Concussions in American football
Concussions and play-related head blows in American football have been shown to be the cause of chronic traumatic encephalopathy (CTE), which has led to player deaths and other debilitating symptoms after retirement, including memory loss, depression, anxiety, headaches, stress, and sleep disturbances.[1]
"Concussion protocol" redirects here. For the 2016 heavy metal album, see Vicious Rumors § Concussion Protocol.
The list of ex-NFL players that have either been diagnosed post-mortem with CTE or have reported symptoms of CTE continues to grow.[2][3]
According to Boston University, CTE is a brain degenerative disease found in athletes, military veterans, and others with history of repetitive brain trauma. Although CTE is highly controversial and misunderstood, it is believed that a protein called Tau forms clumps that slowly spread throughout the brain, killing brain cells.
There is also theoretical research that suggests early CTE might result from damaged blood vessels within the brain. That could trigger brain inflammation and, eventually, the development of proteins such as Tau believed to play a key role in CTE. This hypothesis was tested on adult mice; the researchers state that their brains possess similar attributes to that of human brains. Using a special device, the mice were given precise impacts that would lead to mild brain traumas similar to what an athlete would suffer in contact sports. The mice, whose brains were scanned using a specialized MRI, immediately showed changes to the electrical functions of their brains.[4]
According to 2017 study on brains of deceased gridiron football players, 99% of tested brains of NFL players, 88% of CFL players, 64% of semi-professional players, 91% of college football players, and 21% of high school football players had various stages of CTE.[5]
Other common injuries include, injuries of legs, arms, neck and lower back.[6][7][8][9]
Research[edit]
Other organizations continued to publish study results that linked repeated concussions and long-term health problems contrary to reports by the MTBI Committee. A 2003 report by the Center for the Study of Retired Athletes at the University of North Carolina, for example, found a connection between numerous concussions and depression among former professional football players. Further, the center's follow-up study in 2005 associated both brain impairment and Alzheimer's disease with retired NFL players who had histories of concussions.[22]
A 2004 doctoral dissertation by Don Brady examined NFL Players' knowledge of concussions, studying both active and retired National Football League Players' knowledge of concussions. Brady's findings concluded: that many NFL players lacked accurate and essential knowledge pertaining to various aspects of a concussion; that the preponderance of credible experimental and clinical evidence pertaining to the adverse effects of concussion indicates that the brain is injured as a result of a concussion; that the altered cell functioning and cell death along with subtle to more visible neurological, neurocognitive, psychological, and other medical problems reflect a diverse range of lifelong negative consequences of a concussion / brain injury; and that sports team health-care personnel need to focus primarily on the athletes' health and well-being, and not minimize an injury or primarily concentrate on the players' capacity to perform on the field. This expanded focus of health care is necessary in order to avoid any real or perceived conflicts of interest emerging in the concussion research, concussion management and related return to play decision-making process.[23]
During November 2014, Brady filed objections to the proposed NFL concussion settlement offer. Brady sent a cover letter and detailed objections on behalf of NFL retired players to the presiding US district court judge, Anita Brody.[24]
In addition to the studies that continued to contradict the work of the MTBI Committee, renowned experts and sports journalists wrote critical reviews of the committee's studies. Robert Cantu of the American College of Sports Medicine noted bias in the committee's extremely small sample size and held that no conclusions should be drawn from the NFL's studies. In an ESPN Magazine article titled "Doctor Yes," Peter Keating criticized Pellman and the MTBI Committee's work and argued that the "... Committee has drawn a number of important conclusions about head trauma and how to treat it that contradict the research and experiences of many other doctors who treat sports concussions, not to mention the players who have suffered them."[16]
