A occassional contributor to The Concussion Blog, Matt Chaney, a journalist, editor, teacher and publisher, also has a blog. However, Chaney has published a book titled Spiral of Denial; Muscle Doping in American Football, so he is not new to finding and presenting good information.
Sideline concussed juveniles for three months, says breakthrough neuropath NP testing, lacks validation and might be harmful, critics charge NFL players rebuke ‘safer’ football through their ‘behavior modification’
By Matt Chaney
Posted Friday, January 28, 2011
So-called concussion awareness is said to be sweeping American football, and Scott Fujita, veteran NFL linebacker, agrees to a point.
Yes, Fujita confirms, even hard dudes like him have sobered in their perspective. Head injuries are no longer considered trivial in football but as serious business, and NFL players get it, especially
Fujita, nearing 32 years old at arguably the game’s most violent position for Cleveland.
In his mind the most menacing guys don’t appear so tough anymore, just more human, fragile—even as he targets one to smash on the field.
“I gotta be honest, I think about that every time I go in now to tackle somebody,” Fujita, 6-foot-5 and 250 pounds, said this week in a phone interview. “I’m concerned for my own safety as well as
theirs. I’m a married guy, I’ve got two young kids, and I see a lot more the big picture than I ever did before.”
But has anything changed about danger in tackle football, the game that kills and maims? Is so-called safer play really taking over?
Fujita, member of the players union executive committee, doesn’t equivocate in answering, typical of his trademark frankness. “Do I feel safer with the emphasis on the rules and all that kind of stuff?
No, that doesn’t make me feel safer,” Fujita said. “Do I think the emphasis makes the game safer? No. Overall, I don’t, know.”
The entire article is VERY comprehensive and has some intriguing interviews, below are more excerpts;
Dr. Bennet I. Omalu, the pioneering sport-forensic pathologist who first linked brain damage to tackle football nine years ago, warns that players are dangerously mishandled still—despite official claims this season of “safer” play through rule changes and “concussion management” for the injured.
“That is the name of the game,” Omalu said of the rhetoric, calling it a “corruption at various levels” in information and science designed to deflect damning evidence amid crisis for football.
The official goal, Omalu charges, is not to protect life but to sustain football as pervasive in culture, sanctioned by American government, education, medicine, media and even religion, with elements of each profiting from the violent activity.
Omalu maintains that every concussed football player needs isolation from physical and mental stimulation followed by lengthy rest, further shielding—as he testified one year ago for the House Judiciary Committee. “Two weeks is insufficient time for the recovery of (cerebral) membrane and micro-skeletal injuries caused by concussions. The absence of symptoms does not mean that the brain has healed,” Omalu, chief medical examiner of San Joaquin County, Calif., told congressional members on Feb. 1, 2010.
“I recommend that if a child sustains a concussion in football, that child should be kept out of play for at least three months, or for the entire season to lower the risk of developing any degree of irreversible brain damage.”
Omalu’s public call went unheeded, but a rest mandate would’ve prevented at least one death of a teen player this season. In a recent phone interview, Omalu alleged that rampant, serious brain trauma continues to be disregarded at all levels of football, with injured players fast-tracked back to contact.
“What you do is remove the person from all types of stimulation,” Omalu stressed for diagnosed concussion, especially casualties of football. “You remove him (the athlete) from play. You remove him from school. You remove him from all types of intellectual stimulation.” Omalu is particularly alarmed about concussed juveniles, for the predominant attitude to quickly return kids to football, despite evidence suggesting young brains to be most vulnerable.
Efficacy of NP Testing –
Today’s general view that concussion management works or can work in tackle football is rendered highly suspect, if not effectively discredited, by independent review and mounting adverse opinion of experts and witnesses like players.
Linebacker Fujita notes he hasn’t been measured on neural baseline for two NFL seasons. Might not matter, anyway, for computerized NP testing has taken a systematic beating by reviewers of late. Observations and findings of medical literature from 2005 to 2010, listed without full author groups or first names, include:
- *Randolph et al, 2005, for Journal of Athletic Training
- *Patel et al, 2005, for Sports Medicine
- *Mayers, 2008, for Archives of Neurology
- *Duff, 2009, for ASHA Leader
- *Echemendia et al, 2009, for British Journal of Sports Medicine
- *Covassin et al, 2009, for Journal of Athletic Training
- *Maerlender et al, 2010, for The Clinical Neuropsychologist
- *Piland et al, 2010, for Journal of Athletic Training
- *Schatz, 2010, for American Journal of Sports Medicine
- *Comper et al, 2010, for Brain Injury
- *Eckner et al, 2010, for Current Sports Medicine Reports
Respected researcher and athletic trainer Kevin Guskiewicz stands firm in the Cantu camp, whose members today align with the NFL and football at-large, preaching that “concussion awareness” and “behavior modification” can save the game in largely present form, tens of thousand programs youth to adult.
“I think we’re headed in the right direction,” said Guskiewicz, PhD and chair of the Department of Exercise and Sport Science at the University of North Carolina. Last year he was appointed to concussion committees for the NFL, NFLPA and NCAA.
In recent past, colleagues Guskiewicz and Cantu criticized the NFL and union for foolishly challenging evidence linking the game to long-term cognitive impairment in retired players. But now Guskiewicz and Cantu are on-board with the NFL, avowing faith in new research, concussion management and rules enforcement while also receiving funding from “The League.”
