Mind games

Head injuries on the football field have recently come under greater scrutiny. Photo courtesy of Concussionometer/Twitter

How hits to the head are threatening the future of football
The play began like any other: a normal kick-off to start the second half of a 2016 Football Championship Subdivision (FCS) playoff game between the University of San Diego and perennial power North Dakota State.


The Bison’s return man, Bruce Anderson, caught the ball at his own three yard line, charging into the teeth of the Toreros’ special teams group before being tackled after a modest gain. Players on both sides patted each other on the back and jogged back to their respective sidelines.


That is, except one. Torero linebacker Fia Malepeai was still face down, lying uncomfortably still. Trainers sprinted onto the field as Malepeai attempted to stand, clearly dazed, before resigning himself to a sitting position on the turf.


The 5-foot-9, 215-pound Malepeai would eventually jog off the field under his own power, prompting the game’s announcers to comment, “That has to be a good sign for the Toreros.”


There was just one problem: Malepeai himself doesn’t remember any of it.


“The last thing I remember is seeing the ball carrier and thinking ‘I’m about to clean this guy up,’” Malepeai said. “I don’t even remember coming off the field. Suddenly, though, I had these trainers asking me questions, going through concussion protocol. I messed up something on remembering three words they gave me and they took my helmet so I couldn’t try to go back in.”


The injury, one that left Malepeai briefly unconscious on the field and knocked him out of the final game of his college career, is yet another example in an ongoing parade of blows to the psyche of American football fans.


For years, fans have cheered the huge hits delivered by their favorite gridiron greats, as names like Ray Lewis of the Baltimore Ravens and Junior Seau of the San Diego Chargers became local heroes and highlight-reel regulars. However, after Seau took his own life in May 2012, the long-term effects of those hits have fallen under greater scrutiny.


An autopsy of Seau’s brain revealed a startling discovery: the presence of what scientists call chronic traumatic encephalopathy (CTE). CTE involves the formation of a protein that slowly spreads throughout the brain, killing brain cells and creating changes in mood and behavior such as depression, dementia, and increased aggression.


Suddenly, the connection between consistent contact to the head and the effect those hits can have long after players put on their pads for the last time included a grim, life-threatening possibility.

Crunching tackles like this convey the celebrated physicality of football on a weekly basis without mention of the long-term effects. Photo courtesy of USD Athletics.

That correlation, already acknowledged by the National Football League (NFL), was further strengthened during the summer by Dr. Ann McKee, the head of neuropathology at the VA Boston Healthcare System and director of the CTE Center at Boston University.
McKee studied the donated brains of 202 deceased football players, and her findings published in the Journal of the American Medical Association were striking.


Of the 111 brains examined that belonged to former NFL players, 110 showed signs of CTE — a prevalence of more than 99 percent. Among those who stopped playing after college, the frequency of CTE was still a head-shakingly high 91 percent (48 of 53).
The study involved a targeted sample and the results relied on donations of players’ brains by families and individuals who likely noticed symptoms of CTE prior to death. However, the findings still call into question the simple safety of playing the sport.


Malepeai acknowledged that the statistics surrounding his potential future are frightening.
“Yeah, it does scare me,” Malepeai said. “I’ve been known to be a hitter, and it’s one of my favorite things to do. It’s crazy what might happen later because of that.”
However, not every former player shares that perspective. Head coach Dale Lindsey, now in his fifth year at the helm of the Toreros’ football program, is a former NFL linebacker who spent nine seasons with the Cleveland Browns in the 1960s and ’70s.
A man who entered the league alongside Dick Butkus and Gale Sayers and whose locker sat next to Jim Brown’s, Lindsey has seen his fair share of football since the game’s earliest glory days.

Brain scans of individuals with advanced CTE show significant deterioration relative to brains that have not developed the protein. Dr. Ann McKee found signs of CTE in the brains of 110 of 111 former NFL players. Photo courtesy of the Boston University CTE Center

The 74-year-old remained staunchly skeptical about McKee’s study. “How do we know it hasn’t been out there and we’ve only just discovered it, and it’s caused by factors in society that aren’t related to football?” Lindsey said. “We don’t know if guys like Seau had other problems as well. All I know is there’s a hell of a lot of us that have played football for a long time and don’t have it.”