More studies continued to associate repetitive head injuries with neurological problems later in life. Kevin Guskiewicz, Director of the Center for the Study of Retired Athletes in the Department of Exercise and Sport Science at the University of North Carolina, analyzed data from a 2007 study of nearly 2,500 former NFL players. He found about 11 percent of the study participants suffered from clinical depression, with a threefold increased risk in former players who had a history of three or four concussions.[25] The following year, the NFL commissioned the University of Michigan Institute for Social Research to conduct a study involving more than 1,000 former NFL players. The results reported that Alzheimer's disease or similar diseases appear to have been diagnosed in former NFL players vastly more often than in the general population at a rate of 19 times the normal rate for men ages 30 through 49. The NFL responded to these results by claiming the study was incomplete.[26]
On September 30, 2014, researchers with Boston University announced that in autopsies of 79 brains of former NFL players, 76 had tested positive for CTE.[27] As of January 2017, that number had grown to 90 out of 94.[28] A study published in The Journal of the American Medical Association in July 2017 showed that 110 of 111 former NFL players whose brains were examined were found to have suffered from CTE.[29]
Helmets[edit]
In the article, Sports Law and Governance, it talks about how over 2,000 former NFL players are dealing with concussions later on in life. The players are complaining and the league is getting sued for how the helmets have led players to have severe lifelong brain damage. The NFL has been responding with a new "HIT" system helping players not get these problems so easily.[30]
Wildman, a sports scientist shows how much of an ongoing criticism is about NFL helmets and just helmets in general. The NFL finally acknowledged the negative impact concussions have on its billion-dollar business and opted to start awarding research grants geared toward finding a solution. They are constantly trying to make better ways to protect the players without restraining them.
The Journal of Sociocultural Examinations of Sports Concussion shows significant data on concussions and . No matter what it is they are always trying to figure out a new helmet or new material to use to make it a lot safer for players if they take a lot of big blows to the head area. The article stated, "suicides of former players linked to head trauma have combined to increase the public's awareness about the potential dangers of concussions in all levels of football."[31]
Prevention[edit]
In October 2009, NFL Commissioner Roger Goodell and the NFL Concussion Committee were called before Congress to defend their policies against allegations of neglect.[32][33] Goodell provided testimony, but was unable to answer many questions. As a result of this incident and pressure from the NFL Players Association, the NFL released a comprehensive overhaul of the league concussion policy in November and December 2009.[34] The policy expanded the list of symptoms that would prevent a player from returning to a game or practice on the same day their injury occurred.[34][35][36]
With continued pressure to protect players, the NFL began preventing players knocked unconscious by a concussion from returning to a game or practice, a policy that applied to Detroit Lions running back Jahvid Best in 2009.[37] Various players have filed lawsuits against the league for the concussions, accusing the league of hiding information that linked head trauma to permanent brain damage, Alzheimer's disease, and dementia.[38][39] Some teams chose not to draft certain players in the NFL Draft due to their past concussion history. According to an Outside the Lines report, the head impact telemetry system (HITS) was in question by the League, although Kevin Guskiewicz, a professor at the University of North Carolina, said the system is functional.[40] The technology could detect and measure the impact of blows to the head in real time during a game, but no such measurement exists in the league at this time.[41] Former Pittsburgh Steelers receiver and current NBC Sports analyst Hines Ward stated the use of the system would be "opening a Pandora's Box", and that the data recorded by the system could be used by team owners to give players lower salaries.[40]
In November 2011, the Cleveland Clinic Center for Spine Health created an online study released by the Journal of Neurosurgery in which various football helmets were compared with each other via crash test dummies. It was also found that leather helmets provided similar results to modern helmets, and in some cases, the leather helmets proved to have superior protection against concussive blows. However, the leather helmets did not provide as much protection against skull fractures.[42][43][44]
NFL litigation[edit]
Denial by the League[edit]
