How to ruin your brain

Heinz Field, Pittsburgh. It’s the fourth quarter of a football game between the Pittsburgh Steelers and the Cleveland Browns – a 60-year old rivalry, renowned for close-fought, lavishly violent matches. This one has been particularly gruesome. Two Browns players have left the game after suffering concussions. Ben Roethlisberger, the Steelers’ star quarterback, was carted off the field in the second quarter after having his left leg caught awkwardly beneath him in a tackle. It looked like a broken ankle. But, to everyone’s surprise, Roethlisberger returned to the game after half-time: leg bandaged, limping visibly, obviously in enormous pain. This level of toughness endears a player to the fans.

Now, with six minutes left in the game, the Browns have the ball. They are down 7-3, but have driven into Pittsburgh territory. Colt McCoy, Cleveland’s quarterback, drops back to pass, but pressure from a Pittsburgh defender forces him to run towards the left sideline. He tosses the ball to his running back – a short, easy completion – and an instant later James Harrison, the Steelers’ 260-pound linebacker, flattens McCoy with a vicious, crushing helmet-to-helmet hit that leaves McCoy writhing on the ground to the appreciative roar of 65,000 fans.

McCoy says he has no recollection of this, or of the rest of the game. Here is what happened: McCoy left the game, and was examined by team medics on the sideline. The TV cameras showed them adjusting McCoy’s left hand, apparently re-aligning a dislocated finger. Within minutes, they cleared him to return. McCoy was visibly disoriented and utterly ineffective throughout the remainder of the game, throwing an interception to seal the Browns’ loss. On Friday Pat Shurmer, the coach for the Browns, admitted McCoy had symptoms of a concussion, but said that they were only apparent after the game.

I played football in high school, and rugby throughout my teens and early twenties. The attitude towards concussions was always casual.  A player would take a hit to the head and “get his bell rung”  – he would be briefly inspected on the sidelines, by a coach or trainer rather than a doctor, and, if he could recite his phone number backwards or was an important player in a close game, he would usually be sent back in.

A concussion does not physically prevent you from playing the way that a broken arm or sprained knee does. It doesn’t leave you with a conspicuous limp or an open wound. It doesn’t necessarily hurt: on the few occasions that I’ve “got my bell rung”, it has actually been mildly exhilarating. But it has become evident that the effects of repeated concussions can be far more serious than sprained joints or broken limbs.

When I was in 11th grade, our football team traveled down to California to play a game against Costa Mesa, a high school in Los Angeles. This was in 2001, just two weeks after the attack on the World Trade Centre. I don’t remember much about the game, but I do remember hearing later on that a 17-year old player from Costa Mesa had suffered a fatal brain injury during a game the week following ours. This type of catastrophe is rare, but concussions have other serious, far more common, consequences.

On the NFL network, former players Heath Evans and Rodney Harrison discuss the decision to put McCoy back in the game. Both condemn it. Rodney Harrison, who played in the league for 15 years, is particularly passionate:

During my career, I suffered 15-20 concussions, at least… I knew how to fool the doctors. I’d look at a doctor, tap him on the butt and go ‘put me back in, I wanna win.’ I’m gonna tell you this, Heath – sensitivity to light, nausea, getting dizzy when I’m playing and spending time with my kids – this is what players like myself, and other players like you…  once we’re in our 40s and our 50s, we’re gonna start feeling the effects of these concussions and all these helmet-to-helmet hits.

Harrison is probably alluding to chronic traumatic encephalopathy (CTE), a disease caused by repeated blows to the head. CTE tends to manifest itself later in life, and causes a variety of horrible symptoms: those affected become confused, and undergo sudden changes in their personality; they suffer mood swings and dementia; not surprisingly, they also tend to become suicidally depressed.  CTE can be diagnosed only posthumously, by dissecting the brain. Affected brains are atrophied and, like the brains of Alzheimer’s sufferers, clogged with microscopic brown tangles of ‘tau’ proteins.

Because few athletes donate their brains for dissection after death, is difficult to know how prevalent the disease is. But the early indications are chilling. Ann McKee, a leading CTE researcher, has thus far examined 15 brains of ex-NFL players. 14 of them had the microscopic clumps of protein that characterize CTE. Of the four professional hockey players screened for CTE, all showed symptoms of the disease, including Derek Boogard, a 28-year old enforcer who committed suicide earlier this year.

McKee’s research group also found signs of CTE in the brain of Owen Thomas, a 21-year old football player who committed suicide in 2010. This is worrying not only because of Thomas’s youth, but also because he was never in his life diagnosed with a concussion. It suggests that repeated ‘subconcussive’ brain trauma may be enough to cause serious neurological degeneration early in life.

Over 250 athletes have now pledged to donate their brains for research. This will help to establish the true prevalence of CTE: since many of the athletes screened thus far died by suicide, they almost certainly do not constitute a representative sample.

Some – such as National Hockey League commissioner Gary Betman – will wait for more results before substantially changing league policy on hits to the head. To the extent that the appeal of sports like hockey, rugby and football lies partly in their spectacular violence, it is easy to see why some of those involved are unwilling to follow the precautionary principle.

The NFL, for its part, has instituted a rule that players diagnosed with concussions must be removed from play and cleared by an independent doctor before being allowed to return. It has also made head-to-head hits on defenseless players illegal, but the transition is clearly a difficult one. Until very recently, hits like Harrison’s on McCoy were openly celebrated by players, coaches and announcers alike.

Regarding McCoy, Shurmur insists that all the proper protocol were followed before he was cleared to return to the game. Yet it is now apparent that McCoy did, in fact, suffer a concussion on Thursday evening. This shows very clearly that either the protocol in place are inadequate, or they are not being followed stringently enough.

McCoy’s father is also skeptical:

There were a lot of easy symptoms that should’ve told them he had a concussion. He was nauseated and he didn’t know who he was. From what I could see, they didn’t test him for a concussion on the sidelines. They looked at his hand… If he took another blow to the head, we could’ve been talking about his career here.

But in light of the emerging data on CTE, one has to wonder: are players’ professional careers really all that is at stake?


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