(Third in a series)
It's not clear-cut. It would be so much easier to understand, to make decisions, if there was a simple, certain cause and effect, but there isn't. It's too complex, kind of like the brain itself.
Indeed, it would be convenient, maybe even comforting, if there was a definitive clinical explanation for the suicide of Junior Seau, or the murder/suicide committed by Jovan Belcher. There have been other tragic cases involving other individuals, but those are the most recent, those are the freshest in the news cycle. And because of the nature of the contemporary news cycle, answers must be had.
Obviously, both Seau and Belcher were experiencing serious mental health issues to do what they did, and then when a subsequent post-mortem examination concluded that Seau's brain had abnormalities consistent with chronic traumatic encephalopathy (CTE), and then don't forget, Belcher was an NFL linebacker, too … well, the easy answer became: football.
Football, because that's the sport exposing children and young people to regular blows to the head, which leads to CTE, which leads to mental illness, which leads to suicide. Or worse. This headline appeared above thousands of news stories written when the Seau findings were announced: "Junior Seau Diagnosed With Disease Caused By Hits To Head." Go ahead, Google it. You'll get 569,000 matches, so it has to be right. Right?
The accurate answer is: the science remains unproven.
In fact, Jeffrey Kutcher, a neuroscientist on the cutting edge of brain research and the Director of the Michigan Neurosport Program at the University of Michigan, said in a January 2013 interview with Yahoo! Sports: "The concern about repetitive head injury is still there, but the science is still too early." In the same interview, Kutcher went on to add: "This idea of providing simplistic explanations for suicide drives up the suicide rate. You're giving people in that category a lack of hope – a reason to not seek treatment but seek a way out."
Kutcher also said the evidence linking CTE to repeated hits to the head is "preliminary." There also is no scientific proof that CTE causes suicide, there is no proof that playing football leads to CTE, and statistics tracking head injuries in children do not even point to football as the primary culprit. In fact, the conclusions of two recent international studies throw cold water on the perception that there is a direct link from football to head injuries to CTE to suicide.
The Third International Conference on Concussion in Sport met most recently in Zurich, Switzerland, in November 2008, and part of its Consensus Statement read, "The authors acknowledge that the science of concussion is evolving, and therefore management and return-to-play (RTP) decisions remain in the realm of clinical judgment on an individualized basis."
And the University of Thessaly in Greece, in a 2010 study, suggested a link between genetics and the effects of head injury: "Accumulating evidence has implicated various genetic elements in the pathophysiology of brain trauma. The extent of brain injury after TBI (traumatic brain injury) seems to be modulated to some degree by genetic variants."
According to statistics compiled by Children's Hospital of Pittsburgh:
- Almost 50 percent of head injuries sustained in sports or recreational activities occur during bicycling, skateboarding, or skating incidents.
- More than 775,000 children, ages 14 and under, are treated in hospital emergency rooms for sports-related injuries each year. Most of those injuries occurred as a result of falls, being struck by an object, collisions, and overexertion during unorganized or informal sports activities.
- In a sampling of children between the ages 5-14 who required treatment in hospital emergency rooms: 205,400 were for basketball-related injuries; 285,000 were for bicycle-related injuries; 108,300 were for baseball-related injuries; and 185,700 were for football-related injuries.
According to the U.S. Centers for Disease Control (CDC):
- Nearly 30 million children and adolescents participate in youth sports in the United States.
- Among athletes ages 5-to-14, 28 percent of percent of football players, 25 percent of baseball players, 22 percent of soccer players, 15 percent of basketball players, and 12 percent of softball players were injured while playing their respective sports.
- Seventy-nine percent of all traumatic brain injuries among children are caused by things other than participation in sports and recreational activities.
- By age 13, 70 percent of kids drop out of youth sports.
John Norwig has been the Head Athletic Trainer for the Pittsburgh Steelers for 22 years, and he is a member of the American College of Sports Medicine, and the American Orthopedic Society for Sports Medicine. John Norwig also is the father of three children, and the two boys, Nicholas and Luke, both started playing tackle football in the sixth grade.
"I didn't have any fear of catastrophic injury being related to football," said Norwig. "My concern was making sure that the safety equipment – the helmet, shoulder pads, shoes, thigh pads, everything – was fitted correctly. I know statistically that the risk of injury is not as significant as what is being promulgated by the media. Sometimes we latch onto statistics and it scares folks, but the benefit of playing sports in general, and the risk involved with the sport of football is not so severe that it should limit somebody from playing."
Norwig said, and the Children's Hospital of Pittsburgh statistics agree, that the risk of playing football is similar to the risk of such recreational activities as skiing, skateboarding, riding a bike, or surfing.
"My boys were interested in playing football at a young age," said Norwig, "and my reaction was that as long as they were fitted with the correct equipment and had good coaching, hey, go ahead and play the sport."
Norwig's sons also fell into the majority when their interest in football waned and was replaced by another sport or activity once they got into high school. But still, the benefits of what they had learned through participating in football helped them as their interests morphed in different directions.
"It's a chance for these kids to burn energy, it's a chance for them to be competitive, and it gives them a chance to develop some camaraderie," said Norwig, who attended his boys' practices and games and never witnessed anything untoward. "They also learn they have to listen to somebody, the coach; they have to be responsible for what they're doing. It's about what sports teach young people. I never thought about the risk of injury, or prohibiting my sons from playing because of the danger involved. I just think we're overreacting when we think there are a lot of sub-concussive blows or high-energy injuries."
Norwig isn't the only professional to take this stance.
Kevin Guskiewicz is the founding director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina and is a member of the NFL's Head, Neck and Spine Committee, and he said two of his three sons play football. He advocates teaching safe techniques and refinements in safety rules, and he's also involved with researching sensors that might help improve helmet design.
Said Guskiewicz, "I really believe we can find a way to make the game safe."
To that end, a recent report in The New York Times said the NFL will partner with General Electric Co. on a four-year, $50 million initiative to jump-start development of imaging technology that would detect concussions and encourage the creation of materials to better protect the brain. Also included in this partnership will be determining if some players are predisposed to head trauma; diagnosing and gauging the extent of head injuries and detecting the chronic effects of concussion; and improving equipment to insulate the brain during play.
Chris Nowinski, a former Harvard football player and the co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, told The New York Times that the NFL/GE initiative showed "considerable investment in an area that needs it."
"We're so close to having tracers to be able to diagnose this in living people with accuracy. Who knows what the next 10 years looks like?" added Nowinski. "The clinical trials we may be able to start soon, and the actual hope for effective treatment, it's all real."
Clearly, there is work to be done, but what the excitement over this work proves is that there are no definitive answers as of yet.
As Pop Warner Executive Director Jon Butler said: "There's so much misinformation right now that unfortunately parents treat as fact … I think football is not going to go away."
NEXT: Tunch Ilkin's storyFOOTBALL'S FUTURE: ANOTHER PERSPECTIVEPart 1: Tomlin: Football is a teaching tool for young men