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Grant Cohn: Concussions and the dizzying array of misinformation

Do repetitive blows make football too dangerous to play? A renonwned neuropsychologist and concussion specialist weighs in.|

NFL CONCUSSION PROTOCOL

Steps all NFL teams must follow when a player show signs of a head injury:

1. Player must be removed from game and evaluated by club medical personnel with results compared to the player's baseline assessment.

2. An unaffiliated neurotrauma consultant will work on the sideline with club medical personnel to implement concussion evaluation procedures.

3. A spotter in the press box with access to multiple replay views will help in the recognition of injury.

4. A player determined to have a concussion must be removed from the field and observed in the locker room by qualifying medical personnel.

5. A player can return to the field when his cognitive and balance functions are observed to have return to his baseline status.

Source: National Football League

For more on the San Francisco 49ers, see Grant Cohn's "Inside the 49ers" blog.

The justifiable concern about brain damage in football borders on hysteria. This is especially true after Chris Borland recently announced his retirement after just one season in the NFL. He was worried about brain damage. Now people want to know if football is too dangerous to play, if it could become a dying sport.

To find out some basic facts about brain damage and sports, I called Board Certified Neuropsychologist Elizabeth Pieroth. She is the associate director of the Northshore University HealthSystem Sports Concussions Program in Chicago, and she is on the board of directors for the Brain Injury Association of Illinois. She has been managing concussions for the Chicago Bears for 12 years, working with the Chicago Blackhawks for 15 years, and she works for the Chicago White Sox and Chicago Fire.

Dr. Pieroth argues for caution in rushing to extreme conclusions about concussions in sports, including football. You may be skeptical about what she has to say because she works for teams, but they don’t pay her - she volunteers. She is not beholden to them. She is a pure scientist interested in pursuing the truth. And she has something to say about the scientific data.

Before we get into her philosophies, let’s define terms.

“We define a concussion as any blow of force to the head that causes mental status changes - confusion, disorientation, memory loss,” Dr. Pieroth recently said over the phone. “It does not have to include a loss of consciousness. In fact, research shows only about 9 or 10 percent of concussions result in a loss of consciousness.”

Are there different types of concussions?

“Yes. A linear concussion is when the head is moving forward, someone falling forward, falling back, two people bumping heads on a football field or soccer field.”

Picture a brain bouncing back and forth against the inside of a skull.

“A rotational concussion is when the head moves on an axis.”

Now picture a brain rolling around the inside of a skull.

“If you get hit in the side of the head by a soccer ball and your head turns to the right, it’s a rotational injury. There is some evidence that rotational injuries tend to be more severe, but it’s not that black and white. If somebody falls backward on concrete - that tends to be a more serious injury than taking a soccer ball to the side of the head.”

What Dr. Pieroth is saying may seem counterintuitive. Most of the time, it’s more dangerous for a football player to get hit in the earhole of his helmet than the front of the helmet. But not every player who takes a shot to the earhole will get concussed. And some people are more susceptible to concussions than others. Why?

“That may have to do with the strength of the neck or the size of the head, the ratio of the head to the body,” said Dr. Pieroth. “There are a lot of reasons why one person may have a concussion instead of another person, and it is not all physiological. Some people just are very aggressive in their style of play and tend to use their heads without much regard for their health.”

That describes most professional football players. On almost every snap we see offensive linemen and defensive linemen bonking heads, or linebackers and fullbacks crashing head-first. Those collisions are called “repetitive blows.” Some of those are mild concussions. The players see stars.

Do repetitive blows make football too dangerous to play?

“That is one of those things that is up for opinion,” said Dr. Pieroth. “I am not anti-football. I think some have been calling for the end of football. I think we need to be looking at how we make the game safer. Are there rule changes that can affect safety? Are there coaching techniques that can improve safety? Are there turf changes? Are there equipment changes? People want it to be one thing - just get better helmets. That is only one component of it.”

Let’s linger on that last component - better helmets. We’ve heard about new helmets that have sensors to measure the force of hits. Do the sensors help?

“Once they get the technology right, I think they will be really quite helpful,” Dr. Pieroth said. “The problem is that people oversimplify it. To your question about linear versus rotational injuries, a lot of these sensors simply measure linear hits. They don’t measure rotational hits. And there is no clear cutoff, like a 65-G hit means you have a concussion and a 40-G hit means you don’t, or whatever. We don’t have those clear cutoffs.”

If the sensors don’t work, what else can people do to make football safer?

