Football on the Brain

Concussions are hanging over the NFL like a black cloud, and Dr. Micky Collins wants to clear the air.

Micky is pacing around his den, arms flailing. A yellow flag has been thrown after a red-blooded American football collision and he’s about as incredulous as a 41-year-old concussion specialist can allow himself to be. Most days, Collins wears a white coat and treats patients, including NFL players and other professional athletes, at the UPMC Center for Sports Medicine. On Sundays, though, Micky wears a jersey and stomps around the game room like everyone else.

“It’s a very interesting experience sitting on a couch watching a football game,” Collins admits. “To be honest, all the  information that I have in my head about concussions flies out the window.” Collins handles more than 4,000 concussion cases per year, ranging from youth athletes to NFL stars, and he’s in the trenches of a complex and polarizing debate: Is football a serious threat to the neurological health of its gladiators?

“I see things every day that are very concerning,” Collins says. “I see high school students who have to be taken out of school for six months, patients whose cognitive function drops—mood shifts, sleep problems. But I’ve never seen a patient with those problems who hasn’t very coherently described to me that they had an injury, they were feeling symptoms, and they either kept the injury to themselves or worse, they were told to go back and play.”

In 2008, NFL players suffered 115 concussions through the first eight weeks of the season. In 2010, that number rose to 154. Some see the 30-percent increase as proof of a headhunting pandemic.

But while the NFL brass seems to view the concussion issue as a fungible War on Paychecks, and Steelers fans view the issue as a flagrant War on James Harrison, Collins sees it from a different angle. The path to a safer game has little to do with talking points like the so-called Steelers Rule, “strike zones” or safer equipment, but rather something much less sexy: Education.

“With concussions, the severe injuries are mild and the mild injuries are severe,” Collins says. “When someone loses consciousness, everyone sees it, players take a knee, they’re treated with kid gloves, and those injuries actually end up resolving very well most of the time. The little hits, when no one understands that a concussion is present and an athlete can play through it, those fly under the radar. Then when they suffer another blow things can become very serious.”

Sidney Crosby’s lost NHL season immediately springs to mind. Last winter, fans wrestled with an unfair but telling comparison—the mystery of how Crosby could be confined to a press box prison for five months while Philadelphia Eagles wide receiver DeSean Jackson was able to retake the field just one week after being incapacitated by a helmet-to-helmet nightmare. Jackson left on a stretcher. Crosby skated on. We couldn’t accept it. The real danger, according to Collins, usually comes from the blindside.

“The most important factor is the unexpected nature of a hit,” he explains. “Concussions occur when your neck is loose and you don’t see the hit coming. Your head’s going to spin much more rapidly on its axis and your brain is going to move much more rapidly in the skull.” This is precisely why, despite all the media blustering in the wake of the NFL’s crackdown on headhunting, improving helmet technology is not a viable solution.

“We’re never going to develop a helmet that will stop the brain from moving inside the skull,” Collins says. “Think of the brain like an egg yolk inside an egg shell. I don’t care what you’re wearing around your head, you’re not going to stop that egg yolk from moving inside the shell.”

While the pipe dream of shock-absorbing equipment completely misunderstands the physics of concussions, dramatic progress has been made in the field of post-concussion research. One common misconception is that the athlete holds all the cards in the evaluation process, when in reality, players have little power to cover up what’s really going on inside their brains. Neurological evaluation tools such as ImPACT, a computerized battery test that Collins co-founded, have shifted power to the side of science.

“I expect every athlete to lie to me," Collins says. "I expect them to want to get back on the field. But it’s not like we ask them, ‘How are you feeling?’ and then send them back out there. I spend four, five hours with athletes asking them questions. Some athletes have outright lied [about their symptoms], but when we do the testing, everything shows up. Most of the time if there’s a problem it’s not that the athlete is lying, but that the right questions haven’t been asked.”

More encouragingly, Collins and his fellow researchers have even been able to use the ImPACT test to pinpoint the symptoms that predict a longer recovery time.

“Our research showed that if an athlete suffers from dizziness while on the field of play, they’re seven times more likely to need a longer recovery time to heal," Collins says. "Three days after the concussion, the symptom of fogginess—feeling one step behind yourself, feeling like your high definition TV looks like a standard definition TV—predicts a longer layoff.”

When stars like Crosby and Steelers quarterback Ben Roethlisberger have complained about this general blanket of malaise hanging over them in the post-concussion period, some armchair critics have found it tough to accept. If we can’t see the bone, or the blood, there’s a strange inertia inside of us, perhaps learned by years of watching stirring NFL Films gladiator propaganda and Don Cherry’s Rock ‘Em Sock ‘Em tapes, that pushes us to skepticism.

However, the decision to hold out an athlete isn’t based on grit or fortitude. It’s based on scientific tests that show how well the brain is functioning. And fans—true fans—should be happy that the days of smelling salts and how-many-fingers? assessments are long gone.

For all of the short-term demands we put on sports stars, fans like to think in eras: The Crosby Era. The Roethlisberger era. We imagine them lifting Stanley Cups and Lombardi trophies not just this season, but in 2015. How many will he win?

But as we’ve seen with the tragically short career of NHL star Eric Lindros and the tragically short life of Steelers legend Mike Webster, concussions can quickly turn he will into he was if they are not managed properly.

It’s the ultimate Catch-22. The more concussions frustrate us, the more they seem to be infiltrating sports like a plague, the longer we have to watch stars sipping water in the press box, the better for the future of the game and the player’s life. Despite the hysteria, concussions aren’t a new pandemic. They’re as old as the common cold. What’s really sweeping over sports culture is data and knowledge.

Collins sees the sea change not just in pro sports, but in youth sports as well, where paternal pressure to tough-out injuries has the potential to be overwhelming.

“On at least a thousand occasions, I’ve heard the quote, ‘Well, back when I played football…’ Luckily, we’ve learned more about concussions in the last 10 years than in all of the previous history of medicine combined," Collins says. "When you show a parent or coach the data we collect and they see the athlete’s reaction times were in the 90th percentile before their injury and then they’re testing below the 1st percentile after the injury, that will get anyone’s attention.”

The key is to make baseline cognitive testing a requirement for youth athletes. Collins estimates that 90 percent of high schools in the region are already using ImPACT, and this year, two majors players in the region, the Pittsburgh Penguins Foundation and Dick’s Sporting Goods, are sponsoring separate programs that offer free baseline testing to youth players.

It makes Collins smile, because the more he hears about concussions, the better.

“When I started doing concussion research in the ’90s, no one cared. I couldn’t even get a medical journal to be interested in reading what we were writing. Now Pittsburgh is one of the most enlightened communities on concussions in the country.”

The answer to the bigger question, the one that looms large over the NFL and NHL, remains more elusive. Yet for all the troubling stories of ex-players whose minds failed them before their bodies ever did—Collins sees the miracle of the human brain every day.

“I don’t look at concussions as the bogeyman," Collins says. "The cool thing about my job is that the brain wants to get better from this. The great majority of the time, I can hit the reset button on these athletes. The key is to get them in the door in the first place.”

Categories: From the Magazine