NPR

Brain Injuries Haunt Football Players Years Later

A 2000 study that surveyed 1,090 former NFL players found that more than 60 percent had suffered at least one concussion during their career.

Concussions, a type of traumatic brain injury, generally occur when the head either spins rapidly or accelerates quickly and then stops — like when a player tackles another player on the field. The National Football League and Congress have both held hearings on the head injuries, which can cause memory loss, confusion, nausea, blurred vision and long-term neurological effects, including symptoms of dementia, headaches and concentration problems.

A study commissioned by the NFL in 2009 reported that former NFL players have been diagnosed with Alzheimer's disease or other memory problems 19 times more than the normal rate for men between 30 and 49. And pathologists who have examined the brains of ex-athletes have found signs of chronic traumatic encephalopathy (CTE), a progressive neurological disease that patients get after sustaining repeated head injuries.

Chris Nowinski, who runs a nonprofit organization that raises awareness about concussions, explains how the head injuries continue to damage players years after they've left the field.

Nowinski knows this first-hand. After playing football at Harvard, he became a professional wrestler with World Wrestling Entertainment. His over-the-top personality and penchant for referencing his Ivy pedigree made him a superstar in the ring. In 2002, he was named the "Newcomer of the Year" by RAW Magazine and became the youngest male Hardcore Champion in WWE history.

But Nowicki's wrestling career was cut short in 2003, after he suffered at least six concussions.

"[After one] I remember looking up at the ceiling and I had no idea where I was," Nowinski tells Fresh Air's Dave Davies. "I had no idea what we were doing and I couldn't remember what was supposed to happen next. It's scary to be with 5,000 fans and become completely distracted."

Nowinski started reading everything he could about head injuries. He soon realized concussions were a far bigger crisis than anyone realized. In 2006, his book Head Games: Football's Concussion Crisis, helped put the concussion issue on the NFL's radar, after he profiled several players who exhibited symptoms of neurological damage after their playing careers ended.

"Football did not react well at the beginning," he says. "The commissioner of the NFL saw this as a threat to the game. They did not want to have this conversation."

More cases changed their mind. Ted Johnson, a linebacker who helped lead the New England Patriots to three Super Bowl victories, suffered two concussions in four days in August 2002. When he returned to play, he received several more concussions before his playing career ended in 2005. His neurologist told The New York Times in 2007 that the 34-year-old was already "show[ing] the minor cognitive impairment that is characteristic of early Alzheimer's disease."

In 2009, Congress held hearings on the subject of brain injuries in football. After those hearings, the NFL changed some of its policies on when players could return to games after an injury and how players were allowed to hit each other on the field. But, Nowinski says, there's still more to be done.

"We can prevent them with rule changes, recognize them better and treat them better," he says. "But the bigger change in dramatically reducing how we practice the game. Seventy-five percent of hits happen in practice when no one is keeping score. If this is bad for you, we should eliminate them from practice and save hits for the game. If we did that, we would lower everyone's exposure by 50 percent."

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Transcript

DAVE DAVIES, host:

This is FRESH AIR. I'm Dave Davies, in for Terry Gross.

Part of the appeal of pro football has always been bone-jarring hits delivered on quarterbacks, receivers and running backs. But as four teams battle Sunday for a trip to the Super Bowl, there will almost certainly be fewer head shots than in past years.

That's because the league has finally made and enforced rule changes aimed at reducing head trauma. Players are now fined tens of thousands of dollars for leading with their helmets in tackles, and teams are banned from sending players with concussion symptoms back into games or practice.

One of the agents of those changes is our guest, Christopher Nowinski. When he was a defensive lineman at Harvard, like others, he thought players who complained about head injuries were soft. But after suffering further concussions as a pro wrestler, he became an advocate for safer competition.

In 2006, he wrote the book "Head Games: Football's Concussion Crisis," and he co-founded the Sports Legacy Institute, a nonprofit focused on concussions in sports. Part of Nowinski's work has involved convincing families of deceased former players to give him the athletes' brains so they could be studied for evidence of head trauma.

Nowinski says there's been progress in protecting athletes, but as you'll hear, he thinks far more can be done, especially in youth football. I spoke to Christopher Nowinski yesterday.

Well, Christopher Nowinski, welcome to FRESH AIR. Let's talk about your own experience first. You played football at Harvard. You were an all-Ivy League lineman, right?

Mr. CHRISTOPHER NOWINSKI (Author, "Head Games: Football's Concussion Crisis"):

Mr. NOWINSKI: That's correct.

DAVIES: Do you know if you suffered concussions playing in college?

