What does Cincinnati Bengals owner Mike Brown have in common with Muhammad Ali, Clarabelle the Clown and four-time Kentucky Derby winner Bill Shoemaker?

Yes, Mike Brown can take a punch. He knows what it’s like in the NFL circus. And he knows you can’t win with the wrong horses. But as the headline says, the topic here is concussions. Former football players like Brown share that risk with boxers, jockeys, soccer players, cheerleaders, circus clowns and anyone who has played competitive sports, been involved in a car wreck or been bonked on the head—even with clown hammers. Which is… just about everyone.

“Yes, I had two pretty good ones,” says Brown, former Dartmouth quarterback, Class of 1957. He chuckles and adds in typical droll style, “A lot of people think it’s affecting me now.”

As is typical of concussions, he’s still a bit hazy on exactly what happened.

“The first one was in high school. I was running with the ball and got flipped in the air, I guess. I don’t know because I don’t remember anything until I woke up in the locker room on a gurney and was horrified to see my mother standing there.

“Then in college, I got knocked out in a game. I was walking around, not unconscious. I looked fine, but I was not really conscious, either. At halftime the coach asked me if I was OK. I told him, ‘I’m fine, but I can’t remember the plays. If you give me the playbook I can learn them.’ The coach figured out I was not OK.”

That cartoonish flowerpot-on-the-head memory eraser makes concussions the “Catch 22” injury; players may not remember what happened or know they’ve had one. Like Brown in college, they tell their coach or team doctor, “I’m fine, put me back in the game.” And back in the Osteolithic Age of leather helmets and iron men, tough guys played on. So what if they couldn’t remember the score later? That’s what the sports pages are for.

But all that has changed. Player lawsuits against the NFL and NCAA, media attention (with a side order of exaggeration), better understanding of brain function and increasing worries by parents have made concussions the “climate change” of sports.

Literally, they have changed the climate. And figuratively, the concussion crusade is like global warming—it contains more than a little junk science that makes football look like the “acid rain” of sports.

For example, many media alarms were set off by a study from the University of Michigan that found former NFL players had rates of dementia 19 times higher than the general population. But the players were surveyed by phone. “Dementia cannot be diagnosed over the phone,” one sports medicine expert said, calling the study seriously flawed. Connections to suicide and Alzheimer’s are suspected, not proven.

“I see it as a challenge to the game,” Brown says. “But it’s not fully understood what concussion means in the short run and the long run. I’m not persuaded there is evidence that we totally understand the long-range impact.”

Lawsuits claim that NFL players have a higher risk of dementia from concussion. But more than 5 million people have dementia. They didn’t all play football or have concussions. Yet the NFL faces settlement costs of more than $870 million, and the NCAA is offering $70 million for screening of former players. Those are some big penalty flags.

Most of the talk targets football. “Would you let your son play?” is a sports-talk staple. Football causes the most concussions, especially in high school, where player sizes vary dramatically and there are fewer resources to spot and treat concussions than in college and the NFL.

But there is no safe team sport. The American Academy of Pediatrics reports that concussions score the highest percentage among all injuries in ice hockey (men), lacrosse (men and women) and cheerleading (women).

Basketball, soccer and field hockey send plenty of athletes to emergency rooms. Whenever we play, drive, ride a bicycle or slip and fall, there’s a risk of concussion. And helmets are not much help.

“Helmets are not designed to prevent concussions,” says Bengals Head Trainer Paul Sparling. “They are meant to prevent skull fracture.”

He uses the analogy of a snow globe. The brain is suspended in fluid. Bouncing it around is like shaking a snow globe and has the same result: a mental picture like snow on a fuzzy TV channel.

Sparling has been with the team 34 years, with 22 as head trainer. He doesn’t think concussions have increased. “I think we’re noticing it more. We’re using the term concussion a little loosely. We’ve had situations where the player’s opinion is that he had one, but we do the tests and he is stone-cold normal.”

