Amid Spotlight On Concussions, New Efforts To Improve Gear, Tackling

In 2005, the journal Neurosurgery published a paper by forensic neuropatholigist Bennet Omalu and colleagues at the University of Pittsburgh that linked a neurodegenerative disease to repetitive brain trauma. Omalu was the first researcher to diagnose the disease—known as chronic traumatic encephalopathy, or CTE—in a former National Football League player. Actor Will Smith portrays Omalu in the film “Concussion,” which opened on Christmas Day.

In the decade since Omalu’s groundbreaking paper, the NFL, its players, and fans have been forced to come to terms with concussions and the potentially lifelong—or even life-ending—consequences that stem from them. The focus has spurred a wave of new research on how to prevent, diagnose, and treat brain injuries throughout the sports world, including in Wisconsin.

The NFL responded to Omalu’s research in part by forming a concussion committee and conducting its own study on football and brain injuries that was dismissive of the long-term risks. Ira Casson, a neurologist who helped lead the study and co-chaired the committee at the time, told HBO’s Real Sports in May 2007 that among NFL players, there was no evidence linking multiple head injuries and long-term neurodegenerative diseases like CTE and early-onset Alzheimer’s.

Later that year, the league issued a two-page pamphlet that sought to answer questions current and former players might have had about concussions.

“Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is managed properly,” according to the document.

The NFL, a television ratings behemoth whose revenues totaled about $12 billion last season, was perhaps hoping that releasing the pamphlet would put the dispute to rest. But it was in fact only the beginning of what’s become a protracted battle with Omalu and other scientists, as well as the families of former players afflicted with early-onset dementia.

In April, a federal judge approved the NFL’s plan to settle thousands of concussion-related lawsuits brought by ex-players. The settlement is estimated to cost the league about $1 billion over 65 years, though some of the players have appealed in hopes of getting a larger amount.

But you don’t need to follow court cases to see that head injuries pose a threat to the NFL—it’s apparent just from watching the action on the field. The league has tweaked several rules, including ones pertaining to kickoff plays and hits to ball carriers, in an attempt to make violent collisions—especially those involving helmet-to-helmet contact—less frequent.

Football is arguably America’s new national pastime, which makes brain injuries a national concern, from Hollywood studios to the NFL’s Park Avenue headquarters in Manhattan. The league is not the only organization that’s set out to reduce the number of concussions sustained in contact sports. In Wisconsin, scientists are researching head injuries, and developing new technology they say could make football a safer sport at all levels of play.

Tackling The Problem

Greg Landry has been around football for much of his life.

He played collegiately at Butler University, and later served as a physician for athletic teams at the University of Wisconsin-Madison from 1984 until earlier this year. During that period, he was assigned to the Badgers football team for 25 seasons.

When he watches college football these days, he sees marked differences in how the game is played from decades ago.

“One of the things that I’ve been disturbed about is that the game has changed,” Landry says. “People didn’t tackle then like they do now. They didn’t lead with the head. They didn’t launch themselves.”

In October, Landry co-authored a paper from the American Academy of Pediatrics that addressed, among other things, the relationship between tackling and head injuries in youth football. One finding: “Severe and catastrophic injuries, particularly those of the head and neck, are associated with tackling, often when improper and illegal technique…is used.”

That conclusion probably didn’t come as a news flash to USA Football, a governing body that oversees amateur leagues across the country. Years before the AAP paper was published, USA Football created Heads Up Football, a program designed to teach tackling dos and don’ts to youth and high school players. But Heads Up is not mandatory in all states, and critics charge that the certification requirements for coaches are too lax.

Steve Gleason, for one, has said he doesn’t buy the notion that illegal hits are the problem. Gleason, who played eight seasons for the NFL’s New Orleans Saints and has since been diagnosed with amyotrophic lateral sclerosis—commonly referred to as Lou Gehrig’s Disease—said in a 2012 e-mail to NBC Sports that, “The increased rate of brain disease in the NFL population is caused by the way the game is played within the rules.”

Plus, there’s a great deal of physical contact on the gridiron that doesn’t involve tackling. On one hand, the AAP paper cites a 2013 study that found nearly two-thirds of concussions in high school football occur when a player is making a tackle or being tackled. But that’s difficult to square with the list of players who have received a postmortem CTE diagnosis (there’s currently not a reliable way to test a living person for the disease). That group includes Mike Webster, whose autopsy, performed by Omalu in 2002, led to Webster becoming the first former NFL player diagnosed with CTE. Along with at least five others on the list, Webster primarily played on the offensive line, meaning he rarely carried the ball.

