‘Head Games’: Concussions Now and in the Future

“Football is the perfect game for the country America used to be.”

— Rich Cohen, “A Journey to the End of Football”

On Sunday 14 October, the Redskins’ Robert Griffin III played a magnificent game against the Vikings. Not only did he pass for 182 yards, but he also ran for 138 yards, including two touchdowns. Fans and teammates are ecstatic. And so it appears that the coaching and medial staff who decided he should play just seven days after suffering a concussion were right. Says the quarterback, “I told the team, I wasn’t going to leave them hanging.”

It’s impossible not to love Griffin’s resolve and his brilliance. But even as we’re thrilled by his performance, we might also consider what’s happening here, how a player with a concussion was back on the field so quickly, and also, how the team reported or understood the injury. We might even ponder uncertainty about procedures regarding the concussion: while Fox Sports’ Jay Glazer says the organization is facing a “hefty fine” for its misreporting of the injury on 7 October, USA Today writes that the team is “unaware” of an impending penalty.

Such confusion, such lack of awareness, might be understandable, given the NFL’s changes to its head injuries protocol, as well as its public campaign to showcase that new protocol and $30 million donation to NIH for brain injury research. While these measures may be designed to assuage increasingly worried parents, and so ensure an ongoing population of young players, or contend with the lawsuit brought by some 2,000 former players (including the recently deceased Alex Karras, they also make visible the risks of concussions.

These risks need to be more visible. And so do the NFL’s stated and unstated stakes, for instance, its interests in both its profits and its players. Indeed, the lawsuit looms, with the potential to become “bigger than the bounty scandal,” with regard to bad (PR) for the League. Even as the NFL appears to be policing team management, coaches, and players, the policing remains uneven, in part because injuries remain undefined. As Kent Sepkowitz puts it, “The NFL is treating a traumatic brain injury as if it were a sprained ankle.”

The NFL is one very high-profile sport dealing with concussions (which has been serving as a kind of catch-all term for the problem at hand). But it is hardly the only one, as other sports and other age groups are affected by decisions about naming and treating such injuries. Most recently, Dale Earnhardt is taking two weeks off from racing following two concussions in six weeks. ESPN.com has constructed a timelineregarding the Penguins’ Sidney Crosby’s concussion and effects, James Harden sat out last season following a concussion suffered at the elbow of Metta World Peace, and the Giants’ first base coach Roberto Kelly is out at least two games in the current NL Championship series after he was concussed during batting practice.

The discussion of head injuries in sports is extended as well to non-professional leagues, including those involving children, from soccer to Pop Warner Football, opening up at least some discussion of how a sport might be played to reduce risks. This discussion — layered and convoluted, tentative and anxious — is at the center of Steve James’ Head Games. Now in theaters and on demand, the documentary offers an introduction to what’s at issue, including the problem of how to gather and disseminate helpful information. As the NFL’s slow response indicates (as a symptom more than a cause), even recognizing the problem has is a problem has been a slow process.

Darryl Young, coach for Chicago’s Near North Raiders, a kids’ football team, first appears on the practice field, advising, “Safety first, safety first!” “Prior to last year,” he reports, ” I had very little knowledge of concussions. You know, there were some statistic that 85% of the concussions go undiagnosed because people look at ’em as just bumps or bruises to the head.” His recent education has led him to restructure practices, to train his players not to hit with their heads. Now, when someone looks like he’s had a concussion, “under no circumstances is he going back out to play. We let him know, ‘Hey, good job, take it off for the rest of the day.'” As Young speaks, you see children who look almost like they’d be blown over by a wind, their giant helmets and shoulder pads teetering on tiny bodies with skinny legs. The images underscore that the boys are tiny and vulnerable, not nearly prepared to withstand a head trauma.