But Lindsey’s suspicions did not appear to affect how he coaches his teams. “If something’s wrong, we want to know, and we want you go to the trainers,” Lindsey said. “We don’t want to be part of something that compounds on itself. It’s not worth it. We’re going to hit people, but our primary goal is to be tough and physical within the rules.”


Those rules extend to how players, coaches, and trainers handle injuries to the head, and Lindsey further explained the staff’s standards.


“Our staff teaches players not to use their head for any reason,” Lindsey said. “We want to use our shoulder pads to bring guys down. If you do get a head injury, you’re not going back into the game even if you pass the concussion protocol.”


Former USD player Jonah Hodges agrees with Lindsey’s statement. “The coaches aren’t going to push you and try to slide anything under the table,” Hodges said. “We have certain concussion tests we have to take. If you know you’re not okay, there’s no point in being out there. I never missed any time, though.”


While that perspective seemed to be the consensus among players, making the responsible decision becomes much tougher in the middle of competition.  


“The adrenaline takes over in the game and you don’t want to come out,” Hodges said.
Malepeai echoed Hodges’ perspective. “I’m not going to try to take myself out,” Malepeai said. “I’m out there playing the game I love with my brothers, and I want to put my body on the line for them.”


It is in those moments that the training staff must serve as the voice of reason. Associate Director of Athletics for Sports Medicine Carolyn Greer has been a member of the USD staff since 1978 and was the first female head athletic trainer at the NCAA Division I level.


“We work closely with the athletes and do education with them on concussions and the importance of reporting them,” Greer said. “As a member of the West Coast Conference, we also get our concussion protocol approved by the NCAA, something that’s optional for Division I schools outside of the Power 5 conferences.”
Greer outlined the school’s specific concussion protocol, a measured and methodical approach to head injuries based off of both physical and cognitive evaluations.


“Each player does an initial evaluation as a baseline, and we compare the results of evaluations on the sidelines and in the training room to the results of that initial test,” Greer said. “The sideline evaluations aren’t as detailed, because we’re using physical signs and what the player is telling us to make a decision on whether or not they need to go to the emergency room. Basically, if there’s any concern, they’re not going back in. After the game, players will go up to the training room for a more detailed evaluation.”


If it is determined that an athlete has suffered a concussion, they enter a process designed to return them to the field of play on an individualized basis. As athletes increase their own physical activity through five stages of progression — light aerobic activity, sports-specific activity, non-contact practice, unrestricted training, and a return to competition —  they are evaluated on a daily basis for concussion-related symptoms such as nausea, sensitivity to light, and problems with balance and concentration.

A former football player, head coach Dale Lindsey emphasizes the importance of life after football to his players today. Photo courtesy of USD Athletics.

If symptoms return, no matter where in the progression the athlete is, the athlete must rest before returning to the beginning of the process.


The nuanced and meticulous approach ensures that players have fully recovered from a head injury before they take the field again, no matter how long it takes to do so.


“We’ve had guys miss multiple weeks before, and that’s okay,” Coach Lindsey said. “We want our guys to be healthy first.”


Greer estimated that the football team collectively suffered 10 concussions over the course of last season. Despite the procedures that are in place, Greer noted that she is often approached by players and parents after an athlete suffers a head injury.


“An athlete will get a concussion and wonder if he or she should be playing the sport,” Greer said. “Parents become very interested in the school’s concussion protocol as well.”


Adding that such caution is a good thing, Greer also warned against relying too heavily on marketable changes meant to better protect players from head injuries.


“Since I started here, I’ve seen equipment and techniques evolve over time,” Greer said. “For example, helmets have certainly taken steps forward. However, helmets are meant to prevent skull fractures, not concussions. Concussions happen because the brain hits the inside of the skull, something no helmet can truly keep from happening. As far as technique goes, coaches are doing a better job of teaching players to lead with their shoulders instead of their heads, and the rules are better about prohibiting and punishing contact to the head. Defenders have to hit moving targets, though. It’s much harder to line up a tackle under those circumstances.”


Coach Lindsey agrees, describing how the speed of the game often doesn’t allow for perfectly placed hits on every play.


“This is NASCAR at 20-25 miles per hour,” Coach Lindsey said. “You can’t always control the collisions that happen.”


It is the random and continued prevalence of head-to-head contact, concussion-causing or otherwise, that has given academic members of the campus community cause for concern.


“The players are a lot bigger now,” Dr. Curt Spanis said. “These guys are 300 pounds, going like hell and smacking each other. The force is so much more dramatic than it used to be.”


