The NFL's Response to Brain Trauma: A Brief History

Checking the claim that the league always made sure players "knew the risks"

We've spent quite a bit of time discussing the NFL and head trauma. One rather constant claim is that the NFL has always been always been straight about head trauma and that players "knew the risks."  I think it's helpful to weigh that claim against the actual history. Here is one rendition of that history.

1992 - Al Toon suffers his fifth reported concussion in six seasons. Asked if he will retire Toon says, he's "not thinking about retirement right now." 

A week later Toon retires saying, "I feel better sitting still than moving around. I get real tired. Things I normally help with around the house, I can't."

1994 - The NFL establishes the Mild Traumatic Brain Injury committee. Rheumatologist Elliot Pellman is installed as its chair. "Concussions are part of the profession, an occupational risk," rheumatologist  Pellman tells Sports Illustrated. He says that a football player is "like a steelworker who goes up 100 stories, or a soldier."

Pellman continues--"Veterans clear more quickly than rookies...They can unscramble their brains a little faster, maybe because they're not afraid after being dinged. A rookie won't know what's happened to him and will be a little panicky. The veterans almost expect the dings. You have to watch them, though, because vets will try to fool you. They memorize the answers. They'll run off the field staring at the scoreboard."

1995 - The Jets try to improve Boomer Esiason's recovery time from a concussion by employing what the Times calls a "innovative but unproved form of biofeedback therapy." The Jets team physician explains the treatment as  "having a head filled with marbles knocked around after a hit. The biofeedback is trying to put them back in the same order." The Jets team physician admits that they have no controls to show whether the treatment is effective. The Jets team physician is Elliot Pellman.

1997 - The American Academy of Neurology establishes guidelines for concussed athletes returning to play. The guidelines recommend holding athletes who suffer a Grade 3 concussion (loss of consciousness) be taken "withheld from play until asymptomatic for 1 week at rest and with exertion."

2000 - The NFL rejects these guidelines. ''We don't know whether being knocked out briefly is any more dangerous than having amnesia and not being knocked out,'' says neurologist Mark R. Lovell. ''We see people all the time that get knocked out briefly and have no symptoms,'' he added. ''Others get elbowed, go back to the bench and say, 'Where am I?' ''

Lovell is a consultant for NFL and the NHL.

2002 - Hall of Fame Pittsburgh Steeler center Mike Webster dies. Towards the end of his life Webster was living out a pick-up truck, using a Taser to ease back pain, and applying Super Glue to his teeth. 

2003 - In a game against the New York Giants, Kurt Warner suffers a concussion. Confusion ensues over the medical chain of command. Warner's coach, Mike Martz, says that the team doctor cleared Warner to play. The doctor, Bernard T. Garfinkel, agrees. But asked why Warner was allowed to play even though he "had trouble deciphering plays," Garfinkel says, "That's a coaching decision, not a medical decision."

Warner leaves Giant stadium in an ambulance.

"I would say it's not the coach; it's ultimately the physician's decision," says Pellman. "But you can't have a hard and fast protocol, because the injury is all over the place."

2003 - Wayne Chrebet suffers a concussion in a November game against the Giants. The following discussion between Pellman and Chrebet takes place:

"There's going to be some controversy about you going back to play." Elliot Pellman looks Wayne Chrebet in the eye in the fourth quarter of a tight game, Jets vs. Giants on Nov. 2, 2003, at the Meadowlands. 

A knee to the back of the head knocked Chrebet stone-cold unconscious a quarter earlier, and now the Jets' team doctor is putting the wideout through a series of mental tests. Pellman knows Chrebet has suffered a concussion, but the player is performing adequately on standard memory exercises. 

"This is very important for you," the portly physician tells the local hero, as was later reported in the New York Daily News. "This is very important for your career." 

Then he asks, "Are you okay?" 

When Chrebet replies, "I'm fine," Pellman sends him back in.

2004 - In September, former Steelers offensive linemen Justin Strzelczyk leads the police on a high speed chase through central New York, colliding at 90 MPH with a tractor trailer. The trailer explodes, killing Strzelcyzyk instantly. 

Neuropathologist Bennet Omalu later finds evidence of CTE in Strzelczyk's brain. Dr Ronald Hamilton of the University of Pittsburgh confirms Omalu's assessment: "If I didn't know anything about this case and I looked at the slides, I would have asked, 'Was this patient a boxer?'"

2005 - In January, Pellman and MTBI publish their seventh in a series of research papers on concussions, concluding, in part, "Return to play does not involve a significant risk of a second injury either in the same game or during the season."

