What do big wave surfing and the National Football League playoffs and upcoming Super Bowl have in common? They share the challenges of confronting the significant health harms that can occur with head trauma, especially repeated impacts and outright concussions.
The rich, powerful, and influential NFL also may be illustrating how preventable damage to athletes, their lives, and loved ones can be glossed over into resignation and acceptance. As commentator Jay Caspian Kang observed in a New York Times column:
“Of all the disappearing stories in the American consciousness, none has receded from the public eye quite like football concussions. It’s hard to remember now, but less than a decade ago, President Barack Obama said that if he had a son, he would have to think ‘long and hard’ before letting him play football. Stories were published about parents pulling their children from youth and high school football; obituaries were written for the future of the sport.
“In 2015, Will Smith, one of the biggest movie stars in the world, starred as Dr. Bennet Omalu, the forensic pathologist whose research first linked football with chronic traumatic encephalopathy (CTE), a brain disease that leads to memory loss, erratic behavior, and depression. One study found CTE in 110 of 111 deceased NFL. players. That alarm seems to have been replaced by a type of theater around concussions … A player is knocked out, the TV announcers say, ‘Well, you hate to see this’; the player gets carted away or staggers off to the designated blue medical tent; the sideline reporter tells the audience that the player will not be returning to action. All this is done in somber tones with the implicit understanding that the player will probably be back in a week or two.”
But, as Kang reported, football’s challenges with head trauma don’t diminish so easily:
“The news about concussions hasn’t gotten any better, of course. Last year, Phillip Adams, a former NFL cornerback, shot and killed six people and himself. Doctors later reported that Adams had ‘an extraordinary amount of CTE.’ Vincent Jackson, a former wide receiver, was found dead in a hotel room last February. His widow said that he had been suffering from memory loss and depression. Dr. Ann McKee, one of the leading experts on CTE, examined Jackson’s brain (he had never been diagnosed with a concussion during his playing career) and found he had CTE. These stories were reported on, but they didn’t pierce the larger sports conversation as they might have just seven or eight years ago.
“A season of empty stadiums and the toll of the pandemic have hurt sports across the board. But the NFL has emerged relatively unscathed. Viewership numbers on TV and digital are the highest they’ve been since 2015; 91 of the 100 most-watched telecasts of the year were NFL games. Football — which has gone through domestic violence reckonings and the fallout from the blackballing of Colin Kaepernick, in addition to continuing concussions — is as strong as it’s ever been.”
Kang, a onetime sportswriter, rolls through the NFL data to show that, despite the league’s insistence that changes it pushed in equipment, rules, and play have helped, health-wrecking head trauma persists as a routine part of play not to mention the damaging, repeated lower-level of blows to the head.
He underscores that he does not wish to be a simple scold or that he sees the nation giving up what is apparently a beloved game or that a large point could be missed:
“The way we watch football today feels like a capitulation that’s interesting because of how common this kind of giving in has become in modern life. We, the concerned public, may flare up our indignation for a short period when faced with an obvious problem — from school shootings to Covid policy — but there’s no real sense that we can do anything about these issues that make us mad. This doesn’t mean we are unaware or even particularly apathetic. Again, nine out of 10 sports fans believe concussions are a problem in football; it’s more that we have no faith that we can change our institutions and, with ample evidence and sound reason, have dropped the belief that we even should have any input into how they choose to do business.”
Derek Dunfee, 39, might disagree. The La Jolla, Calif., native (shown above, right) was a prize-winning champion of the oceans, a magazine cover guy for his prowess in a risky sport — surfing the biggest waves that could be found. He told the Los Angeles Times that he loved the adventure, thrills, money, and acclaim surfing brought him.
It led him, for a time, to ignore the repeated, accumulating damage to his health caused by head trauma, described by the newspaper as: “Nausea. Headaches. Painful stabs from bright lights. Memory loss. Mood swings. Fits of rage or sadness.”
