25 page paper

Washington Adventist University

SHOULD THE NFL BE LIABLE FOR CONCUSSIONS SUSTAINED BY ITS PLAYERS?

A THESIS SUBMITTED TO THE FACULTY OF THE DEPARTMENT OF SCHOOL OF PROFESSIONAL GRADUATE STUDIES IN CANDIDACY FOR THE DEGREE OF HEALTH-CARE ADMINISTRATION

BY

Daniel Jang

TAKOMA PARK, MARYLAND

MARCH 2017

TABLE OF CONTENTS

ABSTRACT………………………………………………………………………………3

INTRODUCTION………………………………………………………………………...4

LITERATURE REVIEW…………………………………………………………………6

METHODOLOGY………………………………………………………………………20

CONCLUSION………………………………………………………………………….21

AREAS FOR FURTHER RESEARCH…………………………………………21

REFERENCES………………………………………………………………………….27

ABSTRACT

The National Football League (NFL) is a multi-billion dollar organization in which their employees (players) have sustained numerous concussions under their watch. There is an ongoing debate and controversy between the organization and the players, as well as the families of deceased players on whether or not the NFL provided adequate information on the dangers of playing football and the injuries that can be derived from it. Former players have reported to have major health issues due to football related injuries such as early Alzheimer’s, chronic traumatic encephalopathy (CTE), shortened attention span, and even suicide.. This thesis will provide information and research to further analyze the National Football League’s handling of concussions and related responsibilities of the organization’s management. My research is going to contribute an immense amount of evidence that the NFL knew about the health risks of the sport and decided to deny its accountability .

INTRODUCTION

All too often, when a business or a company prospers financially and an issue arises where its morale is questioned, administration inclines towards looking the other way if it hurts the business or company in a negative manner. It is the truth that everyone knows but is too uncomfortable accepting it in the eye of the public. People and perception tend to change when there is money involved so the question that arises frequently is: Do the ends justify the means? The National Football League (NFL) is a prime example of an organization that ignores all the grey areas because of the capital they are able to bring in.

The NFL is a professional football organization that was founded in the United States. Contrary to what most people believe, American football is not soccer like it is for the rest of the world. Football actually evolved from rugby in 1843 when a college student named William Ebb Ellis was tired of the rule restrictions and wanted to carry the ball rather than dribble it (“Talk American Football”). Almost thirty years later, college students from Harvard, Princeton, Columbia, and Yale wanted to make new rules in rugby in order to adapt to their needs. The game began to evolve into the football society knows today when Walter Camp, head coach at Yale, decided the number of players on the field for a team would drop from fifteen to eleven. He also created a scoring system where a touchdown (when a player that is carrying the ball crosses the opposition’s end zone) is worth six points. In addition, he introduced the most intrical difference between Rugby and American Football and that was the system of ‘downs’, in which “a team is only given a certain number of plays to cover a particular area of the field before they are forced to give up possession (“Talk American Football”).

According to Forces, the average value of an NFL team is in the range of $1.97 billion. Combined, all thirty-two franchises give the National Football League an astonishing value of upwards of sixty-two billion dollars (Stewart 2015). The NFL is the number one sport in America and by far the most popular television product. Emily Stewart, an author for the website ‘The Street’, put the financial success of the NFL in perspective by stating transactions made in the league. “In 1993, Fox paid $1.58 billion to snag the rights to broadcast NFC league games. Just over four years later, CBS spent four billion for the rights to AFC games. Robert Kraft and Jeffrey Lurie spent $185 million and $172 million to buy the Patriots and Eagles in 1992 and 1994, respectively, but by 1999, Bob McNair had set a new benchmark by paying $600 million for the Houston Texans. And, just last year, Terry Pegula paid a whopping $1.4 billion to buy the Buffalo Bills. Despite the high price tag at $1.4 billion, the Bills are listed as the NFL’s least valuable franchise (Stewart 2015). It is of no question the validity of the power and wealth the NFL has over the country and that can be very dangerous.

Every sport has its own risk of injury but in most of the sports such as basketball and baseball it is perceived as safe because they are not physical sports. For basketball, the most gruesome injury is knee ligament tears and for baseball, it is elbow ligament tears. For football, it seems as if a player is 100% guaranteed to get injured. Because a player puts his whole body on the line, injuries can range from the foot all the way to the head. The dark horse injury is concussions because there seems to be not enough information on the short and long-term effects for the players.

Concussions are brain and spinal cord injuries that are caused by “acceleration-deceleration” forces transmitted to the head and spine by direct blunt force impacts and contact transmitted to the head and spine without direct blunt force impact to the head, face, or neck” (Omalu 21). In other words, players can sustain concussions without showing symptoms physically. The NFL finds itself amid a controversy with its current and former players and families over whether or not the league has handled concussion protocol correctly. The purpose of this research is to debate whether or not the NFL is responsible for concussions sustained by players.

