Football and Brain Injury: “Something Needs to Change”


Doctors diagnose more than 200 concussions in NFL players each year.

That’s unacceptable, says Shyam Popat, BA ’15, especially considering the long-term consequences to players’ mental health. The Plan II Honors graduate is so concerned with those statistics that he wrote an award-winning thesis on the NFL’s safety policies. He says players often don’t fully understand the health risks associated with one too many bumps to the head.

Popat’s thesis, “Mental Illness, Football Culture, and the League of Denial: The Current and Future State of American Football,” sheds light on the state of the game and evaluates changes needed to protect players’ well-being.

The culprit, Popat says, is chronic traumatic encephalopathy, or CTE, a disease characterized by protein mutations in the brain. Symptoms can include tremors, memory loss, depression, personality changes, and psychosis. CTE is caused by repeated blows over time, like an offensive lineman might endure during his career. In a 2014 study that examined the brains of 79 deceased football players, 76 were found to have suffered some degree of CTE. While this data represents a skewed population—these players donated their brains for research and may have exhibited signs of the disease before their deaths—researchers believe the results show an unmistakable link between football and brain injury.

The NFL has already made some rule changes to make the game safer, but Popat says more must be done. His research earned designation as a model thesis in the Plan II Honors Thesis Awards.

Popat is headed to medical school at the University of Texas Health Science Center at San Antonio in the fall. He spoke with the Alcalde about where football is headed in the U.S. today.

Shyam ImageWhat exactly did you study about the connection between mental illness and playing football? 

[I found that] players feel obligated to hide their injuries, to ignore them and to do whatever it takes to win the game. The sport and culture focus on tackles, collisions, the big dramatic hits. Football is an exciting sport, but it’s also terribly violent. Fans, coaches, teammates, and even the mind of the player place pressure on each of these athletes to perform at their best, no matter what. When a player feels that he has no choice but to hurt his body, or in the cases I am examining, his mental health, something needs to change.

Why did the NFL deny the connection with CTE for so long? 

 At the core, the NFL is a business that profits from the continued success of the sport. In all honesty, I think the NFL was scared that football would never be able to evolve and that admitting that playing football leads to illness would be a death sentence.

So, the NFL downplayed the crisis. They even created a committee, called the Mild Traumatic Brain Injury Committee, which purposefully published its own works against the issue. Papers published by the MTBI committee made claims that went against all previously published papers. For example, the committee implied that players could receive a concussion in one game and be perfectly ready for play in the next, and that repeated concussions carried no extra risk.

When did they finally admit it? 

The NFL has never officially stated that playing football leads to mental illness. The closest thing we have is a phone interview where league spokesman Greg Aiello stated that it was ‘obvious from medical research that concussions can lead to long-term problems.’ I think that it’s appropriate to say that the NFL has acknowledged the link, but is hesitant to directly state that playing football carries a possible risk of mental illness.

So where do we go from here?

 There’s actually a lot that can be done now. The NFL has taken some steps in the right direction. For example, in 2013 the NFL banned players from leading with their heads during a tackle. The NFL has also slightly modified kickoffs—one of the most dangerous plays in American football. They have also begun to include independent doctors in the concussion recovery process, which would theoretically prevent team doctors from returning players to the game prematurely.

Is there any hope for change in our football-obsessed culture? 

I believe so. The journey is going to be a long one, but we can already see signs that the culture of American football is changing. Before, many players and fans weren’t aware of the risks that football carried. But now, both groups have the information at their disposal, and this is changing the face of the game.

Chris Borland, a former linebacker for the San Francisco 49ers, only played for one year in 2014. A few months ago, he chose to retire after thinking about the risk that football may carry for his long-term health. Sidney Rice, a player for the Seattle Seahawks, retired after watching a documentary relating to the dangers of football. And rather than being condemned by their fellow players, these athletes were instead described as “courageous, proactive, and strong.” So, while the change is slow, I think the culture is definitely changing.

My football-loving husband calls the game ‘wimpy’ now. Does this attitude present a roadblock to change?

Unfortunately, yes. Fans who comment on the decreasing levels of force in the NFL must remember that the people on the field are not just players, but also humans. Their health should not be jeopardized simply because we wish for the game to have more action or be more tough.

Give me an example from your thesis of a change that could make the game safer without spelling the end of football as we know it.

In American football, players use helmets to protect their face and skull from injury. It would seem logical that more padding results in more protection and healthier players, but this is actually not the case. Concussions occur if the brain collides with the skull wall. Because this is a fully internal injury, no helmet could prevent this damage. In fact, increasing the padding can have the opposite effect, due to a phenomenon known as risk compensation. Players believe that they are more protected and will therefore act as if they are protected. Therefore, the initially counterintuitive way to protect our players is to decrease their padding. One possibility is to use softer helmets that provide less protection and therefore a decreased sense of invincibility.

Could the changes you suggest in your thesis still endanger the sport’s existence?

It’s very possible. Many of these changes may cause fans to view the sport as too soft, or may alienate players from participating. But we don’t have a choice. The situation is very similar to one football has faced before. At the beginning of the 20th century, football was almost banned due to growing violence. But with the intervention of President Theodore Roosevelt, football changed. The sport completely shifted overnight and was almost unrecognizable to diehard fans. Yet despite this, the sport not only survived, but thrived, developing into the institution we have today. Football is America’s pastime, and unless we do something to change it, we may lose it permanently.

One study compared American football to Australian football. The two sports are extremely similar, except for one key fact: players in the AFL are not allowed to wear helmets, shoulder pads, or other forms of padding. When the two sports were compared, helmeted NFL players were about 25 percent more likely to sustain a concussion.

Of course, Australian football has its downsides—by not wearing any padding, these players also receive more shoulder, knee, and head injuries (such as skull fractures). However, a balance can be struck. Rather than going from one end of the spectrum to the other—from suits of armor to no protection whatsoever—a balance between the two can be discovered.

Top: Colt McCoy is carted off the field following an injury during the Texas vs. Texas A&M game on Nov. 24, 2006. Photo courtesy Texas Athletics.

Left: Shyam Popat.


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