The NFL spent years trying to deny and cover up any link that emerged connecting head injuries sustained while playing football with long-term brain disorders. The NFL Mild Traumatic Brain Injury (MTBI) Committee, first formed in 1994, reported in December 1999 that the number of head injuries had remained "remarkably the same over the course of four years."[48] The committee went a step further in 2004 when it suggested in an article published in Neurosurgery that "NFL players have evolved to a state where their brains are less susceptible to injury." Two months after that, MTBI publishes another article that concludes "Players who are concussed and return to the same game have fewer initial signs and symptoms than those removed from play. Return to play does not involve a significant risk of a second injury either in the same game or during the season."[48] However, when Dr. Bennet Omalu examined the brain of former Pittsburgh Steeler Mike Webster, he discovered a new brain disease, which he called chronic traumatic encephalopathy, or CTE. He outlined his findings in a scientific paper published in Neurosurgery in July 2005.[48] The NFL's MTBI committee wrote in May 2006 that the article be retracted. Dr. Omalu instead wrote a second paper in the same magazine, this time about former Pittsburgh Steeler Terry Long.[48] Dr. Ira Casson, who was then co-chair of MTBI, denied in a televised interview that there was any link between head injuries sustained playing in the NFL and long-term brain damage. His repeated denials won him the nickname "Dr. No."[48] In September 2009, The New York Times published an article of an NFL-funded study stating that former players are 19 times more likely than the general population to have dementia, Alzheimer's or other memory-related diseases. The NFL's spokesperson, Greg Aiello, publicly said, "the study did not formally diagnose dementia, that it was subject to shortcomings of telephone surveys."[48] Two months later, Aiello told New York Times reporter Alan Schwarz that "it's quite obvious from the medical research that's been done that concussions can lead to long-term problems."[49] It was the first time any League official had acknowledged a link between the two.
Things got worse for the NFL when investigative reporters Steve Fainaru and his brother Mark Fainaru-Wada learned from an anonymous source that the NFL Retirement Board had awarded "disability payments to at least three former players after concluding that football caused their crippling brain injuries – even as the league's top medical experts for years consistently denied any link between the sport and long-term brain damage."[50] One of the cases was that of Mike Webster, who filed a claim in 1999. In 2005, three years after his death, his family received $1.8 million from the Retirement Board. "That same year", write the Fainuru brothers, "the NFL published the 10th installment in its series on concussions research in the medical journal Neurosurgery. The paper, whose authors included three members of the League's [MTBI], asserted that chronic brain injury 'has never been reported in American football players.'"[50]
Since Aiello's admittance, the link between head injuries in football and long-term brain damage have become more accepted in the NFL. In a roundtable discussion with the U.S. House of Representatives Committee on Energy and Commerce, Jeff Miller, the NFL's senior vice-president for health and safety, admitted that "there is a link between football-related head trauma and chronic traumatic encephalopathy."[51] However, public relations issues continue to plague the League. A report from the Democratic members of the House Committee on Energy and Commerce said that "the NFL rescinded a gift to the National Institutes of Health (NIH) for concussion research when it learned the study's findings would be detrimental to the league's image."[52] The NFL had tried to funnel the funds it gave to the NIH towards its own studies. The League rejected the accusations.[53]
To mitigate the public relations (PR) nightmare, the NFL has taken several steps to better assure player safety and bring awareness to head injuries in football players of all ages. Several rule changes took place between 2007 and 2014. NFL commissioner Roger Goodell issued a memo in December 2009 to all 32 teams stating that a player who sustains a concussion cannot return to play if he shows signs or symptoms, such as inability to remember assignments or plays, a gap in memory and persistent dizziness. This move changed the 2007 rule saying a player cannot return only if he has lost consciousness.[54] Additionally, new rules regarding "crown of the helmet" tackles have been installed where a runner or a tackler cannot initiate forcible contact with the crown of the helmet outside the tackle box so as to protect players' heads.[55] Lastly, the NFL and USA Football launched the Heads Up Football initiative, which "emphasizes a smarter and safer way to play and teach youth football, including proper tackling and taking the head out of the game."[56] A mobile application was also launched with help from the CDC where information about concussion protocols and player health and safety can be easily reached by parents and coaches.