Focused on football, hockey, and women’s soccer, the film takes as its point of departure the campaign by Christopher Nowinski, a former defensive lineman at Harvard as well as a former wrestler. His own injuries initiated his study and resulted in a book, also called Head Games. Nowinski notes that during his two sports careers, “I had repetitive concussions for 19 years, but had never had this conversation before about what a concussion was.” Now working with Boston’s Center for the Study of Traumatic Encephalopathy, Nowinski is making the case for more study of head traumas, their long term effects, as well as treatment and at least a modicum of prevention.

If it’s well known that injuries to children’s heads are especially perilous, the film proposes, too often young players and their parents remain unaware of same. The movie offers a brief and disconcerting look-back at the history of head trauma as an idea, as when football players were called “dinged” or boxers were deemed “punchdrunk,” before it lays out some science. This impressed the New York Times‘ Alan Schwarz when he first read Nowinski’s book in 2006: “It was the footnotes that blew me away,” he says.

The film makes such notation part of its storytelling, as Nowinski visits with doctors and researchers, or participates in a conference call with experts at the Center for the Study of Traumatic Encephalopathy, Robert Stern, Ann McKee, and Robert Cantu, speaking with the wife of a former boxer, who suffered from problems with memory, organization, and violence directed at his family, before he committed suicide in front of his wife. After the doctors explain that he suffered from a “structural disease,” not a psychological one, she’s relieved but of course, still traumatized. “I was so angry with him,” she remembers. The team hopes that more understanding of Chronic Traumatic Encephalopathy (CTE) will help victims and their families to cope with their lost or changing capacities.

For a scene showing people on the phone, this one is startlingly painful: Dr. McKee leans onto her desk at one point, listening; Dr. Stern tries to console the wife: “This is a guy who was a great father and husband, until he became a different person.” As Nowinski notes, this part of the job is especially difficult, for the point of such calls is to ask family members for access to their loved ones’ brains. He monitors the news and other forms of notification in order to find potential donors.

In addition to following Nowinski’s work, Head Games also offers up case studies, stories of hiding symptoms and consequences, stories of ignorance and frustration and joy in playing. Nowinski’s college teammate, Isaiah Kacyvenski recalls walking to the wrong sideline after a hit, a story that’s funny in another context, horrifying here, as he reports repeated injuries then and effects now. Olympic gold medalist and former soccer player Cindy Parlow-Cone estimates she scored at least 50% of he goals with her head, and had at least 100 concussions “where [I’ve] seen stars.” Now, coaching girls, she ‘s looking for other ways for them to play the game.

Keith Primeau, a 16-year NHL veteran, appears in TV game footage hitting opponents and the ice, and recalls how players and coaches would consider concussion a “phantom injury,” hard to see or name. “The beginning of my demise was my second concussion, in 2008,'” he says (though it’s hard to guess how many he suffered that went undiagnosed). “My wife said I didn’t look well,” Primeau says, and after a fourth documented concussion, the Flyers team doctor determined he should stop playing, and since his retirement, he’s noticed changes in behavior, headaches and head pressure, or feeling lightheaded or irritable.

Now, he and his wife face the dilemma posed by their son Chayse’s desire to play hockey. It was cool having a dad who was “that tough,” the boy tells James. His sense of how to be has been shaped in part by friends’ positive responses to the YouTube videos that show his dad hitting opponents hard. “If I have to get in a fight,” Chayse asserts, “I will, it builds character.” James asks, “So when your dad talks to you about concussion, you’d rather he not tell you too much?” Chayse laughs, sort of, as he answers no. James asks one more question: “Does he know that?” Chayse shakes his head, “No.”

This appears to be the story of concussion in sports now, with some facts emerging and some myths remaining, with science jostling against culture, pride against worry. Players and parents and fans take pleasure in sports, multibillion-dollar industries are built on them. The head games here are ongoing, complicated, and variously invested. They’re dangerous and they’re lucrative. But it’s good to keep clear on who’s risking what: players risk their health and their very lives, in futures hard to imagine when they’re eight or 12 or 24. Head Games means to change those futures, for players and sports alike.