The NFL and head injuries have been in the news lately, particularly the league's settlement with former players who suffered concussions and its policy of "legal low blows." Opponents of the permissibility -- or even encouragement -- of low hits that can break bones and sideline players for weeks allege that recovery from a concussion or other head injury is swifter than recovery from a serious leg injury. On Sunday, October 13, Baltimore Ravens safety James Ihedigbo hit Green Bay Packers wide receiver Randall Cobb, breaking his fibula and putting him out of commission for up to six weeks. "He wants us to hit low, we'll hit low," Ihedigbo said of NFL Commissioner Roger Goodell, "and guys will keep getting injured."
Some current and former players have gone on the record as preferring a head injury to a knee or other leg injury. However, they may be missing the bigger picture. Researchers presenting at the annual meeting of the American Neurological Association this week found that nearly 40 percent of Ivy League football players who suffered concussions demonstrated continued cognitive impairment after their more obvious symptoms subsided. Dr. Tanzid Shams, who presented the research, cautioned, "[A]n athlete can report resolution of symptoms, but [...] still may have lingering cognitive deficits, and the key thing we have to watch out for is that someone doesn't get a second or a third concussion during the time that they are vulnerable." In a disturbing counterpoint to this advice, researchers at Long Island Jewish Medical Center recently found that "although concussion was managed more conservatively by team physicians in the recent six years, repeat concussions occurred at similar rates during both periods [2002 - 2007 and 1996 - 2001]."
The long-term effects of multiple concussions may be significant: depression, including depression-associated cognitive deficits. Opioid abuse among retired NFL players is also correlated with undiagnosed concussions. Chronic traumatic encephalopathy was first reported in boxers in 1928, and is now being studied extensively in retired NFL players. Researchers are trying to develop brain injury prediction formulas to improve equipment design, but that work is still in its early days. Until both policy and equipment align to protect athletes' health, the unfortunate effects of repeated concussions will affect NFL players, at the time of their injuries, and for many of them, for years to come.