Spanis, a biology and exercise physiology professor at USD since 1965, spent much of his youth playing contact sports like football, hockey, and boxing.


During his interview, it is clear that those years of physical play have taken their toll, as the scientist’s body sometimes stiffens in his seat and his sentences show a tendency to drift away from the topic at hand.


“I used to have a photographic memory, and some of the kids in my classes growing up were really annoyed by it because I didn’t really have to study that much to get good grades,” Spanis said. “I started getting banged around and that faded out pretty quickly, though. I have a hell of a trouble with memory now.”


Spanis added that the biggest challenge in raising awareness about the consequences of head injuries while athletes are still competing is the fact that those consequences are often so distantly set in the future.


“When you’re 21, you’re invulnerable,” Spanis said. “It’s difficult to impress young people with what can happen down the road. I remember standing next to [late boxer] Muhammad Ali at a party once and how grim he looked. You have to think about the long term.”


Some of Spanis’ colleagues in the College of Arts and Sciences have taken those concerns a step further. Last spring, three psychology professors — Dr. Nadav Goldschmied, Dr. Daniel Sheehan, and Dr. Kenneth Serbin — presented a motion pushing for USD to ban football.

Late linebacker Junior Seau’s jersey is now a reminder of the consequences that hits to the head can have on former players. Photo courtesy of Rickey Reed/Twitter


While admitting that he hadn’t personally performed research into the issue, Goldschmied noted that the publications of others have given him reason for pause when it comes to football.
“It’s about knowledge and activism. If I see something that really concerns me, and football’s CTE problem fits that description, I do what I can to try to provide a remedy,” Goldschmied said.
“There are definitely good things that can come out of playing football — you can derive much joy and learn a lot of important lessons. When you weigh those benefits against the costs, though, the costs are considerably higher. You’re messing with the brain and memory and our core identity as humans.”


The motion sparked a quick response from others on campus. Associated Students (AS) released a statement acknowledging that while student government was willing to engage in a discussion about the health concerns behind the motion, they were concerned that the College of Arts and Sciences “chooses to react to these concerns by eliminating an entire organization of students on campus.”


“A simple elimination of a team assumes that a USD student is incapable of making personal decisions, which is untrue,” the statement continued.


“I reached out to AS in an attempt to open a dialogue and received no response,” Goldschmied said. “I didn’t know if they were pressured into the statement by the athletic department or university administration. I’d really like to open a conversation with them about the issue, though.”


Goldschmied acknowledged that an elimination of what is perhaps the country’s most popular sport from campus would be a drastic step.


“I know that there are people on campus who will suffer if the game goes away,” Goldschmied said. “But we have to think about the greater good. I see USD as my community, and we should care about the well-being of the people in that community. It may be extreme, but we need to have a long-term perspective.”


The psychology professor, born in Israel, also admitted an awareness of the social constructs in America that may be preventing such a step.


“Football is very, very ingrained in American society,” Goldschmied said. “At first glance, I thought football was sports heaven. With so many players and formations, it was like basketball on steroids. You can’t beat the disconnect between fandom and responsibility, though. You shouldn’t be watching the game if you believe players are putting themselves at risk.”


“The brain just isn’t built for this,” Goldschmied added, slapping his hand on the desk in front of him. “This is not what we should be doing as a Changemaker campus.”


Spanis and Goldschmied demonstrate that there are people in the academic community at USD who have legitimate concerns about the long-term value of football.


It is also clear that those in athletics, from trainers like Carolyn Greer and coaches like Dale Lindsey to the players themselves, are aware and at times apprehensive of the risks presented by games on the gridiron, and are doing everything in their power to mitigate those risks and protect athletes competing with the USD logo across their chests.


Perhaps most telling, though, was a comment made by Fia Malepeai about the possibility of CTE developing in his brain as he gets older.


“I wouldn’t be surprised about it if I found out I had it,” Malepeai said, deflecting the gravity of the statement with an uncomfortable attempt at a laugh.
With the evidence and awareness rising on both sides of the administrative aisle, it is becoming more difficult for those influential few in academics and athletics to weigh football’s benefits and blemishes on anything more than a strictly-individual level.


American author James Michener wrote in his 1976 book, Sports in America, that “every society decides what it is willing to pay for its entertainment.”


How much are football fans willing to pay for theirs?


Noah Hilton | Sports Editor | The USD Vista