The Cantu camp believes that lofty change and awareness for head injury can reform pro football and “trickle down” through the sport’s vast outback, thousands of cash-strapped colleges, schools and youth leagues.
But they affirm a daunting problem cited by critics: The education and adherence on part of millions of people, beginning with child athletes, for building the theoretical wall of concussion prevention and treatment within prevailing economic and political forces of inherently brutal football.
Guskiewicz is confident though. “We’ve come a long way in the last five years,” he said during a recent phone interview, speaking of protocols for diagnostic and return-to-play decisions. “We have validated neurocognitive testing, we have validated balance or postural stability testing,” he countered for doubters.
“I think the hardest part has been trying to convince the users (of tools), the clients, meaning all the high schools out there, colleges, even the pro teams,” Guskiewicz continued. “I mean, at NFL level, they’ve only over the last two years mandated (ImPACT or like NP) testing for all their football players. And they’ve put into place and standardized, to some extent, return-to-play protocols and having independent neurologists be part of the evaluation process.”
Fujita II –
In fact, Fujita says he’s only been NP-tested a few times during nine years in the NFL. Despite all the talk by management and associate experts, swearing newfound vigilance and concern over brain health in players, Fujita hasn’t seen tangible effect.
His neurological baseline wasn’t re-assessed this season, as concussions exploded into the biggest controversy for American football in more than a century. Fujita even played on the infamous October Sunday at Pittsburgh, Browns versus Steelers, when three shocking headshots leveled guys within minutes.
Had Fujita suffered a concussion this season—or been diagnosed—the NFL would’ve been without proper neural data to gauge his condition. “I took one (a baseline) probably, maybe three years ago?” he said, considering. “Maybe two years ago was the last time, down in New Orleans.”
“Yeah, I think it’s been at least two years,” the linebacker determined. “And there have been a whole lot of train wrecks in two years.”
“I’m not saying that doctors or researchers are acting unethically. But this is an area where such conflicts could potentially arise, and so vigilance is required, as well as attention to issues of research and medical ethics.”
Epidemiologist Charles E. Yesalis works outside concussion management in football, but the independent scientist sees analogy in his expertise of drug use by athletes, specifically the in-house setup of research for ineffective anti-doping—or “prevention” testing in that issue. “That’s something that’s really kept me in the drug research, because the politics are so interesting, to see how (the issue) plays out in the cultural aspects and so forth,” Yesalis said in a phone interview.
And head injury is bigger than doping, Yesalis says, with higher stakes for tackle football because smoking-gun evidence links long-term problems of former players. In response, the NFL and all of football must claim remedy is possible—or concede nothing can be done.
“The intricate part of the culture of the game, violence, isn’t going away anytime soon,” Yesalis said. “It’s very obvious why the NFL is concerned about this. I think that’s why they’re dumping money on this, and this academic show. … This is going to eclipse the drug problem, and it probably already has.”
Like anti-doping in sport, invalid and woefully funded, Yesalis believes some experts are in too-deep with American football, ethically and legally, for their promising to police head injury with tools lacking proper vetting. Funding is paltry, regardless of a few million thrown around by billion-dollar profiteers.
Neuropsychological tests both written and computerized are good in theory but far from proven for sound specificity and sensitivity, only possible through peer review and replication in the realm of long-term, random clinical trial.
Omalu II –
Narrowing to medical analysis, making a base comparison easy for Football America, Omalu discusses and teaches the volatility of head trauma capable of combusting upon further pounding into lasting damage.
“The brain is a post-mitotic organ. It means the brain cells do not have the ability to divide and create new cells. … A very good example I always give people: When you suffer a stroke, your stroke cannot be cured (at cellular level). Once you’ve suffered a stroke, it is permanent. Even if you die 50 years later and we examine your brain, we see the stroke. It creates a space in your brain.”
“Same applies to concussions. A concussion is simply fracture. You know how you break your bone? That is what a concussion is, but now it is on the cellular level. A concussion is a fracture of the skeleton of the brain cells. If you fracture your bone, the NFL will keep you out of play for the entire season. They say it is a season-ending injury. But the bone has the ability to divide, and create new bone, and heal. A fracture can become healed, OK?”
“But—a fracture of the brain, which is a concussion, does not have the ability to heal as well as the bone. The bone is more resilient, but somebody fractures his bone you keep him out of play for three months. But if somebody fractures his brain? You keep him out of play for only two weeks? Does that make sense even if you’re not a doctor?”
Does for Dr. Cantu in many cases. He says he’s secure in knowing most concussed players return to football rapidly, and he does not endorse mandated lengthy rest in every case regardless of severity. “We don’t have the evidence to say that should be the case for all players, no. Those who clear very, very quickly—symptoms are over in less than an hour, or less than a day—I think can safely go back a week after they’re asymptomatic.”
“But it’s true: There are a lot of questions still to answer,” Cantu added. “There are real issues with regard to taking on this trauma quite young in life. But I don’t think we quite know enough about what the risks are.”
Needless to say this is a good article to read and reflect on. Work like this needs to be highlighted and not kept from public consumption. Knowing about the issues, both good and bad, is what is needed to resolve issues and “norm” the situation and move into better performance.