Thursday’s report that the National Institutes of Health found evidence that retired San Diego Chargers All-Pro linebacker Junior Seau, who committed suicide on May 2 by shooting himself in the heart, suffered from chronic traumatic encephalopathy (CTE) highlights the NFL’s brain injury problem.

Recent scientific research confirms the high incidence of brain injury among deceased NFL players.  On December 3, Boston University released a study that concluded “34 NFL players whose brain were studied suffered from CTE, a degenerative brain disease brought on by repeated hits to the head that results in confusion, depression and, eventually, dementia”:

Researchers at Boston University’s Center for the Study of Traumatic Encephalopathy published the largest case series study of CTE to date, according to the center. Of the 85 brains donated by the families of deceased veterans and athletes with histories of repeated head trauma, they found CTE in 68 of them. Of those, 34 were professional football players, nine others played college football and six played only high school football.

Of the 35 professional football players’ brains donated, only one had no evidence of the disease, according to the study.

The brains of many well known deceased NFL stars were used in the study, including John Mackey, Cookie Gilchrist, Ollie Matson, John Henry Johnson, Dave Duerson, Wally Hilgenberg, Joe Perry, Andre Waters, and Eric Scroggins.

While the connection between CTE and boxing had been known for many years, it was not until 2002 that the the football connection was confirmed. The tragic story of Mike Webster, the 17-year NFL veteran who was the starting center on all four Pittsburgh Steeler NFL Championship teams in the 1970s, first brought the relationship between playing in the NFL and brain injury into the public arena. Webster died at the age of 50 in 2002. Dr. Bennet Omalu autopsied Webster shortly after his death and discovered evidence of CTE in his brain.

In February 2012, former Dallas Cowboys star running back Tony Dorsett joined Jim McMahon and 300 other former NFL players who are suing the league for their concussion related health problems:

More should have been done in the past to warn about the dangers of concussions, their lawyers argue, and more can be done now and in the future to help retired players deal with mental and physical problems they attribute to their days in the NFL.

Then, of course, there are the spate of recent suicides by recent or current players in the NFL, which includes Kansas City Chief linebacker Jevan Belcher, Dave Duerson, Andre Waters, and, of course, Junior Seau.

But the Boston University study cautions that there is still very little known about “how much brain trauma results in CTE.” Co-author Dr. Robert Cantu stated that “[w]hile it remains unknown what level of exposure to brain trauma is required to trigger CTE, there is no available evidence that occasional, isolated or well-managed concussions give rise to CTE.” 

Some pundits have argued that the game is so inherently violent that neither improved equipment nor changes in the rules can make it safe enough, and that the federal government, therefore, must ban the game. Similar claims were made back in 1905 when eighteen football players died, but rules changes–such as banning the “wedge” on kickoffs and changing the distance needed to obtain a first down from five yards to ten yards–dramatically improved the game’s safety and calls for a ban died out.

More than a century later, as the connection between the violent trauma that occurs in the NFL and brain injury has become apparent, calls for either banning the game entirely or changing it beyond recognition through the legislative or regulatory power of the federal government are back in vogue. Some football fans have expressed concern that the federal government may intervene in the sport, either at the NFL level or at lower levels of the game.

Rush Limbaugh, a well known NFL fan, has a slightly different prediction:

I’m not predicting that the game’s gonna be banned. That’s not how this is going to happen. They’re not gonna ban the game. What’s gonna happen–and I don’t know how many years it’s gonna take, but–is it’s going to eventually lose (slowly but surely) its fans, its audience. There’s going to be a deterioration at all levels. I’ll be happy to detail how I think this is going to manifest itself. It’s already begun. It’s already begun. “Football can’t be fixed. There’s something inexorably wrong about it.” It does generate a lot of money, but, remember: The liberal left on college campi hate that.

Football team owners, coaches, players, officials and fans who believe the game can address the brain injury problem without radically changing it point to a combination of rule changes, more research, new equipment, voluntary development and implementation of health protocols by the NFL, and training and coaching in safer techniques as avenues worth pursuing.