This study is organized into four sections. Section one is the introduction that serves as an overview and offers background information on the sport of American football, the NFL, and concussions. The second section goes in depth in how and what the NFL is doing present day for safety measures for its players and the effect of concussions on former players. In addition, there will be discussions on the literature that was used to find the evidence. For the third section, it details the specifics of research methodology that was used for this paper. It will include an interview by a family member of a former player who has sustained concussions and direct quotes from them. The fourth and final section summarizes all the evidence presented and presents conclusions that allow the reader to form his or her own opinion on the matter.

LITERATURE REVIEW

METHODOLOGY

DISCUSSION

The purported link between football and concussion has resulted in the conduction of extensive research throughout the years to ascertain the basis of such assertions. As such, there is no dearth of literature that can be reviewed when seeking to gain an enhanced understanding of the link between football and concussion. One area that researchers have placed a great deal of emphasis on when it comes to the study of the link between football and concussion relates to the equipment used in the game, the most noteworthy of which is the helmet. Since football came into being, the equipment used in the NFL have undergone noteworthy changes throughout the years, with the helmet, the most distinct feature that define the NFL, seeing gradual alterations as years went by. Hoffmann, Falk, & Manning (2013) state that leather helmets (referred to as head harnesses) are said to have been used as early as the 1900s. These helmets were rare and were principally designed with the intention of protecting the ears. However, given the fact that the leather helmets had a full ear piece, it was noted that they tended to make communication challenging. Between the years 1915 and 1917, the very first skull protection helmets emerged in the scene and gained widespread use in the game (NFL Helmets, 2012). This new model had ear holes as well as suspension, which was aimed at keeping it from resting right on the head of a player. Further, harder leather (in addition to enhanced cushioning and a more teardrop form) are known to have emerged back in the 1920s and the 1930s.

Plastic Helmets

Moreover, the earliest plastic helmets are reported to have been brought in back in 1939. It is stated in NFL Helmets (2012) that these plastic helmets were quite different from the earlier versions, in particular, as they featured one face bar, which was incorporated into it later. Beginning in the 1960s all the way to the present times, helmets used in the game are said to have gone through transformations with a view to augmenting their capability of absorbing impact. In an article focusing on the evolution of sports-related headgear, Salvaterra (2016) points out that back in the 1970s, foam cells were used in the place of the interior of the helmets, which resembled a web. Salvaterra (2016) also mentions that on top of this, a number of helmets made use of air valves with an eye on creating a custom fit. As of now, the most recent innovation with respect to helmets relates to the employment of polyurethane “cap”. The cap is said to fit over the exterior of helmets, hence offering greater protection against concussions.

Shoulder Pads

Shoulder pads also represent another important equipment that has been used in the NFL for quite some time. During the initial years of the game, players tended to be the subject of derision from their fellow team members due to their decision to stash padding underneath their informs, which were made out of mole skin. Dolan and Kriz, (2016), in an article focusing on protective equipment in sports, make the point that shoulder pads started to gain a great deal of popularity by the 1950s. At the beginning, should pads were made up of pieces of leather that were stitched together. In the course of the 1960s, hard plastic (as well as foam) ended up replacing the leather. According to Hoffmann, Falk, & Manning (2013), these new models of shoulder pads were of the essence as they were said to enhance protection against not only shoulder injuries but also rib injuries. Dolan and Kriz, (2016) emphasize that shoulder pads have the potential to play an immense role in the diminution of shoulder-to-head injuries, which has been cited as the leading cause of concussions.

Information on the Health Risks

Further, the NFL is not adequately providing information on the health risks of playing the sport. Bennet Omalu, the medical professional who is credited with discovering CTE in the Pittsburgh Steelers legend presented his findings in a publication in the hope that the NFL would express a great deal of interest in his findings. In their investigative book regarding the manner in which the NFL handled Omalu’s revelations, Fainaru-Wada & Fainaru (2013) note that Omalu did not attain the kind of response that he had been hoping for, with medical professionals contracted by the NFL publicly attacking and deriding his findings and research as a whole. In fact, NFL’s medical professionals affirmed that Omalu’s deductions were not in line with medical literature, hence their demand that Omalu retract his findings following his publication on the link between playing football and permanent brain damage. Nevertheless, it was reported that, privately, the message that was given by Omalu was taken quite differently. Sometime later, the castigation of Omalus’s work came to a halt, and as he laid bare in a documentary that disclosed the concussion crisis in the National Football League, the issue lay in the potential negative outcomes of his deductions to one of the most popular sports in the nation. Fainaru-Wada & Fainaru (2013) also make it clear that the officials at NFL had fears that the outcomes of the doctor’s discoveries would have severe monetary implications for the body, hence their reluctance to reveal it. Unfortunately, as noted by Fenno et al. (2013), the National Football League’s greatest fears appeared when numerous former football players filed lawsuits against the body for placing their lives in peril when they had knowledge of the likely dangers of recurrently playing football after grappling with numerous concussions.

