1

EvaluatingtheEffectivenessoftheNFLConcussionPolicy
Killtheheadandthebodywilldie,proclaimedGreggWilliams,theformerdefensive
coordinatoroftheNewOrleansSaints,tohisteamjustbeforeagame.Althoughthiswasnotthe
firsttimethesewordswereuttered,accordingtoSaintsplayers,itwasthefirsttimethestatement
wasrecordedandreleasedtothepublic.Playersonthefootballfieldcarryaggressiveattitudes,
especiallywhenencouragedbyinfluentialpeopleintheNFLsuchasGreggWilliamswhopaid
hisplayersbounties,orbonusestointentionallyhurtopponents(ESPN).Concussions,which
aretraumaticbraininjuriesthatalterthewaythebrainfunctions,havebecomeaprominent
conflictincontactsportssuchasfootball.TheNFLConcussionProtocolwasmadetocombat
thisinjury,buthasprovedtobeineffectiveinpreventingconcussions.Subsequently,itshouldbe
modifiedtoguaranteetheplayerssafetyaswellasthefutureoftheleague.TheNFLprotocol
hasattemptedtotakeprotectivemeasuressuchasdevelopingnewandmoreefficient
technologiestoensureplayersafety.However,concussionscontinuetopersistandare
increasinglypervasiveinyouthsports.Coupledwithincreasedmediaattention,publicscrutiny
towardstheNFLconcussionprotocolanditseffectivenesshasbecomeincreasinglyextensive.
Withoutalteration,theprotocolwillcontinuetoallowdetrimentalaffectstoplayerhealth,and
costtheleaguemoneyintheformoflawsuits.TheNFLconcussionprotocolmustbemodifiedin
ordertoprotectthesafetyofplayersatalllevelsoffootball,aswellastoprotectthefutureofthe
leagueitself.
ToeffectivelyjudgethecontemporaryNFLConcussionPolicy,examiningthehistoryof
headtraumaisnecessarytodeterminetheoriginofthisissue.JeanneMarieLaskas,an
establishedauthor,journalist,andprofessorattheUniversityofPittsburgh,reportedthe

concussivefindingsofHippocrates,AbuBakrMuhammadibnZakariyaRazi,andJacopo
BerengariodaCarpiinherworktitledConcussion.Tobeginwith,Hippocratess
documentationofcommotiocerebri,orcommotionofthebrain,beganthefoundationof
concussiveresearchin460B.C.(Laskas).Thiscerebralirritationhappenswhenanimpacttothe
headcreatesadangerousimpulsethroughthenervoussystem.Theresultingsymptomswere
foundtobelossofhearing,speech,orsight.Inthe10thcentury,PersianphysicianAbuBakr
MuhammadibnZakariyaRaziconstructedthetermcerebralconcussionoratransientlossof
functionwithnophysicaldamage(Laskas).Inotherwords,theconditioncancause
unconsciousnessandtemporarilyalterthebrainsnormalfunctions.Afterward,inthe16th
century,ItalianphysicianJacopoBerengariodaCarpibuiltoffHippocratescommotionofthe
brainresearchthroughtheexplorationofhumanremains.Throughhisobservationsofthe
humanskull,Carpifoundthatcommotionofthebrainwascausedbybruisingofthebrain
developedfromviolentbraincontactagainsttheskullbarrier.Astimepassed,researchon
concussionswasdismisseduntilthe20thcenturywhencontactsportssuchasfootballmadethe
healthissueunavoidable.Inspiredbytheconcussioncrisisthatwasbeginningtounfold,tests
performedbyneuropsychiatristsMichaelOsnatoandVincentGilibertiprovedRazistheoryof
transientconcussionsfalse.Subsequently,insomecasesthebrainneverfullyrecovered.In
essence,modernexperimentationanddefinitionofconcussionswasfoundedthroughthese
historicalcontributions,whichisprominentlylinkedtocontactsportssuchasfootball.
Americanfootballisknownforitsviolentnature.Injuries,specificallyonestothehead,
arenotanuncommonoccurrence.AccordingtotheCentersforDiseaseControlandPrevention,
aconcussionoccursfromahitorblowinwhichtheheadshakesbackandforthrapidly.The

