Earlier this month, at a Congressional roundtable on concussions, Ill. Rep. Jan Schakowsky asked Jeff Miller, the National Football League’s senior vice president for health and safety policy, a point-blank question: Is there a link between football and degenerative brain disorders—including chronic traumatic encephalopathy, or CTE.
Miller's response, later affirmed by an NFL spokesman, came as a shock to many. "The answer to that," Miller said, "is certainly, yes."
A story in the New York Times described Miller's answer as "a stunning about-face" for the NFL, and compared it to "big tobacco’s confession in 1997 that smoking causes cancer and heart disease."
Miller's comment may have a ripple effect on football policies and practices—from the pros on down to the pee wees.
We asked MossRehab Clinical Manager/Physical Therapist Michael Parlatore, PT, DPT, for his thoughts on the NFL's new stance.
Do you think that Miller's acknowledgment of the health risks associated with playing football at the pro level will make it easier to get that point across at lower levels—college, high school and pee wee leagues?
Without a doubt, this is a leap (not a step) in the right direction. Having this statement come from a league official is incredibly important and will help get the point across.
What I would like to see happen next is the commissioner of the league address this statement and explain how professional football plans on assisting with the education of all athletes and age groups. The commissioner is not a healthcare professional, but he does have lots of power and influence over how his sport and product are marketed.
The NFL can use this as an opportunity to obtain and distribute the proper equipment to our younger athletes (pee wee, middle school and high school) to help promote safety within the sport of football and to emphasize how much risk there is associated with the sport.
Now, some individuals may say that if you give teenagers the most up-to-date equipment and tell them that it will help prevent injuries, they will play the game even harder and with less regard for injury. I don't believe that. They need to be taught the fundamentals of the game and they need to see and hear real stories from these NFL veterans with chronic issues to help illustrate the associated long-term risks.
Something I think we all need to acknowledge is that football is a violent sport. Our focus should be on identifying ways to minimize, not eliminate, the risk of head injuries. In my opinion, we will never completely eliminate concussions from football. We can, however, improve our skills in identifying why and how concussions happen and how to improve equipment to minimize injury, and learn the best ways to return an athlete to sport.
For college, high school and middle school students, we tend to forget about the impact these injuries have on their performance in school. Symptoms should be taken seriously, so athletes do not end up with longstanding and chronic issues.
Do you think there has been some reluctance at those levels, perhaps among both coaches and parents, to take the risk seriously?
I do believe that some coaches and parents do not think that an athlete "getting their bell rung" is the same as sustaining a concussion or brain injury. Something that needs to be understood is that we are talking about an injury to the brain.
The word "concussion" may not create the same reaction or response that being told that you have a "mild traumatic brain injury" does. These individuals need to understand the repercussions of these injuries that can impact players for the rest of their lives. There will always be some reluctance to take these risks seriously at all levels. Coaches want to win, athletes want to compete and parents want to see their children succeed. They may be turning a blind eye to these risks so they can achieve all of the above.
For college, high school and middle school students, we tend to forget about the impact these injuries have on their performance in school. Symptoms should be taken seriously, so athletes do not end up with longstanding and chronic issues. I also think that the concept of learning sportsmanship and teamwork is beginning to take a back seat. It seems that it is all about winning and making it to the next level. For our younger athletes, we need to understand that sports mean much more to them than winning; sports are supposed to be fun. There are philosophical changes that need to occur.
Do you think the NFL official's acknowledgment of the risk might increase awareness of the risks of concussion among physicians who might have patients who play football? Or do you think they needed educating or persuading in the first place?
There is always a need for education. One thing that is very apparent is our lack of knowledge of how the brain works, how it responds to injuries and how it recovers. Please don’t get me wrong, we have learned an awful lot about what concussions are and how they affect our bodies, but the top neurologist in the country needs more education.
Part of our role as healthcare professionals is to continue to pursue new ways to improve our care and delivery of services. Healthcare professionals, coaches, athletes and parents all have to understand that not all concussions or brain injuries are the same. You cannot base the expectations of recovery on how someone else has recovered.
The world of education is another area where I believe the NFL needs to step in and continue to promote and fund research, and offer education opportunities for everyone (coaches, parents, athletes and health care professionals). The education should be focused on prevention, management and recovery from brain injuries. A huge part of that education needs to be if, not when, an athlete can return to sport.
There's already a lot of concern that youth football in particular could disappear unless changes are made. Is it even possible to make the game safe to the point where concussions and brain injury are far less likely? Is it possible to eliminate the risk of concussion and brain injury from the game of football?
Even if we change the rules so that there is no contact allowed, you can still sustain a concussion without an opponent hitting you. In my opinion, you will never completely eliminate concussions from football. Again, we need to recognize that this is a violent sport and people are going to get hurt. I do think we can reduce the likelihood of concussions through education and application. Coaches need to educate their players to tackle correctly. Tackling is a high-level skill that takes practice. My fear is that you eliminate tackling until high school and you end up with a bunch of 17-year-olds running around with no idea of how to bring their opponent down. This to me would lead to even more injuries.
Healthcare professionals need to educate the coaches and league officials on how to properly identify and manage a player with a concussion. We have ways to do that now, but they are not perfect. Everyone who participates in this sport should have the proper equipment. I’m not saying that they need a helmet—I’m saying that they need a good helmet that fits correctly. Hopefully, the NFL can assist with getting the best equipment to anyone and everyone who plays the game of football.