Jim Proebstle, a Michigan State tight end on the Spartans' 1965 UPI national championship team, is the author of "Unintended Impact." He is uniquely qualified to comment on football concussions and CTE dimentia. He not only played the game, his brother, Dick Proebstle, a quarterback at Michigan State in the early 1960s, suffered concussions playing football and died with CTE. Jim's book, "Unintended Impact," details his brother's deteriorating condition. Jim has continued to research the subject. However, he is not anti-football. His focus is on making football a safer game.
Has the NCAA Really “Walked the Talk” Regarding Player Safety?
By Jim Proebstle
Writing the non-fiction story of Unintended Impact: One Athlete’s Journey from Concussions in Amateur Football to CTE Dementia didn’t stop when the book was first completed. As an author you’re expected to “go on the road” to promote the book—which naturally leads to continued research in preparing presentations and dealing with the vast array of questions, mostly from concerned parents. All of us know that the topic of “concussions” is prominent on TV, radio, and in the news, as well as at the water cooler, health clubs, and almost everywhere that sports talk is welcome. Yet, how could we have been kept so ignorant for so many years.
It is these years of systemic ignorance—or willful lack of responsibility and action by those running the football system in America, pro and amateur—that bothers me. How is it, that dementia pugilistica (punch-drunk syndrome) in boxing could be discovered in 1928 by the pathologist Harrison Martland, but still not be medically connected to head injuries in football until 2002? It was Martland’s firm opinion that “in punch drunk there is a very definite brain injury due to single or repeated blows on the head or jaw.” He was confronted with skepticism by the neurological community until he proved his point through extensive research with ex-boxers. This reaction is no different than the much touted statements by the NFL that there is no connection with concussions in football and CTE dementia.
Furthermore, the book Concussion Crisis: Anatomy of a Silent Epidemic documents another study published by the British Medical Journal in 1957 where Dr. MacDonald Critchley documented his reference to the term “chronic progressive traumatic encephalopathy of boxers.” Critchley examined sixty-nine boxers with chronic neurological disease and determined that most were suffering from the condition. He observed “a flood of mental symptoms including dementia, memory loss, slowed thinking and speech,
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mood swings, irritability, and violent behavior. He found that mental and physical symptoms insidiously developed an average of sixteen years after the beginning of the boxer’s career and that they progressed inexorably and irreversibly.” Were people on this side of the pond just not paying attention or was the British research considered not up to our standards and dismissed?
Finally, in the early ’60s some breakthrough thinking started to take place. A team of medical professionals led by Stephen E. Reid, M.S., M.D.—team physician for Northwestern University football for many years and a 1936 All-American guard for the Wildcats—went after the issue of head and neck injuries in football. Their pioneer study of conducting live research on college players had never been done before. Apparently, it was difficult to find subjects willing to endure concussions for the sake of research.
With the help of NASA, the AMA and financial backers data was collected from the mid-1960s to the mid-1970s. Key players had electrodes connected to their skulls in order to capture the location, duration, and intensity of each live hit during the game. This data was routed through a power transmitter at the base of the helmet and telemetrically sent to a receiver in the press box. Later it was synchronized with game films to study how the player’s movements were involved. Because of the non-standard changes to the player’s equipment, opposing teams and the NCAA were notified. Tommy Prothro and UCLA were the only dissenters as they thought plays were being illegally communicated to the quarterback—not the case.
Huge gains were made in our knowledge about the effect of “unyielding resistance vs. no resistance” to head impact, which led to increased focus on the importance of neck strength and how to anticipate a blow through good coaching and training. Yet the practice of “head slapping” that was perfected by Deacon Jones while in the pros wasn’t outlawed by the pros until after Deacon retired in the ‘70s. The NCAA did not take note, however, and unfortunately, no significant information was uncovered regarding the ongoing impact on the brain—instead, much of the focus was on the effectiveness of the helmet. In the end, the football medical community was still of the mindset that a concussion was a stand-alone event. According to a Subcommittee on Classification of Sports Injuries, Committee of Medical Aspects of
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Sports, AMA, in 1966, “A concussion causes some loss of consciousness, with little, if any, gross brain injury, and is likely to be temporary.” In 1984, Dr. Reid published the findings from his research in the book, Head and Neck Injuries in Sports. As amazing as Dr. Reid’s research was, it seems that our medical thinking at the time was locked into the same paradigm as that of broken bones or sprained ankles, where specific treatment and healing processes are applied and the player recovers. The idea of long-term damage as a result of repetitive hits to the head got little attention.
