Grant Cohn: Concussions and the dizzying array of misinformation
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.