For the NFL, Focus on Concussions Yields Mixed Results

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Concussion Watch: FRONTLINE tracks and analyzes officially reported head injuries in professional football.

The 2012 NFL season was supposed to be Laurent Robinson’s year. Coming off of a breakout performance in 2011, the young wide receiver had signed a new $32.5 million contract with his hometown team, the Jacksonville Jaguars.
Then came the concussions. Four of them, in four months.

The first concussion occurred during training camp in August, followed by a second head injury midway through the third game of the season. Seven days later, the Jaguars’ top receiver was back on the field against the Cincinnati Bengals, but his comeback would be short-lived. Before the game was over, Robinson would suffer concussion No. 3 when a pile of defenders landed on him after a catch.

“I just felt like my head was going through the ground, it was spinning like crazy,” he told FRONTLINE.

Seven weeks later, he was down again. This time for good.

“The crazy thing is, they would have cleared me [to play] again if it weren’t for my agent coming in being like, ‘No, no, no, we’re shutting him down,'” said Robinson.

By the end of the season, Robinson was damaged goods, slowed by debilitating headache after headache, as well as heightened sensitivity to light and noise. Even certain odors would trigger his symptoms. In March — just one year into a five-year contract — he was cut from the team.

Robinson’s case represents an uncomfortable conundrum for the NFL: Despite a new emphasis on safety and concussion prevention, league guidelines continue to foster an environment where a single player can still suffer four concussions in as many months.

For the past 11 months, FRONTLINE’s Concussion Watch  has been tracking both the number of concussions occurring in the NFL and how long players are sitting out post-injury. Robinson’s story offers a snapshot of the initiative’s major findings, revealing multiple gaps in how teams report and treat injuries.

In all, 2012 saw a total of 160 players placed on a team injury report for either a head injury or a concussion during the regular season, with at least one additional player hurt in the playoffs. In 86 cases, including Robinson’s second concussion, an injured player was back on the field for their team’s very next game. At least 10 players, including Robinson, suffered multiple concussions, and 19 additional players saw their season end early because of a head injury.

Among the project’s other findings:

  • The 160 players hurt in the regular season is up from 142 in 2011, marking a 12.7 percent increase.
  • When counting the 10 players who suffered multiple concussions, as well as injuries from the postseason, 2012 saw a total of 171 concussions reported by NFL teams.
  • The most commonly injured position: wide receiver. A total of 29 concussions sidelined receivers, such as Laurent Robinson, in 2012. On the opposite side of the field, cornerback (26) was the most frequently injured position on defense.
  • The Oakland Raiders reported the most concussions in total. Oakland had 12 separate concussions among a group of nine players. Defensive backs Matt Giordano and Phillip Adams, as well as guard Mike Brisiel, each had two.
  • The Cleveland Browns had the most players with concussions: 10. The Miami Dolphins had the fewest. Miami lost just one player, Daniel Thomas, to a head injury in 2012, though Thomas was among those hurt twice.

The Concussion Watch analysis draws on information from team injury reports, but as we reported last year, these reports fail to provide a complete picture.

For example, because teams do not release official injury reports throughout the preseason, the data only reflects injuries that occurred beginning with Week 1 of the regular season. The only exceptions for 2012 were the six players added to the season’s first injury report for a concussion from training camp. This omits injuries that came early in the preseason, such as Laurent Robinson’s first concussion.

It is also unclear how many concussions go unreported when an injured player’s team has a week off and he recovers before the next game. In such cases, the player does not go on the injury report. Similarly, the 20 teams that fail to make the playoffs do not provide injury reports following the regular season finale. This means that any Week 17 injuries from those teams are unreported in the final Concussion Watch tally. The same issue arises as additional teams are eliminated from the playoffs.

Lastly, the Concussion Watch data is only as good as the injury reports provided by teams. If a diagnosis is missed, then the injury won’t show up in the data. The same is true of players who hide their symptoms to stay on the field — something that 56 percent of players said they would do in a 2012 poll conducted by The Sporting News.