The PR issues surrounding the NFL's cover-up of concussions are far from over, and it is too early to tell how and to what extent these events will impact the NFL or football playing. Robert Boland, professor of sports management at New York University and former college football player says, "In the short-run, [the NFL] is still thriving", but downward trends in youth football players shows that future generations "might have less of an intimate attachment to the sport."[57] Boland says this in light of Pop Warner football enrollment dropping by 9.5 percent between 2010 and 2012, likely linked to the high-profile concussion problem.[57]
Federal NFL concussion litigation[edit]
In April 2011, attorneys Sol H. Weiss and Larry E. Coben from the Philadelphia law firm of Anapol Weiss filed a federal lawsuit on behalf of Ray Easterling, Jim McMahon and five other players. Thousands of former NFL players have since filed lawsuits against the League after suffering repeated concussions throughout their careers.
The multidistrict litigation (MDL) titled In re: National Football League Players' Concussion Injury Litigation (MDL 2323) was filed on January 31, 2012, in the United States District Court for the Eastern District of Pennsylvania. Judge Anita B. Brody presides over the matter.[58] The master administrative long-form complaint, filed by Plaintiff's Co-Lead Counsel Sol Weiss and Christopher Seeger on June 7, 2012, alleges the League "... was aware of the evidence and the risks associated with repetitive traumatic brain injuries virtually at the inception, but deliberately ignored and actively concealed the information from the Plaintiffs and all others who participated in organized football at all levels." The master complaint argues the NFL knew or should have known players who sustain repetitive head injuries are at risk of suffering "... early-onset of Alzheimer's Disease, dementia, depression, deficits in cognitive functioning, reduced processing speed, attention, and reasoning, loss of memory, sleeplessness, moods swings, personality changes, and the debilitating and latent disease known as Chronic traumatic encephalopathy ('CTE')."
In April 2012, Easterling was found dead from a self-inflicted gunshot wound in his home.[59] An autopsy report concluded Easterling's brain had evidence of CTE, a degenerative brain disease associated with frequent blows to the head.[60]
One month later, former San Diego Chargers player Junior Seau also died of a self-inflicted gunshot wound, and a brain autopsy showed he suffered from CTE.[61]
Like Easterling and Seau, an autopsy of Bears safety Dave Duerson's brain after he committed suicide earlier that year revealed he also suffered from the same degenerative brain disease.[62]
The autopsy results following these players' suicides heightened existing concerns regarding the connection between player deaths and concussions. Neuropathologist Bennet Omalu has identified CTE in the autopsies of former players Mike Webster, Terry Long, Justin Strzelczyk, Andre Waters, and Chris Henry.[63][64] One of the difficult issues facing doctors is attempting to identify mental health effects from concussions during the lives of former players rather than after their deaths.[65] In April 2012, a group of former Dallas Cowboys—including Pro Football Hall of Fame inductees Randy White, Bob Lilly, and Rayfield Wright (among other retired players from around the league)—filed a lawsuit against the NFL, again accusing it of ignoring a link between concussions and brain injury.[66]
In August 2012, the number of players involved in suits against the NFL increased to 3,402, and the League sued three dozen insurance companies in an attempt to force them to cover the costs of defending claims of not protecting players. However, Travelers ultimately sued the League on August 21 in a lawsuit called Discover Property & Casualty Co. et al. vs. National Football League et al., New York State Supreme Court, New York County, No. 652933/2012. The company provided liability coverage for the League's merchandising arm (NFL Properties), and the insurer also pointed out that the above-mentioned lawsuit has allegedly 14 counts against the League, while only two against NFL Properties.[67]
After quarterbacks Jay Cutler, Michael Vick and Alex Smith sustained concussions in Week 10 of the 2012 season, the National Football League Players Association (NFLPA) reiterated their plans to have independent neurologists on the sidelines at every game.[68] The 2013–14 NFL season involved an independent neurological consultant per team on the sideline of every game.[69] Concussion guidelines released by the NFL in 2013, mandated a four-stage protocol for concussions, including examinations, treatment and monitoring prior to a return to play.[70][71][72] In March 2013, the League proposed a rule to reduce concussions by making it illegal for a ball carrier or tackler to "initiate forcible contact by delivering a blow with the top crown of his helmet against an opponent when both players are clearly outside of the tackle box." However, the proposal was met with criticism from players like running backs Matt Forte, Emmitt Smith and Marshall Faulk.[73]