Mr. NOWINSKI: I believe I suffered two very minor ones, and they were not diagnosed at the time because, of course, I never said anything to anybody. But the one I remember most vividly was, it was actually an inter-squad scrimmage before the season my junior year. And I was in the back wall on the kick return team, and we had some bad kickers back in that day, and unfortunately, they kicked the ball to me, and I was never allowed to touch it when I played football as a lineman.

So I didn't know what to do except for run forward and put my head down. And I went helmet-to-helmet against one of our most vicious tacklers and didn't remember falling down.

And I remember when the sky, when I opened my eyes, the sky had gone from blue to orange, and that was a significant difference, I think, for me. But of course, I just kept on playing through it and then pieced together what exactly happened when I watched the film the next day and saw that we both - found out we both got knocked silly and just kind of fell sideways, and it wasn't nearly as cool of a collision as I thought.

DAVIES: Wow. Was anybody talking about, you know, head injuries and concussions back then?

Mr. NOWINSKI: Not in any serious way. You know, we'd heard - I started college in '96. And '94 was when Troy Aikman and Steve Young had those concussion issues, and that was kind of an early blip on this issue. But there was never really a context as to what, you know, what mattered about concussions and why it was a big deal that troy Aikman suffered, you know, 10 concussions.

And so, I remember thinking that the teammates that I knew that got concussions, I was one of those guys who thought they were soft and that there was something wrong with them.

DAVIES: So you get out of Harvard and then end up with a pro wrestling career at World Wrestling Entertainment. Tell us a little about your persona as a wrestler.

(Soundbite of laughter)

Mr. NOWINSKI: I got to have a lot of fun by being a snobby Ivy League graduate. I happened to - pre-WWE, I was on a reality television show called "Tough Enough," and there were two Chris's on the show, and so that was back in the day they didn't use last names, and so they started calling me Chris Harvard.

And once I was called Chris Harvard, I was immediately going to be a bad guy. And so I would travel the world, insulting the fans and insulting my opponents, and, you know, say things like, when we went to Iowa State University, and I said: You know, Harvard and Iowa State have a lot in common. You know, Harvard has lots of Rhodes scholars, and Iowa State has lots of dirt roads.

(Soundbite of laughter)

Mr. NOWINSKI: And, you know, I was...

DAVIES: It went over big, I gather.

Mr. NOWINSKI: Oh, huge.

DAVIES: You know, we've got a little piece of sound from your days back in the ring, and I thought we'd listen. I don't know where this is, but this is you with a microphone talking to the crowd in the center of the ring and doing your act. And we should say that you come out, and you wear red shorts with a Harvard H across your rear end, right?

Mr. NOWINSKI: That's correct.

DAVIES: And so in this clip, we'll hear you talking to the audience, and then we've got some TV announcers sort of chirping in and reacting to you. Let's listen.

(Soundbite of applause)

Mr. NOWINSKI: (As Chris Harvard) Ever since I made my debut in the WWE, I've been perplexed as to why you people seem to hate me just because I'm a Harvard graduate.

Unidentified Announcer #1: Right. You ever heard that word before, Jim?

Unidentified Announcer #2: Perplexed? (Unintelligible).

Mr. NOWINSKI: (As Chris Harvard) You people should be grateful to have someone of my intelligence in your presence.

Unidentified Announcer #1: (Unintelligible) Harvard. It's an honor.

Mr. NOWINSKI: (As Chris Harvard) But I understand why you people can't relate to a guy like me, because after all, I am a Harvard graduate.

Unidentified Announcer #1: Right.

Unidentified Announcer #2: We understand that.

DAVIES: Well, that seems like more fun than graduate school.

(Soundbite of laughter)

Mr. NOWINSKI: Those were the days.

DAVIES: And, of course, you were the foil. You were the guy that folks loved to hate because you were this Ivy League snob. But you did get in the ring, and you mixed it up. What kind of head shots did you take?

Mr. NOWINSKI: You know, I took quite a few. Of course, wrestling is meant to be, you know, predetermined, and you're not supposed to injure your opponent. But the reality is that the moves are so fast, and most of the matches are improvised. There's a very small margin for error.

And so I got four concussions while I was wrestling, and a few of them were from kicks to the head, you know, just the fact that I'm running full-speed across the ring, and one of them, Bubba Ray Dudley, is giving me a, you know, kicking me in the head with a straight leg.

And were just six inches closer than we thought, and he was trying to make it look good, and so he just knocked me silly.

Another time, somebody was giving me a move called an enziguri, where they kicked me in the back of the head. And the sound you usually hear is the person slapping their hip while they do it, but in this one, my friend, Simon Dean, later told me he thought he broke his foot.

