Here is the presentation that accompanied the lecture on concussions.

1. Critical Issues in Sports
JRN 589
Concussions
Prof. Hanley

2. Concussions
• Concussions have been a part of
football since the 19th century
and hockey since the early 20th
century.
• And doctors have documented
concussions and issued warnings
about head injuries beginning in
the late 19th century.

3. Concussions
• Yet is has been only since 1994
when the NFL formed the Mild
Traumatic Brain Injury
Committee to “investigate the
cause of concussions, evaluate
equipment (particularly
helmets), and recommend
methods for prevention” that
concussions began to be taken
seriously. (Note how NFL used
the word “mild” in the name)

4. Concussions
• In 19th century college football,
medical records and descriptions
of players suffering concussions
are many.

5. Concussions
• “There have been frequent
instances of men playing
subconsciously to the end of the
game and not being able
afterward to recall a single
circumstance of it.

6. Concussions
• “There are still others who tell of
games in which they did not
even see anything, so far as they
can remember, but that is
usually after a blow to the
head,” read one account.

7. Concussions
• Take this passage from the book
Andy at Yale, written for boys:

8. Concussions
• “It was the signal for Andy to
take the ball through right tackle
and guard. He received the
pigskin and with lowered head
and hunched shoulders shot
forward.

9. Concussions
• “He saw a hole torn in the
varsity line for him and leaped
through it. The opening was a
good one, and the coach raved
at the fatal softness of the first-
team players. Andy saw his
chance and sprinted forward.

10. Concussions
• But the next instant, after
covering a few yards, he was
fiercely tackled by Mortimer,
who threw him heavily. He fell
on Andy, and the breath seemed
to leave our hero. His eyes saw
black, and there was a ringing in
his ears as of many bells.” (Italics
added)

11. Concussions
• In May 1896, the founder of
American football Walter Camp
asked a physician to comment
on the possible concussions, or
accidents to the “nervous
system” suffered by football
players.

12. Concussions
• The doctor, Morton Prince,
reported that the force of two
men colliding exceeded that of
passengers in train accidents.

13. Concussions
• Football Days, written by
Princetonian William Hanford
Edwards in 1916, revisited the
game as it was played at the
turn of the century.
• It included images of the
violence, such as the one on the
next slide that shows a
Princeton star named Hillebrand
on the field, unconscious, in
1900.

14. Concussions
• At 22 institutions studied in the
late 1920s, football caused an
inordinate number of injuries.
At one school, almost 75
percent of the players were
injured in all.

15. Concussions
• During the same period, a study
of 376 former football players
revealed that 44.1 percent had
suffered concussions.
• Another study found that up to
30 percent of all players on any
given team had suffered
concussions.

16. Concussions
• “The possible seriousness of
concussion is attested by the
fact that nearly one-half of the
team physicians … have
observed that concussion, once
suffered severely, tends to recur
more easily,” the report noted.

17. Concussions
• Overall, at least 25 percent of all
football players suffered a
serious injury during the course
of a season.

18. Concussions
• During the period between 1872
and the 1940s, physicians
documented cases of severe
head trauma that led to what
they described as ”moral
delinquency,” according to
medical historian Stephen
Casper quoted in a February
2023 New Yorker article.

19. Concussions
• “The scientific literature has
been pointing basically in the
same direction since the 1890s,”
Casper said in the article. “Every
generation has been doing more
or less the same kind of studies,
and every generation has been
finding the same kinds of
effects.”

20. Concussions
• Despite the cumulative medical
knowledge of what was once
known as “punch drunk”
syndrome in boxing, and, more
formally, chronic traumatic
encephalopathy (CTE), football
continued to be played without
warnings of potential head
injuries.

21. Concussions
• Fast forward to the
contemporary game in both the
NFL and college.

22. Concussions
• According to the NFL, up to 68
percent of NFL players may be
injured in a season.
• That leads to “consequences
from an increased risk for more
serious injury and pain,”
reported by researcher Dr. Linda
Cottler.

23. Concussions
• The Cottler survey of 644
players who retired before 2009
showed:
- Only 13 percent reported current
excellent health compared to 88
percent with excellent health at
the time they signed their first
NFL contract.

24. Concussions
• Some 93 percent reported pain,
with 81 percent describing pain
as moderate to severe.
• - That’s three times the rate in
the general population.

25. Concussions
• Knee injuries were the most
reported NFL injuries, followed
by shoulder and back injuries.
• Nearly half (47 percent) had 3
or more NFL injuries.

26. Concussions
• Nearly half (49 percent)
reported diagnosed
concussions.
• 81 percent reported
undiagnosed concussions.
• The average number of reported
concussions of either type was
9, Cottler found.

27. Concussions
• Nothing concerned football
administrators, coaches and
players more than head injuries
because of the potential for
long-term consequences,
including the risk for dementia
and early death, a fact that
football helmet manufacturers
point out on their products.

28. Concussions
• Zach Langston (No. 39) was a
star player at Pittsburg State in
Kansas, a Division II power that
has won four national
championships.
• Langston’s family estimates he
suffered some 100 concussions
in middle and high school and in
college.

29. Concussions
• In February 2014, Langston
committed suicide at the age of
26 after periods of depression,
rage and anxiety.
• His mother, Nicki, sent his brain
to Boston University to see if he
had chronic traumatic
encephalopathy (CTE). He did.

