By DAVE STEPHENS
South Bend Tribune Staff Writer
5:17 PM EDT, September 24, 2011
(First of two parts)
They crash together with ferocity.
Helmets collide. Teeth clench. Feet pound.
It is practice day for the Granger Rocket Football league, and the gathered boys - ages 9, 10, 11, 12 - are going through the standard tackling and blocking drills that are a fundamental part of football practice.
At this age, league president Randy Schneider said, the game is not really about showcasing skills, but about coaches teaching fundamentals.
How to tackle. How to block. How to take a hit.
“Sometimes, it’s just trying to get them to hit,” Schneider said, commenting on the timidity of many young players.
But what if those hits were doing harm?
What if the game they are learning to play possesses not just the potential for broken arms and legs, but brain damage that could take decades to manifest itself in the form of depression, memory loss or dementia?
Ten years ago, the idea was openly ignored by most in the sports world.
But today, researchers, advocates and players alike are openly asking a question that shakes one of our most beloved national pastimes to the core:
What if football will one day kill our boys?
Familiar story: Players haunted by dementia
The sheriff’s deputies had been parked along the quiet, suburban cul-de-sac for nearly seven hours last month when they heard the gunshot.
The waiting SWAT team, which had been slowly approaching the home of Corwin Brown, rushed to investigate.
Inside, the former University of Michigan and NFL football player and one-time Notre Dame assistant coach lie bleeding, suffering from a self-inflicted gunshot wound to his torso.
Hours earlier, police had rushed to the home after a domestic dispute erupted between Brown and his wife, leading to the standoff and ending only after Brown was rushed to the hospital.
Afterward, Brown’s family released a statement, a possible explanation for why the well-respected coach had fallen so low:
“There is a tragedy in this story which has unfolded over the last several years,” the statement read, in part. “We believe Corwinis suffering from symptoms similar to those experienced by the late Dave Duerson and were caused by the many notable collisions during Corwin’s career in the NFL.”
Brown - who has been charged with three felonies after the standoff - is reportedly undergoing treatment at the University of Michigan and could not be reached for this article. But his family’s statement tells a familiar story.
Like the story of “Iron” Mike Webster, the Hall of Fame center for the Pittsburgh Steelers, dead at age 50 after years of erratic, bizarre behavior.
Or Lou Creekmur, eight-time Pro Bowl lineman for the Detroit Lions, whose NFL career was followed by a 30-year fight with dementia marked by memory loss and angry outbursts.
Or Thomas McHale, who played with the Tampa Bay Buccaneers and died of a drug overdose at the age of 45 after a rapid descent into substance abuse.
Or Duerson, former player for Notre Dame and the Chicago Bears, who at the age of 50 fatally shot himself in the torso in February.
Next to Duerson’s body, found in a south Florida condo, was a note that asked for his brain to be given to “NFL’s brain bank.”
After a descent that included a charge of domestic battery, a divorce, concerns of memory loss and bankruptcy, many speculated that Duerson’s request stemmed from a belief his fate would be similar to others who had shared his occupation.
In the past five years, more than a dozen former NFL players had been diagnosed - after death - with Chronic Traumatic Encephalopathy, a form of dementia that has only one known cause: repeated, traumatic blows to the head.
More than just a hit in the head
To call Chronic Traumatic Encephalopathy a football disease is a bit of a misnomer.
For decades, scientists identified the condition as “dementia pugilistica,” the boxer’s disease, the result of too many punches to the head.
But in the past decade, as researchers began examining the brains of more and more football players, the realization grew that it wasn’t only boxers who were being put in harm’s way.
Today, CTE has been found in the brains of hockey players, a soccer player and professional wrestlers.
But more than anywhere, it has been found in the brains of football players, and not just professionals.
It has been found in the brain of a college football wide receiver. Even more shocking to some, it has been found in the brain of an 18-year-old high school athlete.
“And in nearly all of those cases, you find a history of concussion,” said Chris Nowinski, a former Harvard football player who advocates for tougher football safety rules. “That’s why the issues of preventing concussions has become so huge.”
But to prevent concussions, you have to understand where they come from.
You have to understand the brain. You have to understand physics.
First, the brain.
Steve Simons, a physician with Saint Joseph Regional Medical Center’s sports medicine clinic, likes to compare the brain to a multilayered Jell-O salad.
Soft and mushy, each layer of the salad has a different density. Imagine a bottom layer that’s filled with fruit, as opposed to a middle layer of whipped cream, topped by pure gelatin.
