Traumatic Brain Injury And the National Football League

Andrew Coatsworth
Emaan Jaberi
Jackson Schmidt
Jeff Lindquist
Management 320
Tod Bergstrom
April 22, 2014

The evils of the intercollegiate sports . . . continue without real redress and diminution. In
particular the game of football grows worse and worse as regards foul and violent play, and the
number and gravity of injuries which the players suffer. It has become perfectly clear that the
game as now played is unfit for college use . . . The state of mind of the spectators at a hardfought football match at Springfield, New York, or Philadelphia cannot but suggest the query
how far these assemblages differ at heart from the throngs which enjoy the prize-fight, cockfight, or bull-fight, or which in other countries delighted in the sports of the Roman arena.
Charles William Eliot, Former President of Harvard University (Davies, Sports in American
Life: A History )
In American footballs earliest days, players marched on to the field helmetless and only
protected by thick wool sweaters. The style of play resembled that of modern day rugby as
teams utilized brute force to run the ball down the field. In 1905 alone, this barbaric style of play
led to 19 fatalities at the collegiate level (Hild, The NFL on Trial). President Eliots quote
captures the controversy surrounding the sport at the time. Despite these issues, President
Theodore Roosevelt remained one of the sports strongest advocates. Upon winning the Nobel
Peace Prize for mediating Peace between Russia and Japan, Roosevelt had the opportunity to
meet with the football coaches of Princeton, Harvard and Yale (Dr. Ellenbogen, Concussions). In
this meeting, the men set out to save the sport through a complete overhaul of the rules.
Roosevelt employed strong language such as, In life as in a football game, the principle to
follow is: hit the line hard; dont foul and shirk . . . I believe in rough games and in rough, manly
sports (Hild, The NFL on Trial). Despite Roosevelts stubborn stance on the game, these men
forever changed American football, instituting rules such as the forward pass. As a result,
injuries declined and at the conclusion of the 1909 season, the game established further rules and
regulations. Football began to resemble the sport so wildly popular today. Although Roosevelt
and the Ivy League coaches revolutionized football, a brutal culture began to triumph over player
safety as the sport gained popularity. In the modern era of football, the violent culture persists.
A change of culture has never been more needed as concern grows for players in regards to

traumatic brain injury. With a desideratum for broader public health education, a reprioritization
of business ethics that places player well being ahead of profit maximization and the
strengthening of regulation to prevent and react in a more effective manner to player injury, it
will become possible to alter the culture of football, thus lessening the prominence of traumatic
brain injury within the lives of athletes.
In 1928, a New Jersey pathologist, Harrison Martland, first discovered a syndrome
commonly found in boxers, which he coined as punch drunk. Symptoms of this ailment
included slowed movements, tremors, confusion and issues with speech. In 1966, punch drunk
became known as Chronic Traumatic Encephalopathy (CTE). Despite gaining the attention of
the medical field, doctors believed CTE to be exclusive to boxers. CTE research within the
scope of American football began to gain momentum after a coincidental chain of events left Dr.
Bennett Omalu examining the brain of former Steelers center, Mike Webster. Prior to this more
expansive CTE research relating to football, there had been 49 documented cases of CTE, 39 of
which were found in boxers. Of the ten remaining, some included former football players along
with several anomalies such as two mentally challenged individuals with head banging behavior
and an Australian circus performer participating in an act known as dwarf-throwing (Sports
Legacy Institute, What is CTE?).
CTE is categorized as a progressive degenerative disease that is commonly found in the
brains of athletes who have a history of repetitive brain trauma, including symptomatic
concussions along with sub-concussive hits. These repeated instances of head trauma cause a
build up of a protein known as tau which can be seen as dark brown splotches throughout the
amygdala, the area of the brain that controls emotion, and hippocampus, which controls memory.
Consequently, this form of brain degradation results in memory loss, confusion, impaired

judgment, impulse control problems, aggression, depression, and, eventually, progressive

