WASHINGTON, DC—Lately, traumatic brain injury (TBI) is receiving due attention on both the battlefield and the gridiron. An October 28, 2009 hearing before Congress has prompted NFL Commissioner Roger Goodell to implement a new policy for players with suspected head injuries. The NFL is also reportedly initiating collaboration with the Department of Defense to share information on the most successful strategies for managing head injuries.

Goodell was accompanied by NFL Players Association head DeMaurice Smith at a discussion of the league’s policies on brain injury before the House Judiciary Committee last month. The two faced tough questioning from legislators, who expressed concern that player safety does not take priority over economic factors. The result is that players, afraid of losing time on the field, are hesitant to report symptoms of head injuries. In addition to the danger of delaying treatment, repeated aggravation of an injury may also increase the probability of long-term damage. Gay Culverhouse, former president of the Tampa Bay Buccaneers, painted a bleak picture of the current situation, saying players “are a disposable commodity. There is a draft coming up every April, and these players fight to hold on to their jobs, and they welcome shots and anything else that will keep them on the field. This is, in my mind, inhumane, and I watched it since the early ’70s, and I will tell you that it has not changed.”

In response to Goodell’s assurances that the NFL is making progress, Rep Maxine Waters, D-CA, said, “We’ve heard from the NFLtime and time again — you’re always ‘studying,’ you’re always ‘trying,’ you’re ‘hopeful.’ I want to know what is being done to deal with this problem and other problems related to injuries?” In addition, Dr Robert Cantu, co-director of Boston University’s Center for the Study of Traumatic Encephalopathy, submitted expert testimony on the physiological consequences of injuries sustained during play. “The public health risk is already here, and we cannot afford to wait any longer to make changes to the way we play sports,” he concluded. While Commissioner Goodell was hesitant to acknowledge any failing on the part of the NFL, the hearing brought to light the pervasiveness and gravity of head injuries in professional football.

The October Congressional hearing yielded almost immediate results. FOX Sports is reporting that NFL team doctors were informed in mid-November that a new league policy will require them to supplement their staff with independent neurology consultants, approved by both the league and the Players Association. In addition, players will be required to have clearance from an independent neurologist before returning to practice and games following a head injury. Goodell is hopeful that the new guidelines will be implemented during the current NFL season, starting as soon as next month, although there is no defined timeline. He emphasized that this issue requires “special attention and treatment.”

Relevance to DoD

In addition to executing a new policy for head injuries, Goodell is reportedly exchanging information with the DoD, another organization that is no stranger to public scrutiny on the topic of TBI. Jay Glazer of FOX Sports and Peter King of Sports Illustrated have both received statements from Goodell to this effect. The conversation between the NFL and DoD was apparently initiated in July of 2008, when Goodell traveled to the theaters in Iraq and Afghanistan with Admiral Michael Mullen, the Chairmen of the Joint Chiefs of Staff. Goodell is quoted as saying, “he said one of the issues they were having was MBTI, the Mild Brain Trauma Injury. When a soldier has a brain injury, when is it safe to put him back on the battlefield? I said, ‘We have a lot of experience with this, admiral. We’d be happy to exchange information with you.’” Indeed, concussive injuries sustained during full-contact football are analogous to those from combat scenarios. Regardless of the context, traumatic brain injuries present with similar symptoms, including headaches, cognitive deficits, nausea, and blurred vision, according to the CDC.

On recent events, Goodell continues, “Our people went down and spent time at the Defense Department and exchanged information. And literally two weeks ago, I saw Gen [David] Petraeus and the chief Army doctor, and they’re going through a very similar issue…return to the battlefield. That’s something our medical personnel should keep sharing.” In summary, Goodell stated that “there’s a lot of dialogue going back and forth.’’ While no concrete results of the reported exchange of information have been released, a synthesis of NFL and DoD knowledge is a promising first step. This collaboration would ideally produce a protocol for response to brain injury that would not only improve treatment, but actually save the lives of both players and soldiers. Dick Ben-son, whose son suffered a fatal head injury during a high school football game in Austin, TX, testified before Congress that the stakes are life-or-death on both the battlefield and the playing field.

Despite Goodell’s reluctance to concede any past mishandling of the issue on the part of the NFL, his actions since the congressional hearing indicate a sea change within the organization. No longer will coaches, team doctors, and administrators be able to minimize the implications of repeated head trauma, intentionally or as a result of ignorance. In fact, within the past month, two high-profile running backs—Clinton Portis of the Washington Redskins and Brian Westbrook of the Philadelphia Eagles—have undergone neurological evaluations at the University of Pittsburg Medical Center. This, in addition to preliminary collaboration with DoD, signals that meaningful change is underway.

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