rapidmotionoftheheadcausesthebraintobounceortwistintheskull,damagingbraincells
andcreatingharmfulchemicalchanges.Contrarytowhatmanybelieve,concussionsarenot
physicalinjuries.Theyareinfactfunctionalinjuries,meaningtheyimpairthefunctionofthe
brain.Inthepast,doctorsclaimedthatconcussionswereconsideredmildheadinjuriesdueto
thefactthattheysupposedlywerenotlifethreatening.Butwithincreasingresearchand
understandingoftheeffectsofaconcussiononthebrain,theassertionwasfounduntrue.Itwas
discoveredthattheyinfactcanleadtodetrimentaldiseasesandseverementalillnessesinthe
future.Throughouttime,repeatedconcussionsandotherheadinjuriescancauseCTE,orchronic
traumaticencephalopathy.CTEisadegenerativediseasethatleadstoconditionssuchas
memoryloss,depressionanddementia(Breslow).WhenresearchedbytheDepartmentof
VeteransAffairsandBostonUniversity,CTEwasidentifiedin96percentofNFLplayersthat
theyveexaminedandin79percentofallfootballplayers(Breslow).TheNFLslargeportion
ofplayerswithheadtraumahasledtoscrutinyandpublicconcernsassociatedwithplayer
health.Intotal,thelabhasfoundCTEinthebraintissuein131outof165individualswho
playedfootballeitherprofessionally,semiprofessionally,incollegeorinhighschool,andforty
percentofthosewhotestedpositiveforCTEwereoffensiveanddefensivelinementheplayers
whocomeintocontactandcollisionswitheachotheroneveryplayofagame(Breslow).
Unfortunately,CTEisadiseasethatcanonlybethoroughlyandconclusivelyidentified
posthumously,orafterdeath.Brainscansthatareperformedonplayerscanonlyshowsignsof
CTE,butcannotpreciselyrecognizeitmakingthediseasealmostimpossibletotreateffectively.
AlongwithCTE,researchersarealsostudyingtheeffectsofpituitaryglanddysfunction.Inan
NFLPlayersAssociationinterviewwithKevinGuskiewicz,PhD,an
Americansportsmedicine

researcher
,heexplainedthatthroughtraumaticheadinjuries,theglandisdamaged.Thepituitary
glandistheoneofthemostimportantpartsoftheendocrinesystemasitregulateshormonal
functionssuchasproducingortransportinghormonesthroughoutthebody(Hadhazy).When
thisglandisdamaged,thebloodsupplyisdiminished,creatingahypoactivecondition.This
conditioncausesmanyproblems,includingpostconcussionsyndromessimilartothose
developedfromCTEsuchasdepression,anxiety,sleepdisorders,Alzheimer'sandothermental
illnesses.Butmorespecificallytopituitaryglanddysfunction,thehormoneimbalancecreates
harmfulconditionssuchas
Adrenalinsufficiency,Diabetesinsipidus,Hyponatremia,
Hypogonadism,Growthhormonedeficiency,andmanyothers.
Boththedamagingofthe
pituitaryglandandCTEareconditionsthatcauselifethreateningabnormalitiesinthebrainand
aredevelopedfromfootballrelatedconcussions.Theseandmanymorearetherisksthatfootball
playersundergowitheverygametheyplay.Sinceplayershavetoendureexpensiveand
persistenttreatmentbecauseoftheirinjuries,theylooktotheNFLforaidwithmedical
expenses.
Thelargenumberofplayerswithhealthconcernscausedbyheadtraumahasdevastating
effectsontheeconomyoftheNFL.Professionalfootballisamultibilliondollarindustry
expectedtoreach$25billioninrevenueby2027(Ejiochi).TheissueofconcussionsandCTE
posesathreattotheNFLsflourishingeconomy.Injuriesinprofessionalfootball,namelytothe
brain,requirelargesumsofmoneytopayforthehealthofplayers.Muchofthisfundingis
expectedtocomefromtheNFL.Toaccountforaportionofthemedicalexpenses,theleague
provideshealthinsurancetoformerplayersforfiveyearsafterretirement(JenkinsandMaese).
Thesefiveyearsofinsurancesupportplayersforonlyashorttimeafterleavingtheleague,but