2005 - In March, the Times reports that Pellman has exaggerated his credentials. 

2005 - In June, former Pittsburgh Steelers guard Terry Long commits suicide by drinking antifreeze. Neuropathologist Bennet Omalu later examines Long's brain and concludes he suffered from Chronic Traumatic Encephalopathy. 

"People with chronic encephalopathy suffer from depression. The major depressive disorder may manifest as suicide attempts. Terry Long committed suicide due to the chronic traumatic encephalopathy due to his long-term play," Dr. Omalu tells the Pittsburgh Post-Gazette "The NFL has been in denial."

Steelers neurosurgeon Joseph Maroon says Omalu is employing "fallacious reasoning" saying "I don't think it's plausible at all ... to go back and say that he was depressed from playing in the NFL and that led to his death 14 years later, I think is purely speculative."

2005 - In July the peer-reviewed journal Neurosurgery prints Omalu's autopsy and brain analysis of "Iron" Mike Webster. Omalu concludes that Webster suffered from Chronic Traumatic Encephalopathy.

2006 - Pellman's MTBI committee releases research concluding that "on-field evaluation by team physicians is effective with regard to the identification of cognitive and memory impairments immediately after an injury." 

The paper also again rejects The American Academy of Neurology's guidelines, concluding that:

...current attempts to link prospective grading of concussion symptoms to arbitrary, rigid management decisions are not consistent with scientific data. We believe that if one insists on grading concussion severity, the best way is retrospectively, on the basis of how long it actually takes the player to become asymptomatic, with normal results on neurological examination. It is the recommendation of the NFL's Committee on Mild Traumatic Brain Injury that team physicians treat their players on a case-by-case basis, using their best clinical judgment and basing their decisions on the most relevant, objective medical data obtained.

2006 - In May,The NFL's MTBI committee attack Bennett Omalu's analysis of Webster claiming it contains "serious flaws." The committee then demands a retraction.

2006 - In November, former Philadelphia Eagles safety Andre Waters shoots himself in the head.  After examining his brain, Omalu diagnoses Waters as having suffered from CTE. Waters was 44 at the time of his death. Omalu says he had the brain of an 85-year old man.

MBTI member and Baltimore Ravens physician Andrew Tucker says, "The picture is not really complete until we have the opportunity to look at the same group of people over time."

2007 - In May, the NFL commissioner establishes a league-wide minimum for "baseline neurological tests" to be mandatory on sidelines. Goodell announces an offseason "concussion summit." "We're protecting the players against the players." 

2007 - An NFL safety pamphlet notifies players, "Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is managed properly."

2009 - NFL spokesman Greg Aiello acknowledges, "It's quite obvious from the medical research that's been done that concussions can lead to long-term problems,"

2009 - The NFL begins to put up posters in locker rooms that state, in part, "Concussions and conditions resulting from repeated brain injury can change your life and your family's life forever." 

"This is about Roger Goodell, that fraud, covering his own ass," says former defensive lineman Dave Pear.

2009 - Goodell testifies in front of a House Judiciary Committee saying, "My approach to this concussion issue in football has been simple and direct - medical considerations must always take priority over competitive considerations." 

2010 - Responding to research from neurologist Ann McKee on CTE, Ira Casson, co-chairman of the MTBI, tells Congress that, "Tau deposition is the predominant pathology in a number of other neurologic diseases that have never been linked to athletics or head trauma. Some of these diseases have genetic causes, some have environmental toxic causes, and others are still of unknown cause."

2010 - In March, the NFL creates a new committee to study concussions, distancing itself from Pellman and Ira Casson. Prominent neurologists Dr. H. Hunt Batjer and Dr. Richard G. Ellenbogen are appointed as co-chairs. Batjer says the following about the MBTI: "We all had issues with some of the methodologies... the inherent conflict of interest... that was not acceptable by any modern standards or not acceptable to us."

2010 - In September, Eagles quarterback Kevin Kolb and linebacker Stewart Bradley suffer concussions. ESPN reports that Kolb "slammed into the turf, his eyes closed for several seconds and he was slow to get up and walk to the sideline," while Bradley, "on all fours, struggled to get up on his own power, stumbled for a few steps and toppled to the ground." 

Both players had concussions. Both were returned to the game.

2010 - In a display of seriousness over player safety, Steelers linebacker James Harrison is fined $75,000 for his hit on Browns receiver Mohamed Massaquoi in an October game. Somewhat undercutting this display, the NFL sells pictures of the hit on its website.

UPDATE: Forgive me but I forgot to thank Malcolm Burnley for the assist he lent on research. I could not have pieced this together alone. Thank you.