So, you know, I got unlucky a number of nights, and it was rough.

DAVIES: And what symptoms did you experience and do you still experience?

Mr. NOWINSKI: Well, at the time he kicked me, I remember we were in the Hartford Civic Center, and he hit my back, and I remember looking up at the ceiling of the arena and realizing that I just had no idea where I was, and I had no idea what we were doing out there.

I couldn't remember what happened before, I couldn't remember what was supposed to happen next. And it was a very scary feeling to be out in front of, you know, 5,000 fans with - it was a tag-team match, three guys moving around you at full speed and just being completely - I felt like I was just dropped in on the situation.

So we ended up finishing the match. They just would tell me what to do, move for move, because I had the memory or a goldfish. And when I got backstage, I just remember my head just pounding and pounding and pounding.

And the athletic trainer had come out to see - you know, he could tell something was wrong. But the first thing I said was, you know: I'm fine. Leave me alone. And I just, I actually went and disappeared and hid in the bowels of the arena, laying on the floor to try to cool of my head.

And as time went on, I ended up essentially - I didn't know any better that you're supposed to rest a concussion after you get it. So I ended up wrestling or working out every day for five weeks and made the symptoms worse and brought on new ones.

I developed short-term memory problems. It started with not being able to remember the matches as I was going out there and actually planning a couple matches at the end with Plan B, saying: If I blank out out there, let's do X, Y, Z.

And then what really, you know, made me stop was the fact that I - we did a show. We went from Green Bay to Indianapolis. I'm driving from Indianapolis to our show that night in Terre Haute. Apparently, I'm going in and out of normalcy and consciousness or something, where my driving partner, unbeknownst to me though he's sitting next to me, called ahead to the managers of that show, saying don't let Chris wrestle, there's something wrong with him.

So I show up, and they say we're giving you the night off. So I don't wrestle. I go back to Indianapolis to get ready for the next show, and I go to bed. And my girlfriend happened to be on the road with me at the time, and I woke up, apparently about an hour after I went to bed, on the floor of the hotel room surrounded by a broken nightstand and a broken lamp.

My girlfriend told me that I had started acting out my dream, and so I stood up on the bed at one point. She couldn't wake me up. She couldn't pull me down. And in my dream, I guess I thought I saw something falling, and I jumped for it and just went head-first into the wall and through the nightstand, and apparently, even hitting the ground didn't wake me up. It took about 30 seconds.

And that's really what scared me straight and said: Jeez, I think there's something wrong with my brain, and I should get checked out. And I never wrestled again.

DAVIES: So tell us about this becoming not just a personal issue but, well, a crusade for you.

Mr. NOWINSKI: My eyes were opened when I was traveling from doctor to doctor to try to really understand what was going on inside my head. And nobody could help me understand, you know, why suddenly, you know, one kick to the head is causing all these problems.

Finally, doctor number eight, was a gentleman named Dr. Robert Cantu, who became my co-founder of SLI and became my mentor. But at the time, he was my concussion doctor, a neurosurgeon.

And when I went into his office, he said: How many concussions have you had? And I said: Well, I've had zero. And that's what I told the other seven doctors. I'd never been diagnosed with a concussion.

And he said: Okay, well, I appreciate that. But how many times have you been hit in the head, and you've seen stars or got double-vision or felt nauseous or got confused, dizzy. And I was, like, well, doc, those happen all the time. That's just a ding.

And he was, like, well, that's actually, they're all concussions, whether or not you're knocked out, and maybe you've had too many. And that's how I kind of pieced together my concussion history of six in the previous five years.

And then, you know, he started just sharing all this other information, you know, talking about - you know, I couldn't believe: A, I didn't know what a concussion was; and B, he told me had I rested the concussion and not fought through those five weeks that I would've really probably been fine - that a concussion itself is not necessarily a huge problem. But when you return to play too soon and keep stressing an injured brain, that's really the problem.

And so I realized that I'd really thrown my career away and a few years of my life, out of just, you know, plain old ignorance.

And then on my own, I happened to have a life prior to wrestling as a life sciences consultant for a company called Trinity partners outside of Boston. And I decided to read every study ever published on traumatic brain injury and concussion and what the consequences are.

And it helped me realize that what people really didn't appreciate in the medical world, was how many concussions were actually happening. There a ton of studies out there that talked about the fact that five percent of football players or hockey players or soccer players each year were diagnosed with a concussion.

But there were a small group of studies that actually asked the players, you know, because you don't tell an athletic trainer when you have a concussion. Because: A, you don't want to come out; and B, you don't really even know you have the injury.