30. Concussions
• CTE is a “progressive
degenerative disease of the
brain found in athletes (and
others) with a history of
repetitive brain trauma,
including symptomatic
concussions as well as
asymptomatic subconcussive
hits to the head,” according to
the Center for the Study of
Chronic Traumatic
Encephalopathy.

31. Concussions
• The center, at Boston University,
examines the brains of deceased
players who either willed their
brains or whose families agreed
to have the organs examined.

32. Concussions
• Some 99 percent of the brains of
former NFL players had CTE, the
center announced in July 2017.
• For college players, the percentage
was 91 percent.
• Some 21 percent of the brains of
high school players studied had
CTE.

33. Concussions
• In November 2017, center
director and neuropathologist
Ann McKee said that an
examination of the late Aaron
Hernandez’s brain showed the
most extensive CTE damage of
anyone ever studied under 40.
• Hernandez played at Florida and
for the New England Patriots.

34. Concussions
• He was convicted of murder and
late committed suicide in 2017
while serving his sentence.

35. Concussions
• Washington State quarterback
Tyler Hilinski took his own life in
2017 at the age of 21.
• “After reviewing the tissue, we
can confirm that he had the
pathology of chronic traumatic
encephalopathy (CTE),” the
Mayo Clinic reported.

36. Concussions
• The stories of football players
dying before their time persist.
• There’s the group of a dozen
USC linebackers from 1989. Five
died before they turned 50.
Alcoholism, suicides, diabetes.
Each exhibited evidence of brain
pathologies before they died.

37. Concussions
• Alana Gee, the widow of USC
linebacker Matt Gee, sued the
NCAA for $55 million in
Calif0rnia state court, asserting
the organization did not
adequately protect Gee from
concussions.
• In November 2022, a jury ruled
against her claims.

38. Concussions
• Gee played for USC from 1988-
1992. He died in 2018 after a
heart attack triggered by
hypertension and cocaine and
alcohol toxicity. Alana Gee
contended that the substance
abuse stemmed from CTE.
• Tests at BU concluded that he
suffered from CTE.

39. Concussions
• The Gee case was the first CTE
case against the NCAA to reach
a jury.
• In 2016, the NCAA settled a
class-action lawsuit. It agreed to
pay $70 million over 50 years to
monitor former college athletes’
medical conditions and $5
million toward medical research.

40. Concussions
• The kinetic force of modern
players who are much larger and
faster than players from the
1960s and earlier plays a role,
but the evidence suggests the
constant hits to the head
accumulate and trigger the
onset of CTE, dementia and
other brain disorders.

41. Concussions
• Studies show that all players are
potential victims of CTE, but
some positions tend to be more
dangerous than others.

42. Concussions
• The positions most susceptible
to brain trauma and, hence, the
onset of CTE in players, are:
- Defensive backs
- Kicking team
(kickoffs)
- Running backs
- Linebackers

43. Concussions
• The NFL first responded to
increasing scrutiny of
concussions in 1994 and
stepped-up research in 1996.
• Since then, the league has
changed rules and funded
research into helmet technology
and tackling techniques to
dampen criticism.

44. Concussions
• The NFL moved kickoffs to the
35-yard line to make touchbacks
more likely.
• The league also barred players
with concussion symptoms from
returning to the game and left
the decision for that in the
hands of independent
neurologists.

45. Concussions
• The NFL is also enforcing hits to
the heads of quarterbacks and
to what it describes as
defenseless receivers.
• College, meanwhile, is enforcing
targeting rules designed to
eliminate the helmet from
tackling and blocking.

46. Concussions
• Helmet size, meanwhile, has
evolved over the past 50 years,
with each iteration designed to
protect the head from trauma.
• More innovation is expected in
this area as the NFL increases
funding for research and
development.

47. Concussions
• After years of denial, the NFL
acknowledged a measure of
responsibility for the long-term
effects of head trauma on
players.
• It settled a lawsuit filed by
thousands of players for what
eventually reached more than
$1 billion in 2015.

48. Concussions
• As of March 27, 2023, 20,571
retired NFL players and 3,638
representative (authorized
people representing deceased
or incapacitated players) have
registered for a settlement.
• Maximum benefit: $5,000,000.

49. Concussions
• The NFL has distributed
$1,126,677,807 as of March
27, 2023.

50. Concussions
• Two European scholars sees
a reconfiguration of the
concept of masculinity
already in play among NFL
players.
• In a recent paper, Eric
Anderson and Edward M.
Kian argue that:

51. Concussions
• “ … the devastating effects of
concussions, in the form of
chronic traumatic
encephalopathy, combined with
a softening of American
masculinity is beginning to
permit some prominent players
to distance themselves from the
self-sacrifice component of
sporting masculinity.”

52. Concussions
• But whether the nation and
players back away from the
game is unlikely.
• Casper said in The New Yorker
that the game can never be
“neurologically viable” but
despite that, the sport “is too
woven into the fabric of
American culture at this point to
talk about something like
banning it.”

53. Concussions
• The NFL reported in February
2023 that concussions rose
dramatically during the 2022
regular season.
• According to the league, there
were 149 concussions suffered
over 271 games this season, an
18% jump from 2021 (126) and
14% higher than the three-year
average (130) between 2018 and
2020.