manyhealthproblemsinducedbyheadtraumalastformanyyearsafterretirement.Forthis
reason,playersaresuingtheNFLtoreceivemoneytocareformedicalproblemslaterinlife,
whichsupplementstheNFLsdirectmedicalexpenses.Consequently,theNFLhasagreedto
allocate$675milliontoinjurycompensation,buttheleagueisinvolvedinotherlawsuitsthat
couldincreasethetotalto$750million(Breslow).AlthoughtheNFLiseconomically
prosperous,theselawsuitswouldseverelyreducetheleagueswealthandinhibitthemonetary
growthofprofessionalfootball.TheNFLwouldbenefitfrommoreeffectiveconcussionpolicies
tosharplyreducetheeconomicburdenduetoheadtraumainplayers.Duetothethreat
concussionsposetotheeconomyofprofessionalfootball,theNFLhasoftenchangedhelmet
technologyinattemptstoprovidegreaterprotectiontoplayers.
Throughouthistory,theNFLhascloselyregardedtheissueofheadtrauma.Earlyon,
playersworesoftleatherhelmets,whichprovidedlittletonoprotection.Asthehelmetevolved,
manufacturers,suchasRiddell,begantointroducenewtechnologiesinthehelmetsthemselves.
Forexample,inthe1970s,Riddellcreatedairbladdersinsidethehelmettohelpabsorbimpact.
Inadditiontoimprovementsofhelmetmaterial,manufacturersintroducedinnovative
technologiessuchassensorsandimpactindicatorstohelpcoachesandtrainerstomore
accuratelyidentifyconcussions.Despitetheseadvances,thehelmetsarefarfromperfect,asthey
cannotfullypreventconcussions.Newtechnologiessuchastheuseofkeratin,amaterialfound
inramshorns,arecurrentlybeingresearchedtoattempttoreduceconcussionsintheNFL.
AccordingtoAinissaRamirez,amaterialsscientistwith13yearsofexperienceinthefield,
keratinisverystretchyaswellasimpactabsorbent,whichwouldprovidegreatprotectionfor
players.However,thismaterialcannotbeimplementedimmediatelyduetothegreatamountof

researchthatiscurrentlyneeded.Regardlessoftechnologicadvances,playersthroughouthistory
havegrownasDr.Levy,aboardcertifiedneurosurgeon.Forexample,WilburPeteHenry,a
5feet11inchesand245poundswasoneofthemostdominantlinemaninthe1920s.Today,
however,hewouldbedwarfedbysomeofthesmallestlinemanintheleague.Inadditiontothis
growth,playershavebeenencouragedbycoachestohitharderandplaymoreaggressively.This
attitude,coupledwiththesheerstrengthoftheplayers,causesfootballtobeplaguedwith
injuries,primarilytothehead.Althoughequipmentimprovementshavehelpedreduce
concussions,playersattitudeshavechanged,whichinturnhasinfluencedtheyouththatlooks
uptothesesuperstars.
TheNFLConcussionPolicyhasalsodemonstrateditsinadequacyinmonitoringand
preventingconcussionsthroughitsinfluenceonhighschoolfootball.Inrecentyears,high
schoolsacrossAmericahavealteredtheirconcussionprotocoltomirrorthechangingNFL
concussionpolicy.Theresultsofsuchparallelrulesregardingthesigns,symptoms,or
behaviorsconsistentwithaconcussionhavebeenpoorthusfar(OhioHighSchoolAthletic
Association).Currently,highschoolfootballplayersaretwiceaslikelytosufferconcussionsas
collegiateplayers.Thiscanbelinkedtothefactthatonly5.3percentofhighschoolsimplement
HeadsUpFootballintheirprograms.HeadsUpFootball,createdbyUSAFootball,isayouth
programsponsoredbytheNFL,NCAA,andRiddell.Itimplementsmandatorycertificationsfor
officialsandcoachesandteachesplayershowtotacklesafelytoreduceheadinjuries.This
program,usedwidelyinyouthfootballhashadsuccesswithagesunder14.Astudybythe
DatalysCenterfoundthatimplementingHeadsUpFootballresultsina29percentreductionin
ingameconcussions(TheDatalysCenterforSportsInjuryResearchandPrevention).This