The studies that asked the players directly, it wasn't five percent who had concussions, it was 50 percent each year. So one out of every two players on a football field got dinged each year, and if that was truly the case, then we did not have a handle on the situation at all.

DAVIES: We're speaking with Christopher Nowinski. We'll talk more after a break. This is FRESH AIR.

(Soundbite of song, "Night Clubbing")

DAVIES: If you're just joining us, our guest is Christopher Nowinski. He was a college football player and former pro wrestler who's been an activist to reduce head injuries in football and other sports. He's also the author of the book "Head Games: Football's Concussion Crisis."

In 2006, you wrote the book "Head Games," and I'd like you to tell us the story of Andre Waters and your involvement with him.

Mr. NOWINSKI: Right, so I put all that information into "Head Games," and then a month after the book came out, I read about Andre Waters committing suicide. He was a strong safety for the Philadelphia Eagles and a guy I grew up watching in great battles with the Chicago Bears.

So in the book, in Chapter four, I profiled the medical examiner, named Bennet Omalu, who had studied the brains of two Pittsburgh Steelers who had died in Allegheny County, where he worked, and decided to take a look inside their brains to see if the symptoms that they had shown throughout their lives, and they both struggled mightily in their 40s before dying young, may have been correlated to the disease chronic traumatic encephalopathy, also known as dementia pugilistica, punch-drunk disease.

Apparently, nobody had ever looked for this disease in a former football player. Even thought it was widely known in boxing, nobody ever pieced together that football players might be at risk, as well.

And, you know, Mike Webster really struggled, was homeless and suffered from dementia.

DAVIES: He was the center for the Chicago Bears, right?

Mr. NOWINSKI: He was the center for the Pittsburg Steelers.

DAVIES: The Steelers, okay.

Mr. NOWINSKI: Yeah, he was a Hall of Famer, probably the best center to ever play the game. And then Terry Long was another offensive lineman for the Steelers who had committed suicide and had shown very bizarre behaviors in the last few years of his life, including, you know, he burned down his chicken processing plant for the insurance money, you know, just prior.

So because Long committed suicide at about the same age, I thought, you know, I bet you Andre Waters, because he was known as Dirty Waters for being a big hitter with his head, had a lot of concussions, and I wonder if the concussions led to the disease, and the disease contributed to the suicide.

And so I Googled Andre Waters' concussion history and found that he was quoted in 1994, saying that he stopped counting his concussions at 15, and he would just grab smelling salts and keep playing.

So I knew that he was - if anyone was at high risk for CTE, it was Andre. And so I decided to call his family and ask if they would let Dr. Omalu study Andre's brain.

DAVIES: And this is sort of a remarkable part of the story. You got a look at his brain. You called and asked, and where was his brain?

Mr. NOWINSKI: His brain was with the medical examiner. The medical examiner, in cases where people die in unusual circumstances, they retain tissue and blood and some other things. And so he'd retained five parts of Andre's brain.

And so - and I actually asked the medical examiner first if he was doing the studies. I kind of naively assumed that the medical examiner would have some interest as to the cause of the suicide. And, you know, then I remember the medical examiner telling: Yes, I know the cause of the suicide. He shot him -the cause of death, he shot himself in the head.

And so he wasn't interested in seeing the underlying issues. And so he was one who actually told me that if I had the family's permission, that he couldn't stop me from having the studies done.

And so, you know, I tracked down his family, and I laid it out to them. I said, you know, I think the brain trauma might have contributed. We can find out, and the findings will go a long way towards making this game safer for the next generation.

DAVIES: And so it was Dr. Omalu, you said, when he examined Andre Waters' brain, what did he discover?

Mr. NOWINSKI: He discovered that Andre Waters was the third of three former NFL players who all died by the age of 50 who had CTE. And, you know, considering the fact that prior to this, when people though, you know, what are the odds of someone getting CTE, they really talked in terms of one in a million. To go three for three in this very select club was shocking. And it did not bode well for people who played a lot of football.

DAVIES: So a movement got underway. I mean, you and some others formed this group, the Sports Legacy Institute, and started raising this issue both with the media and with the league. How did the rest of football react?

Mr. NOWINSKI: Football did not react well at the beginning, unfortunately. You know, the football community, whether you're talking NFL, college, youth, they saw this as a threat to the game and as an unnecessary nuisance. I mean, people just did not want to have this conversation.

I mean, not just belittling it in the media and saying this isn't, you know, this isn't a real thing, it's just anecdotal evidence, it's, you know, people practicing bad science. I mean, those things were all said. But also just people were annoyed.