dementia (Boston University CTE Center, What is CTE?). As a public health issue, the damage
from CTE is life long, and essentially heightens the rate at which the brain ages and degrades,
leaving patients with early onset symptoms commonly found in much older subjects afflicted
with dementia. For example, in the case John Grimsley, a former NFL linebacker who perished
at the age of 45, it was discovered during his autopsy that his brain contained tau deposits similar
to that of a 73 year-old boxer with dementia. Unfortunately for those who experience CTE like
symptoms or fear a later onset of the disease, there is currently no cure and it can only be
diagnosed posthumously (Sports Legacy Institute, What is CTE?).
In 1994, NFL Commissioner at the time, Paul Tagliabue, created the Mild Traumatic
Brain Injury Committee and appointed Dr. Elliot Pellman to serve as chair. Upon the inception
of the committee, the issue of knee injuries, drinking, drugs and steroids were believed to be a far
greater problem than brain injuries in the NFL. With the already low priority of concussions, Dr.
Pellman began to stack his committee with a multitude of members, chiefly team doctors and
executives. While the NFL began to take precautionary measures relating to player safety, this
board was plagued by numerous conflicts of interest. The most obvious being that the members
of the committee, all major stakeholders within the NFL, were financially dependent on the sport
(PBS, League of Denial Timeline). This committees flawed ethical standards became evident in
their public stance on concussions. At one point, Dr. Pellman stated; Concussions are part of
the profession, an occupational risk (Farber, The Worst Case). Pellmans dialogue in
downplaying the significance of concussions aided the idea that concussions were simply
embedded in the culture of football and the players accepted this risk. During the time of
Pellmans committee, doctors unaffiliated with the NFL including Dr. Bennet Omalu and Dr.

Anne McKee began research of their own. Their findings included a prevalence of CTE in the
brains of former NFL players who most likely played through numerous concussions. On the
other hand, Pellmans MTBI group held the that theory NFL players quickly recovered from
concussions and that 92 percent of concussed players returned to practice in less than seven days
with more than half returning to play in one day (PBS, League of Denial Timeline). As the NFL
became aware of these conflicting theories, they sided with their own committee. The NFLs
obvious conflict of interest in siding with their own committee and denouncing Dr. Omalu and
Dr. McKee depicts their motivation in choosing favorable data to help maintain profit.
Furthermore, by denouncing the theories of Dr. Omalu and Dr. McKee, the NFL fortified their
position by unscrupulously attacking the theories that would call for massive regulatory overhaul
in the sport of football. With ethical standards evoking memories of the tobacco industrys
deceitful discourse in Congress, the current commissioner, Roger Goodell, avoided
acknowledging a connection between football and traumatic brain injury in a Congressional
hearing in 2009. Goodell dodged the incriminating questions posed by member of Congress
claiming that his medical experts would be better suited to respond (ESPN, Goodell Grilled). In
the aftermath of the NFLs time in Washington Goodell, realized the need for wholesale change
in football. With the appointment of Dr. Richard Ellenbogen, and Dr. Hunt Batjer to serve as
chairs of the new NFL head, neck and spine medical committee, the sport began to make changes
on the forefront of concussion regulation within the game of football (ESPN, NFL Adds Two
Chairmen).
The public health issue of concussions doesnt solely revolve around football. The
culture that has derived from football, and the idea of walking it off and showing tough
fortitude has spread to other sports, and as a result, had a detrimental impact on athletes in

general. In 2012, former MLB player Ryan Freel committed suicide, bringing a shock to the
entire sporting community (ESPN, Ryan Freel). After having reportedly suffering roughly 10
concussions, Freel decided to retire after suffering the adverse consequences of repeated
traumatic brain injury. Known for his diving grabs and [hurdling] over seats, teammates and
fans came to expect Freel to play in a reckless and gritty fashion. When he eventually took his
life at the age of 36, he was found to be suffering from stage II CTE entailing severe
headaches, loss of attention, and depression. When Freels battle with CTE surfaced, it
demonstrated the magnitude and extensive impact of the disease. Not only did it affect NFL
players, but also, it transcended football and it became clear that concussions affect a much wider
audience.
Incidents of concussion in younger athletes such as high school and youth athletes depicts
the broad impact the NFL has in the world of sports, especially football. With the culture of
football rewarding big hits and tough players, the influence on players such as Eric Pelly, who
dreamed to play in the NFL proved to make a lasting impact on young athletes. Growing up on
watching the hard crushing hits of Troy Polamalu, Eric wished to emulate the tough as nails
mentality of his favorite players. By the age of 17, Eric had experienced a couple of
concussions that his parents. [Knew] about, and maybe a couple they [didnt] know about
(Solotaroff, This is Your Brain). The culture of football in addition to insufficient knowledge
regarding the significance of concussions, led to Erics death after suffering two concussions in a
two-week succession. The result of the NFLs refusal to recognize and research the dangers of
concussion, and more so their research in disapproving of any sort of connection has led
individuals to their early deaths. The ethical issue of denying the knowledge of such a dangerous
problem robs many the chance of knowing the true risk of the sports they are partaking in, while

