The National Football League is nine days away from the kickoff of its regular season. If social media, fantasy sports, and hype are any indication 2014 is set up to one of the most watched seasons in history. There are plenty of story lines abound: from each division, to playing time of newly drafted players, to veterans returning from injury, and of course concussions.
The league is doing its best to keep concussions from overriding the game itself, as they should be. Concussion is but just one of a myriad of injuries sustained in the sport; plus it is not unique to just American Football. However this issue continues to gain/keep traction because of the relatively late and “slow-footed” response to this topic. Even though the settlement with the players has been all but signed-sealed-delivered (there are some interesting issues posed by Patrick Hruby that are worth noting), the youth arm of the league is promoting and teaching a “safer” way of tackling, and the talking points about this injury are becoming more evident from players and the league; there still is a shroud of secrecy. In all the hand-wringing and court battles and public relations scuffles the leader of this glorious sport has yet to “rip the band-aid off” and assess the situation.
How can you assess the situation? I think it is rather simple: gather data to find out the “true” value of actual concussions sustained in the NFL over a season. Then and only then can you see if any changes brought forth are actually helping the cause.
Sure the league has its own data and is probably doing just that, but it is so far behind a curtain, tucked in a corner where light has no chance of hitting it. I have always thought we should be transparent on this issue; or at least have a truly (Pollyannaish) independent data collection group for it. At the very least an Ombudsman should be hawking this situation, for this is not going to go away over night. It won’t go away until we can definitively say ‘X’ is the way to play this game with ‘Y’ & ‘Z’ at the professional level; then each subsequent level below the pro ranks need to modify based upon age and development.
The NFL probably doesn’t want this responsibility for it comes with some liability, not only on the medical front but in the public relations department… SO WHAT! When I chose to have a child I didn’t have the choice to be a role model and change the way I played life in order to make sure my children grew up safe and learned a better way to live. The NFL is basically the “father figure” for the other levels of this great sport. I have heard a great saying, it was applied to business in general: “the tree rots from the top”. This is exactly the case in a family, in a business and in sport.
When the blog began in 2010 there was no way to find out how many concussions were occurring in the NFL without piecing together the Official Injury Report. So, for posterity sake I started to catalog all of the injuries for my own curiosity; lo and behold I had created my own data collection. But a few weeks into that season I noticed something; players that were said to have “their bell rung” or even reported as having a “head injury” in the TV coverage or print media following were not showing up on the injury reports. This was in 2010. That is when I refined the way I searched for concussions and had a database that was – at the time – unique to the interwebs. By the end of Week 7 in 2010 the data was getting massive attention from all sorts of different media outlets (still top 30 of most viewed pages on this site).
I have since collected not only player, team, week injured and position but helmets and if they were on special teams at the time of injury (so difficult). With all this information staring at me I could see things, but I didn’t know how to present them other than showing you the raw numbers. But, in 2012 I was approached to possibly publish what I have found, all I needed was someone smarter than I with statistics and someone to capture an angle on this issue from the “inside” to give our words/data context. That I did and we wrote a paper and subsequently it was rejected, almost out of hand.
Initially I was bitter – as most would be – but upon reflection of the reviewers submission (can be found at the end of post) it was clear that even if we were to “clean up” the writing style they were never going to get it. There is a massive difference between in vitro and in situ; when you try to write about real world data/collection and present to those that mostly deal with laboratory observation there will be conflict. Moreover, those that have not had extensive training/experience when dealing with actual human interaction and the subtleties of behavior cannot fathom how that affects this type of data, concussions.
Rather than change the entire narrative of what we came up with and resubmit to another journal we are going to publish it as a white paper here, on the Concussion Blog. It is with great pleasure I present to you (WAIT A SECOND… Read the paper then look at this post to answer most of the questions you may have before going nuts in comment section or twitter…), try again.
It is with great pleasure I present to you Trends In NFL Concussion Recording 2010-2012.