Correcting poor tackling form could potentially lead to fewer concussions in football, but there appears to be a limit to that potential. So what else could be done? One Wisconsin physician is taking a fresh look at the equipment worn by today’s players, asking whether helmets should be constructed more like devices designed to keep drivers safe in crashes.

Air Apparent?

John Whitcomb has practiced medicine for decades. He currently works at an anti-aging clinic in the Milwaukee area. It seems fitting, then, that he’s seeking to turn back the clock to the early days of football, when helmet exteriors were made using softer materials than the hard plastic manufacturers have favored since the mid-20th century.

But instead of reverting to the leather helmets worn in that bygone era, Whitcomb is developing prototypes that use air cells to protect players’ brains. His eureka moment came in 2013 when he was watching television commentators discuss concussions, and wondering why there seemed to be few people working to address the problem, he says. Then he noticed a sheet of bubble wrap close by.

Since then, he’s formed Whitcomb Technologies and received four patents, with another four pending. He says he leaves the clinic early most Wednesdays and spends the afternoon building and testing helmets at his home office.

In order to grasp how Whitcomb’s helmet could be safer than existing models, it’s necessary to understand some of the forces at work when a person is concussed.

According to the AAP paper Landry co-authored, a concussion results when a blow to the head causes the brain to experience a rotational acceleration. “The brain is sitting within the skull surrounded by fluid,” Landry says. “When there’s a jerk of the skull, the brain bangs up against the skull on the other side.”

Whitcomb says that one way of mitigating this is by inserting shock absorbers between the brain and the point of impact. The goal is to reduce or eliminate brain rotation upon impact.

This is not a novel concept. In 1971, Gerard E. Morgan received a patent for “Energy Absorbing And Sizing Means For Helmets,” which features illustrations of padding under a plastic shell. Morgan was then the chairman of Riddell, a Chicago-area helmet maker that continues to be an industry leader today.

While most experts view the addition of padding as a logical decision, Whitcomb says the next step in the evolution of helmets—removing the outer polycarbonate layer Riddell and its competitors mold onto helmets—is less intuitive.

“We still have a helmet that’s made out of a rigid, brittle surface, so [upon impact] you create a shockwave,” Whitcomb says.

Landry says he agrees with Whitcomb that helmets are effective at certain things, like diffusing concussive force, but there are downsides to how they’re made.

“Helmets [today] are designed to prevent skull fractures and lacerations, and they do a fine job of that,” says Landry. “But they’re not particularly designed to prevent concussions. [Whitcomb] may be on the right track—the bubble wrap makes some sense because it has more give than current padding.”

Landry says the efficacy of Whitcomb’s helmets may come down to their ability to reduce “acceleration-declaration” forces. When it comes to concussions, says Landry, these forces are associated with the sudden movement of the head in space, which can cause the brain to rotate. They’re also a concern for engineers aiming to protect athletes in high-impact sports besides football.

“When I lived in Indiana, I learned about interventions that they did with IndyCar drivers to try to reduce the risk of injury,” Landry says. “Many of the walls and different barriers on an Indy track collapse when they get hit, to reduce the force to the car and the driver. Similar concept, I think, in a helmet—if you can find a material that can absorb some of the force, then you reduce the acceleration-deceleration of the head in space, and therefore the brain inside the skull.”

Whitcomb says this energy-absorption principle is also visible in the design of car bumpers and air bags, and rubber cases for smartphones. He believes his helmet, which he says should weigh less than 6 ounces once completed, could be used for other team games like baseball and cricket, as well as for adventure sports like kayaking and horseback riding.

One type of helmet testing involves taking two prototypes, each of which has an accelerometer attached, and crashing them together. Whitcomb says he uses a machine made by a company called Data Physics that can measure up to 250,000 data points per second.

“Let’s see how big of a shockwave the two helmets create and see how much the air cells reduce the shockwave,” he says. “It requires incredible repetition to get clean data collections. If your air cells pop, then you have to put on new ones. That’s the design challenge: making tough enough air cells with enough pressure and resilience in them.”

While Whitcomb’s idea has garnered attention and awards, turning football helmet design on its head would require committing large amounts of time and money to the endeavor.

But changing public sentiment may be creating the impetus for those investments. Some Americans—including President Obama—are starting to think twice about whether they’d let a loved one play tackle football.

Landry, who has been around the game as both a player and a medical professional, says the trend is understandable. But he says that inactivity, which contributes to childhood obesity, is the greater concern.

“There’s no question that the risk of playing football is higher than other sports,” Landry says. “I do have a problem with kids who are not physically active and getting exercise, and football is the only sport they would play. Our biggest problem in this country is inactivity.”

Trending on Xconomy