granting them illusion of being safe by wearing copious amounts of protective gear. Despite the
damaging impacts felt throughout all levels of athletics, the NFL continued to realize massive
profits and popularity all over the globe.
With $9 billion in annual revenue, and an expected increase to $25 billion by 2027, the
NFL is clearly an incredibly successful business (Burke, How the National Football League).
The NFLs branding is evident throughout the world, and with a substantial amount of goodwill,
much of their success is based upon the publics image of this organization. When the issue of
concussions arose, recognizing the harm that would occur to a business built around big hits, the
NFL attempted to prevent the problem from gaining momentum. Attempting to avoid a media
blitz that would paint football in a negative light, the NFL endeavored to settle lawsuits prior to
court denying that they concealed what [they] knew about the dangers of repeated hits to the
head (Belson, NFL Agrees). The implications of such bold accusations could have lead to an
adverse impact on the NFL. The media exposure led to even more drastic concerns by parents,
with the likes of even Barack Obama saying that if he had a son, he would be uncertain if he
would allow him to play football. The significance of such a large swing in public opinion
regarding concussions and football could lead to a long-term impact on the sport. If the opinion
swayed so significantly, causing youth to cease playing football, the effects would eventually hit
all portions of the NFL and in turn, the United States economy would endure a massive setback.
In August of 2013, the NFL settled a class action lawsuit filed by over 4,500 former NFL
players and their families. The litigation process began over two years prior to the settlement
when the players filed suit against the NFL and the helmet company Riddell. The players
claimed that the NFL had concealed information regarding the potential dangers of playing
football. Many of the players involved in the lawsuit suffer from severely debilitating

neurological issues with symptoms similar to those seen in the athletes shown to have CTE. The
players and the NFL agreed to a settlement worth $765 million. $675 million of this settlement
will be paid to players or families who sustained traumatic brain injury. $75 million will fund
baseline medical exams for players and a $10 million research fund will also be established.
While this is a step in the right direction for the NFL in ameliorating the lives of its most crucial
employees, this settlement does not apply to current players. In addition, former players would
not have to prove that their head injuries were sustained during their careers. Rather,
compensation will be determined only by the players age and number of active years in the
league. The NFL will not take into account the position of the claimant or number of
concussions suffered. As a result of these standards, there could potentially be a larger number
of claimants than anticipated by the plaintiffs involved in the lawsuit. Michael LeRoy, a
professor at University of Illinois College of Law specializing in labor and employment
relations, believes the size of the settlement is problematic. LeRoys worries lie in root with the
low settlement considering the number of claimants and the severity of their conditions,
although the settlement depicts how the NFL is keenly sensitive to its public image, and
really lets the air out of the publicity balloon. Although a settlement of over three-quarters of a
billion dollars may seem like an overwhelming win for the players, in the grand scheme of things
as LeRoy points out, this money could prove to be an insignificant resolution to such a vast issue
(Belson, NFL Agrees).
Many NFL players benefitted from handsome salaries during their playing days, yet
countless retirees now face astronomical monthly medical bills. Former fullback, Kevin Turner,
a current A.L.S. patient at the age of 44, spends around $8,500 per month on medicine and
doctors visits. While numerous veterans of the NFL endure the adverse consequences of their