I remember I had a good friend, who his good friend was a coach in the NFL who told - I said, you know, I'd like to speak with you. I'd like to share this information. And the message was passed with me to stop messing around with the game. So it kind of fell on deaf ears there for a while.

DAVIES: And I think one of the things that really got people's attention were some really heartbreaking stories about players who hadn't died but who'd really lost a lot of memory and cognitive function. Do you want to talk about one of those folks and the impact they had?

Mr. NOWINSKI: Sure. Well, the person who really, you know, became a face for this was a former New England Patriots middle linebacker Ted Johnson. Ted had been introduced to me actually in '06, before, you know, well before Andre Waters, by a mutual friend who said, you know, Ted retired from concussions at the end of the '04 season and had since gone on a pretty strong downward spiral, to the point where he was abusing amphetamines, he was, you know, his marriage was falling apart.

At times, he wasn't leaving his house for days, no one could ever get a hold of him. I mean, it was really a bad place. And he said: Can you help Ted out?

And so I went out to Ted's house, and I sat down with him, and I said, you know, I said: Talk to me. What's going on? And he told me his symptoms. And I said, you know, I had the same thing. And he said: What's it called? I'm like, post-concussion syndrome.

And he was, like, I've never heard that phrase before. And apparently, Ted had no understanding that the concussions he suffered could be contributing to the problems he had that day, and Ted had a very public problem.

He'd gotten a concussion in a Patriots game, and, you know, Bill Belichick put him back in practice, in live practice, two days later against doctor's orders.

DAVIES: That was the head coach, yeah.

Mr. NOWINSKI: Yeah, yeah, head coach of the Patriots, put Ted back in, and Ted got another concussion two days after the first, and he said he's never been the same guy since.

And so, you know, Ted actually had agreed to write the introduction to my book because I figured that would help people take it seriously. And he actually wrote it, and it was all ready to go to the printer, and then he - his family requested that he withdraw it because he didn't want to be seen, they didn't want him seen as someone with brain damage because that would hurt his ability to make a living the rest of his life.

So he pulled out. We didn't talk for a little while, and then when Andre, you know, committed suicide, and then the story came out by Alan Schwarz on the front page of the New York Times, I actually brought the Times over to Ted's apartment, before we went out to dinner. And I said: Ted, you know, this happened because guys don't know the name for what they're feeling. And if you came forward, you could make a huge difference.

And, you know, he accepted that challenge, and he went public with his story, and things were never the same.

DAVIES: Christopher Nowinski is president of the Sports Legacy Institute, a nonprofit working to fight brain trauma in athletes. He'll be back in the second half of the show. I'm Dave Davies, and this is FRESH AIR.

(Soundbite of music)

DAVIES: This is FRESH AIR. Im Dave Davies in for Terry Gross.

As we approach the end of the NFL playoffs, we're talking about head trauma in sports with Christopher Nowinski, a former college football player and one-time pro wrestler who has become an advocate for safer competition.

He's the author of the book Head Games: Football's Concussion Crisis, and he co-founded the Sports Legacy Institute, a nonprofit focused on concussions in sports. He's helped get scientists access to the brains of many deceased NFL players, where they discovered many suffered from a form brain damage found among aging boxers called CTE or chronic traumatic encephalopathy.

Youve talked about some really tragic cases where former players who apparently had CTE, this, you know, this chronic traumatic injury, kill themselves. What are the symptoms before it reaches that point, someone who gets advanced chronic traumatic encephalopathy? What do they experience?

Mr. NOWINSKI: The symptoms you see at the beginning of chronic traumatic encephalopathy are, it starts a lot with short-term memory problems and then overall memory problems. It starts a lot with impulse control issues. And so you just you don't have control of your behavior, things you say, things you do, which leads to behavioral problems. And then you combine mood disorders like depression and so, and all that often leads to personality change. And so you're really focused on memory, cognition, emotion and mood, all of those things will change dramatically.

And what that becomes is that players who have had chronic traumatic encephalopathy, many of them have committed suicide. Many of them have developed drug and alcohol abuse issues. You know, a lot of them were actually self-medicating through headaches, didn't have any impulse control issues so would get addicted to things. You have very bizarre behaviors.

Justin Strzelczyk was hearing voices before and giving away money on the streets and became hyper religious before leading the police on a 40 mile chase where he went through the windshield and died. You know, and I think the worst example would be Chris Benoit - not an NFL player, but Chris Benoit was my colleague with World Wrestling Entertainment - who in 2007, after being one of the most respected guys in WWE, decided to wake up one day and kill his wife, kill his seven-year-old son and hang himself. And his brain was very progressed with CTE. And so, you know, it's really an ugly disease.