Accusations on the NFL

As a result, accusations have been hurled at the National Football League for apparently covering up a vast number of cases with respect to concussion in football all through the years, in particular, Mike Webster’s case. Confronted with a massive heap of proof, the organization elected to discredit the input of the medical professional who led to the discovery of permanent brain damage in a celebrated former football player. Hanna (2010) makes a strong point regarding the league’s potential legal liability for players’ owing to the fact that its concussion policy has not been that strong. In their in-depth fact-finding analysis of the organization’s handling of the concussion issue, Fainaru-Wada & Fainaru (2013) affirm that the NFL has for a long time been committed to fighting researchers and scientists who go on to disclose anything that has the potential to put the league’s reputation at risk. It is for this reason that the body has been accused of only focusing on the attainment of massive sums of money at the expense of its players’ health. According to Omalu et al. (2006), it is safe to surmise that the league’s players have been wrongly led to believe that the impacts of playing football on a person’s long-term mental health are virtually insignificant, if not existent at all. A number of documentaries have been produced over the years to demonstrate the lengths to which the NFL is willing to go just so that it can protect its reputation and make more money from the sport. Indeed, the NFL is said to have suppressed the release of the findings of numerous bodies of research that had been carried to determine the real impacts of concussion on players in the game. Despite such assertions, the NFL has consistently pleaded its innocence in such matters even though a great number of media platforms and individuals tend to think otherwise.

NFL Rule Changes

The NFL has introduced several rule changes to lessen the number of concussions that players suffer while at the same time making the game safer on the field. Ellenbogen, Berger, & Batjer, (2010) note that, in 2010, the National Football League rephrased the league’s rule to bar players from launching themselves off the ground and applying their helmets in striking players who are in defenseless postures in the neck or the head. A breach of this rule results in a 15-yard needless roughness punishment being imposed. During the same season, the league ordered that once a player has lost their helmet on the field of play, the ongoing play has to be immediately whistled dead. What is more, Ellenbogen, Berger, & Batjer, (2010) mention that, still in 2010, the league ordered that during extra point attempts and field goals, defenders have to assemble their whole bodies to the exterior of the snapper’s body to protect them while they are in a vulnerable position. Memos were sent to all NFL teams to stress the gravity of the new rules with significant punishments being meted out to those who breach the new rules.

Regulations

Further, one of the most important changes made to lessen head injuries also occurred in 2010. According to Ebstein (2011), it was a change to the National Football League kick-off regulations. The kick-off was shifted from the 30-yard line to the 35-yard line. As a result, players on the side of the kicking team have to assemble nearer to the end zone, which reduces the amount of room the players have in order to have a running start. Additionally, in 2011, Ebstein (2011) further notes that the league ordered that qualified athlete trainers must be present in the press boxes in every league game. These trainers help medical personnel who are on the sidelines to identify possible concussions since the symptoms are not easy to see and evaluate from the field level.

According to Smith (2013), the NFL works toward the protection of players through the adoption and enforcement of the rules, the education of athletes at each and every level of the game, the advocacy of improved technique and training at each and every level, and continually carrying out research on novel technologies and innovations. All through the history of the NFL, the body has made amendments to its rules with a view to getting rid of unsafe play from football. The NFL’s Competition Committee, which is at the forefront of the process of changing rules, performs a review of injury statistics following the conclusion of every season and undertakes and examination of video to ascertain the manner in which injuries take place. Other parties that are involved in the process of changing rules include an array of the organization’s health and safety panels, committees, and subcommittees, as well as the body’s Players Association.

The NFL has gotten rid of various forms of dangerous tackles (for instance chop blocks, horse-collar ones) as well as hits on players who are in defenseless positions. Among other things, Ellenbogen, Berger, & Batjer, (2010) makes the point that the organization has placed a lot of emphasis on roughing-the-passer rules, which are said to have provided greater protection for players, hence preventing unnecessary risks. What is more, during the time injuries on kickoffs become one of the greatest concerns in the game back in the 2000s, the NFL went ahead to move the kickoff line with the intent of reducing the rate of returns as well as banned wedges of three or more blockers. On top of this, the organization works in collaboration with the NFL Players Association in the protection of players through the provision of a summary of infractions and the penalties for inappropriate behavior on the part of players, unsafe plays, or wrong employment of safety equipment. Additionally, the organization has rules regarding the appropriate maintenance and testing the fields of play in a bid to diminish the risk of injury.

Education and Advocacy

Regarding education and advocacy, the league works in cooperation with coaches, staff, as well as players in each and every level of the game with an eye on stressing appropriate tackling methods and educating the football community as a whole regarding approaches to limiting injuries (Sailors, 2015, p. 3). Further, another approach that the NFL has employed in the effort to ensure and improve safety in the game relates to the evolution of equipment. Today, the organization works in collaboration with its equipment partners as well as engineering professionals with a view to identifying cutting-edge technological advancements to aid in keeping players safe without an unwanted effect on how they perform or on the quality of play. Overall, the evolution of equipment used in the game can be witnessed from head to toe, with various subcommittees within the league tasked with testing the safety, durability, and flexibility of the equipment.

