HJNO Sep/Oct 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2023 21 Football season is raging here in the South. The hits are mounting, concussion protocols are in place, and a dark cloud of CTE is looming over practice fields and stadiums at all levels. Game makers, perhaps not realizing the latest science, are still focused on concussions, which, ironically according to the NFL, were up 18% last season. But those who follow CTE research are acutely aware that it isn’t the concussive hits, as bad as they are to the brain, that are thought to cause the long-term neurodegeneration many former players are now facing. Instead, it is repeated subconcussive hits. These subconcussive hits are so inherent to American football, removing them is impossible. One former NFL player we spoke with said his neurologist suggested, “the only way to make the game safer for the brain is to remove the helmet.” Football helmets actually evolved the game. Players used to wear leather helmets, and one could almost argue the game was more violent when they did. Players were dying on the field at a much higher rate than they do today. When the plastic helmet was invented in 1939, guys mostly tackled with their shoulders, and broken teeth and noses were the norm. In 1955, an innovative trainer, determined to keep a key player with a bloody mouth on the field, attached a single bar across the helmet at mouth level. This caught on and a second bar was added soon after to protect the nose. The helmet became the weapon we know in the 1970s when the full-face mask was introduced. “Leading with your head” was taught as players and coaches thought brains were protected by the helmet. We now know, unfortunately, that while helmets may protect the skull, it is impossible to protect the brain during the type of hits incurred on the football field. The speed and impact are just too high. How much is too much? Well, we don’t know that for sure, but recently players have been fitted with special devices in their helmets to try to measure these impacts. The following research piece is more technical than you will usually find in this Journal, but we know this series is receiving attention, and we wanted you to have the latest research from the leading CTE experts. Our hope is that you can better understand as a clinician what a former tackle football player’s brain has been exposed to and help advise concerned parents, players, and hopefully the game makers on the future of this game.