A federal hearing was held on April 9, 2013, in Philadelphia to discuss the League's motion to dismiss the lawsuits brought on behalf of more than 4,500 former players. On July 8, 2013, Judge Brody ordered representatives of both sides of the litigation to explore a possible settlement in the litigation. Judge Brody ordered a report on or before September 3, 2013, regarding the results of the mediation.[74]
A proposed settlement was reached in the litigation on August 29, 2013. Under the agreement, the NFL will contribute $765 million to provide medical help to more than 18,000 former players. Retired players who suffer severe neurological conditions such as Alzheimer's and amyotrophic lateral sclerosis (ALS) diseases in the future will also be eligible to apply for medical help. In addition, $10 million will fund brain injury research as well as safety and education programs.[75]
The settlement says it should not be interpreted as a statement of legal liability on the part of the NFL.[76]
The settlement, which is projected to protect retired players for nearly 65 years, will compensate injured former players who need immediate help and will provide baseline assessments and medical benefits to those who are symptom-free or beginning to show signs of neurological problems.
"I think it's more important that the players have finality, that they're vindicated, and that as soon as the court approves the settlement they can begin to get screening, and those that are injured can get their compensation. I think that's more important than looking at some documents", attorney Weiss said.[77]
The settlement also allows a player diagnosed with CTE the eligibility to up to 4 million dollars in compensation. This has been met with criticism of the settlement's structure as it only applies to players diagnosed before the settlements preliminary agreement and disallows those diagnosed after the approval of the deal in July.[27]
Controversy continues to surround the NFL response to concussive injuries among current and former players. Although Mike Webster was the first patient to be diagnosed with CTE, posthumously, being the first diagnosed case and one of the higher profile cases illuminating the issue of head trauma injuries to the NFL, his family has not received financial compensation from the NFL. The reason for this is Webster's died before January 1, 2006, and in the terms of the NFL's settlement agreement, the organization is only responsible for dispersing compensation payments to families of players who died from head related trauma and injuries from 2006 and beyond. The Webster family is currently taking legal action against the National Football League with the goal of removing that qualification from the settlement.[78]
The NFL has paid nearly $1 billion in settlements from claims alleging long-term injuries from repeated blows to the head. Courts have examined these claims using a "Trigger" process. This trigger process includes 4 triggers: The "exposure" trigger, the "manifestation" trigger, the "injury-in-fact" trigger, and the "continuous" trigger.[79]
The dementia tests that the NFL-approved process used came under scrutiny in 2021, as black players were assumed to have a lower baseline cognitive function than non-black players, making it more difficult to prove dementia in their case. The practice was called "race-norming" by opponents. A lawsuit attempting to overturn the practice was thrown out in March 2021 and the judge ordered the parties to resolve it via mediation.[80] In June 2021, the NFL announced it would end the practice and would form a panel of neuropsychologists to create new, race-neutral standards.[81]
Kansas City Chiefs concussion lawsuit[edit]
On December 3, 2013, five former NFL players filed a lawsuit against the Kansas City Chiefs organization: former Chiefs players Alexander Cooper, Leonard Griffin, Christopher Martin, Joe Phillips, and Kevin Porter. They wish to know what the Chiefs knew about concussions and when they knew it.[82]
This lawsuit is unique and different from the thousands of lawsuits previously filed against the NFL. These players are not suing the NFL, and are instead suing the Chiefs.
From 1987 to 1993 there was no Collective Bargaining Agreement established in the NFL. With no existence of a CBA in these years, players who played during this time for the Chiefs can sue the team for many of the same reasons the NFL has been sued. The $765 million settlement in August 2013 between the NFL and former players only protected the NFL. "I think all of our clients were disappointed", McClain said of his clients reaction to the settlement with the NFL.[83] The players gordon suing the Chiefs have all opted-out of the settlement from the previous mediation with the NFL.