brain injuries, in 2012 Commissioner Goodell earned $44.2 million in 2012 including a $5
million incentive payment and a $4.1 million pension payment from the lockout in 2011
(Schwab, Roger Goodell Made). Goodells massive salary suggests that the NFL follows the
conventionalist ethic suggesting that business is a game. Within this game, it is acceptable to
follow permissive morals. In addition to these questionable ethics, the NFL is registered as a
501(c)(6) tax-exempt organization. However, only the league office, the administrative branch
of the NFL, is tax exempt. This office is responsible for the rulebook as well as negotiating
stadium deals (Staff, NPR, The NFL: Big Business). Although administrative arms in other
professional sports also enjoy loopholes in the tax code, the manner in which the NFL handles
workers compensation is ridiculous. With Commissioner Goodell earning a ludicrous salary and
capitalizing on major tax breaks, it should not take litigation for former players to receive
workers compensation. A larger portion of these massive profits should be applied to the players
that require extensive medical care.
While the NFL is facing the defaming conflict that has risen from the lawsuits, problems
involving CTE, and repeated traumatic brain injury, their ability to capitalize on the issue is
uncanny. The almost infallible business structure of the NFL seems prevalent as corporations
jump at the chance to increase profits by partnering with professional football. With an effective
rebranding campaign in the realm of head trauma, the NFL has partnered with GE in a $40
million research project designed to better diagnose mild head trauma and predict its
outcomes. GE isnt alone in their collaboration, as the NFL also provided Under Armor with a
$20 million grant for research in an effort to improve preventative head trauma technology
(Burke, Think The NFL). The NFLs ability capitalize on an epidemic stemming from the culture
that they cultivated is absurd. Specifically when matched with the potential of beneficial

publicity they will receive from these business ventures. Corporations are eager for a chance to
ally themselves with the NFL because they all want to be able to say we helped the NFL
solve this problem (Burke, Think The NFL). Yet in the grand scheme of things, these programs
are only going to total about $60 million dollars, paling in comparison to the three quarters of a
billion dollar from the settlement and even seeming questionable when compared to the $44
million Goodell earned in 2012. It can be concluded that, although any effort is considered
helpful, the amount of the effort in the grand scope of the sport of football is miniscule and
arguably unethical. While stadium sponsorship deals can reach upwards of $500 million dollars,
which have the potential for increasing more capital, these miniscule investments for players
safety show much less promise (Burke, Think The NFL).
Dating back to the times of President Eliot, players have dealt with and received
concussions. Its often been regarded as a part of the game and simply unavoidable collateral
damage. However, as the game has become more and more violent, the prevalence and impacts
of concussions have become more profound. As many ex-professionals begin to encounter the
crippling long-term effects of concussions, a discussion arises relating to the extent of necessary
regulation changes not only in the NFL but all athletics and the key players involved in initiating
these regulations.
While many are attempting to limit the occurrence of traumatic brain injury within
athletics, the approach that will provide the fastest improvements are changes to the reactionary
measures taken. Rob Scheidegger, Head Trainer of the University of Washington Husky football
team, claims that even though players are aware of the risks of the game, many choose to play
anyway: Football is an inherently dangerous thing to do, but theres lots of inherently dangerous
things to do that people decide they want to do (Scheidegger, Culture of). Often, the worst

aftermath of concussions result from players toughing it out through concussions, or