I will address some of the pertinent questions (also known as #hottakes) regarding this paper below. They will be basically question/answer format. I will keep them as brief as possible. As with about every piece of research you can glean what you want from the numbers, I understand that. I also know that simply throwing this information in the trash will do nothing for the advancement of the concussion cause. Finally, I want to unequivocally state that I love the sport of football, I want it to remain as an option for players of all ages (albeit with hitting modifications for younger players); the overall objective of this information is to bring to light data that may have been glossed over or never even broached before. This information can and should help the sport become more proactive with this injury. I cannot wait for the season to begin! Now on to the Q/A…
This is unofficial data, how do you know you captured all the data?
Simple answer is that I don’t know, but I do know that there are plenty of players included on the data that were never on the NFL Official Injury Report (NFLOIR) but were confirmed via other methods. Over the past few years it has become much easier to collect the data due to the great work of journalist and social media data miners (@nflconcussions).
Your numbers are only regular season, why?
Simple, preseason concussion reporting is unreliable, period. You will note the reasoning in the paper but to illustrate, in 2010 there were only 4 reported concussions in all media outlets, FOUR! This year, (as of 8/20/14) there were 50. Each season since beginning in 2010 has produced an increase in concussions in the preseason. As for postseason, read the paper.
Dustin, dude, this isn’t scientific… You realize this, right?
Certainly I do. The Journal of Athletic Training said so. As I mentioned above we feel that there is a conflict in how we are read and we feel the data was captured. THIS IS THE ONLY WAY POSSIBLE to collect this data (biggest objection of reviewers) outside of internal mechanisms from the league itself. Moreover it is our opinion (put on tin hats and I need a pair of asbestos underwear for this), the editor has benefited from NFL support and was even trained by someone we consider and NFL insider.
Do you know what else isn’t “scientific”:
- all the apps we use for assessment
- the educational material we disseminate
- “Heads Up Football”
- force sensors
- clinical evaluation/judgement
- legislation
- rule changes
- etc…
How can you include data that you see on TV, don’t you have to be there and actually assess the individual?
First, I cannot diagnose any injury, but if it walks like a duck and quacks like a duck often times it will not be an elephant. It takes training and education to understand the concussion paradigm; in short yes you can identify someone who’s brain is not properly functioning after a traumatic event. Although you cannot “diagnose” a concussion from a distance there are overt signs that would indicate inclusion for concussion after a traumatic incident. These are but not always limited to: being knocked unconscious and the Fencing Response. It is widely accepted that you do not have to have either sign to be concussed, but it should be known and accepted that if you produce either of those signs after a traumatic incident that, in fact, you have disrupted the brains normal activity. Thus, fitting the criteria for inclusion of concussion. This has been and will always be the case 100% of the time.
Fink’s Rule, now you are just making stuff up!
Perhaps, but it makes logical sense – to me, at least. Fink’s Rule was developed by the primary data collector, Dustin Fink, for a way to notify those interested in determining concussion as an indicator of potential forces great enough to disrupt normal brain activity. This “rule” was only applied one time in the data in 2011, since that time each instance where the rule could have been applied the athlete was classified as having a concussion.
Why again are you only including regular season numbers and even excluding Week 17?
This is the only time that injuries in the NFL are reported in a standardized manner. During preseason there is no mechanism for teams to formally – nor required – to publish an injury list. In fact, the NFLOIR produced by teams only have to include players that will have some degree of uncertainty playing in the next contest. In the post season, there is so much riding on the outcomes of games for the winning teams that often times reporting can get away from being as accurate as needed for data collection.
Data can also be missed during bye weeks as teams going into a bye are not required to furnish an injury report, this is especially an issue in Week 17 when over half the league will not play another game. The data during those periods of non-reporting is completely dependent upon journalistic reporting and team information on their own volition.
How are your numbers better than the leagues numbers?
We don’t know if they are, rather this is a data set we feel is as accurate as possible given the extreme limitations from afar. This data was never meant to be used as weapon against the players, teams or league. Rather, an independent analysis using what was available.