Moreover, Roehr (2012) mentions an important point that the safety measures used in the league are also evident in its commitment to research and funding. An array of the body’s health and safety panels, committees, and subcommittees undertake comprehensive studies with respect to issues regarding the prevention of injuries. Roehr (2012) also states that following the conclusion of studies, they go on to make recommendations to the NFL as regards policies, matters related to health, research and programs, and, as such, contributing to the process of making rules. What is more, the NFL offers significant amounts of funding (in the tens of millions of dollars) in support of various research projects. Back in 2014, for example, the NFL Foundation pledged twenty-five million dollars over years to be used in testing and expanding health and safety projects.

New Protocols

The NFL has come up with specific protocols for the team doctors and trainers that aid them in dealing with players who have suffered a concussion. Back in 2013, the NFL made an announcement with respect to the introduction of an array of guidelines that are to be used in the evaluation of concussion (Pallone, 2013). These guidelines were brought into being by the NFL’s Head, Neck, and Spine Committee with the intention of better detecting concussions in the course of practices and games. Pallone, (2013) further clarifies that the policy carries protocols for sideline assessment in addition to rules regarding baseline testing, preseason education, and the setting up of personnel tasked with carrying out concussion assessments. In the protocol, an elucidation of a concussion is provided as well as a list of indications. However, it is noted in the protocol that the list of symptoms is not comprehensive.

The implementation of the NFL concussion policy takes places in phases, starting with education and the collection of information prior to players even entering the field of play. To begin with, during preseason, it is mandated by the protocol that players (as well as team staff) needs to be provided with education regarding concussions prior to the commencement of the season and offers advice on the value of swiftly reporting indications of concussion (NFL Protocol, 2014). In the course of the preseason, a baseline neurological examination is equally carried out. Further, the protocol mandates in-game identification of indications of concussion in players, with team medical staffs being tasked with this responsibility. The protocol has created toe positions that are explicitly aimed at aiding in the identification and diagnosis of concussions.

The first position, Unaffiliated Neurotrauma Consultant (UNC), is a reference to a medical professional who has no affiliations with any NFL team. These medical professionals are assigned to each and every team in the league and tasked with the role of monitoring games from the sidelines, recognizing indications of concussion, noting situations in which hard hits call for concussion assessment and work in collaboration with physicians in the conduction of said assessments (NFL Protocol, 2014). The role of the UNC is largely advice-giving given the fact that the ultimate decision with regard to the diagnosis of a concussion and the sending of players back into the field of play is on team doctors. The second position created by the protocol relates to the Booth ATC in which athletic trainers are mandated to sit in stadium booths in the course of each and every game with a view to spotting possible concussions in players from the teams in play. These spotters are allowed to evaluate game film with the intention of identifying plays possibly leading to concussions after which they are allowed to call “medical timeouts” to pass on the information to physicians on the sidelines in order that more assessments can be carried out.

Further, there are guidelines regarding in-game evaluation. In case a player demonstrates or reports indications of concussion, it is mandated by the protocol that the player be taken away from the game in order that the medical team can carry out an assessment. In case the play is established to have suffered concussion, he is barred from getting back into the field of play or practice that day (NFL Protocol, 2014). Lastly, there are guidelines regarding post-game assessments. A player who has suffered a concussion has to be watched every day and may not get back to football undertakings until the player has gotten back to his standard cognitive function, after which the medical professional working with the team (as well as an Independent Neurological Consultant) has to clear the individual to get back to play.

A number of past footballers, as well as their families, hold the belief that the NFL had, to some extent, knowledge with respect to the disadvantageous impacts of regular concussions. Gove (2011) offers and indication that, unfortunately, such players were time and again spurred to continually play through such states and give out their utmost in the field to with the intention of increasing their respective teams’ likelihoods of emerging victorious.

Following the revelations, many, including his family, were shocked at the description of Webster’s physical state before a post-mortem was carried out with the intention of ascertaining the cause of the individual’s death. According to a FRONTLINE interview conducted by Gilmore (2017), Pam, Webster’s wife, revealed that the Pittsburgh Steelers legend was acting differently as he neared retirement stating, “I was noticing things about brain injury, you know, just at home, that he wasn't the same as he was before. I don't know if that happened. I don't know the reason it happened. We were totally in shock by it”. The outcome of the post-mortem was a groundbreaking revelation that shook football as a whole. The medical profession who was tasked with carrying out the post-mortem on Webster, Bennet Omalu, came to ascertain that the individual was grappling with a severe form of brain damage, that is, CTE. “I had to make sure the slides were Mike Webster’s slides,” Omalu revealed in an interview with FRONTLINE, which was conducted by Kirk (2017) after reviewing samples of Webster’s brain. He continued in the same interview with Kirk, (2017), “I looked again. I saw changes that shouldn’t be in a 50-year-old man’s brains, and also changes that shouldn’t be in a brain that looked normal.” Many expressed their shock at the disclosure owing to the fact that CTE had never been ascertained in individuals playing football in the past. Thus, Omalu’s discovery related to the initial concrete proof that playing football has the potential to bring about the development of permanent damage to the brain (Omalu et al., 2006). In a study conducted by DeKosky, Ikonomovic, & Gandy (2010), the authors pointed out that some of the grim conditions that football players that have suffered from CTE experienced including depression, loss of memory, Alzheimer’s disease, dementia, Lou Gehrig’s disease, Parkinson’s as well as other severe neurological disorders.

