When the Broncos take on the Seahawks on Super Bowl Sunday, Michael C. Miller, M.D., will be watching for more than just a good game or the final score. Dr. Miller, who advocates stronger efforts to protect athletes from concussions, will be looking for how the referees and coaches respond to helmet-to-helmet hits and blows to players' heads.
After decades of allowing violent on-field play, the National Football League has taken steps to minimize head injuries among players. Those efforts were prompted by several highly publicized cases of players who say they suffered long-term problems after sustaining concussions during their NFL careers. Last year, the NFL sought to settle a lawsuit filed by more than 4,500 players for $765 million, but a federal judge rejected it as insufficient.
"It's difficult to be just a fan when you know the potential damage is being caused in the game to the players," says Dr. Miller, a self-described NFL fan and former editor of the Harvard Mental Health Letter. "Some of the visuals and strategic elements of the game make it one of the most interesting games to watch. But the violence that's inherent in the game can't be ignored."
Dr. Miller tells Newsmax Health the efforts made by the NFL to make the game safer are steps in the right direction, but more needs to be done. The challenge is to strengthen safety precautions while preserving the elements of contact at the heart of the game.
"I think they are definitely helpful," he says of the NFL's recent efforts. "What I would say is that players and the league share a responsibility to make the game safer. But it's a tough game to make safe. If the whole game is organized around contact and the thing that is both the most prized and the most effective for winning is hitting … then this is a recipe for brain damage."
In recent years, the NFL has outlawed certain on-field practices that were once common to the game and instituted new sideline protocols for dealing with potentially serious head injuries.
For instance, players are barred from helmet-to-helmet hits and from targeting the head of a defenseless player — such as a receiver, quarterback, or kicker — who may not see a hit coming. Those who have violated the rules have been penalized and fined. The NFL has also outlawed the four-man wedge formation, in which players collide with one another at high rates of speed, and moved the kickoff to the 35-yard line from the 30. What's more, teams have significantly limited full-contact hitting during practice.
In addition, the league has instituted new requirements for evaluating players who have sustained hits to the head. In years past, most players were allowed to continue playing after such a blow, as long as they did not lose consciousness. But today, players with suspected concussions must be evaluated, according to new protocols established by the NFL, by a team's medical staff and an independent medical consultant before being allowed back into the game.
This week, the NFL announced concussions during the 2013 season dropped by 13 percent from the previous year and injuries caused by helmet-to-helmet hits fell by 23 percent. Jeff Miller, NFL senior vice president of health and safety policy, said there were 228 diagnosed concussions during the 2013 preseason and regular-season practices and games combined, down from 261 in 2012. He credited the new sideline protocols with making a difference.
Dr. Miller applauds the progress, but suggests more can be done to change the culture of violence that surrounds football, fed by commentators and players alike — both on off the field.
Up to 80 percent of mild concussions are not readily or easily diagnosed, experts say. Research suggests repetitive, "sub-concussive" hits — often sustained during practice, as well as on game day — can have long-term adverse consequences and may raise the risk for dementia, cognitive problems, and the neurodegenerative disease chronic traumatic encephalopathy (CTE).
This week, Joe Namath became the latest former NFL player to reveal that suffered brain damage he believes was the result of multiple concussions he suffered during his years on the field. The former New York Jets star told Fox News Channel's "The O'Reilly Factor" on Thursday he has had tests on his brain "that have shown some things," and that he had at least five concussions he thought were serious.
Some experts have called on the NFL to outlaw all hits to players' heads and pressed for developing better equipment — such as high-tech helmets equipped with better padding, sensors, and impact monitors — that offer better protection.
A new study released on Friday, for instance, found that such helmets could cut concussion risk in half. Researchers who scrutinized concussion data collected from more than 1,800 players from eight college football teams found a 54 percent reduction head-injury risk between two different helmets. The players wore one of two helmet models made by the Riddell company: the older VSR4 and the newer Revolution. All were equipped with sensors that recorded forces experienced by the players' heads during a hit.
Lead researcher Stefan Duma, head of biomedical engineering at Virginia Tech-Wake Forest University, noted that no helmet can completely prevent concussions, but adding more padding and protection can reduce the risk of concussion.
Others health experts have urged more research into whether some players are more susceptible to long-term problems, due to genetics or other factors. In addition, sports scientists are working to improve on-field assessments of players who sustain hits to the head.
Because such evaluations are very subjective, scientists have been looking for objective biomarkers to flag serious head injuries. Earlier this year, researchers from the University of Rochester reported that they had developed a new blood test
that may soon be able to allow medics to accurately distinguish a sports-related concussion from a less-serious problem in players, while they are on the field.
The simple on-field finger-stick test detects a brain protein — known as S100B — that is a known biomarker for traumatic brain injury. In Europe, it is already being used to decide who is at high risk for intracranial bleeding and in need of head CT scanning.
In new research published in the Public Library of Science journal PLOS ONE, Jeffrey J. Bazarian, M.D., said studies involving 46 college athletes in Rochester and Munich, Germany, found the test accurately identified increased levels of the protein in those suffering serious brain injuries.
Dr. Miller says the progress being made at the professional level to protect pro athletes needs to go beyond the NFL and include other sports, as well as younger players — including children, teens, and young adults who participate in recreational and school-based leagues.
"It's one thing to be playing in the NFL where the rewards of putting the body at risk are considerable," he notes. "But the problem really is for the vast majority of people who play football from early ages through high school and college, who never get any of those benefits who put themselves at risk.
"So anything the NFL can do to publicize the risks and decrease the player's motivation to behave a certain way and treat their bodies a certain way would be helpful. This is a problem throughout many sports, not just football."
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