knowingly electing to return to play before they are fully healed from their previous concussion.
The hits taken by a recovering brain often create worse injuries because the brain is still inflamed
from the previous hit, and it is prone to increasing damage, even with small amounts of contact
(R.E.A.L, Who is Really). Damon Huard, a twelve year NFL veteran quarterback, says that
players would knowingly put themselves in situations where they played concussed because of
pressure they felt to make and remain on team rosters, Guys internally, fighting for jobsI can
guarantee they were going to try to play through concussions (Huard, Toughing it Out).
In an attempt to combat the oxymoron of the rugged culture of football and the increased
risk associated with repetitive traumatic brain injury, many new regulations have been
implemented across all levels of athletics. As concussions inevitably occur during games, the
NFL Head, Neck and Spine Committee has instituted a league-wide Protocol for the diagnosis
and management of concussions. Often the health impacts of a player returning from a
concussion too early, leads to immensely worse medical outcomes that the initial injury. This
protocol contains many different procedures for diagnosing concussions and determining return
rules for the concussed player, in order to prevent further brain injuries. One aspect of this
protocol is the addition of an Unaffiliated Neurotrauma Consultant. The NFL Protocol states
each team will be assigned an Unaffiliated Neurotruama Consultantwho is impartial and
independent from any club and is board certified and board eligible in neurology, neurological
surgeryand hasexperience in the treatment of acute head injuries (NFL, NFL Head, Neck).
This specific section of the protocol aims to give an unbiased diagnosis of a players condition
and whether or not he should be able to return to play. The value of an unbiased opinion allows
the players health to be the sole focus of diagnosis. There is always the chance that team

doctors may have a skewed vision when diagnosing players because of a potential conflict of
interest between the players health, and the potential outcome of a game. However, given that
team doctors are the most likely to be familiar with the injured player, the NFL protocol gives the
Head Team Physician of each team the final decision to determine whether or not a player should
return to play following a hit to the head (NFL, NFL Head, Neck).
Additionally, regulations for returning to play have tightened at all levels of football.
While the most violent concussions occur at the professional level, they also occur at the
collegiate and high school levels as well. In 2009, the Zackery Lystedt Law was signed in
Washington State. Zack, a high school football player in the state of Washington, is an
unfortunate victim of a catastrophic brain injury he sustained while playing in a game in 2006.
During this ill-fated game, Zack sustained a concussion while tackling an opposing player.
Rather than sitting the rest of the game out, Zack returned to play. Due to his injuries sustained
during the game, Zack was later airlifted to Harborview Medical Center where he was treated for
the bilateral subdural hematomas that resulted from his return to play. After two years of
rigorous rehabilitation, Zack began to walk again (Dr. Ellenbogen, Concussions). Inspired by his
story, Gov. Christine Gregoire signed the nations toughest youth athlete return-to-play law.
(Zackery Lystedt Law). In order to prevent players from returning to play before they are fully
recovered from their brain injuries, the Zackery Lystedt Law requires youth athletes to be
medically cleared before they are allowed to return to a game, practice or other types of training
(Zackery Lystedt Law). Currently, all 50 states have adopted regulations similar to those of the
Zackery Lystedt Law and the Lystedt family is advocating for it to become a federal law (The
Zackery Lystedt Law Now)

Along the lines of preventing further concussion damage, there has been a steady increase
in concussion education throughout the country in order to increase and awareness and
prevention. The Center for Disease Control began a campaign called Heads Up, in which they
aim to bring simple, yet clear message for seeing the symptoms of concussions, teaching ways to
reduce the risk of concussions and giving proper courses of action for dealing with concussions.
The Heads Up campaign aims to educate players, coaches and parents of athletes so that they
all can be more aware of concussions (Heads Up Concussion). Damon Huard said the awareness
and education of NFL players regarding concussions greatly increased during the mid 2000s.
Throughout his career, Huard noticed a transformation of attitudes surrounding concussions.
They were viewed as a more serious health issue than previously before, and Doctors became
more aware of the concussion situation (Huard, Toughing it Out). Huard did admit there was a
period of time during his career that when you getting your bell rung was simply a part of the
game and you were expected to play through it, but Huard now suggests, that was the old days,
the old ways (Huard, Toughing it Out). The attitude and awareness have since changed
dramatically since the start of his career in 1996.
In addition to return to play regulations as well as a shift in technique, further actions
have been taken by many different parties to attempt to minimize both the effects and regularity
of concussions. To bring about these changes, policy adjustments include rule changes and
improved technology. In the last three years, the NFL has instated a handful of changes to the
actual game of football to discourage plays that are likely to induce concussions.
Prior to the 2011 NFL season, the NFL committee and the teams voted to move kickoffs
from the 30-yard line up to the 35. According to Rich McKay, President of the Atlanta Falcons
and chairman of the NFLs competition committee, There was a 40 percent reduction in