In the ’60s, organized football enjoyed an unprecedented popularity with large crowds thanks to a greater exposure provided by the media. More young athletes became involved. Many were motivated by the potential for an athletic scholarship. Competition increased and serious injuries became more prevalent. In football, thirty-two fatalities were documented in 1968 from head and neck injuries directly due to participation in the sport. To counter this trend, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) was formed in 1969 to commission research directed toward injury reduction. Football helmets were targeted for the initial research effort. It made sense that the NCAA was a founding board member. Yet, coincidentally, the NCAA dropped its role in NOCSAE in 1985. A curious decision, because it was just the year before that Dr. Reid’s Head and Neck Injuries in Sports was published, sounding the alarm for head and neck injuries in football. The NCAA remained absent from their board member role in NOCSAE until 2010.
Like all good work, however, Dr. Reid’s message of potential head and brain injuries did not die on a researcher’s shelf. In 2010, former Sports Illustrated writer Rick Telander wrote an eight-part series for the Chicago Sun-Times titled “What Football Did for Us and . . . What Football Did to Us.” As a starting cornerback for the Wildcats in the late ’60s and early ’70s, Rick had a firsthand familiarity with the sport and Dr. Reid’s research at Northwestern. His remarkable series connected Dr. Reid’s research, in a personal way, with the work from the Boston University School of Medicine and the CTE Center involving Dr. Robert Cantu, Dr. Ann McKee, and Dr. Robert Stern. Lou Creekmur, Wally Hilgenberg, Mike Adamle,
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Mike Webster, Justin Strzelczyk, Jack Rudnay, and the cast of Northwestern players “wired-up” for Dr. Reid while on the field and were featured by Telandar in his series. Some were former teammates of his. In Telander’s final article he concludes by saying, “The compelling connection between brain hits and future dementia might make parents of young football players rethink their attitudes about routine head-knocking.” This announcement was well before the dramatic deaths of Dave Duerson and Junior Seau, and well before the groundswell of public opinion regarding the potential long-term consequences of concussions and sub-concussive blows.
So what can we conclude regarding player safety?
? It is clear that the helmet became the focus of considerable effort and has undergone many changes to conform to the demand placed on it. But without the knowledge of the “cumulative effect” from concussions, rather than protecting athletes, the helmet became a weapon used to administer punishing blows. The pinnacle of this practice was represented by the exploding helmets and dramatic music on Monday Night Football—fans loved it.
? The laboratory conditions for testing helmets, at that time, proved inadequate as their static conditions for experiments could not reproduce the variables found on the field. There was no way to reproduce the phenomenon of energy absorption that occurs when players collide. More live research was needed.
? High-intensity impact with the potential for permanent disability can result in greater frequency under two conditions. First, when the player offers too much rigid resistance, creating a more pronounced impact of the brain against the inside of the skull. Second, when the player offers very little resistance, usually from a surprise hit to the side of the head, and the head and neck are driven beyond their normal range of motion, creating a whiplash effect on the brain. It was believed that proper
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coaching and player response to game conditions, involving a better understanding of the total physiologic response, became necessary.
? The study of kinesiology found its way into the academics of college and university settings. It is the study of human and nonhuman animal-body movements, performance, and function by applying the sciences of biomechanics, anatomy, physiology, psychology, and neuroscience. Applications of kinesiology in human health include physical education teachers, rehabilitation professions, such as physical and occupational therapy, and applications in the sport and exercise industries. According to Wikipedia, the world’s first kinesiology department was launched in 1967 at the University of Waterloo, Canada. By my count there are over six hundred universities today with various sports medicine majors including kinesiology, exercise science, athletic training, sports psychology, and the psychology of medicine.
? For the most part, we have migrated away from yesterday’s thinking regarding the attitude that dings, getting your bell rung, and concussions are inconsequential. It has taken many years, but we now know that it is the medical team’s responsibility, not the coach’s, to make absolutely certain that no athlete returns to the game or practice until recovery is complete. And we know that concussions and repetitive sub-concussive blows to the head can lead to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease that can lead to death later in life.
? Everyone involved—coaches, players, officials, trainers, etc.—is responsible for minimizing the occurrence and severity of head injuries through proper training, education, and player safety protocols. Once the physical and mental aspects of the athlete are determined, an extensive conditioning program will prepare the player to remain relatively injury free. We now recognize that in a situation where a head injury has occurred, its seriousness can be exacerbated by the player, coach, and/or trainer
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because of the player’s (or coach’s) motivation to remain in the game. Oversight by a qualified team physician or medical professional is imperative.
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With the evolution of the game of football came inevitable rule changes. As football developed, rules were changed with the presumed purpose of promoting player safety. With this in mind, the NCAA has arbitrated the amateur game of football through its Rules Committee. But as the NCAA points out, “rules alone cannot accomplish this end. Only the continued best efforts of coaches, players, officials, and all friends of the game can preserve the high ethical standards that the public has a right to expect in America’s foremost collegiate sport.” Therefore, as a guide to players, coaches, officials, and others responsible for the welfare of the game, the Committee publishes the following Football Code: “Traditionally, football is the game of the schools and colleges. Therefore, only the highest standards of sportsmanship and conduct are expected of players, coaches, and others associated with the game. Football is and should be an aggressive, rugged contact sport. However, there is no place in the game for unfair tactics, unsportsmanlike conduct, or maneuvers deliberately designed to inflict injury.”
