At the same time as Chrebet was losing his own battle with the syndrome, Pellman and the NFL were still broadcasting the message that concussions were just transient events that didn’t produce any long-term effects. The NFL was now justifying its position with studies produced by Pellman’s Mild Traumatic Brain Injury Committee. By the beginning of 2005, seven of the committee’s studies had been published in the journal Neurosurgery. Those studies, based on head injury data collected from the NFL’s team physicians and analyzed by a group of researchers that included a neurologist and a neurosurgeon, argued that concussions were benign. The committee concluded that multiple concussions did not lead to long-term consequences and that it was safe to return certain players to the same game in which they were concussed. This flew in the face of all the accepted return-to-play concussion guidelines, of studies conducted by researchers unaffiliated with the NFL, and of the growing roster of pro players plagued by lingering symptoms.
That didn’t stop the committee from suggesting that its conclusions might well extend beyond the pros to college and high school players. “Under the right circumstances,” Pellman and his colleagues wrote in a 2005 study, “it might be safe for college/high school football players to be cleared to return to play on the same day as their injury. [We] suggest that, rather than blindly adhering to arbitrary, rigid guidelines, physicians keep an open mind to the possibility that the present analysis of professional football players may have relevance to college and high school players.”
• • •
The implications of that controversial assertion stretched far beyond the bounds of the NFL and the medical journal that published it. For years, its impact was felt in doctors’ offices around the country. Even if a physician was savvy enough to diagnose a concussion and progressive enough to prescribe rest as a treatment, some parent or child would invariably pull out the NFL’s 2005 study and use it as evidence that the doctor was being far too overprotective. “They say what I tell them about it not being safe to go back in the same game is totally wrong, and they’re backed by the NFL,” grumbled Dr. Gerard Malanga, director of the New Jersey Sports Medicine Institute and a team physician for several colleges and high schools. “So they go to a doctor that tells them what they want to hear. And we remain the guys holding our breath that the kid doesn’t get hurt again.”
College and high school players didn’t need the NFL’s studies to tell them how to view concussions. Long before the studies were published, these student-athletes were taking their cues from what they saw on TV.
The macho culture so evident in the NFL flowed freely down to all the Americans playing tackle football at every level—from the two thousand in the pros to the seventy-five thousand in colleges to the million and a half in secondary schools to the more than three million in organized youth leagues. Kids were looking to emulate not only the skills of their NFL heroes, but also the toughness of those role models. A seven-year-old on a peewee team was just as likely to feel he needed to push through pain and ignore the dizzying effects of a concussion as the NFL player he cheered from his living room.
Kids weaned on televised football were barraged with the message that most jolts to the head were benign. They grew up not only seeing their favorite stars bounce back from head-rattling hits, but also hearing broadcasters hype that part of the game as fun and exciting. Announcers would glorify the hit that left a player woozy: “Wow, he really got his bell rung on that one!” They would extol the courage of the player who shook it off: “What a warrior—nothing can stop this guy!” At the same time, they would play down any possible ramifications from a head injury: “Oh, it’s just a dinger.”
Small wonder researchers found that college and high school players didn’t connect dingers and bellringers with brain injury. In a study that surveyed eight college football programs from across the nation, an astounding 91 percent of players and coaches believed that concussions were different from dingers and bellringers. That ignorance helped explain another of the study’s findings: less than one-sixth of concussions sustained during the 2002 NCAA season were reported immediately after the injury, and fully two-thirds were never reported by players to either trainers or coaches.
The confusion over just what constituted a concussion led to widely varying estimates of the injury’s prevalence. Incidence rates reported in medical journals ranged from 15 percent to almost 50 percent of high school players surveyed. That wide spread could be explained by the way researchers asked players about head injuries: if they used the word “concussion,” the rate was low; if they simply listed concussion symptoms, the rate soared. The most eye-opening study surveyed high school players from two school districts, one in Pennsylvania and the other in Ohio, about head injury symptoms with no mention of the word “concussion.” It found that 47 percent of players had suffered at least one concussion during the 1996 season. Of the injured players, 74 percent said they’d sustained multiple concussions, with an average of more than three.
The studies based on confidential reports from players contrasted sharply with trainer surveys. Several studies that included information only from trainers found concussions in just 4 percent of high school players. That statistic clearly reflected the reluctance of players to own up to their concussions. When asked why they didn’t report concussions to trainers or coaches, players gave researchers enough reasons to fill a playbook: didn’t want to leave the game, didn’t want to let teammates down, didn’t want to appear weak or injury-prone to the coach, didn’t want to risk losing playing time or a starting position, didn’t realize it was a concussion, didn’t think it was serious enough to report.
Kids were often introduced to that play-through-pain mentality in youth leagues and then had it reinforced all through high school and college. The model for all those youth leagues was Pop Warner. From its 1929 inception at a time when the fledgling NFL was barely a footnote in a society obsessed with college and high school football, the Pop Warner program became the kicking-off point for millions of boys aged five to sixteen. Pop Warner football offered little kids the trappings of the pro ranks: big games and big pressure, miniature cheerleaders, national “Super Bowl” championships, rabid fans disguised as parents, coaches who fashioned their dictatorial style on the likes of Vince Lombardi and Pop Warner himself. The program was named for the famed coach who learned the game as a rugged lineman playing college ball for Walter Camp, the innovator universally known as “The Father of American Football.”