What is the number of concussions we might expect as a “true” value?
Given evidence based methods employed by the Ivy-league schools, it would not be surprising to see between 1 and 2 concussions per team per game.
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We thank you for the time you have taken to read the paper and the questions here on the blog. You can feel free to address this further in the comment section or on Twitter, the inbox is also open (you can see the JAT Reviewers Comments by clicking on the hotlink). Be forewarned that I do have a “real job” that keeps me rather busy and I will get to you as soon as possible.
We look forward to producing follow-up data that will include 2013, 2014 and beyond. Remember our conclusions;
The NFL and NFLPA should be commended for having made enormous strides in publicly communicating the serious nature of mild-traumatic brain injury in the past few years. Further, there has been a nearly uninterrupted stream of media coverage surrounding the topic. The number of concussions recorded by the NFL increased during the period of this study; however, it is unlikely this result is approaching the true value. In fact, it may not approach a stable level for many years.
‘None of us is as smart as all of us.’
The Concussion Blog 
Dustin,
Great job on as scientific an approach to the subject as you possibly could do, while addressing potential weaknesses in your data. But it is what it is. The NFL can no longer continue to downplay concussions as “getting your bell rung.”
As a biologist, scientist, environmental and traumatic brain injury consultant and survivor of 9 NFL caused emergency VP Shunt brain surgeries (and still don’t qualify for any NFL benefits), I feel I am as qualified as any to speak on the subject.
You nailed it brother. Keep up the good work.
Thank You
George Visger
The Visger Group – Traumatic Brain Injury
Thank you George… Your comments are very comforting and appreciated!
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Your bringing the often elusive concussion / brain injury issue to the forefront has great heuristic value, and is also socially significant. … as the collected information serves as an aid to discovery, learning, assessment, management and future research.
The data gathering methods used also serve to expand upon, what is considered by some traditionalists as, acceptable statistical analysis of data.
Current / modern research methods emphasize and support the value and use of both quantitative and qualitative data. A recognized art and science to collecting and reporting data exists within this broadened research framework.
Related to this notion is the stated essence of the Journal of American Medical Association’s primary goal:
the promotion of not only the science, but also the art of medicine.
The article raises other important issues and severely under addressed concerns…
1- the under reporting of concussions and the
2-lack of scientifically validated concussion guidelines utilized in assessing and making return-to-play decisions.
Interestingly, variations of these so-called guidelines and decision making approaches that lack traditional empirical evidence, have been published in various major professional journals.
Roos (1996) emphasized that the existence of various guidelines and resulting differing viewpoints may be attributed to the difficulty in accurately assessing the severity of a concussion, and the lack of a scientific basis for determining when an athlete has adequately recovered from the concussion
Three well known professionals, Damasio (a respected neurologist), Patton (an internationally distinguished researcher) and Meeuwisse (sports medicine physician) share perspectives that encourage and support a more expansive view of acceptable data gathering approaches. Their corresponding views will be briefly discussed:
Damasio:
In addition to utilizing solely traditional research methods to gather information,
Damasio (1994) acknowledged THE VALUE OF HUMAN WISDOM employed within natural settings when he pointed out that our perceptive grandmothers used the powers of deduction to obtain information about the adverse effects of psychological disturbances on the body.
Despite their acuity, our grandmothers’ observations were often viewed as being “too folksy” or “too soft” by the scientific establishment. Damasio also reminded us that it took a significant period of time for medicine to uncover and scrutinize the claims of our forebears.
Damasio’s insights ALSO seem to reflect AND reinforce the essence of the Journal of American Medical Association’s primary goal of promoting the science and the art of medicine.
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Patton
The notions of science neither being truly objective nor value free have also been enunciated by Patton (1990).