A law unique to Missouri allows certain former NFL players to sue the individual team. The current Missouri law states that employees can sue employers in civil court if the employees declined worker's compensation. The Independence attorney for the five ex-Chiefs, Ken McClain said, "The lawsuit is allowed in Missouri after a state workers' compensation statute was amended in 2005 to exclude cases of occupational injury that occur over an extended time."[84]
The amendment of the 2005 law is set to be changed at the end of December 2013. Martin and McClain have both encouraged former players who are eligible to join the lawsuit before their window of opportunity expires.
On December 1, 2012, Jovan Belcher, a then-current member of the Kansas City Chiefs, shot and killed his fiancée, Kassandra Perkins, before committing suicide in the Arrowhead practice facility parking lot. On behalf of Belcher's and Perkins' daughter, lawyers have filed a wrongful death lawsuit against the Chiefs. Belcher's mother has filed a similar suit accusing the Chiefs of ignoring Belcher's cries for help as he complained of concussion like symptoms. The first occurrence came against Jacksonville in 2009 where Belcher was knocked unconscious and failed to receive adequate treatment. The second occurrence was against the Bengals in November 2012. The lawsuits allege, Belcher "suffered what should have been recognized as an acute concussion." However, one lawsuit continues, "despite exhibiting obvious symptoms, Decedent was never removed from play for evaluation and recovery." The lawsuits also claims Belcher exhibited signs of CTE, including changes in his mood and behavior.[85]
On September 30, 2014, it was announced that the brain of former Kansas City Chiefs player, Jovan Belcher, contained neurofibrillary tangles of tau protein; which is associated with CTE. The tangles were distributed throughout Belcher's hippocampus, an area of the brain involved with memory, learning and emotion. If the findings of CTE come to be true, Belcher's daughter and mother are eligible for up to $4 million under the National Football League's current Collective Bargaining Agreement.[85]
Riddell concussion litigation[edit]
On March 11, 2016, the family of deceased San Diego Charger defensive back Paul Oliver sued helmet-maker Riddell along with its related corporate entities, in the Circuit Court of Cook County, Chicago, Illinois. Shortly thereafter, Pro Football Hall of Fame running back and Super Bowl champion Paul Hornung, represented by The Brad Sohn Law Firm and Corboy & Demetrio, filed a related case against these defendants. Now, some 100 former professional players have sued Riddell in the consolidated litigation in Cook County, which alleges Riddell to have conspired with the NFL in creating false science. Riddell's attempt at the same federal labor preemption defense attempted by the NFL failed. The NFL remains subject to discovery in this case, even though it is a non-party.
Screening procedure[edit]
In September 2015, researchers with the Department of Veterans Affairs and Boston University announced that they had identified CTE in 96 percent of NFL players that they had examined and in 79 percent of all football players.[135]
As of February 2015, Gary Small and colleagues have been called into question by the FDA for their overzealous commercialization and promotion of clinically unproven screening that fellow peer researchers deem fit only for research and they have responded by withdrawing related materials from their website.[136][137]
To date, all screening procedures that examine football players for brain damage have been post mortem. In 2013, Gary Small and colleagues developed an in vivo chemical tracer that can detect tau protein build up in living players. Small and his team invented this new chemical tracer, 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile, or FDDNP, that could be used in Positron Emission Tomography (PET) scans.[138] This new tracer measures for tau protein and amyloid plaque accumulation in human brains; symptoms of repetitive brain trauma among other things. Although tracers have been developed to screen for the build-up of tau proteins in the human brain, FDDNP is the first PET tracer that can be used in vivo in human trials. FDDNP was originally developed in an effort to detect Alzheimer's in elderly individuals, thus the article was published in the journal of the American Association for Geriatric Psychiatry. However, because there are similarities between Alzheimer's and the effects of Chronic Traumatic Encephelopathy (CTE), FDDNP was used to study the extent of brain trauma in consenting, retired NFL players.