Another former player who suffered the detrimental impacts of concussion years after retiring from the game relates to Junior Seau. According to Samson (2013), Seau suffered from a degenerative condition of the brain that is connected with recurrent brain trauma when he ended his life back in 2012. The National Institutes of Health (NIH) reached the conclusion following an analysis of Seau’s brain posthumously. Samson (2013) quoted NIH’s findings in his article, which confirmed that the symptoms shown by Seau were in line with CTE. In the same article, Samson (2013), the NIH goes on to state that “The type of findings seen in Mr. Seau’s brain have been recently reported in autopsies of individuals with exposure to repetitive head injury including professional and amateur athletes who played contact sports, individuals with multiple concussions, and veterans exposed to blast injury and other trauma.” Following the ascertainment of the fact that Seau grappled with a degenerative brain disease, Gina, the late player’s ex-wife, revealed in an interview with Fainaru-Wada, Avila, & Fainaru (2017): “I think it’s important for everyone to know that Junior did indeed suffer from C.T.E. It’s important that we take steps to help these players. We certainly don’t want to see anything like this happen again to any of our athletes.”

Apart from Omalu’s findings on Mike Webster, another report made available by Boston University and the U.S. Department of Veterans Affairs offered proof that 87 out of 91 former football players had brain disease connected with head trauma. During the study, researchers examined the brains of 165 individuals who at one point took part in the game as players at various levels including professional, college, or high school. According to Breslow (2017), the study came to the conclusion that 79% (131) of the study subjects were grappling with CTE. Of the brains that were subjected to the assessment, 91 of them were of ex-players of the game, with 96% of them (87out of 91) demonstrating indications of CTE. Breslow (2017) reiterates the fact that, according to the researchers who carried out the study, the long-term impacts of playing numerous seasons have the potential to have a permanent impact on the body of football players. Even though a player has the potential to recuperate within weeks following their experience of a concussion, the long-term impacts of cognitive impairment could be demonstrated years later. The risk of suffering serious brain damage rises in situations in which players lose consciousness following a concussion.

Further, in a separate study that was put forth at the AAN’s (American Academy of Neurology) yearly gathering in Vancouver, experts under the leadership of Dr. Frank Conidi (who holds the position of director the Florida Center for Headache and Sports Neurology) issued a report affirming that over forty percent of former players of the game indicate signs of unusual brain structures. Based on the information provided by Science Daily (2017), in the course of the research, the former players were subjected to an array of cognitive examinations, with half of them showing severe issues with executive functions, for instance, problem solving, attention, reasoning, as well as planning. In addition, 45 percent of the players involved in the study exhibited difficulty with respect to learning and memory. In the study, Conidi carried out an analysis of the brains of forty ex-players of the game who lasted around 7 seven years in the game (that is, active play) and had ceased active involvement for fewer than 5 years (Science Daily, 2017). All the players involved in the said were said to exhibit damage to the white matter of the brain, a feature that is tasked with the responsibility of linking nerve cells among dissimilar parts.

Science Daily (2017) reports that Conidi determined that the degree of damage shown by the players’ brains was sufficient to be categorized as traumatic brain injury. Conidi came to establish the longer an individual lasted in the league, the greater the likelihood of them demonstrating indications of traumatic brain injury. He added that the sum of concussions that were suffered by a player is not associated with the degree of brain injury in the MRI that was carried out in the study. It is affirmed by Science Daily (2017) that according to Conidi, the latter observation is an indication that it is not only the huge hits that typically cause a lot of debates that solely contributes to brain injury but also the collective impacts of numerous, smaller hits that equally have the potential to be detrimental. Conidi stated, “It’s not the big hits, the one big concussion but more likely the repetitive banging that causes problems”.

In addition, Munro Callum of University of Texas Southwestern Medical Center affirms that suffering a concussion, and particularly becoming unconscious following a conclusion, has the potential to have enduring impacts on the brain. In a report published in JAMA Neurology, the professor of psychiatry and neurology in collaboration with his colleagues undertook a study of twenty-eight ex-players of the game. According to Hart et al. (2013), all the ex-players involved in the study had suffered concussion in the past and the Munro matched them to twenty-one volunteers who had not suffered a concussion in the past. All in all, the ex-players’ performance was worse when it came to standard tests of memory in comparison with health controls. This, according to Munro, is an indication that the ex-players’ history of grappling with concussion had an effect on their memory capabilities in a way.

