Concussions an issue as well as an injury

Concussions and their consequences remain a topic of intense interest from courthouses to pathology labs, Hollywood studios to locker rooms, doctor's offices to sidelines. While concerns haven't noticeably lessened fan enthusiasm for football _ the NCAA achieved record attendance levels in 2015 _ college players are paying close attention, as evident during last month's 2016 ACC Football Kickoff at Charlotte, N.C.

A random survey of players in attendance found about a third had knowingly suffered concussions during their college careers. Keep in mind that only one in six concussions is diagnosed, according to the Concussion Legacy Foundation. "A lot of times they go unnoticed, and it's up to the athlete to report that to us," says Rob Murphy, N.C. State's director of sports medicine. "The mentality of an athlete is fight through it, be tough. But the reality is, you can't be tough when you're dealing with head trauma."

Wake Forest linebacker Marquel Lee didn't hide anything. "I felt my bell get rung," recalls Lee, felled while trying to tackle Florida State quarterback Jameis Winston in 2014. "I knew something wasn't right. I stayed on the ground." After ministrations by trainers, Lee was sidelined during a bye week, then returned to action. "Concussions, it's part of the game," says the team captain. "I've been playing this all my life. It happens. It doesn't deter me from doing my job."

Several ACC players reported watching the 2015 film "Concussion," in which Will Smith portrays Dr. Bennet Omalu, who deduced that CTE, chronic traumatic encephalopathy, is caused by repeated blows to the head, leading to memory loss, depression, mood swings and suicides among a number of prominent former NFL players. Central to the movie's narrative was the NFL's years of obfuscating the dangers of brain injury, particularly the cumulative harm caused over the course of players' careers.

By now, though, the leader in denial has come around. The shift was emphasized earlier this year when Jeff Miller, the NFL's vice president for health and safety policy, responded to a congressional query about a possible link between playing football and degenerative brain disorders. According to The New York Times, the NFL official conceded, "The answer to that is certainly, yes."


Contrasting concerns

The prospect of risking long-term trauma has depressed youth participation and persuaded a trickle of NFL players to retire early, vocally citing health concerns. Included was seven-year pro veteran Eugene Monroe, an All-ACC pick at Virginia in 2008. "Has the damage to my brain already been done?" he asked in "The Players' Tribune" upon retiring as an NFL offensive tackle. Monroe suffered a concussion and sat out three games in 2015. "Do I have CTE? I hope I don't, but over 90 percent of the brains of former NFL players that have been examined showed signs of the disease. I am terrified."

NHL commissioner Gary Bettman appears unworried. He recently minimized any relationship between CTE and repeated concussions as "nascent science." With his league facing a lawsuit by former players over failure to warn of the long-term effects of head injuries _ the NFL and the NCAA have settled similar class-action suits _ Bettman attempted to deflect concerns by fingering a familiar culprit, echoing Gov. Pat McCrory's defense of House Bill 2 by blaming "media hype."

In contrast, Nathan Peterman, a quarterback and grad transfer enrolled in Pitt's business school, watched "Concussion" and found it "pretty educational." He took note of a statistic shown on the screen at the end of the film. "Actuaries hired by the NFL have concluded that 28 percent of all professional football players will suffer from serious cognitive impairment, including CTE," it said.

"I've been very blessed to not have that to happen to me yet, and hopefully ever," Peterman says. And while he didn't knock on wood to ward off a concussion, three other ACC players did. Peterman's football career had more targeted protection – control over who in his family in Jacksonville, Fla., got to see "Concussion." "It would probably scare my mother at home," he notes. "I don't know if my dad's let her watch the movie yet."


Accepting the risks

Virginia's Micah Kiser was assigned to view the Smith movie for a class called "Race, Sport and Film." He demurred. "I did not watch it because I kind of know what it's about. I don't want any doubt in my head." Nor did he care to watch a movie that cast "a bad light" on the sport he loves.

The inside linebacker says the violence inherent in football attracts spectators, consistent with entertainment popular for thousands of years. "If you look at history, places like in Rome wanted to watch gladiators, boxing. Football, people want to see that kind of sport. I think there's always going to be a lane for it."

Kiser believes those uncomfortable with a game that might cause cognitive decline, schoolmates among them, don't appreciate football as he does. "I think that's what a lot of people don't understand _ how important football can be in your life," he says. "They don't understand just because they're looking from afar. Why would you want to play a sport where you can be getting these concussions, you could get CTE? But until you're part of it you'll never understand."

Jack Tocho understands _ both the lure of football and the pain of a concussion, which he incurred last season in a 56-41 home defeat against Clemson, the ACC champion. The N.C. State cornerback struck his chin on the Carter-Finley turf defending a pass into the end zone. "The experience was breathtaking," Tocho said. "You take pause. You just think, like, wow! Because I was blacked out. I woke back up and my trainers were over me."


Step back and think

Murphy was with Tocho when he regained consciousness. The Wolfpack athletic trainer won't discuss specifics for privacy reasons, but acknowledges Tocho, a graduate of Charlotte's Independence High, underwent a standard protocol for handling concussions. That meant immediate removal from the game; checks for everything from balance and memory problems to pain levels to sensitivities to light and noise; and distancing for a while from "noxious stimuli" such as computers, cellphones and TV.

Tocho sat out the ensuing contest at Boston College. "You just have to step back and think about the impact a concussion can have on your body, on your life," he says. "As for myself now, you don't go into a game thinking I'm going to get hurt or stuff like that."

In fact, ACC players were quick to express confidence in protection against traumatic head injuries afforded by updated equipment and tackling techniques.

Murphy says individual differences, and the body's position when it takes a blow, prevent easy visual analysis to determine when a concussion occurs. Team doctors and trainers watch closely, whether as press box observers through a program the ACC initiated last season, or from the sidelines. "We know our athletes very, very well, and we've been embedded with them throughout every activity that we do, so if something's wrong we can pick up clues as to what that might be," Murphy notes.

Diagnosing concussions, and promoting recovery, is a start. Football rulesmakers are increasingly focused on curtailing kickoffs in order to reduce injuries, especially concussions. And the National Institutes of Health just launched a 7-year, $16 million study aimed at identifying and possibly ameliorating CTE's long-term effects. The study could ultimately save lives and, perhaps, the enduring popularity of playing football.