Although the brain is connected to the spinal cord, it’s actually buoyant, floating inside the skull in a liquid called cerebrospinal fluid.
Now, physics. Specifically, Newton’s Third Law of Motion: “For every action, there is an equal and opposite reaction.”
When a person’s head hits an object, the force generated by that object (equal and opposite to that of the person’s own force) is transferred onto the head. Even when the head is protected by a helmet, that force pushes the brain - floating and unfixed - into the wall of the skull in what is known as a “lateral concussion.”
“The head suddenly stops, but the brain does not,” Simons said. “It hits the skull and bounces back.”
Even more concerning, Simons said, are the hits that come with some sort of rotation, causing what is known as a “shear” concussion.
In that instance, the Jell-O salad’s layers are being rotated violently. But because they have different densities, some layers spin faster than others.
“The shear forces, caused by the rotation, can come from a hit on the side of the head,” Simons said. “The intensity of the hit may not appear to be that strong, but the rotation forces are enough to disrupt the axon connections between the nerves.”
And with each concussion, maybe with each hard collision, scientists now worry that the brain is undergoing chemical changes that include the buildup of an abnormal protein called tau.
That tau, over time, degrades brain function and can lead to early symptoms such as memory impairment, emotional instability, erratic behavior, depression and poor impulse control. Eventually, CTE can progress to full-blown dementia.
And although scientists say the disease in its final stages appears to be similar to Alzheimer’s, there is one major difference.
Unlike other forms of dementia, CTE is the only known form that is completely preventable.
Making the game safer
To be clear, concussions have always been a concern for football players, coaches, parents and the doctors who treated the injuries.
But it’s only in the last decade that concern has changed to alarm.
“There was a time when the rule was that anyone who suffered a concussion in a game had to sit out for a week,” Simons said. “There was no science behind that; it was just a way from keeping a kid playing in next week’s game.”
Simons, who is chairman of the Indiana State Medical Association’s Sports Medicine Commission, said the growing medical data about concussions and head injury has resulted in some positive changes to help protect student-athletes.
This year, Indiana’s legislature passed a law that requires any high school athlete suspected of sustaining a concussion be removed from play at the time of the injury - and won’t allow the player to return until he is cleared for play, in writing, by a medical professional.
When the law goes into effect next July, schools will be required to provide education about concussions and head injury, along with copies of the new rules.
The hope, Simons said, is that as more players, parents and coaches become aware of the potential consequences of traumatic brain injuries, they will be less likely to put themselves at risk.
And thanks to a new computer program now required by most local high schools and at Notre Dame, the final decision doesn’t have to rely solely on a doctor’s opinion.
The tests require the user to focus on the computer screen, clicking on moving playing cards or other objects that test reflexes and reaction times.
Both Saint Joseph Regional Medical Center and Memorial Hospital’s sports medicine groups offer computer-based cognitive tests that local athletes can take.
The goal, Simons said, is to establish a baseline of cognitive ability before the athletic season starts. If the player suffers a concussion, he will have to retake the test until his reflexes have reached the baseline level.
“Just today, I had a young man whose symptoms have cleared up dramatically, but he still failed the test,” Simons said last week. “The tests are able to detect reaction time better than I can do.”
Those tests, which are now standard for most college and NFL teams, are still not mandatory for high schools, although some states have recently enacted legislation mandating them.
“If you mandate it, you have to find a way to pay for it,” Simons said, explaining why mandatory tests are not required in Indiana.
But as the technology spreads, Simons said, it will become easier to identify players who’ve had concussions and to keep them off the playing field until the symptoms are gone.
And keeping players out of harm’s way while they are recovering has been shown to prevent things from getting worse, at least in the short term.
“With a repeat head injury, when you have not recovered from the first one it is much easier to be reinjured,” Simons said, “and in many cases you could be injured worse.”
Although rare, Simons said cases of “second impact syndrome” result in concussions combined with swelling of the brain, a situation that’s often fatal.
“And it’s even more critical with the very young,” Simons said, referring to children in middle school or younger. “Their brains are still developing. You need to give their brains plenty of time to recover and not push them back into the sport too soon.”
But what if the brains of young players were actually being damaged and no one knew it?
What if concussion like trauma was occurring inside the brain, but from the outside, everything seemed fine?
Coming Monday: Part 2: The concussion problem that researchers are just starting to understand, and what that means for the future of football.
Staff writer Dave Stephens:
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