The deduction made by Munro was based on imaging information of the hippocampus, the part of the brain that is tasked with the responsibility of coordinating memory. Overall, the ex-players demonstrated smaller hippocampal volumes in comparison with the controls, with the volumes of ex-players who lost consciousness following a concussion reported to be even smaller. As per Hart et al. (2013), Munro affirms, “We know that normal aging itself is associated with some declines in both hippocampal volume as well as memory function”. He goes on to add in the article that “But it seems that those declines are accentuated when there is a concussion, and when there is a concussion with loss of consciousness.”

CONCLUSION

Football has been demonstrated to cause brain damage. One of the most important reports on the connection between football and brain damage was made available back in 2002. More precisely, the date was September 28, 2002. On the morning of the aforementioned day, a post-mortem was carried out on the body of a former celebrity named Mike Webster, said to be one of the finest players to ever play football and a Pittsburgh Steelers legend. According to Omalu et al. (2006), Webster’s body demonstrated disquieting hints of wear. Late in this widely applauded individual’s life, the former football player’s private doctor had come to notice a number of disturbing things in his body. Reports affirmed that the skin on the forehead of the Pittsburgh Steelers legend had ended up becoming firmly placed to his scar, which was a reference to a layer of scar tissue that had developed in the course of close to decades of taking part in professional football. On top of this, Omalu et al. (2006) goes on to affirm that peculiar bulges struck out from this person’s back, profound scars could be perceived along the Webster’s feet. What is more, varicose veins were also said to spread the individual’s legs while his fingers also seemed thicker and crooked. By the time this football legend had passed away, Webster appeared as if he was seventy years of age yet he had only lived for five decades.

This paper draws on research that has been conducted by other scholars on concussion. Concussion is a phenomenon that is relatively new. Indeed, the link between concussion and brain damage was established not long ago. As such, using the available research that has been conducted on the issue represents best avenue to attaining vital information on concussion. To that end, the paper extensively draws on a diverse range of scholarly literature with the intention on attaining the most appropriate information on the matter. Through the analysis of different bodies of literature, various views can be analyzed, hence allowing for the making of well-informed conclusions based on common themes emerging from the works. Other than the use of scholarly works, the paper also uses online research to attain the perspectives of the relatives of former players who were diagnosed with brain damage. In this way, comprehensive information on concussion and its impacts can be acquired from professionals while the perspectives of families affected by the phenomenon can equally be acquired.

Certainly, the NFL is responsible for compensating players and their families for health care received associated with former players or even deaths of players with health issues due to concussions. This stance is based on a number of noteworthy reasons. First off, it has been asserted that the league was aware of the dangers of concussions as early as the 1920s, yet they opted to hide the information from trainers, coaches and others until June 2010 (Fenno et al., 2013). As such, the organization is responsible for the poor health that former players are showing while the responsibility for deaths that are significantly linked to the condition should for on the league (Didehbani et al., 2013). Without a doubt, the conditions suffered by the former players came about as a result of the league’s failure to notify and protect players from the vast range of risks that come with football-related concussions. On top of this, prior to taking a more serious stance on issues related to concussion, it is safe to surmise that the league demonstrated negligence when they failed to carry out its duty of enacting league-wide regulations as well as mandatory rules that would aid in the regulation of post-concussion medical assistance and return-to-play conditions for players who experience a concussion and/or several concussions. Due to said reasons, the NFL is responsible when it comes to the compensation of players and their families for health care received associated with former players or even deaths of players with health issues due to concussions.

Lastly, the standards and practices carried out by the organization can certainly be improved on. Concussion is a severe problem that has plagued many players and will continue to do so if not sufficiently addressed. One of the first ways in which this situation can be combated relates to the conduction of more research on the problem. Indeed, a lot has been done in this regard. Nevertheless, more needs to be performed. Research needs to focus on more and more living athletes, given the fact that the majority of the studies on brain conditions related to athletes have been carried out on dead bodies. Further study on more and more living athletes this condition may reveal important findings that can assist in tackling the concern.

Secondly, more safety policies need to be brought in. On top of the more recent introductions made by the NFL, additional improvements need to be made in facets that pose threats to player safety (Smith, 2013). Rules tend to be flexible and, as such, the policymakers tasked with the responsibility of coming up with guidelines need to recurrently make rules that have the potential to guarantee absolute player safety. In this way, on-field concussions can be diminished greatly.