Although objectivity has been viewed by many as the cornerstone of scientific investigation, Patton (1990) emphasized the absurdity of the objective versus subjective debate among philosophers and experimentally-based researchers when he clearly and succinctly pointed out:
” the ideals of absolute objectivity and value-free science are impossible to obtain in practice and are often of questionable desirability in the first place because they ignore the intrinsically social nature and human purposes of research. ”
Subjectivity…has such negative connotations in the public mind that to openly advocate the value of subjective insight into a research is to undermine the credibility of one’s work (p. 55).
Patton (1990) urged the avoidance of these constructs in order to bypass useless debates, while at the same time advocating for the investigator to commit to “comprehending the world as it is while simultaneously utilizing credible research strategies which are balanced in reporting both confirming and disconfirming evidence” (p. 55).
He emphasized as well the importance of the investigator maintaining a neutral position, and strongly cautioned and reminded the reader that:
(a) instrumentation designed by humans is subject to inherent biases of the researcher; and
(b) no single research methodology adequately explains away differing causal variables.
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Meeuwisse:
” Meeuwisse (Clin J Sport Med. 2002), after recently attending the first International Symposium on Concussion in Sport held in Vienna not only warned, but also highlighted in his article entitled, Science without logic, the possibility of over-relying on “objective scientific evidence” when assessing concussions.
This concern was emphasized in the following statement:
“the pendulum of [sports-related concussion] science has swung too far by focusing too much on rigorous methodology and complex statistical tests which therefore lose sight of logical and relevant clinically based interpretations or biological plausibility.”
He further cautioned that these errors of isolated focus and thinking create “’nonsignificant’ findings/conclusions and a façade of ‘science’ pertaining to these erroneous conclusions” (p 1).” (Brady, 2004)
Awesome comment, Don… And yes, this information is not objective enough for some, but in the eyes of those that truly know and understand this is groundbreaking information…
Dustin,
You and your co-authors have entered a new frontier of research and disseminating information and perspectives.
Below are excerpts and paraphrases from a recent article that I believe fitting apply to
” various lenses ” utilized to cultivate your reported research.
This internet article discusses the value of social media and the internet in providing health info to the public.
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Social media: An opportunity for Psychiatrists / Psychiatric Times – Holly Peek, MD, MPH
http://www.psychiatrictimes.com/blogs/couch-crisis/social-media-opportunity-psychiatrists?GUID=36A233B9-5214-40B6-A2B4-079999E6088F&rememberme=1&ts=08082014
August 4, 2014
Social media now encompasses the use of many sites including : Facebook; Linkedin; Twitter; YouTube; Instagram and Printerest.
Psychiatry residents and early-career psychiatrists were among the first to engage in social media while in their college dorm rooms. The current generation of residents and early psychiatrists have essentially been engaged in social media for longer than any other generation.
This means they are more likely to know how to use the technology and are more accustomed to readily sharing their thoughts and ideas through this very public platform.
Recreating an online presence from personal to professional has several advantages.
Engaging in social media as a psychiatrist is important because our patients spend a significant amount of their time online, and this is where they receive their health information.
According to 72% of online users have accessed the internet for health related information this past year. Furthermore, smartphone users average 24 minutes per day using social networking apps.
Social media and internet use have changed the landscape in how the internet may be used to provide valuable information to the public and also dispel myths.
More than traditional Web sites, social media has changed the landscape of how psychiatrists can make use of the Internet. It has unlocked doors for open conversations among physicians, patients, and the general public.
Instead of avoiding social media altogether, I encourage mental health professionals to embrace this new and exponentially growing mode of communication. It is essential that we align ourselves with the public and our patients both to disseminate accurate information and to educate.
i respect your work and
over here my computer has been acting strange; i lost my aol email account and all correspondence with terry ott thru that account; anyway i think what you are doing is great; i had emails from george visgoth as well and i believe the only prevention of this is BIG media attention. AND the only way to get that attention is thru law suits which bring it to the public eye . keep up the good work for the health and safety of players that want to play the sport with no negative consequences in later life.