In both 1965 and 1967 rules were introduced involving the use of football helmet. It was engineered “for the protection of the player and is not to be used as a weapon—no player shall deliberately and maliciously use his helmet or head to unnecessarily butt or ram an opponent” Wait a minute?! Did we just learn that the malicious use of the helmet was prohibited fifty years ago? In a chronological review of the NCAA Rules from 1965 to 2015 relating to head injuries it would also seem that the only real accomplishment in refining the rule was to use more words in establishing a standard for the illegal use of the helmet. The people responsible for the game clearly struggled in their efforts regarding a clear definition involving helmet use, and for sure in the lack of a standard for oversite, as one was never developed.
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In fairness to those making and/or amending the rules and their interpretations, the requirement for player safety and the connection to any reality of litigious outcomes has made the game of football complex. One has to speculate, however, whether the complexity of the rules, particularly from 2009 forward, have added an important set of guidelines for player safety in the interest of players, coaches, and officials, or just added protection for the NCAA relating to any future lawsuit.
Recent news regarding the $70 million lawsuit against the NCAA indicates “that it [the lawsuit] needs to be redone.” Previously the payment plan only included payments for brain trauma testing, and limited the legal immunity for the NCAA. The expanded ruling proposed by the judge in 2016 includes sports other than football, and also eliminates the blanket protection for the NCAA from class action lawsuits over concussions. The NCAA will fight this, of course, but it appears the judge is in favor of changes, which ultimately may include payouts to the athletes and their families, as well.
As the author of Unintended Impact, my research and findings involving concussions and the potential for CTE dementia have uncovered what I believe to be a pattern of diminished accountability by the NCAA with regard to player safety and concussions. While positive achievements by the NCAA have improved the ethics, safety, and value of sports at the collegiate level, it is my opinion that systemic issues and critical opportunities related to concussions have been missed in the NCAA rule implementation and enforcement, which can’t be ignored. From as far back as the discussions with President Theodore Roosevelt in the early 1900s, the existence of the NCAA has included a charter of reform regarding player safety. Yet it wasn’t until one hundred years after its foundation that the NCAA first appointed a qualified medical professional to its staff in 2010 – Brian Hainline, M.D., Senior Vice President and Chief Medical Officer.
With NCAA revenues nearing $1 billion and the NFL revenues at $6 billion, coupled with major college dependence on football revenue, the sport is not going away. The question is, will there be a shift in emphasis on player safety significant enough to stem the tide of concussion driven injuries in players?
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Since football is clearly America’s game, why can’t those responsible use their influence and power to set an example for the many other sports that are also challenged with concussions? Our culture is fueled by competitive sports. Solving the problem of concussions would appear to be in the best interest of everyone involved.
However, there is one recent ray of light. In 2014, the Chronicle of Higher Education conducted a national survey that documented that athletic trainers, in particular, function under the heavy influence of the coaching staffs: thirty-two percent of respondents indicated the head coach influences their hiring; forty-two percent reported feeling pressured to return a concussed athlete to play early; and fifty-two percent reported feeling pressured to return injured athletes early.
As a result, The NCAA’s committee responsible for student-athlete health and safety took momentous steps during its 2016 summer meeting. The Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) approved a series of recommendations built upon legislation passed by the NCAA’s five autonomy conferences earlier in the year that would establish athletic trainers and team physicians as unchallengeable decision-makers for medical management and return-to-play decisions related to student athletes. The recommendation would also create a new designated position/role on campuses—an athletic healthcare administrator—which would ensure campuses are following established best practices for medical care. According to Forrest Karr, CSMAS chair, “We envision a future where each member institution, in all three divisions, will designate an athletic healthcare administrator responsible for ensuring that their school’s policies and procedures follow inter-association consensus recommendations and comply with all NCAA health and safety legislation.” This is very good news!
In the big picture however, effective implementation of recommendations and changes across the board will take aggressive, positive, and objective leadership from the National Collegiate Athletic Association, and must happen with a much greater sense of urgency than demonstrated in the past. I
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make these observations and offer these opinions as one who played and enjoyed the game at a Division 1 level. All levels of college and organized youth programs must be required to buy into making necessary recommended guidelines for player safety, insisting that these guidelines become operational requirements for all athletic programs under their watch. If action is not taken, the problem of concussions will continue to parallel the tobacco industry denials regarding cancer from cigarette smoking.
Jim Proebstle, Author
Unintended Impact: One
Athletes Journey from
Concussions in Amateur
Football to CTE Dementia