successinyouthfootballshouldbemirroredbyhighschools.TheNFLConcussionProtocol
needstofurtherenforceHeadsUpFootballinhighschoolstoimproveitseffectiveness.In
additiontothelargeriskforconcussions,highschoolplayersareespeciallypronetoignoring
symptomsandplayingthroughconcussions.Thisignorancetowardsthealreadyweakprotocolis
aresultoftheadolescentbeliefthatt
heymayplaythroughaconcussiontoavoidlettingdown
theirteammates,coaches,schoolsandparents.(
HBORealSports/
Marist
Poll
).Thisplaces
playersatincreasedriskforchronicbraininjuryandevenCTEasresearcherssuchasBennet
Omaluhavepointedout.TheNFLconcussionprotocol,althoughinfluencinghighschool
football,hasfailedtoaddressthisunhealthycultureofignoringinjury.thusputtingmillionsof
youngplayersatrisk.ToexpandontheresearchandopinionofDr.BennetOmalu,chronichits
totheheadcanaltercognitivebrainfunctionandleadtodiseasessuchasdepression.Thisis
especiallydangerousinthedevelopingmindsofhighschoolplayers,andcanterriblydamage
whatOmalucalls,themostpreciousorgan.TheopinionofOmaluandtheincreasingamount
ofpeoplechallengingtheNFLconcussionprotocolhavebeenfueledbytragicincidents
involvingformerhighschoolplayerssuchas25JosephChernachwhowasdiscoveredtohave
CTEaftercommittingsuicide.HeadtraumaobtainedintheNFLcontributedtohisunusual
changeinmood,ashebecamesuddenlydepressedandreclusive,whichultimatelyledtotheloss
ofhislife.Therefore,theNFLconcussionprotocolisweakinregardstoprotectinghighschool
playersandshouldbealtered.
Mediaaffectshowparentsandplayersarerealizingthedangersofprofessionalfootball,
whichisfuelingadebateoverconcussionpolicies.
Manyparentswerefrightenedbyconcussions
afterwatchingthemovieConcussion(2015).ThefilmisbasedonthestoryofDr.Bennet

Omalu,anaccomplishedpathologist.Dr.Omaludiscoversthatseriousbraindamageisoccurring
toplayerswhosuffermultipleconcussions,butishinderedfrompublicizinghisfindingsby
unethicalNFLbusinessmen.ThesportsmagazineMondayMorningQuarterback(MMQB)
publishedanarticleonthereactionsofIndianapolisColtsfanswhowatchedthemovie.Kalyn
Kahler,aneditorialassistantoftheMMQB,recordedtheresponseofamothernamedKatie
Whitewhoproclaimedthatbefores
eeingthismovie,Ilumpedconcussionsinwithanyother
injurymykidscouldsustainfromfootball.Katieisanaverageparentshebelievedthat
concussionswerenotmajorinjuries.Thereforeitisconcludedthatmostuninformedparents
assumethatconcussionsareregularinjuries,similartobruises,cuts,orscrapes.Katiecontinues,
tellingaboutherchildrenandtheirexcitementforfoot
ball,whichshemustspoilduetothelack
ofprotectionagainstheadtraumainthesport.Sheproceedssaying,Iwillnotletthem
play
footballnowbecauseshehasbecomeawareoftherisksassociatedwithgettingaconcussion.
Ontheotherhand,manywonderhowtheviewofparentsaffectsthoseofprofessionalplayers.
Katieanswers,IknowthatImanadultandsoarethey,sotheycanmakethatchoiceto
continueplaying,knowingwhatmighthappentothem.She,likemanyothers,feelsthatthe
responsibilityofdecidingtoparticipateinthisriskygamefallsontheshouldersoftheplayers
themselves.
Whileplayersaregiventhechoicetoremaininthegame,manyareinfluencedby
theoutcryofparentsandthemediaagainsttheineffectiveNFLConcussionPolicy.Many
parentswhobelievechangingthepolicyisnotsufficienttokeeptheirchildrensafearelooking
tothedevelopmentofnewtechnologiestoensurethewellbeingoffootballplayers.
Althoughconcussionshaveundisputablyincreasedinthepastfewyears,theNFLhas
beenmakinganefforttodevelopnewwaystopreventsuchanincrease.TheNFLhas,for