concussions on that play [kickoffs] (Moving Kickoffs). Kickoffs are often regarded as the most
dangerous play in the game of football. The NFL moved the kickoff up five yards solely for
player safety (Moving Kickoffs). In fact, there have been discussions to completely eliminate
kickoffs from the game (Maske, NFL Pushes), the interference being that kickoffs arent
necessary to the overall function the game. With players running at such high speeds into
unprotected, exposed ball carriers, the biggest, most damaging hits often ensue during the
kickoff. In addition to the new kickoff rule, referees and the rulebook now are very strict and
active on penalizing players for targeting, or intentionally aiming to hit an exposed opposing
player in the head. In fact, the NFL has gone as far as to suspend players for unnecessary hard
hits. Along the same lines as targeting, the NFL also made spearing illegal. Players are now
penalized for leading with their helmets and hitting opposing players. These rule changes all aim
to eliminate and discourage the big hit where players truly cant defend themselves (Maske,
NFL Pushes).
In addition to rule changes, there have been many technological advances in equipment
and helmets to increase player safety. Many equipment companies aim to tackle the concussion
problem by creating new helmets with better, more efficient padding inside the helmet.
Essentially, the new padding within the helmet softens the harshness and suddenness of the blow,
slowing down the linear speed of the head; similar to use of airbags in cars. Helmets with more
extensive padding are intended to limit concussions involving linear acceleration. However,
over 96% of concussions involve rotational acceleration, something that these helmets fail to
protect against (Johnson, Kinetic Response). Roger Johnson, a Seattle area resident and a
founding member of Eidon LLC, supports the idea that rotational acceleration is the real issue
causing concussions. Johnson and Eidon LLC are currently patent pending for a Kinetic

Response Safety Device, a helmet that uses kinetic energy to create acceleration of small
masses along curved paths within the helmet (Johnson, Kinetic Patent) that react and counter
the rotational acceleration of the head caused by a hit, resulting in a softened blow. Johnson
compared the motion of the brain inside the skull to the movements of the snow in a snow
globe. When dragged across a table in a straight line, the particles inside the snow globe hardly
move. However, a simple twist sends the particles flying. Johnsons helmet, using kinetic
response technology, eliminates the suddenness and magnitude of the rotation, or in simpler
terms reduces the potential for the motion of the brain within the skull. Although Johnsons
Kinetic Response technology is the only one of its kind, other types of technology are being
created and developed to reduce the prevalence and severity of concussions.
Concurrent with developing technology, changes and improvement of playing techniques
can greatly reduce the number of concussions sustained during the game. Rob Scheidegger
explains that, There are ways we can teach technique that can reduce head injury risk. As an
example, offensive linemen who use their hands instead of their face to block defensive
linemancan reduce the head impact of the individual (Scheidegger, Culture of). Likewise,
players are now being taught from young ages to lead tackles with their shoulder pads, rather
than their helmet. The number of head impacts will greatly reduce as athletes begin to
implement these types of techniques. As head impacts decline, so will the occurrences of
traumatic brain injury.
Throughout the previous century, the culture of sport and the ethical decisions made by
the NFL have created both long lasting and wide spread consequences. Traumatic brain injury
holds a prominent stake in athletics of all levels, in part due to the desire of spectators to witness
bone crushing hits as well the desire of players to accentuate Roosevelts idea of a manly athlete.

This culture stemming from football combined with the NFLs capitalist business structure,
demonstrates their questionable willingness to maximize profits in every possible facet of the
game. However, the improvements made in health research, shifts in the culture of athletics and
the creation of new regulations has spurred an enhancement for player safety and in turn, an
improvements of the NFLs public image. With innovations in safety equipment, and a more
proactive direction of CTE research, what has previously been an uphill battle attempting to
cover up the flaws of the brutal game of football, can now become progress. Although there has
been considerable headway made in the prevention of traumatic brain injury, the results wont
truly be seen until more time has passed and the outcomes of these programs can be assessed.
The success ultimately cannot be measured until the current generation of athletes continue to
participate in athletics and it becomes possible to examine the tolls that sports have taken on their
bodies.