In the late nineteenth century, Camp transformed football from a sport that resembled English rugby into something every bit as uniquely American as baseball. The regimented structure he forged looked more like a clash between warring armies than a contest between competing athletic teams. The gridiron he laid out became a new male proving ground for collegians eager to demonstrate their toughness in hand-to-hand combat and their grit in the face of the casualties that inevitably resulted. It was a game as raw and rugged as the country that spawned it. Marauding bands of collegians would slam into each other, mauling, pushing, pulling, and tackling until the play ground to a halt in a heap of writhing, howling, gouging, kicking, and punching bodies. Watching that spectacle at a Harvard-Yale game, John L. Sullivan declared football more savage than the bare-knuckled fights he’d survived during his legendary reign as boxing’s first world heavyweight champion. “Football, there’s murder in that game,” Sullivan told an acquaintance. “Prizefighting doesn’t compare in roughness or danger with football. In the ring, you know what your opponent is trying to do, he’s right there in front of you, there’s only one of him. But in football, there are eleven guys trying to do you in!”
Nothing epitomized the brutality of the era better than Harvard’s infamous “flying wedge.” Two groups of Harvard players would race full-tilt diagonally from each sideline past the quarterback and then converge in a tight V-shaped wedge flying like an arrowhead toward the line of scrimmage, its tip aimed at a single defender to literally
mow him down under nearly a ton of massed momentum. Just as the wedge pierced the opposing team’s line, the quarterback would hand the ball off to the halfback, who would then tuck himself behind the wedge as it left defenders bruised, battered, and broken in its wake. The play proved so dominating that many other college teams promptly adopted it and adapted their own variations on it. The play was also so dangerous that it led to a spate of crippling injuries and even deaths.
Although the flying wedge was particularly brutal, it wasn’t the only source of football fatalities. Players were dying on the gridiron with alarming regularity. The deaths were mostly from head injuries like skull fractures and brain bleeds. With nothing to protect their heads in that age before helmets, players took to growing their hair unfashionably long in a futile attempt to provide some cushioning. The flimsy leather helmets that started popping up on a few heads here and there around the turn of the century afforded little more protection than the long hair.
As the death toll mounted, the public began to take notice. Clergymen denounced the sport’s brutality from their pulpits. Newspapers carried sensationalized accounts of bloodbaths, players screaming in pain, spectators shrieking in horror, and, of course, the deaths. Editorialists called for the abolition of football by act of Congress. State legislators introduced bills to outlaw the sport. College administrators responded to the carnage by canceling games that featured fierce rivalries like Harvard-Yale and Army-Navy in which passions pumped up the violence. A few colleges even suspended their football programs entirely. The abolitionist movement was gaining steam and threatening to kill the sport.
Things came to a head in 1905 during a particularly brutal season that left twenty-five players dead and more than six times as many seriously injured at all levels. A graphic newspaper photo—depicting Swarthmore’s star lineman staggering off the field after a merciless and deliberate beating, his face a bloody mess—caught the attention of President Theodore Roosevelt. A gridiron enthusiast who avidly rooted for his Harvard alma mater, Roosevelt was incensed. He embraced football as a metaphor for the rugged American spirit he energetically espoused, more so than his own college sport of boxing. “In life, as in a foot-ball game,” he had written, “the principle to follow is: Hit the line hard; don’t foul and don’t shirk, but hit the line hard!” He was proud that his eldest son, Ted Jr., was a plucky lineman on Harvard’s freshman team that season. “I am delighted to have you play football,” the president wrote his son in a letter. “I believe in rough, manly sports.”
Fired into action by the gruesome newspaper photo, Roosevelt summoned representatives from college football’s three biggest powers—Harvard, Yale, and Princeton—to the White House to address how to make the game safer. Although he believed that playing through pain built character, he was concerned about the rash of fatal head and neck injuries. Roosevelt, as vigorous a reformer as he was a sportsman, certainly didn’t want to abolish a rugged game he considered an integral link to the American identity, but he wasn’t shy about using his bully pulpit to save it. “I demand that football change its rules or be abolished,” he blustered. “Brutality and foul play should receive the same summary punishment given to a man who cheats at cards. Change the game or forsake it!” Over lunch at the White House, Roosevelt delivered a stern warning to the powerful football figures seated around his dining room table: the sport they all loved would surely be banished from campuses without urgent reform.