DAVIES: Well, as you and others raise the issue of head injuries in football, it sort of came to a boil in 2009. And for a long time the National Football League didn't really acknowledge that there was scientific evidence that repeated concussions was having impacts on their players. But they turned around and they began to make some changes. Let's talk about them. One of them had to do with keeping players off the field who've had a concussion. What did they do?

Mr. NOWINSKI: Yeah. In November-December of 2009, after a pretty ugly congressional hearing for them, the NFL saw the light and decided to make some pretty dramatic changes to their policies on how they treated head injuries. And one of them was that, you know, athletes were no longer allowed to return back to game when they were symptomatic. You know, symptomatic from a concussion. Prior to this, you know, a famous example is 2005, when Wayne Chrebet, a New York Jets wide receiver, was knocked unconscious on the field for a minute. And the Jets team doctor happened to be the head of the NFLs concussion committee and thought it was a good idea to let Wayne go back into the game 10 minutes later. And, of course, Wayne retired from the game from post-concussion syndrome at the end of the season. But no one ever pieced those two things together. And so, that practice was now going to be stopped and to the benefit of a lot of players.

DAVIES: And in your impression as you watch the game, is it being enforced? Are they keeping guys out of the game when they should?

Mr. NOWINSKI: Well, they're getting better at it. I mean I think at the end of the season I think we saw it happening very, very consistently. There were some striking examples at the beginning of the season that the policy wasn't exactly working. I think the best example being a Philadelphia's Eagles game early in the year where Kevin Kolb first got a concussion. And when he went to the sideline to be evaluated, Stewart Bradley got another one for the Eagles and actually fell over trying to get to the sideline. And clearly, I mean to anybody, he clearly had a concussion. But apparently no one from the Eagles medical staff was watching the game because they're were all with Kolb and didn't see it. And no one on the coaching staff or the players thought they should alert them to and so Stewart Bradley found himself back in the game four minutes after falling over after a hit to the head. And it was just horrifying and shocking, and everybody in the entire world watching the game knew he was concussed and shouldn't be in there but the Eagles didn't handle it.

And so, you know, those, became - what was great about it, it became a media event. And I saw and realized based on the reaction to it, you know, it was, you know, the mood had changed and that was never going to happen again, because someone knew they were going to lose their job. But, of course, Kevin Kolb even went back in that game.

DAVIES: Okay.

Mr. NOWINSKI: So it got better at the end of the year.

DAVIES: Now they also change the rules in the enforcement of rules about vicious hits. You can't lead with your helmet now, right? And you can't hit a defenseless player. That is to get someone who is sort of open to contact, you can't hit him with your helmet, what your forearm or the pads, right?

Mr. NOWINSKI: Or your shoulder.

DAVIES: Shoulder pads.

Mr. NOWINSKI: Right. Right.

DAVIES: And is that working?

Mr. NOWINSKI: You know, that's working to diminish the biggest hits in the game. You know, the issue is that, you know, as helmets have gotten better, you know, players have found it very effective to use them as a weapon and its exactly how you can deliver the most forced to somebody and you can easily knock somebody out if they don't see it coming. Well, you know, that was a, you know, while it might be an effective strategy, it was extraordinarily dangerous for the players. And in the rulebook it was actually, you know, technically illegal but was never being enforced. And so, the NFL stepped up and said okay, we're going to eliminate these really vicious helmet to helmet hits on defenseless players. And, you know, it has clearly changed the way the game was played. And I even heard rumors that scoring was up this year because receivers were no longer as fearful to run across the middle.

I mean, you know, I mean it's one thing to get the wind knocked out of you. I think we'll bring that back. But to get knocked out to catch a five yard pass across the middle is never worth it. So it's been remarkable to see how quickly the players adjusted and have gone back to better tackling techniques. But, you know, the reality is, you know, while that's a great change, its certainly not going to solve the problem in any major way by itself. I mean we are eliminating a few dozen hits from the league each year out of hundreds of thousands. And so the bigger change that needs to be made is dramatically reducing actually how we practice this game.

Studies show that 75 percent of the hits to the head a player will take happen in practice when no one is keeping score. And having played and practiced and talked to guys who played, no one really enjoys the hitting in practice. And if we found out that it's bad for you we really should almost eliminated from practice. Just hit as much as it takes to be safe but then save the hits for the games. If we did that we would lower everyone's exposure tomorrow by 50 percent and maybe even higher.

DAVIES: And coaches - I assume coaches want people to get in practice because they feel they are better prepared for the game, right?