As a final point, close attention needs to be paid to the helmets worn by players of the game. Typically, the standard of helmets employed by players constantly pass through rigorous tests prior to their approval (Drysdale, 2013). Nevertheless, while the quality of helmets does not guarantee the end of concussions, comprehensively evaluated versions of helmets have the potential to aid in the reduction of concussions significantly. Certainly, the incorporation of said measures in addition to the continuing measures aimed at the enhancement of player safety can result in an improvement in the fight to bring concussions to a halt.

AREAS FOR FURTHER RESEARCH

Concussions happen in many other sports apart from football. To begin with, soccer is an example of a sport in which sports-related concussions are regularly witnessed throughout the globe. According to Delaney, Puni, & Rouah, (2006). Although between fifty and eighty percent of injuries in soccer tend to be sustained in the legs, it has been demonstrated that head injuries represent between four and twenty-two percent of injuries in the sport. In addition, it has asserted that heading the ball has the potential to bring about damage to the head owing to the fact that the ball has the potential to travel 62 miles per hour. However, the majority of professional soccer players have affirmed that their experience of head injuries came about as a result of collisions with other players as well as the ground. Research conducted by the University of Colorado over the course of several years and made available in JAMA Pediatrics noted that player-to-player collisions that take place in the course of heading (as opposed to impact with the ball itself) tends to be primarily culpable for concussion in soccer.

Further, in a study that was carried out in Norway (made up of present and former players of the nation’s national soccer team), it was ascertained that three percent of present players and thirty percent of the former players demonstrated continued indications of concussion (Straume-Naesheim et al., 2005). Based on the analysis conducted by Straume-Naesheim et al. (2005), the findings offered a clear indication of the fact that concussion afflicts a significant proportion of soccer players. As such, soccer should also be viewed in the same lens as other sports in which concussion tends to be prevalent. In this way, greater focus can be placed on the issue of concussion in soccer so that the most fitting response can be ascertained.

Further, concussions are said to rank among the most serious injuries that have the potential to take place in the game of boxing. Data gathered from 1918 all the way to 1998 showed that 659 players of the game of boxing lost their lives as a result of brain injury. In addition, concussion is said to occur in gymnastics owing to the fact that the majority of skills in the game entail blind landing or flipping, which heightens prevalence of head injury. Moreover, in ice hockey, the prevalence of concussion has been long demonstrated, with many players having suffered the condition (Delaney, Puni, & Rouah, 2006). It is for this reason that the NHL (National Hockey League) has moved to introduce various measures aimed at the prevention of head injury. In Rugby, concussions are said to be pervasive, which explains why World Rugby (the body tasked with the government of the sport) has come up with a number of measures that seek to see to it that head injuries are prevented from happening. It is important to compare concussion in said sports with football so that incidence data can be contrasted. When it comes to discussions regarding concussion, football tends to be the only sport that crosses people’s mind. However, and as demonstrated, concussion also exists in sports such as soccer, gymnastics, boxing, hockey, rugby. By disclosing information and data regarding the existence of concussion in other sports, greater awareness can be created regarding the issue. In this way, increased measures can be taken to prevent players involved in the games.

Additionally, a vast number of reports have shown that women’s sports are also afflicted by concussion (Chiang et al., 2009). In fact, women’s sports are said to record more concussions in comparison with male athletes. According to a report made available in the December of 2008, nearly thirty thousand female high school students playing soccer in the US ended up suffering concussion back in 2005 in comparison with the figure recorded by their male counterparts, which stood at around twenty-one thousand. What is more, when it comes to high school basketball, the same report noted that nearly thirteen thousand girls experienced a concussion in comparison boys, whose figure stood at just over 3,800. Dick (2009) notes that in the game of ice hockey, concussion has been said to be more prevalent than in men’s ice hockey (and even college football), which has resulted in women’s ice hockey being ranked among the most unsafe sports with respect to the NCAA.

Similarly, women’s basketball has been cited as being among women’s sports that has the greatest risks of ending up with a concussion. According to Dick (2009), Comparisons between concussion in women’s sports and concussion in football have not been conducted owing to the widespread perception of football as the real scourge when it comes to such issues. As a result, less concern has been shown for women’s sports. However, with research showing that concussion is more prevalent in women’s sports, more attention should be drawn to the developments so that the most fitting measures can be created to address the issue.

REFERENCES

Breslow, J., (2017). New: 87 Deceased NFL Players Test Positive for Brain Disease- pbs.org. Retrieved 21 December 2017, from https://www.pbs.org/wgbh/frontline/article/new-87-deceased-nfl-players-test-positive-for-brain-disease/

Chiang Colvin, A., Mullen, J., Lovell, M. R., Vereeke West, R., Collins, M. W., & Groh, M. (2009). The role of concussion history and gender in recovery from soccer-related concussion. The American Journal of Sports Medicine, 37(9), 1699-1704.

DeKosky, S. T., Ikonomovic, M. D., & Gandy, S. (2010). Traumatic brain injury—football, warfare, and long-term effects. New England Journal of Medicine, 363(14), 1293-1296.

