Ignorance Is Not Bliss & Won't Make Concussions Go Away

Major sports leagues appear intentionally and willfully blind to brain injury.

Posted Feb 13, 2017

Millions of people thrill to the athletic spectacle of professional contact sports. Like those millions, I enjoy watching the fast paced games of the National Hockey League, the National Football League, and the Canadian Football League. Having extremely highly trained athletes sprinting--or skating even faster--to make plays reveals the graceful athleticism humans are capable of achieving.

Combining that graceful athleticism with a limited playing surface and the ability to hit and check also produces extreme collisions. Those collisions are felt by the brains and bodies of those athletes in motion. Like any exposure to repeated trauma, those collisions can accumulate in effect and carry over in the long term. For example, initial concussive events that are the product of disruption of function in the brain can lead to chronic issues as part of post concussion syndrome. This may result in disruption of form and function referred to as chronic traumatic encephalopathy or CTE.

Yet CTE, in common with other disorders like Alzheimer's disease, requires an examination of brain tissue. This usually occurs post mortem (although advances in imaging technology will help) and raises questions about diagnosis in the intact brains found in those athletes who may be suffering post-concussion symptoms of CTE. Regardless, many deficits in post-concussion syndrome can also persist in the absence of morphological changes in the brain. CTE is an example of long term exposure to concussive incidents, not the the only endpoint. And this causes confusion and possible opening of a legal loophole for sports leagues.

Those leagues that rely on collision as part of the allure of their product--NHL, NFL, CFL, Rugby, etc--have a vested economic interest in denying the prevalance of concussion and links to post-concussion syndrome including CTE. In 2015 the NFL famously (infamously?) settled a billion dollar class action lawsuit from former players (but litigation continues). Even for a league that generates as much income as the NFL, that is a lot of money. Smaller leagues like the NHL and CFL would likely be decimated by similar lawsuits.

Enter the wishful thinking of sports leagues that has led to some spectacularly tone deaf and ignorant (and I mean that literally) recent comments. On the eve of the CFL Championship "Grey Cup" game in November 2016, Commissioner Jeffrey Orridge denied a link between physical exposure in football and long term post-concussion effects. Probably it is not a coincidental that the CFL is dealing with a $200 million class action lawsuit. Recently NHL Commissioner Gary Bettman has said a link between the contact hockey players experience and brain injury is inconclusive.

I've been writing about concussion since my 2008 book "Becoming Batman" and continuing in Inventing Iron Man, Project Superhero, and the forthcoming Creating Captain America. I've written posts at here at Psychology Today, at Scientific American, at the Science and Entertainment Exchange, and at ComiConverse. I believe it is critical that people understand concussion, what it means, the underlying physiology, and our societal response to it. Sometimes, I wonder if I need to keep pushing this agenda like this.

I sometimes wonder, am I actually "preaching to the converted"? Maybe everyone has already gotten the message already. Then I hear those comments from the commissioners of major sports leagues like the CFL and NHL and realize that no, more work actually does lie ahead and constant effort is needed.

We now have a vast body of biomedical science supporting the link between impact exposure, concussion, and possible post-concussion syndrome. Almost 90 years ago, back in 1928, American physician Harisson S. Martland coined the term “punch drunk syndrome” to describe the presentation of a boxer who had a lifetime of head impacts. That boxer had impaired motor coordination, slurred speech, and balance problems, things we associate with concussion and post-concussion syndrome.

Moving forward it's time to demand that sports leagues stop ignoring the problem and deal with it more effectively. To stop looking at athletes as almost disposable commodities. Instead of adhering to an out of date approach that is reminiscent of the denials of links smoking and cancer, and seek find better assessment tools, better monitoring of the effects, and better follow up for athletes exposed to concussive incidents. A recent study in the British Journal of Sports Medicine by Markku Tuominen and colleagues in Finland, the USA, and Canada showed that in International hockey, changes in equipment, playing surface and better rule enforcement can reduce concussion incidence.

It's time to realize that the world of concussion isn't flat. Ignoring the evidence and denying the problems of concussion and post-concussion syndrome won't make them go away.  We need to move towards solving problems instead of assessing blame; to invest in prevention and management solutions rather than plausible deniability.

It is 2017 and the world? It's not flat. Oh and smoking? Causes cancer. What about heavy collisions in sport? Those collisions can cause concussions and ignoring the evidence won't make the problem go away.

(c) E. Paul Zehr (2017)