Just a few years ago, it looked like the NFL was on the ropes. Public concern about concussions was reaching a fever pitch, huge lawsuits about the league’s handling of concussions were being litigated, and a Hollywood blockbuster was being made dramatizing the efforts to cover up the scandal.
My how things change.
Thanks to a number of rule changes and new fancy technology, the public outcry has largely died down. Concussions are back to being seen as “just part of the game”, even when accompanied by permanent brain disease. The number of concussions in the most recent season dropped slightly. Perhaps most concerningly, the game is seen as being mildly “safer” than it was way back in 2015.
Of course, that perception isn’t exactly backed by reality.
Two separate reports from this month show that many efforts to prevent repeated concussions or brain injuries in football may be ineffective – at best.
The first, from SB Nation, reveals that many players are actively gaming the NFL’s concussion protocol to stay in the game after being injured.
The concussion protocol has been the most widely championed effort by the NFL to protect players from the long-term risks associated with repeated brain trauma and has been implemented in similar forms for high school athletes across the country. Among its provisions, it notably puts in place rules removing athletes suspected of having a brain injury until they can be assessed for a concussion. These athletes are then sidelined until they are cleared to play.
Unfortunately, as Seattle Seahawks wide receiver Doug Baldwin explained, the protocol may not actually be keeping injured players off the field.
“Guys — we know the protocol, so if you are cognitively there somewhat then you can cheat the system,” Baldwin explained.
The problem isn’t with the protocol itself, which has been praised by medical professionals and football experts alike. Instead, the issue lies with the inexact science of diagnosing concussions.
Even the most advanced concussion assessments rely on medical professionals being able to interpret many subjective factors. What objective tests do exist are only accurate enough to help inform a diagnosis, not definitively pinpoint an injured athlete. Nearly every step of the way requires athletes to be forthcoming about symptoms and honest about their mental state.
As retired NFL safety Husain Abdullah explains, “passing the concussion test was cake because I already knew everything.”
Between baseline testing and word of mouth, most members of Abdullah’s team all knew what screening questions they would be asked before trainers assessed them. This meant athletes could practice their responses and be prepared, even if they were injured by a concussion.
“And they go back through the same thing. He’d ask me the date. He would ask me who was the vice president. He would ask me to count backwards by seven from 100. The first time it’s like, ‘OK, by seven backwards. OK. Yeah, 100, 93, 86 — ’”
In addition to subjective assessments and testing, the inexact nature of concussion science and monitoring explains why other areas of the NFL’s concussion defenses are crumbling as well.
Once a concussed player has been identified, they are removed from practice and competition until they are cleared to play. It sounds like a good strategy on paper, but reports show injured players may fall through the cracks and wind up on the field too early – putting themselves at heightened risk for more grave injuries.
In one example detailed by the Wall Street Journal, a 17-year-old high school football player from Washington state died after a collision on the field. Kenny Bui lost consciousness on the sideline after being removed from the game and never came back.
What makes Bui’s death so notable is that he had experienced another concussion just one month before his death. Bui was removed from play until he passed several assessments, including a commonly used cognitive evaluation. By every metric used, Bui’s brain had healed. But now, most experts agree that was not actually the case.
Instead, Bui was in a middle-ground area when he returned to the field. His cognitive and mental symptoms had resolved, but it is believed the biological effects of his first concussion were likely not completely healed. In fact, many recent studies suggest the biological impact of a concussion may leave the brain vulnerable for months or even years afterwards.
For their piece of Kenny Bui’s passing, the Journal interviewed Michael McCrea, part of a team of researchers advocating the use of brain scans to assess injured athletes. McCrea notes that there appears to be a significant gap between the symptoms assessed in commonly used diagnostic evaluations and the physical or biological effects found through scans.
“McCrea said the early findings show that the biological symptoms of an injured brain last significantly longer than the clinical signals that health professionals gauge through symptoms and cognitive testing. That finding is crucial because scientists know that after an initial concussion there is a time of heightened danger when athletes face a major risk of significant injury or even death if they experience another head trauma.”
“Ultimately,” McCrea told the Journal, “we want to know not only when the athlete is recovered but when his or her brain is safe and ready to play.”
As both these reports show, even when sporting organizations take brain injuries as a gravely serious matter, there may not be any existing way to completely protect athletes from serious brain injury and even death. In both cases, the NFL and Bui’s high school athletics department took all the steps recommended by medical professionals and followed every guideline. But, the gaps in both situations allow players to slip through – both accidentally and intentionally.