Delaney, J. S., Puni, V., & Rouah, F. (2006). Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study. Clinical Journal of Sport Medicine, 16(2), 162-165.

Dick, R. W. (2009). Is there a gender difference in concussion incidence and outcomes?. British journal of sports medicine, 43(Suppl 1), i46-i50.

Didehbani, N., Cullum, C. M., Mansinghani, S., Conover, H., & Hart, J. (2013). Depressive symptoms and concussions in aging retired NFL players. Archives of clinical neuropsychology, 28(5), 418-424.

Dolan, E., & Kriz, P. (2016). Protective equipment. In Head and Neck Injuries in Young Athletes (pp. 13-26). Springer International Publishing.

Drysdale, T. (2013). Helmet-to-Helmet Contact: Avoiding a Lifetime Penalty by Creating a Duty to Scan Active NFL Players for Chronic Traumatic Encephalopathy. Journal of Legal Medicine, 34(4), 425-452. doi:10.1080/01947648.2013.859969

Ebstein, N. (2011). The NFL’s Big Problem: Concussions and What We Can Do To Prevent Them.

Ellenbogen, R. G., Berger, M. S., & Batjer, H. H. (2010). The National Football League and concussion: leading a culture change in contact sports. World neurosurgery, 74(6), 560-565.

Fainaru-Wada, M., & Fainaru, S. (2013). League of denial: The NFL, concussions, and the battle for truth. Three Rivers Press.

Fainaru-Wada, M., Avila, J., & Fainaru., S (2017). Doctors: Junior Seau's brain had CTE-espn.com. Retrieved 21 December 2017, from http://www.espn.com/espn/otl/story/_/id/8830344/study-junior-seau-brain-shows-chronic-brain-damage-found-other-nfl-football-players

Fenno, N., Rosiak, L., Holden, Z., Nightingale, N., & Schad, T. (2013). NFL Concussion Lawsuits. The Washington Times.

Gilmore, J., (2017). Pam Webster- pbs.org. Retrieved 21 December 2017, from https://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/the-frontline-interview-pam-webster/

Gove, J. P. (2011). Three and out: the NFL's concussion liability and how players can tackle the problem. Vand. J. Ent. & Tech. L., 14, 649.

Hanna, J. (2010). NFL shaky concussion policy exposes the league to potential liability headaches. The Entertainment and Sports Lawyer, 28(3), 9.

Hart, J., Kraut, M. A., Womack, K. B., Strain, J., Didehbani, N., Bartz, E., ... & Cullum, C. M. (2013). Neuroimaging of cognitive dysfunction and depression in aging retired National Football League players: a cross-sectional study. JAMA neurology, 70(3), 326-335.

Hoffmann, F., Falk, G., & Manning, M. J. (2013). Football and American identity. Routledge.

Kirk, M., (2017). Dr. Bennet Omalu- pbs.org. Retrieved 21 December 2017, from https://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/the-frontline-interview-dr-bennet-omalu/

NFL Helmets. (2012). History of the NFL football helmet. Retrieved from- http://www.nfl.com/news/story/0ap1000000095139/article/history-of-the-nfl- football-helmet

NFL Protocol. (2014). National Football league Head, Neck, and Spine Committee’s Protocols Regarding Return to Participation Following Concussion. Retrieved from http://static.nfl.com/static/content/public/photo/2014/08/21/0ap3000000381608.pdf

Omalu, B. I., DeKosky, S. T., Hamilton, R. L., Minster, R. L., Kamboh, M. I., Shakir, A. M., & Wecht, C. H. (2006). Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery, 59(5), 1086-1093..

Pallone, B. (2013). NFL Concussion Protocol: A System Redesign. Am. J. Mediation, 7, 55.

Roehr, B. (2012). Why the NFL is investing in health research. BMJ, 345.

Sailors, P. R. (2015). Personal Foul: an evaluation of the moral status of football. Journal of the Philosophy of Sport, (ahead-of-print), 1-18.

Salvaterra, G. (2016). Evolution of sports-related headgear. Sports medicine and arthroscopy review, 24(3), e34-e41.

Samson, K. (2013). NIH: NFL'S Junior Seau had chronic traumatic encephalopathy. Neurology Today, 13(4), 1-12.

Science Daily, (2017). More than 40 percent of retired NFL players have brain injury- sciencedaily.com. Retrieved 21 December 2017, from https://www.sciencedaily.com/releases/2016/04/160412091353.htm

Smith, R. K. (2013). Solving the Concussion Problem and Saving Professional Football. Thomas Jefferson Law Review, 35(2), 127.

Straume-Naesheim, T. M., Andersen, T. E., Dvorak, J., & Bahr, R. (2005). Effects of heading exposure and previous concussions on neuropsychological performance among Norwegian elite footballers. British journal of sports medicine, 39(suppl 1), i70-i77.

Talk American Football (2017). http://www.talkamericanfootball.co.uk/guides/history_of_american_football.html

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