As a result of that summit meeting, colleges from across America established a national governing organization to regulate athletics and reform football. Over the next several years, the newly formed National Collegiate Athletic Association would revolutionize the way the game was played through rules designed to make it safer. By outlawing lethal flying wedge formations and legalizing the forward pass, the NCAA opened up the game and cut back on the mass maulings. The advent of aerial assaults and open-field running attacks modernized football into a spectacle more thrilling for spectators and safer for players. The fatality rate dropped, but a false sense of security arose regarding head injuries. The NCAA, becoming ironically indifferent to the very injury problem that necessitated its creation, would take another three decades to make helmets mandatory. With the lack of any standardized guideline leaving return-to-play decisions up to each college, concussions would become more and more of a problem. Only now there were no Theodore Roosevelts around to command reform.
For all the rules changes designed to improve safety over the intervening century, nothing could legislate away the macho mentality. Football became the sport that defined the way athletes viewed competition, toughness, and injury. Football would drive the way everyone thought of concussions. The attitude insidiously spread to every other sport. If concussions were going to be dismissed on the football field, they would be just as easily ignored on a basketball court or a hockey rink.
• • •
If any team sport could challenge football for sheer brutality and dangerous machismo, it was ice hockey. From its inception in Canada during the latter part of the nineteenth century at the same time as football was gaining a foothold in the United States, hockey offered its own brand of violence—high-flying collisions, head-rattling bodychecks, teeth-loosening fisticuffs—along with a play-through-pain mentality every bit as ingrained as football’s.
The model of hockey toughness was Eddie Shore, the dominating defenseman whose reckless and ruthless style popularized the sport in U.S. cities in the ’20s and ’30s. Shore was notorious for inflicting pain—a hated villain whose most vicious blindside hit drove scoring star Ace Bailey into the ice headfirst with a skull fracture that ended his career and almost his life. Taking as good as he gave, Shore was equally renowned for ignoring pain—a fierce warrior whose battle scars included the 978 stitches he took without local anesthesia and without missing a shift on the ice.
If hockey players were expected to stoically skate with freshly stitched lacerations on bloodstained ice, they were hardly likely to break stride for head injuries no one could see. Given this cultural dynamic permeating every level from the National Hockey League all the way down to the peewees, it isn’t surprising that hockey’s concussion history would mirror football’s.
With players wielding sharp elbows, skates, and sticks on an unforgiving sheet of ice enclosed by boards and tempered glass, catastrophic head injuries were virtually inevitable. After crashing headfirst into the sideboards during a 1950 Stanley Cup playoff game, a rising star named Gordie Howe needed a ninety-minute operation to relieve pressure on his brain, save his life, and send him back on his career path to rewriting the NHL record book and carving out his legend as Mr. Hockey. In a 1968 regular-season game, an obscure rookie named Bill Masterton was skating at full speed when he was bodychecked by a defender just after sliding the puck to a teammate; he bounced off another defender and flipped backward, slamming the back of his unprotected head on the ice with such impact that blood gushed from his nose and ears. He lingered a day on life support before massive brain bleeding made him the only player ever to die from an injury suffered in an NHL game. The NHL president, Clarence Campbell, characterized Masterton’s death as “a natural hazard of our business” and took pains to avert any public hand-wringing over the sport’s violent nature, deflecting calls to make helmets mandatory.
Still, the tragedy did spark a gradual change in attitudes toward protective headgear. Until then, helmets brought nothing but ridicule to the odd player brave enough to wear one amid taunts of “chicken” in a league where goaltenders were still exposing their bare faces to rising slapshots that exceeded a hundred miles an hour. By the time helmets were finally mandated for any player entering the NHL from 1979 onward, they had long been standard equipment at every other level of play. By the time the last bareheaded veteran retired from the NHL in 1997, their impact was clear. Although helmets no doubt reduced the number of catastrophic head injuries, they had a paradoxical effect of making players more fearless and making
concussions more commonplace.
On the rink as on the gridiron, the concussion problem grew in direct proportion to the size, strength, and speed of the players in the world’s fastest team sport. As the average NHL player sprouted to six foot two and 205 pounds, the laws of physics collided head-on with the realities of neuroscience. Blazing up the ice at breakneck speeds in excess of thirty miles an hour, strapping NHL players routinely collided with impacts significantly greater than their NFL counterparts experienced. Even peewee skaters were found to deliver hits packing the same force as college football players; the thirteen-year-old hockey players in one study sustained head impacts averaging about twenty times the force of gravity and sometimes approaching a hundred g’s.
By the mid-’90s, hockey’s concussion epidemic could no longer be ignored, even by fans who reveled in the sport’s violence. All they had to do was watch its devastating effects on Pat LaFontaine, one of the most electrifying stars in the NHL and the greatest American-born player of all time.
From the frozen ponds where he honed his sublime skills in the hockey hotbed of Michigan to the raucous NHL arenas where he showcased them, LaFontaine had always compensated for his small stature with finesse and explosive speed, fearlessly hurtling around the ice like a pinball. His deft stickhandling, playmaking, and shooting made him a perennial All-Star center, but that also made him a constant target of much brawnier opponents hell-bent on crushing him before he could outskate and outsmart them. It was only a matter of time before all the jarring hits—and the concussions that resulted from them—caught up with him.
The Concussion Crisis Page 7
