NFLPA Player Safety and Welfare Committee member and Arizona wide receiver Sean Morey has collaborated with NFLPA Medical Director Dr. Thom Mayer in providing a comprehensive report on the Concussion Conference, held at the NFL office in New York on May 19. Both Morey, a 2009 Pro Bowl selection for special teams, and Mayer, an expert in emergency medicine, trauma and sports medicine, attended the conference.

 
The NFL's Mild Traumatic Brain Injury (MTBI) Committee, in coordination with the NFL and the NFL Players Association, held a conference May 19 at NFL Headquarters in New York City.

The five-hour meeting was held in response to ongoing debate within the medical community on the precise long-term effects of concussions and how they relate to other risk factors. The NFL invited multiple neurological experts to present their research in an effort to better understand the cumulative effects of head trauma experienced in former NFL players.

NFLPA Medical Director Dr. Thom Mayer and NFL Medical Advisor Dr. Elliot Pellman selected an impressive list of specialists in their respective fields with the intent of assuring a detailed and comprehensive scientific discussion. The conference was a follow-up to last year’s NFL-NFLPA Conference on Concussions, at which participation by all NFL physicians and trainers was mandated, and the ongoing exchange of data and viewpoints was a central goal.

Members of the NFL’s MTBI committee, medical advisors from the NFL and NFLPA, neuropathologists, neurosurgeons, neurologists, and neuropsychologists studying the chronic effects of head trauma participated in a comprehensive clinical and pathological discussion about the complex dynamics surrounding concussion-induced brain trauma. Sean Morey, member of the NFLPA Player Safety and Welfare Committee, was on hand to represent NFL players and help provide practical knowledge on the controversial topic. Members of the NFL’s MTBI committee have been working diligently to understand the biomechanics of head injuries and provide solutions to help prevent, report and manage concussions properly in the NFL.

The conference was extremely productive and allowed insightful interaction between team doctors, medical advisors, researchers, one player and one owner. This environment provided open dialogue from several points of view, addressing the reality of the complex dynamics surrounding the prevention of mild traumatic brain injury. The research is ongoing and the results are still preliminary in studying the cumulative long term effects of repetitive head trauma. Most researchers agree that the brain, once concussed, experiences a window of vulnerability where another event could render brain damage sometimes seen in patients suffering from post-concussion syndrome. Post-concussion syndrome is a set of physical, cognitive and behavioral symptoms--such as headache, difficulty concentrating, and irritability--that a person may experience for weeks, months or occasionally years after a concussion.

One of the main issues identified is that concussions are downplayed by players and coaches, each of whom may have incentive not to report them. Both players and coaches have a competitive, vested interest in players finishing the game, and that exposes the player to increased risk of head trauma. Players not only fear letting down their teammates and coaches, where loyalty runs deep, but also fear losing their jobs.

The Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, representatives of which presented at the conference, has uncovered a neurological disease diagnosed in eight former NFL players. Chronic Traumatic Encephalopathy (CTE), a condition previously almost exclusively found in boxers, may have contributed to the premature death of some of these players. Although it seems that repetitive head trauma may lead to the development of CTE in some individuals, it is not clear how genetic and environmental risk factors like drug use also affect the development and progression of CTE. Studying the brain tissue of the eight former NFL players, researchers have found the presence of an abnormal toxic protein called tau that is typically found in Alzheimer’s disease, but present in these athletes in a pattern and location distinct from Alzheimer’s patients.

Neuropathologists studying CTE confirm that the disease has only been known to develop in individuals who have suffered repetitive trauma to the brain, primarily boxers and football players. Researchers believe there may be a genetic predisposition for this condition. It is not known what type of other risk factors may make some individuals more likely to develop this disease than others. It is unclear how much head trauma is required or if the interval between repetitive head trauma determines susceptibility to this condition.

Although research is ongoing, the League and Union representatives agree that these findings are medically significant enough to warrant further clinical study and neuropathological research. Dr. Mayer and members of the NFL Committee on Mild Traumatic Brain Injury hypothesized that more than trauma alone is required to account for what was observed, and suggest there is a multi-factorial nature to this disease. However, it is certain that trauma definitely plays a role.
 
We are convinced that the format in which specialists and physicians were able to share information, with full transparency, while maintaining mutual respect for one another’s contributions, was a way in which we can all move forward and enhance further discussion surrounding this controversial topic.

Helmet technology has advanced dramatically, and helmet manufacturers now offer concussion-reducing technology in the latest helmet models. It is incumbent upon the NFL, and the Players Association to promote the use of modern helmets clinically proven to reduce the severity and frequency of concussions. Members of the NFL’s MTBI Committee who are working primarily with the biomechanics and prevention of head injuries are planning to test modern helmets in conditions causing concussion in NFL players. This data should give players and equipment managers unbiased information on the performance of different helmets in preventing concussion. Some players have resisted the use of such helmets, either because of comfort or concern with the look of the helmets.

The criteria determining if a player is cleared to return to play has been standardized, and must continue to be strictly adhered to throughout the League. Comprehensive cognitive baseline skills testing before training camps commence has been mandated league-wide by NFL Commissioner Roger Goodell. Sideline ImPACT, “Immediate Post Concussion Assessment & Cognitive Testing Program” was developed to provide a standardized format for the collection of important information regarding the nature and severity of the brain injury. Sideline ImPACT is also a highly portable injury tracking tool that contains information regarding the athletes’ past concussion history and performance on past ImPACT evaluations, and can be used to help determine more precise ‘Return to Play’ criteria. If players are sufficiently aware of the risks associated with post-concussion syndrome and educated on the importance of reporting their concussions, then ultimately players can help team doctors manage their head injuries properly.

We believe our conference was a step in the right direction. The NFL and NFLPA have been asked at times in the media to acknowledge the difficult issues retired players face today. We applaud the work being done within the neurological research community and the willingness of the League and Union to collaborate information in order to advocate for player safety. It is our common goal to protect both the long term & short term health concerns of our players and their welfare as patients. We also believe that this issue will continue to evolve with the cooperation of Retired Players in the efforts to collect data made by the NFL, Center for the Study of Chronic Traumatic Encephalopathy, and other independent research groups studying the long term effects of concussions.

Addressing this complicated issue systematically will take effort on all fronts to make progress. We recognize the NFL serves as a model for collegiate, high school, and youth football programs. We intend to continue to preserve the integrity of the shield we represent by doing our due diligence to understand, prevent and manage concussions in a manner advocating strictly for player safety above competitive interests. We also recognize the complex nature of our business. Owners have invested millions of dollars in players with an expectation of performance and results. Coaches feel pressure to win now. Players want to play, and team doctors want to protect them, both from the opposing teams, and in these complicated instances, even themselves. It is important to recognize that these players are also husbands and fathers who will continue to provide for their families and contribute within our communities long after their playing days are over. Moving forward, the NFL and NFLPA are focused on working together to provide solutions to this challenging issue affecting both active and retired players.