Surfers and their fans — as has occurred in a rising array of athletics — only slowly have recognized that slamming the head against objects at high speeds, whether a towering wall of water or a flying, uncontrolled surfboard, is bad for thinking and more brain activities. As the Los Angeles Times reported:
“On Dec. 22, 2012, Dunfee was at Cortes Bank, a barely submerged seamount about 100 miles west of Point Loma. It’s Mt. Everest for surfers, capable of generating waves that approach 100 feet. Dunfee took off on one beast that folded back and buried him. Tumbling around under water, 10 seconds went by. Then more. ‘Keep fighting,’ he remembered thinking. ‘Stay conscious and you’re going to make it.’ He surfaced in time to be sent over the falls on a 20-footer. ‘Just hold on,’ he told himself, a mantra that had gotten him through other wipeouts.
“This one was different. His chest burned at the lack of oxygen. His voice of encouragement faded. His body went limp. Ten minutes later, a rescuer on a jet ski found him a half-mile away from the whitewater line, floating on his side along the edge of a reef. He was barely conscious. He spent the rest of the day on a boat in a daze. Outwardly, he shrugged it off as just another bad spill. Inwardly, he felt otherwise. ‘My brain,’ he said, ‘was worked.’”
The incident led him to wind down his pro career, and, as the newspaper reported, to write “a book, Waking Up In the Sea about the highs and lows of his career. He’s appeared on surfing podcasts, talking about the cumulative effects of what he estimates were dozens of concussions large and small. He’s used Instagram to post updates about his medical condition and his decision to walk away from big-wave surfing.”
His candor has allowed others in the sport to talk openly about head trauma risks and to highlight that their pastime has significant problems, including these data points reported by the newspaper about a sport in which participation has almost tripled from 13 million riders to 37 million between 2010 and 2020:
“Most of the studies [on its health harms] have been survey-based. In one, 91% of surfers said they had sustained an injury at some point in their lives, with head injuries the most prevalent. A 2020 study in the Journal of Orthopaedics took it beyond self-reporting and looked at 15 years of U.S. emergency room activity. It found 34,337 surfing-related head injuries. Lacerations were the most common wound, followed by blunt head trauma and concussions. Overall, the number of head injuries over the 15 years had remained stable — but the incidence of concussions ‘increased significantly.’
“The study authors noted that because an estimated 50% of concussions never get reported, the actual numbers are probably far higher. Some of the rise was due to better diagnoses by clinicians, but another factor was design changes that have made boards faster and more maneuverable — and also easier to fall off. Not many surfers wear helmets — in one 2015 survey, only two of 50 participants did — although that may be changing, too. Several big-wave riders are donning them, and if younger surfers see their heroes in them, usage could increase.”
Still, as the newspaper reported, even with protective measures in place, the pressure will always be on to push boundaries, to gain a little notice or notoriety with extreme conduct — and this especially so, not just in surfing but also in too many sports. Isn’t this what fans clamor and pay for?
Hmm. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by spinal cord and brain injuries, especially due to concussions and other head trauma. Brain harms change forever the lives of patients and their families. These injuries cannot be taken lightly or ignored, especially as growing evidence shows that severe damage can occur not only with big shocks to the head and neck but also due to repetitive lesser blows.
Progress has occurred in the battle against preventable head harms, especially in pro and amateur athletics — from soccer to diving to equestrian events. Better gear, more sensible rules and play, and other more positive steps are making a difference. It also has helped that those with injuries have sought justice in the civil system, including with a $1-billion lawsuit settlement reached by the NFL with former players.
But society changes slowly. The brutality of boxing and the sport’s shabby treatment of its athletes, especially African American champs, has led to this pastime’s diminished public interest. The NFL should take note, and, c’mon, at some point excesses like the cage fights now popular on cable television will see their day pass. We have much work to do to minimize the risks of head trauma and other injuries in what should be fun, exciting, and healthy sports that are so much a part of our lives.