“I don’t know; I don’t play football,” Dr. Pieroth said. “I’m a petite little woman. I will leave that to the experts about how to make the game safer. The point is we need to be having a discussion. We need to be saying, ‘Can we make this game safer?’ And I think that is what a lot of organizations are doing.

“I’m on the national advisory committee for USA Football’s Heads Up Program. There are numerous components to it, and that’s why I’m so supportive of it. One component is teaching kids to take their heads out of the tackle. As the helmets became better, bigger, stronger, more protective, people started using their head as part of the tackling process. And that’s what we need to change. We need to teach kids to tackle with their shoulder and to keep their head out of the way.

“Organizations that use Heads Up football training show a lower rate of injury. There are things we can do at all levels of play to keep football and all other sports safe.”

What was Dr. Pieroth’s reaction when Chris Borland announced he was retiring?

Dr. Pieroth didn’t answer right away. “My reaction whenever these stories come up is if somebody has gotten good information, then more power to them,” she said after much thought. “If Chris got solid information, accurate information, unbiased information and he decided ultimately that the sport was not for him, then good for him. I wish him well.

“But Chris made a comment about his life being shortened by 15 or 20 years. We have no evidence of that currently. I am concerned about what kind of information he got.”

Preliminary research is being portrayed as fact, Dr. Pieroth said. That concerns her. Just because research was published doesn’t mean it was good research. The hype has outpaced the science of concussions.

“Nobody says repetitive blows to the head are OK,” Dr. Pieroth said. “But we have to look at a lot of things, and there is a lot of research that has to be done, and we have a lot of work that needs to be sorted out.

“My hope is that any athlete and, if it’s a youth athlete, their parents, simply get accurate information. And that’s very challenging these days. It is very difficult for parents and athletes to wade through the sheer volume of information that is out there, and truthfully the misinformation.

“I see really good kids who are genuinely freaked out that they’re going to have some horrible outcome because they had one concussion. Where is this coming from? It comes from the media.”

“I get people all the time who say, ‘I will never let my kids play football. I’m going to take my kids off to play hockey or wrestling or soccer.’ It’s this false notion that these injuries don’t happen in other sports,” Dr. Pieroth said. “They do.”

My parents did not allow me to play tackle football growing up. I didn’t fight them. Looking back, I probably didn’t want to play. But I played soccer for 12 years, and coaches taught me and my teammates to head the ball when we were 6. We were expected to head the ball in practice and games.

If the soccer ball hit the right spot on my forehead I didn’t feel it. But if the ball didn’t hit the right spot, if the ball hit my forehead a little too high or a little too low, I saw stars.

“That’s exactly equivalent to helmet-to-helmet contact,” Dr. Pieroth said. “There is research that shows a typical header has 160 to 180 percent higher G-force than a typical tackle or a typical check in hockey.

“If I lined up a bunch of 9-year-olds in football equipment and I had them tackle each other and bang heads, you would have me arrested. But I’ll line up a bunch of 9-year-olds and throw a soccer ball at their heads, and that’s OK?

“We need to be looking at all of these sports, looking scientifically at how are people injured, and not making the assumption that one sport is safe and the other ones are dangerous.

“Parents are being shamed, for lack of a better word, for allowing their kids to play contact sports, and that is not fair. I have two sons and they both play hockey. My son is in fourth grade now, and our school starts football in fifth grade. My husband and I are letting him play.

“People ask me (if I will let my sons play football) all the time as if somehow my opinion is more valuable, and it is not. Every parent has a comfort level with risk, and that is incredibly personal. That’s something that nobody can say is right or wrong.

“Parents just need to make an informed decision. I know this research very well, and I think it’s OK for my kid to play football. However, if he is injured, if he gets a concussion, I will re-evaluate that.”

Grant Cohn writes sports columns and the “Inside the 49ers” blog for The Press Democrat’s website. You can reach him at grantcohn@gmail.com.

NFL CONCUSSION PROTOCOL

Steps all NFL teams must follow when a player show signs of a head injury:

1. Player must be removed from game and evaluated by club medical personnel with results compared to the player's baseline assessment.

2. An unaffiliated neurotrauma consultant will work on the sideline with club medical personnel to implement concussion evaluation procedures.

3. A spotter in the press box with access to multiple replay views will help in the recognition of injury.

4. A player determined to have a concussion must be removed from the field and observed in the locker room by qualifying medical personnel.

5. A player can return to the field when his cognitive and balance functions are observed to have return to his baseline status.

Source: National Football League

For more on the San Francisco 49ers, see Grant Cohn's "Inside the 49ers" blog.

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