Mr. NOWINSKI: Some coaches do. The fact is that there's a few great examples of programs who never hit, like St. Joseph's in Minnesota who, you know, is a D3 national champion almost every, you know, every few three years, they never hit in practice.

The fact is when you talk to programs, hitting in practice is not really correlated to winning. Its just kind of a mindset that people have that if you're not doing well you hit more, if you win you say it's because you hit more. You know, it's an easy out. You never, coaches are scared to be that program that if you never hit in practice then you start losing. People, well say oh its because you guys are soft. But we're trying this model in different places.

We actually worked with, the Sports Legacy Institute worked with a youth football league in Westport, Connecticut - the Westport Police Athletic League. We laid out all the research and everything we knew and we said look, these are the changes you have to make and it really starts with how you practice. They went from 30 concussions three years ago to 25 last year, to 11 this year and still won their league.

DAVIES: Right.

Mr. NOWINSKI: So they were...

DAVIES: But the issue really is sub-concussive of impacts, really, right? I mean you want them to...

Mr. NOWINSKI: Right.

DAVIES: Its the repetitive hits that aren't concussions that you're really concerned about here, right?

Mr. NOWINSKI: Right. The repetitive hits that dont cause concussions are the ones that, you know, they're just theres just so many of them and thats what we need to focus on right now to eliminate. Because by eliminating just overall hits to the head you're also going to dramatically reduce concussions. And so that's what the conversation we need to have and that's the conversation we are pushing. And even from the NFL and NFLPA perspective you want to make NFL players less likely to get CTE. It's not changing the game they're playing today because the average NFL plays only three years. The reality is you want to change the 10 years they played prior to the NFL, recognize the fact that they are doing most of this as children, and dramatically reduce the exposure they have to brain trauma.

DAVIES: Christopher Nowinski is the author of the book Head Games: Football's Concussion Crisis.

More after a short break.

This is FRESH AIR.

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DAVIES: We're speaking with Christopher Nowinski. Hes a former college football player, and a one-time pro wrestler who is president of the Sports Legacy Institute, a nonprofit working to fight brain trauma in athletes.

You know, one thing I never quite understood about, you know, helmet to helmet hits is that a player who isn't a player who leads with his helmet in a hit observing just as much punishment as he is inflicting?

Mr. NOWINSKI: No, actually. It's actually - its kind of the way the physics works out it's more like a game of Chicken. If you come into the hit with more force than your opponent you almost always push them backwards and therefore, your brain doesn't slow down as abruptly as theirs does. And therefore, you almost certainly find, there are rare situations where the forces are so great that both guys are concussed.

But my recollection is, if I brought more force into the hit I wouldn't feel a thing. It actually felt really good. And so if that's the case, it's a game of Chicken because you're both better off if you don't give each other as you can helmet to helmet. But the reality is, if you win the battle you're fine. And so everyone just tries to win the battle and that's why weve got these enormous collisions.

DAVIES: Yeah, long ago coaches used to use the expression for good blocking, put a hat on somebody.

Mr. NOWINSKI: Yeah.

DAVIES: But, you know, I've also it's one of the things that I just observed watching the game, is that it always occurred to me that a lot of the helmet contact seemed almost unavoidable because the game is just so fast. You may be going in low to hopefully make contact with your shoulder pads, but if at the last minute the player tackling, you know, takes a dip you could end up catching the head. But as I've watched the game since they've been tougher on the rules, it's remarkable to me that these guys are such great athletes. They can actually avoid using their helmet if they're thinking about it, right?

Mr. NOWINSKI: No, you know, youre absolutely right. It's a great observation. You know, to address the first part, you're right. It is, you know, there's going to be a ton of accidental helmet to helmet contact. I mean, if I was out there right now trying to tackle Michael Vick, when I got within three feet of him and I thought I was going to hit him a certain way, the fact is he such a great athlete he can move his head four feet from where I thought I was going to hit him. And the problem is it might end up, you know, where I was going and it might not.

And so the player people find out that if you pick a side. If you say okay, I'm not going to go straight at his head, I'm going to go after one shoulder, it makes it harder to tackle him because you're exposing one side of your body and he could run that way and avoid you. And so it's a tough situation for defenders and blockers to be in because the safest way to make sure you catch some of somebody is to aim right for their middle.

But I mean, you know, when you watch youre right, when you watch these defensive backs going after wide receivers across the middle in slow motion, you know, youre seeing them put their head, you know, just six inches over from where it used to be and suddenly the hits clean and everyone gets up and they keep playing rather than having to get a cart to wheel somebody off because you went helmet to helmet.

DAVIES: We're speaking with Christopher Nowinski who has been an activist to reduce heavy injuries in football and other sports. He's author of the book Head Games: Football's Concussion Crisis.