example,launchedin2013a$10millionprogramtodevelopnewtechnologiestofurtherattempt
topreventconcussions.Newmaterials,sensors,andimpactindicatorsarecurrentlybeing
developed,butmosttechnologiesarestillbeingtested.Sensorsandimpactindicators,whichare
occasionallybeingusedintheNFLandincollegiateleagues,cangreatlyhelpcoachesand
trainerstoidentifyconcussionsasthesetechnologiesindicatewhenahitexceedsaplayers
threshold,basedonpasthits.Furthermore,revolutionaryideassuchasGuardianCapsshells
madeofpolyurethanefabricdesignedtofitoutsideofhelmetshavebeendevelopedtominimize
concussionrisks.AccordingtoLeeHanson,thecreatorofGuardianCaps,hisproducthas
proveneffectiveinlabtestsastheycanreduceheadimpactupto33%.Despiteinnovations
provingoptimisticinlabandfieldtests,thesetechnologicaladvancesmayprovecontroversialas
playersareencouragedtohitharderastheyarewearingmoreequipment.Rugby,footballs
Britishcounterpart,isconsideredequally,ifnotmore,dangerousasfootballsinceplayerswear
littletonoprotection.However,concussionsandotherheadinjuriesarenotascommoninrugby
astheyareinfootball.Some,suchasJimMcKenna,professorofphysicalactivityandhealthat
LeedsMetropolitanUniversityaswellasrugbycoach,arguethatfootballplayersusetheirheads
totackle,leadingtotremendousstresstothespinalregion.McKennaaddsthatsincefootball
playerswearmoreprotectionandpadding,theyareindirectlyencouragedtousemoreforceand
brutalityintheirhits,thusmakingthegamemoredangerous.Inspiteoftechnological
advancementstowardsmakingthegamesafer,playerconductremainsanissue,asmanyargue
againsttheexcessofprotectionasitcausesplayerstobecomemoreaggressive.Thiscreatesa
needfortheuseoftechnologycompoundedwithregulationinordertoimprovethesafetyofthe
game.


10

ConcussionshaveanimmenseimpactontheNFLastheyhaveahugeeffectonthe
leagueanditsplayers.Concussions,whichcanbederivedfromrecurringhitstotheheadin
football,canprovedetrimentaltothehealthofplayers,asmanycasesofCTEarebeing
discovered.Therefore,theNFLhasbeenactivelyattemptingtomakethegamesaferthrough
regulationsandprograms.Inaddition,moretechnologiescanbedevelopedtofurtherminimize
concussions,butthosealonecannoteradicatethisissuefromtheleague.However,many
technologiesarestillundertesting,thusprovingineffectiveasanimmediatesolution.
Furthermore,despiteequipmentgreatlyhelpingthesafetyoftheplayers,italsohasdrawbacksas
theincreaseduseofpaddingindirectlyinfluencesplayerstoplaymoreaggressively.Onthe
otherhand,technologiessuchasGuardianCaps,haveprovensuccessfulatminimizinghitsinlab
tests,thussheddinghopeintothematter.MoreresearchfundedbytheNFLinnecessaryinorder
todevelopmoreequipmenttofurtherguaranteeplayersafety,despitethedrawbackstheymay
have.Additionally,testingplayersbeforeandduringtheseason,aswellasutilizingsensors,to
determinetheminimumforcerequiredforaplayertobecomeconcussedwillgreatlyhelp
trainersandcoachesidentifythistypeofinjury.Moreover,programssuchasHeadsUpFootball
mustbemademandatorythroughoutthenationinhighschoolconcussionprotocoltodevelopa
safementalityfortheyouth,makingthegamesafer.Theimplementationoftheseprogramsand
enforcementbytheNFLwillgreatlyinfluenceyouthtoplaysafer,thusmakingthefuture
generationofplayerssaferandmoreprudent.Ultimately,thecurrentNFLpolicyandtechnology
regardingconcussionshaveprovenineffectiveasconcussionsarenotdecreasing.Inorderto
preservethesafetyofplayerswhilenewtechnologiesaredeveloped,theNFLshouldimplement
GuardianCapswhilealsoutilizingsensorstopreventincreasedaggressiveness.Throughthe


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combinationofusingtechnologytomakethegamesafer,improvingpoliciestomakethenext
generationofplayerssafer,andfundingthedevelopmentoffutureinnovations,theNFLwould
beabletominimizethisissuethathaseruptedthroughouttheworld.


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