These holes in reporting standards are reflected in the NFL’s own tally of concussions. According to a league spokesman, the NFL counted a total of 217 concussions last season across 333 preseason, regular season and playoff games. That represents a 14 percent increase over the 190 concussions  the league reported for 2011.

The NFL would not comment on FRONTLINE’S findings but the league has repeatedly said it is making progress on the concussion problem. As part of a recent $765 million settlement with more than 4,500 former players, it is also devoting $10 million to a research and education fund.

But the question still remains: Are head injuries increasing despite efforts to rein them in, or are teams simply getting better at reporting them? With no clear answer, it becomes difficult to determine how much progress is being made to establish a less dangerous game.

“There clearly is an increased recognition and a change in how [concussions] are reported, but it could also be that there are more of them,” said Jesse David, a partner at Edgeworth Economics who has conducted independent analyses of NFL injuries based on data from the player’s association.

In his analysis, David found practically no improvement — 265 concussions in 2012, one less than the previous season. The Edgeworth total incorporates injuries reported during team practices, whereas the NFL’s total does not.

One thing that is for certain, according to David, is that players are increasingly becoming bigger, stronger and faster. In 2012, he noted, that meant a record number of “severe injuries” resulting in either surgery or eight days or more of missed playing time. There’s no surgical option for treating a concussion, but “if there are more serious knee injuries every year, it makes sense that there might also be more serious head injuries,” said David.

When it comes to head injuries, NFL players are put through a multi-stage recovery process, but as the Concussion Watch analysis found, this process often lasted seven days or less. In some cases, players were playing in games just four days after their concussions.

Research suggests there is no standard recovery time from a concussion. Rather, it varies from individual to individual. Still, according to guidelines endorsed by the player’s association from the American Academy of Neurology (AAN), athletes are at the greatest risk of repeat injury in the first 10 days post-concussion. And the more head injuries a person suffers, the more likely they are to face complications later in life.

“The literature is pretty strong that if you accumulate concussions, there will be a cognitive cost down the road,” said Christoper Giza, a UCLA neurologist who helped author the AAN guidelines.

Among the most troubling conditions observed in former football players is the degenerative brain condition known as chronic traumatic encephalopathy (CTE). The disease is linked to dementia, memory loss, and depression and is believed to stem from repeated head trauma. In December, researchers at Boston University announced that they had found CTE in the brains of 50 former football players — 33 of whom played in the NFL.

Until it was disbanded in 2009, the NFL’s Mild Traumatic Brain Injury Committee had denied any link between football and long-term brain damage, but after being taken to task in a series of congressional hearings, the league switched gears. In the wake of those hearings, the NFL has donated more than $100 million to research with a focus on brain injuries, introduced mandatory guidelines for removing injured players from games, and adopted a series of rule changes designed to reduce concussions.

Ahead of the 2011-2012 season, for example, the league moved kickoffs up by five yards in a bid to emphasize touchbacks over kick returns, one of the most dangerous plays in football. Last year, the league announced that the decision contributed to a 40 percent drop in concussions on those plays. The NFL has similarly passed new rules limiting the amount of contact allowed at team practices.

Additional changes were made this past offseason. In March, team owners approved a new rule banning ball carriers from striking an opponent with the crown of their helmets in the open field.

And for the first time ever, the NFL will place independent neurologists on the sidelines beginning this season. The experts will examine players if they are suspected of having a concussion. If a player fails a test, he cannot return to the game, regardless of what a team physician says.

The trouble, of course, is some players will continue to slip through the cracks. That’s football. For players like Laurent Robinson, that leaves a dilemma. As he told FRONTLINE:

“It’s hard because you’ve done something your whole life and you don’t want to give it up. Even though you got hurt, you want to try to overcome that injury and prove to people, prove to yourself, that you could still do it. But at the same time, this is a risk, [a] violent game that we’re playing, and anything can happen … on any play you can end your career. So it’s tough to think about in that sense, because I want to live a long life and enjoy my life and not be hindered by something I did when I was in my 20s.”

Green Bay Packers and Seattle Seahawks players line up at the line of scrimmage prior to the snap of the football during an NFL preseason game on August 23, 2013. (AP Photo/Scott Boehm)
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