Concussions in Football

Michael Craig Miller, M.D.

Senior Editor, Mental Health Publishing, Harvard Health Publishing

I have to applaud today’s editorial in the New York Times that anticipates a new football season. Here is the first paragraph —

The millionaire players of professional football are suiting up for the new season with a startling caution on their locker room walls. A poster headlined “CONCUSSION” warns players that lifelong brain damage can result if they persevere with macho gallantry through multiple head injuries.

And the Times editors are applauding changes in attitudes about head injuries in football.

In the National Football League, players are generally not considered real men unless they shrug off injuries and play on. As common and even understandable as it is, this attitude has undesirable consequences when the brain is injured. A hearing before the U.S. Congress in October 2009 called attention to the long-term effects of head injury in professional football—and by extension provided cautions worth heeding by the parents of football players as young as age 6.

At issue is the growing awareness that repeated blows to the head, not just those that are severe enough to cause concussion, increase the risk for a variety of symptoms later in life, such as depression, poor motivation and concentration, and problems with learning and memory.

Consider what happens to the brain on impact. It accelerates very quickly, then decelerates just as quickly as it bangs into the skull. Nerve cells get stretched, connections between nerve cells get disrupted or sheared. Neurologists dispute the definition of a concussion, but terminology aside, all of this causes a shortterm disturbance in brain function. It’s no wonder that victims feel dazed, assuming they remain conscious.

But there is growing evidence that professional football players are prone to the kind of brain damage common in boxers, a condition that used to be called dementia pugilistica, but is now referred to as chronic traumatic encephalopathy (CTE). Postmortem analyses of the brains of players who died relatively young have revealed signs of neurodegeneration similar to that found in Alzheimer’s disease.

In recent years, researchers have focused attention on the effect of repetitive impacts, which are common in football. One concern is that of “second-impact syndrome.” If two head injuries occur in relatively rapid succession, such as within the course of one game, the outcome can be catastrophic, with brain swelling and death. So players are at great risk if they return to the field too soon.

But perhaps just as worrisome as serial concussions (however they are defined) is the sum of smaller impacts over time. The typical football player—over the course of a high school, college, and pro career—will encounter thousands, if not tens of thousands, of hits to the head. Many experts now believe this increases the risk of CTE.

NFL leaders have not been quick to endorse the idea that employment as a player is a risk factor for chronic brain disease. Of course, everyone involved in the sport knows that it is violent. It has not been clear what part of the responsibility for managing risk of injury should fall to owners and what portion to players.

Pros who play at a high level accept the dangers and hard work, while also enjoying the game’s challenges and rewards. In fact, many players and commentators have openly disdained rules that soften the game. Thus, long-term risks usually don’t become salient to the players until long after they’ve retired. They are more focused on the thousands of hours of work they have invested to attain their position than on the number of head bumps they’ve received along the way. It is probably impossible to walk away from the rewards of playing at a high level.

Last year, NFL commissioner Roger Goodell explained to members of Congress that football is the most popular spectator sport in the United States and that more than four million children play for their school teams. Almost 100 million people watch the Super Bowl each year. This puts NFL leadership in a powerfully influential position. By establishing safety guidelines that no doubt would be emulated by youth programs, NFL leaders could protect the brain health of countless children and young adults. They should delight in the pleasure of making such an enormous contribution to the public health.

Real men would grab that opportunity and run with it.


  1. Raymond Veguilla

    What an interesting post, thanks for sharing!

    [url removed by moderator]

  2. Jan

    I think the effect of repetitive impacts in boxing can cause very long leaves from the sport.

  3. Second City Jerseys

    Football is a heavy contact sport and over the years i have watched it, there has always been heavy hits to the body and head. The players are paid a lot of money to play the game and know the risks involved. Maybe banning hits to the head in high school and college, but the NFL should allow it.