Bengals players are tested when they join the team to establish a baseline of cognitive function, he says, “So we can tell when they return to normal.”

If a concussion is suspected during practice or a game, the Bengals follow the NFL protocol. Players are checked out by the team doctor, an unaffiliated neuropsychologist and an independent neuro-trauma physician. The SCAT test, or sideline concussion assessment tool, is described in the NFL policy:

“The test measures memory, concentration and balance, as well as measuring how quickly and thoroughly the player recalls words given to them at least five minutes earlier. … The team doctor asks players to name the month, date, day of week, year and time. The additional questions include specific sideline orientation questions that ask players to identify the venue, quarter of game, who scored most recently, the team’s previous opponent and whether the team won or lost its most recent game. This process takes about 8-12 minutes.”

If there is unanimous agreement that the player is OK, he can go back into the game. “The way we do it,” Sparling says, “if one of them says he is not ready he cannot return.”

At the University of Cincinnati Bearcats football camp in Higher Ground, Ind. during August, Joe Clark met with all 110 players. “I’m not a doctor,” he hastens to say. He’s a professor of neurology, a certified athletic trainer and neuro-diagnostician. He was in camp “to gather baseline data and gain the trust of the athletes so hopefully they will self-report when something happens.”

The baseline history can be used like passwords to test player responses. “It makes it impossible to sandbag,” Clark says. He is part of a team of three—with the team trainer and team physician—that makes the “go or no-go” decision to bench a player after a concussion.

The tests are so reliable, “We have never disagreed,” he says.

Youth sports, high school teams and even many college teams don’t have such resources. The best rule: When in doubt, take them out.

Sparling says, “Let the dust settle, so to speak, before returning to any kind of exertion.”

The Journal of the American Medical Association warns, “Young athletes’ brains are still developing, thus they may be at higher risk for the effects of a concussion.”

Second concussions are more likely within 10 days of the first one, and cause dangerous second-impact syndrome. “Experiencing a second concussion before signs and symptoms of a first concussion have resolved may result in rapid and usually fatal brain swelling,” the Mayo Clinic says. “After a concussion, the levels of brain chemicals are altered. It usually takes about a week for these levels to stabilize again. However, recovery time is variable, and it’s important for athletes never to return to sports while they’re still experiencing signs and symptoms of concussion.”

Clark compares second-impact syndrome to a bad bruise. “Think about having a bruise. If you push on it, it hurts, it causes pain. A second concussion event is like that. It’s an amplified injury.”

On the other hand, the topic of concussions causes some in the media to see eight fingers where there are only two. Many sportswriters have already decided concussions cause dementia, Alzheimer’s and suicides. This still hasn’t been definiteively proven.

Clark, who treats and researches concussions, says, “Cause and effect with dementia has not been demonstrated. I tell players, ‘I’m going to help you get better, but there is not proof of cause and effect.’”

Rule changes discourage hits to the head in football and other sports. Since adopting new concussion policies four years ago, the average for a UC football season has dropped from 7.5 to 1.5. Clark says.

The NFL’s USA Football program teaches kids safer “heads-up” tackling techniques. “In peewee football, the risk is low to nonexistent because they are not big enough to cause any damage,” Brown says.

But injuries are part of sports, and concussions are part of injuries.

Brown says, “When you look at the impact at all levels, it has eroded some support for the game, but support still is extremely high. More colleges than ever are playing football.”

Anyone who thinks our annual fall football frenzy can be replaced with safer solar-powered soccer and flag football should check out a Bengals game, a high school stadium or the UC campus on Saturday. Or maybe have his head examined.

The American Academy of Pediatrics ranks youth sports by concussion risk:

Boys:
Football
Hockey
Lacrosse
Soccer
Wrestling
          Basketball          
Baseball

 Girls:
Soccer
Lacrosse
Basketbal
Softball
Field hockey
Cheerleading
Volleyball