Tell us a little more about this brain bank and how it works, what you're looking at?

Mr. NOWINSKI: Sure. Sports Legacy Institute partnered with Boston University in 2008 to start the Center for the Study of Traumatic Encephalopathy, and with that is a brain bank under the watch of Dr. Ann McKee. Ann McKee has been a neuropathologist for years and has a brain bank of about 1,000 brains. And I said well, we're going to start getting you the brains of athletes and start looking at CTE. And so what's been great is, partially because of the publicity and partially because we work very hard, weve been able to acquire the brains 57 athletes since we started in 2008 - including nearly 30 football players, boxers, hockey players, pro wrestlers. And so, you know, we're finally getting an understanding as to what is going on inside the brains of athletes and it really is telling us that we've been extremely reckless and we need to change things.

DAVIES: If a layman looks at a brain thats had this chronic traumatic damage, does it look different than a normal brain?

Mr. NOWINSKI: Depends how advanced it is. If it's a young person that's passed away, no, grossly itll look the same. If it's an older person, for example, Hall of Famer, Lou Creekmur, NFL player died in 82, it's smaller. It's much smaller and the ventricles in the middle are much larger, just because the brain has lost so much mass from cells dying. The way, you know, we can't diagnose this disease in living people right now so we have to look at them after death. And the only disease you can really see is when you look under a microscope.

When you look cell by cell, you see a toxic protein called tau that has been slowly choking the cell to death. Essentially, it used to be part of the structure of the axon. The swelling from the injury probably caused it to fall apart and start to behave abnormally and cause degeneration in the brain. So you see these - they actually paint the tissue with an antibody that turns the toxic tau protein brown. So you see these brown splotches on a microscopic level, cell by cell.

And in some places in some of these brains you will see more dead or dying or diseased cells than you see living cells in parts of the brain that control things like memory and emotional control. And so it really is no surprise that these players suffer so greatly because their brain, you know, is literally falling apart.

DAVIES: Before I let you go, are you still experiencing symptoms?

Mr. NOWINSKI: I am not experiencing the headaches anymore. I don't have the sleepwalking anymore. My short-term memory is actually pretty good. And so I think I'm out of the woods when it comes to post-concussion syndrome. The problem is I have to be concerned that chronic traumatic encephalopathy is in my future because 90 percent of the guys in our brain bank who had the same brain trauma exposure that I have have CTE.

And so when they got into their late 30s and 40s their short-term memory started disappearing, they started developing impulse control issues, they started developing mood disorders and depression. And so I'm keenly aware that every time I overreact to something that I don't know if that's just me or I don't know if my brain is slowly falling apart. And so I deal with that and I try to pour that energy into the work that we're doing so we can eventually have a treatment for people like me and maybe a cure.

DAVIES: Let me ask one more question. If you tell young players what the risks are and count on them making intelligent decisions, it's got to be tough. If, you know, if you're in your 20s and the rewards include playing on Sunday in front of 70,000 screaming fans, making a ton of money, becoming a celebrity, a lot of people will take all kinds of risks, won't they?

Mr. NOWINSKI: You know, that's a great question. I'm glad you brought it up. You know, I'm a big believer that adults with informed consent can do - any dangerous job they want. I mean look at me, I used to go through tables off the top rope on your average Friday night as my career. I thought it was great.

The issue here is not - so I don't begrudge players that, as long as they've been told this information and say, you know what, I'm going to take the risk. It's worth $10 million to me and will set up my family for the rest of my life, I'm okay with that. The problem is that 95 percent of the players that are playing football are under 18 and there's no such thing as informed consent for children on this issue.

And so what, you know, we have to give them a chance by educating them, and then we have to force them to adhere to responsible medical practices by sitting out and letting their brain recover. And separating the kids' game of football from the adult game of football is something that we need to do going forward. I mean, I think when you step back and you hear old baseball players say they're lucky that they're adults that get to play a kid's game, I think of football the opposite way, and I think we have kids playing an adults game. And we need to separate what those two games are because, you know, kids can't, you throw away a kids future just have a little fun after school and on the weekends.

DAVIES: Well, Christopher Nowinski, it's really been interesting and I wish you the best of luck. Thanks so much for speaking with us.

Mr. NOWINSKI: Thank you. It's been a pleasure.

DAVIES: Christopher Nowinski is the author of the book "Head Games: Football's Concussion Crisis" and president of the Sports Legacy Institute, a nonprofit working to fight brain trauma in athletes. You can find a link on our website, freshair.npr.org. Transcript provided by NPR, Copyright NPR.

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