Small and colleagues performed a controlled experiment on retired NFL players and an equal number of control participants. Unfortunately the sample size was very small as only 5 players of the 19 contacted were eligible for the study. Though the sample size was small, a good range of positions were represented (linebacker, quarterback, offensive lineman, defensive lineman, and a center) and all players had played in the league at least 10 years. The players had to be at least 45 years of age and currently exhibit symptoms of cognitive and mood disruption. Control participants had to meet certain criteria as well to ensure that they were as similar as possible to the NFL players in order to eliminate any biases or confounding variables. Age, Body Mass Index (BMI), years of education, and family history of dementia were all selected as the selection criteria for control participants. All participants received intravenous injections of the FDDNP tracer and were tested over 4 weeks using PET imaging technology.
The injection of the FDDNP tracer was successful, and the results of the study showed significant differences between the NFL players and control participants. The NFL players had significantly higher FDDNP signals than control participants, indicating a greater amount of tau protein accumulation. The cortical regions of all the participants studied showed no significant difference, but the NFL players had FDDNP levels that were significantly higher in the caudate, putamen, thalamus, sub thalamus, midbrain, and cerebellar white matter regions of the brain as compared to the control participants.[138] In addition, a positive correlation was found between the number of head injuries the players sustained and the levels of FDDNP binding. This suggests that players with a more severe history of head trauma will likely have significantly more accumulation of tau protein. This, in turn, gives rise to the suggestion that a more severe history of head trauma will result in greater deterioration of the brain, cognitive functioning, and mood regulation.
The findings of the study were consistent with previous autopsy studies of individuals with CTE. The important distinction to make, however, is that the patients in Small's study were not on the slab and walked out after testing was completed. This is monumental in the field of brain trauma and concussion research.
Based on recent new blood tests; evidence is revealing no change in blood plasma tau and serum neurofilament light concentrations following sport related concussions. However these levels did rise in more severe concussion sport related injuries. This can potentially suggest that a new blood test be developed and help aid in identifying the severity of concussion, and assist in concussion protocols.[139]
Recovery efforts[edit]
Concussions are proven to cause loss of brain function. This can lead to physical and emotional symptoms such as attention disorders, depression, headaches, nausea, and amnesia. These symptoms can last for days or weeks and even after the symptoms have gone, the brain still will not be completely normal. Players with multiple concussions can have drastically worsened symptoms and exponentially increased recovery time.
Researchers at UCLA used a brain-imaging tool to identify a certain protein found in five retired NFL players. The presence and accumulation of tau proteins found in the five living players, are associated with Alzheimer's disease. Previously, this type of exam could only be performed with an autopsy. Scientists at UCLA created a chemical marker that binds to the abnormal proteins and they are able to view this with positron emission tomography (PET) scan. Researcher at UCLA, Gary Small explains, "Providing a non-invasive method for early detection is a critical first step in developing interventions to prevent symptom onset and progression in CTE".[140]
Post-concussive symptoms (PCS) is an area of recovery that is often not discussed. New evidence suggest that new recovery protocols have been recommended and designed to more adequately and efficiently recover from concussions. PCS is a concussion symptom lasting longer than 14 days. Current protocols suggest that the athlete refrain from any physical activity until symptoms free. However, according to the Journal of Athletic Training "a physiological approach to prolonged recovery from sport-related concussion" suggests some aerobic activity may be beneficial to more appropriate healing from concussion, and may lessen the reoccurrence of repeated concussions.[141]
There has been promising evidence that blood flow restriction based exercises can be used to improve Post-Concussion Syndrome (PCS). "The leading theory supporting this is that human growth hormone is released in response to increased lactate production from exercise, enhancing the brain function and recovery". This exercise based program could potentially be used in conjunction with aerobic therapy to better improve concussion symptoms during the recovery process.[142]
As of 2011, all 32 NFL teams are required to have at least one Physical Therapist on staff. Physical Therapist can help with current and former NFL players that have experienced a concussion. A Vestibular Physical Therapist can create customized treatment for dizziness and balance dysfunction associated with a concussion.[143]