncos spokesman said that the cause of death has yet to be identified.) Omalu said he was not surprised that Nash showed no evidence of C.T.E. because the condition could almost certainly not develop in someone that young. "This is a progressive disease," he said.

Omalu and Nowinski said they were investigating several other cases of N.F.L. players who have recently died. They said some requests to examine players' brain tissue have been either denied by families or made impossible because samples were destroyed.

Bailes, Nowinski and Omalu said that they were forming an organization, the Sports Legacy Institute, to help formalize the process of approaching families and conducting research. Nowinski said the nonprofit program, which will be housed at a university to be determined and will examine the overall safety of sports, would have an immediate emphasis on exploring brain trauma through cases like Strzelczyk's. Published research has suggested that genetics can play a role in the effects of concussion on different people.

"We want to get a idea of risks of concussions and how widespread chronic traumatic encephalopathy is in former football players," Nowinski said. "We are confident there are more cases out there in more sports."

Mary Strzelczyk said she agreed to Omalu's and Nowinski's requests because she wanted to better understand the conditions under which her son died. Looking at the C.T.E. tangles on a computer screen on Wednesday, she said they would be "a piece of the puzzle" she is eager to complete for herself and perhaps others.

"I'm interested for me and for other mothers," she said. "If some good can come of this, that's it. Maybe some young football player out there will see this and be saved the trouble."

[Diomedes]

from PFT, also today

FOR CONCUSSIONS, THREE APPEARS TO BE THE MAGIC NUMBER by Mike Florio and Larry Mazza

One of the concepts that will be discussed at the June 19 concussion summit in Chicago is the clearer-than-ever link between multiple concussions and chronic changes in the brain that cause depression and other problems for former athletes.

And the magic number, one leading expert in the field believes, is three.

On June 13, Dr. Julian Bailes, the Chair of the West Virginia University Department of Neurosurgery, explained to us new findings linking multiple concussions to significant changes in the brain.  Dr. Bailes, the only physician from a non-NFL city who has been invited by the NFL to provide expertise regarding the issue of traumatic brain injuries, explained that autopsies performed on former pro football players like Steelers center Mike Webster revealed apparently normal brain tissue.  After applying a certain type of test, however, changes that could cause serious cognitive problems were discovered.

Three concussions is the threshold, Dr. Bailes explained, for problems like depression and dementia after retirement from the game.  "They've got really strive to not get that third concussion, because based on our data, which is the only thing out there, that's where the threshold is."

Per one of the studies in which Dr. Bailes was involved, it was found that a player who has three or more concussions is five times more likely to have "MCI," or mild cognitive impairment.  Thirty percent of all persons who develop MCI are later diagnosed with Alzheimer's disease.  Per another study, three or more concussions resulted in a triple incidence of depression.

Dr. Bailes will be sharing his opinions and findings at the meeting in Chicago.  "I want to make a contribution.  Hopefully, I will still be optimistic when I leave [Chicago] on Tuesday night.

"For the first time, the new Commissioner has invited outside experts to meet with the committee," Dr. Bailes said.  "Under Commissioner [Paul] Tagliabue it was rather closed.  So what our reception is going to be in Chicago, I'm not certain.  I hope they have the best motives.  But this is troubling, troubling evidence.  And there's more to come."

As to the notion that the NFL might eventually conduct its own study of retired players in order to show that there is no long-term consequence of concussions, Dr. Bailes said, "Well, I hope they do, and I hope they prove us wrong for the sake of the sport.  But I'm not optimistic that real research will do that. . . .  If they do their own study, it's going to take them two to three years to do it, another year to get published.  Who suffers in the interim if we're right?"

A big part of the problem is the common failure of players and teams to acknowledge that a concussion has occurred.  "There's a lot of concussions that go unrecognized," Dr. Bailes said.  "Players don't quite still understand.  If you're seeing stars, if you don't quite feel right, if you're memory's a little off or if you're confused about your assignment, that can be a concussion.  Only five to ten percent of the athletes who get a concussion get knocked out, so 90 to 95 percent of the time they're walking around talking.  So I think education [is important], and that will trickle down to the 1.3 million playing high school football."

Dr. Bailes also advocates a more conservative game day approach, along with a strong effort to ensure that a player doesn't get that third concussion.

Better helmets aren't the answer.  "Helmets cannot prevent this," Dr. Bailes said.  "They can mitigate it some. . . .  This is what we call an acceleration/deceleration injury.  The brain floats in a bath of cerebral spinal fluid.  It has about a centimeter or a centimeter-and-a-half of play.  And so it's going to continue to go forward.  It doesn't matter if there's a lot of padding.  It's going at a certain speed and it suddenly stops."

And regardless of any changes to the equipment or the rules, the reality is that "as the cliche goes, players are getting bigger, stronger, and faster," Dr. Bailes said, "as that occurs, there's just going to be higher velocity injuries."

It remains to be seen where this all leads.  But if the NFL ultimately agrees that players can't afford to have a third concussion, there could eventually be rules changes aimed at reducing head impacts.

Though we've heard nothing specific in this regard, we could envision an elimination of all low blocks and tackles, which would limit the number of times that a player might be kicked or kneed in the head.  A more radical possibility would be the elimination of the three-point stance, which would take out of the game that collisions between helmets that occur as the linemen strike each other.

Regardless of the specific changes that are imposed, some type of change will be necessary if/when the NFL accepts as valid the findings of folks like Dr. Bailes. 

[phattymatty]

so having your brain bounce off your skull multiple times could cause brain damage?  never would have guessed.

[SunMo]

it does seem painfully obvious, doesn't it?

which makes it all the more laughable that the NFL's "doctors" have said they see no correlation to concussions and long term brain damage

[Seabiscuit36]

I've had 3 concussions 

[SunMo]

nice knowing you...grandpa

[rjs246]

I've had 3 concussions 

As have I. On more than one occasion when I was growing up I rung my own bell so badly that I threw up. I refused to accept that my skinny ass maybe wasn't made for such idiotic behavior and now I have squishy brains.

[Seabiscuit36]

Same here all growing up minus a bad car accident when i was 19.  I was a catcher and took a bat to the side of the head in little league.  The other one was playing CYO football, i saw a flash of white, then i woke up a few minutes later puking. 

[phattymatty]

i've had a bunch too.  got one during a HS football game where i got flipped on my head, it was severe and led to fluid on my brain or some shtein.  basically i had amensia for one night.  my parents said i asked the same questions and kept finding the same five dollar bill in my pocket for like 12 hours straight.  was fuzzy for about a week.

i also got one tackling some dude down a flight of concrete steps once.  still have a major gash scar right on top of my dome.

[PhillyPhreak54]

Since we're all comparing # of concussions, I've had 4. One of which was severe enough where I lost consciousness for about 10 seconds and had a speech impairment for 2 weeks. OMGIMGONNADIE!

[SunMo]

that must've happened less than 2 weeks before i met you

[Cerevant]

This goes a long way to explain the general quality of posts on this board.

[Geowhizzer]

I had one.  I was going for a pop-up in the infield, and the pitcher and I collided.  Apparently he wasn't told that pitchers are supposed to get the heck out of the way.

He was about three or four inches taller than me, and my forehead hit him square in the mouth.  I was out for probably 20-30 seconds (I think), but he had to get braces because I pushed his teeth back into his mouth.

[rjs246]

I just had a seizure.

[SunMo]

so what, i just got raped in the shower