Proposals to modify the rules of the game range from changes on the margin to more dramatic alterations, such as an idea suggested by Greg Schiano, head coach of the NFL’s Tampa Bay Buccaneers, who recently proposed banning kickoffs entirely. Schiano, who was the head coach at Rutgers in 2000 when one of his players, Eric LeGrand, was paralyzed during a kickoff, argues that the kickoff is the most dangerous play in football. 

Under Schiano’s proposal, the game would start with one team possessing the ball on their own 30-yard line with a fourth down and fifteen yards to go for a first down. Most teams would choose to begin the game by punting to their opponent, but teams would have the option of going for it. If they failed to gain 15 yards and convert the first down, possession would go to the opponent, who would be in excellent field position to start the game.

Despite Schiano’s personal experience with a player experiencing a catastrophic injury on a kickoff, there has been little conclusive scientific research on either the causes of brain injuries in football or the specific types of plays that may have higher risk associated with brain injuries. There is also no study that shows the kickoff play contributes to brain injuries at any greater level than any other type of play in football. Specifically, no research shows that shows the kickoff play is any more or less dangerous–as it relates to long term brain injury–than the punt and punt return Schiano advocates as a safer replacement for the kickoff.

There has, however, been some research done on the incidence of cervical cord injuries with incomplete neurological recovery in football, and that research is inconclusive. One study conducted by the University of North Carolina showed that three of the seven, or 37.5%, of cervical spine injuries with incomplete neurological recovery that occurred at the high school and college levels in 2010 came on the kickoff. Those 2010 results, however, appear to be an “outlier.” 

That same study showed that during the entire 33 year period beginning in 1977 and ending in 2010, 26 of 314, or 8.4%, of cervical spine injuries with incomplete neurological recovery came on the kickoff. Of these 26, 19 occurred while tackling on the kickoff, 4 occurred while blocking on the kickoff, and 3 occurred while being tackled on the kickoff. The study does show, however, a lower rate of cervical spine injuries with incomplete neurological recovery for punts–4 of the 314 of cervical spine injuries, or 1.4%.

Other, less radical rule change proposals would address the brain injury problem directly by limiting the number of the most violent head to head collisions that, on a cumulative basis, are believed to lead to permanent brain damage. The NFL currently imposes a 15 yard penalty, for instance, for players who initiate head-to-head collisions, but increasing that penalty to, say 25 yards or even ejection from a game would certainly influence player behavior on the field.

More scientific research on the causes of concussions and brain injury could help pinpoint the yet undetermined specific triggers for brain injury. While it is widely accepted that at some point, multiple head traumas will lead to increased rates of brain injury, no one really knows when that trigger is passed.

Stanford University is leading the way in research on the causes of concussions and brain injury in football. As KQED reported last week:

It’s no secret that concussions are endemic in American football at every level, from pewees to the pros, but little is known about the hits that cause them. Stanford University is searching for answers by meticulously gathering data on every impact their football players sustain. The study is only in it’s second year, but they’ve already made some interesting discoveries.

Changes in equipment could also lead to lower rates of brain injury over time, though at present it’s not clear which specific changes could have that effect.

Voluntary development and implementation of health protocols by the NFL is another area that has great promise. For instance, health protocols could involve dramatically increasing tests for brain function, with warning signals that would automatically require the placement of players in the danger zone on injured reserve or on the physically unable to perform list. With tight monitoring of brain function throughout a player’s career–and especially during the season–players might experience shorter career spans due to early detection of potential brain injuries.

Some players may have made career decisions that reflected their own concerns over the cumulative effect of injuries. The great Detroit Lions running back Barry Sanders, for instance, looks very smart in retrospect for choosing to retire after only nine years in the NFL.

Finally, training coaches and coaching players in techniques that are safer and lead to fewer head injuries is another area that shows promise. Coaching players at every level, starting in youth football, not to lead with the head or hit the opponent’s head when tackling, for instance, has already begun. There are numerous additional techniques that may be developed in the near future.

Despite the numerous league- and player-inspired areas that offer promising approaches to the NFL’s brain injury problem, some on the left will continue to call for governmental action to control–and possibly eliminate–the game.