  4. Tim

    If you’ve ever played tackle football with gear, it is a tuff contact sport, and there is much intentional head banging going on just because of having a helmet, any other sport you don’t get that. People put on the gear and they think they are invincible. I would be curious to see head injuries in comparison with other sports.


  5. jerry vanhorn

    great article here you are a great writer here is a little something i found about the topic particularly concussions, in football players. Concussions are the most common injury in the sport of football. Each year, over 40,000 high school football players suffer from a concussion due to the sport. This number does not even take into account college and professional football players. Nationally, over 300,000 individuals suffer from a sports related concussion. As more and more football players suffer from multiple concussions during their football career, coaches and trainers are becoming more aware of the growing problem.
    Over the years notable NFL players, such as Troy Aikman and Steve Young, have retired from the sport after suffering from multiple concussions. Multiple concussions in an individual greatly increases the risk of permanent brain damage and even death. Brain injuries often show different symptoms each time one occurs because of the complexity of the brain. The symptoms of a concussion vary in each instance and in each individual. This makes it extremely difficult to diagnose a concussion, thus making an individual more prone to multiple injuries.
    DETECT (Display Enhanced Testing for Cognitive Impairment and Traumatic Brain Injury) is a devise that works in as little as 7 minutes to diagnose a concussion after an injury. The helmet-like device works by quantitatively comparing the player’s response time after the injury to response times recorded when the player was not injured. Researchers working on DETECT are optimistic that the device may also be used to detect other brain trauma related conditions, such as Alzheimer’s, with the device. DETECT is still in its initial stages, but researchers hope to have the product on the market within 2-3 years. thans so much J.V.

  6. migraines causes in children

    football with brain health turns out to have a close connection, this is important information for me, because my brother likes all of football. This information will I tell him to be more careful. thank info.

  7. Melbourne Website Designers

    I totally agree with your views ..Football is a wonderful game and interesting …

  8. Richard Cooper

    The public has only recently become aware of the long-term damage suffered by former football greats because of injuries sustained during their playing career. This is long overdue.

  9. Shawn

    This is a big concern for today’s players. Well maybe not the players as many think they are invincible, but every time I saw a big hit from the sidelines while coaching, I cringed and held my breath.

    It was not uncommon for me to pull a kid when the slightest hint of head trauma was suspected. I played the game a long time and feel blessed to have left with most of my faculties in place, but with every new headache, I worry.

    keep informing the masses of such a silent killer.

    Great Post!

  10. clint herman

    I agree with your post. Football is a great game but there’s really a risk whenever they hit the ball using their head.

  11. Dr Nathaniel Popp

    This remains a serious issue in my country also. Concussion and Mild Traumatic Brain Injury (MTBI) accounts for the majority of traumatic brain injuries in Melbourne and across the Australia. People often sustain concussion as a result of injuries sustained during a car accident or sports. Research has also demonstrated that a considerable number of people who have sustained concussion or a mild brain injury actually show brain damage on brain scans.

    Following a concussion it is common to experience a number of symptoms.

    On the positive side, in the majority of cases, concussion or mild brain injuries tend to resolve themselves through a natural recovery process. Indeed, the likelihood of a full recovery from a single, uncomplicated alteration in consciousness is high

    Unfortunately, in a number of instances (like these serial concussions), these difficulties can be persistent. Factors that are potentially related to persistent problems include longer periods of loss of consciousness, brain scan reports of brain damage, a lower Glasgow Coma Score, the duration of PTA, premorbid problems suggestive of reduced cerebral reserve and trauma.

    When difficulties persist, it is often worthwhile to conduct a formal neuropsychological assessment to understand the impact that the concussion or mild brain injury has had on a persons functioning. In some cases, treatment can be provided or recommended to help with a person’s recovery. Treatment can include the development of tailored compensatory strategies as well as working through emotional issues when they are present. While things can be done after a head injury, the most sound advice, as put forward by Dr Miller is: try to prevent the injury occurring at all. Appropriate safety standards are essential.

    Dr Nathaniel Popp (Consultant Neuropsychologist)

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