Helmet-to-Helmet Injuries: The NFL and Brain Damage

NFLInjuriesPatriots running back Stevan Ridley claimed he didn’t remember the hit. The vicious blow by Baltimore Ravens strong safety Bernard Pollard knocked down Ridley during a running route in the 3rd quarter of the 2013 AFC Championship game. The helmet-to-helmet collision caused Ridley to fumble the ball and allowed Baltimore to seal a berth to the Super Bowl. Amidst the mountain of bodies arguing which side won the ball, Stevan Ridley was still on the ground. Ridley was diagnosed with a concussion and did not return to the game.

Ridley’s concussion is one of the more recent issues that surround professional football and brain injury today. The sport is riddled with athletes using their helmets as weapons to tackle opponents. Bernard Pollard’s hit was not ruled a personal foul. The National Football League has a helmet-to-helmet foul that can bring a hefty fifty thousand dollar fine and possibly multiple in game suspensions, as was the case with Ravens weak safety Ed Reed, who had multiple head-to-head tackles this past season. However, these brain injuries are still on the rise. More than 160 head injuries were officially reported by NFL sources, but there is still a question of injuries that some teams refuse to openly acknowledge.

By definition, a concussion is a traumatic brain injury that occurs when the head hits an object or a moving object strikes the head [1]. Basic symptoms are a loss of consciousness, seeing flashing lights, and being drowsy or unable to wake up. Individuals who have sustained a concussion before are more susceptible to future concussions. Moreover, as studies suggest, there is a “negative progress process” whereby smaller impacts cause the same symptom severity [2]. In fact, the loss of consciousness is a relatively rare phenomenon, and most NFL players sustain the concussion and continue to play the game for a few minutes at a time. Chicago Bears quarterback Jay Cutler continued for seven more snaps until being relieved by a backup quarterback.

In order to diagnose a concussion, there are three major grading systems for concussion severity tests that include the Robert Cantu Scale, Colorado Medical Society, and American Academy of Neurology guidelines. Each specifically grades the sustained injury in terms of gradation and from symptoms of confusion and amnesia to any loss of consciousness or function. After the player is evaluated by a trainer or other medical personnel, the NFL mandates that the player must perform tests under the supervision of an independent neurologist. These tests are scrutinized and must be properly reported lest the League enact a heavy fine on the entire team. This was the case for the inconsistency in reporting Robert Griffin III’s failed memory test after being “shaken up” during an Atlanta Falcons game.

One can argue that players are incentivized to use their helmets as a weapon. Before the construction of the modern football helmet, traditional football merely employed leather helmets. Injuries may have been rampant, but both the offense and defense were more careful in employing their upper body as a battering ram. Ex-Steelers player Hines Ward claimed that to prevent concussions, the League merely had to adopt “taking the helmet off” [2]. In fact, as mentioned earlier, both Pollard and Ed Reed used the forward momentum of a stride and then channeled the force onto their helmet, creating a battering ram where the power of the strike was limited to a smaller surface area. The general trend in modern football seems to ignore or even gloss over the dangers of concussions.

In a similar vein, the hit that Stevan Ridley took was comparable to the many that the late Junior Seau suffered. Seau had been a decorated linebacker, both for the San Diego Chargers and the New England Patriots. On May 2, 2012, Seau committed suicide, inflicting a fatal gunshot wound to his chest. The autopsy report of his brain showed he had been suffering from CTE, or Chronic Traumatic Encephalopathy. This condition is akin to individuals with exposure to repetitive head injuries [3]. Seau also suffered from depression and dementia, two major conditions that are common symptoms of another brain disease, Alzheimer’s.

The correlation between CTE, brain traumas, and Alzheimer’s is a recent development. Particularly, researchers at the Northwestern University have found that the tau protein is highly expressed in the brains of diseased deceased football players. This protein is also found primarily in Alzheimer’s patients, although in different regions of the brain.  Within a healthy brain, the tau protein actually helps in transmitting brain signals, strengthening the microtubules along the axons of neurons [4].This protein can lodge itself deep into structures of the brain, such as the amygdala or hypothalamus, affecting rage and motions. This can cause dementia, depression, and a whole slew of other symptoms that the late Junior Seau suffered.

The “holy grail” of concussion research, as Dr. Julian Bailes, director of the Brain Injury Research Institute at North Shore University suggests, is to identify those suffering from CTE earlier on [5]. This would allow a more thorough treatment and prevention course, allowing retired NFL players to live the rest of their lives without this disease crippling their livelihood. Possibly, the NFL, in conjunction with independent neurologists, could actively scan players with documented concussions and check if elevated levels of the tau protein are expressed. One could hope that this research could extend beyond football and into the fields of military medicine, for example. A quick scan could check soldiers with head injuries and prevent or reduce overall depression in the army.

In the end, concussions and the nature of brain injury will continue to haunt the National Football League. Stevan Ridley was lucky to leave the field with only a concussion and a few bruises. But his story and the countless stories and tragedies of people like Junior Seau will continue to highlight the inadequacies of the NFL’s health standards. Newer regulations will be needed in order to address these long-term problems. Although the sport has always emphasized the brutality of tackling and toughness, brain damage, memory problems, and deep psychological issues are starting to erode this traditional American sport.


1. “Concussions,” last modified 1/30/2012, http://www.nlm.nih.gov/medlineplus/ency/article/000799.htm
2. McRoy, Paul and W.H. Meeuwise, and K.M. Johnson, and J. Dvorak, and M. Aubry, and M. Molloy, and R. Cantu, “Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008,” Journal of Athletic Training 44 (2009): 434-448.
3. Baugh, Christine and J.M. Stamm, and B.E. Gavett, and M.E. Shenton, and A. Lin, and C.J. Nowinski, and R.C. Cantu, and A.C. McKee, and R.A. Stern, “Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma,” Brain Imaging and Behavior (2012): 244-254.
4. “Tau Protein & Alzheimer’s Disease,” last modified 1/11/2011, http://www.livestrong.com/article/354853-tau-protein-alzheimers-disease
5. “High levels of brain protein in retired NFL players”, last modified 1/22/2013 http://www.universityofcalifornia.edu/news/article/28964

Varun Moktan is a junior majoring in English Language and Literature at the George Washington University. He currently does research in the Department of Emergency Medicine at the George Washington University Hospital and will be attending medical school in the fall of 2014. Follow The Triple Helix Online on Twitter and join us on Facebook.