‘Dingers,’ dementia and depression: concussions and the future of football

Football is in Sam Dapper’s blood. His father was a first-team Pac-12 player at Stanford University, and introduced Sam to the sport when he was a baby.

Dapper, 23, started playing contact football when he was nine and continued for 13 years. In that time, he likely had six diagnosed concussions, he said.

Dapper suffered concussions as a child, in high school and during his time at Chapman, he said. Those concussions can contribute to an increased risk of developing chronic traumatic encephalopathy (CTE), a degenerative brain disease officially discovered in 2005 and diagnosed in many deceased NFL and some college players.

According to a study by Boston University researchers published in July this year, 110 of 111 deceased NFL players and 48 of 53 college players studied suffered from CTE. All of the brains were donated for examination, meaning selection bias was likely.

Many of these players struggled with memory loss, dementia and depression, according to the study. Some NFL players diagnosed with CTE, like Aaron Hernandez and Junior Seau, committed suicide and had requested for their brains be examined.

Dapper, whose father’s friends exhibited symptoms of CTE, was aware of the risks of football while playing at Chapman, he said.

“It didn’t matter, I was going to play football regardless,” Dapper said. “Let’s say I’m diagnosed with CTE, which, I’m sure, one day, I will be. Whatever happens down the line, it was worth it for what football gave back to me. I would not be anywhere without football.”

Dapper graduated from Chapman in May 2016 with a double major in accounting and business administration. He works for the Nasdaq composite two blocks from Times Square and lives on the upper east side of Manhattan – but he wasn’t always a stellar student.

“I got into Chapman with a 2.9 GPA,” Dapper said. “I was an awful student. I didn’t apply myself.”

I met the right guys in football and I ended up graduating magna cum laude with that double major because of the influence football had on my life.”

Gaylen McGinn, who is in her first year of the graduate athletic trainer program, practices checking junior Linebacker Dominic Ashley for signs of concussion. Photo by Catie Kovelman

The science of head trauma

A study published Sept. 19 by Boston University researchers found that subjects, like Dapper, who started playing contact football at the age of 12 or younger, had increased rates of neurological issues in areas like behavioral regulation, apathy and executive functioning. The risk of clinically elevated depression scores tripled, the study found.

David Kruse, a sports medicine physician, Chris Koutures, a pediatrician and sports medicine specialist, and Chapman’s Director of Athletic Training and Sports Medicine Pamela Gibbons designed Chapman’s concussion protocol.

During a concussion, the brain’s nerves stretch on a cellular level, Gibbons said. This changes the ability of the brain to function how it is expected to, Koutures said. Those changes, when repeated over an extended period of time, can cause long-term damage like CTE, which can only be definitely diagnosed posthumously.

“(CTE is) structural damage to the brain that occurs from repetitive trauma, whether it’s major incidents of injury or lots of smaller impacts,” Kruse said.

Those smaller impacts are known as subconcussive impacts and fall below the concussion threshold – more frequent, but lower force than bigger impacts. Cumulatively, those hits can cause brain dysfunction, Koutures said.

A recent study suggests CTE could be diagnosed in living subjects by testing spinal fluid. Research on these subjects diagnosed with CTE will help doctors and researchers understand whether some levels of CTE are more manageable than others, Koutures said.

In 2014, the Department of Defense and NCAA put $30 million towards the Concussion Assessment, Research and Education (CARE) study of concussions in student-athletes and service members.

California Lutheran University is one of the 30 college schools part of the study. It is the only school involved from Chapman’s athletic conference, the Southern California Intercollegiate Athletic Conference.

Patrick Holmberg, the assistant athletic director and the coordinator of the study at California Lutheran University, said that so far, football has demonstrated the highest rate of concussion of any sport.

We’re talking about practice

Kory Cablay’s career as a Chapman football player lasted two weeks. After his eighth concussion during a summer practice, Cablay, a 16’ Chapman alumnus who is applying to medical schools, stopped playing football to prevent further brain injuries, he said.

“It’s kind of wild,” Cablay said. “I want to be a doctor, but my brain’s a little jacked.”

Cablay compared his eighth concussion to “being in a cloud.”

“You know you’re present,” Cablay said. “I knew I was at the football field, I knew I was at practice, but it didn’t feel like I was there. It felt like I was watching a movie.”

Dapper’s concussion at Chapman caused him to have blurry vision and become emotional. He said that Gibbons immediately saw that something was wrong.

“I knew I was at the football field, I knew I was at practice, but it didn’t feel like I was there. It felt like I was watching a movie.”

“She pulled me right off the field and she was like, ‘Are you OK?’ Of course, she knew the answer,” Dapper said. “ I just started crying uncontrollably for no good reason.”

The majority of concussions happen in practice, Holmberg said. According to a 2015 study, nearly 58 percent of concussions at both high school and college levels happen during practice.

Since monitoring the data, the NCAA has modified its practice policy during football training camps, Holmberg said, prohibiting twice-a-day practices and consecutive days of padded practice.

Gibbons deals with roughly 12-15 football concussions per season, she said. In order to diagnose those concussions properly, she has to get to know all 98 Chapman football players personally, and be able to notice things most people cannot, she said.

“It’s not all about that big hit,” Gibbons said “For me, it’s more about, ‘Is this player after this contact now behaving differently?’ It may be something as simple as just a shake of the head.”

Graphic by Emma Stessman

Senior defensive back Benjamin Briglio said he suffered his worst concussion when he was at Chapman. During a practice his freshman year, he was blindsided by a hit in the back of his helmet and then hit his head on the ground.

“I immediately popped up really fast – because I was super mad – to try and fight this kid, and my legs just fell out from underneath me,” Briglio said. “I went back down and it just felt super weird for the rest of the day and few weeks. I had sensitivity to light, headaches, ringing in my ear, (and) it was hard to remember things.”

The concussion recovery process can have variations, and is difficult to predict, Koutures said. It is highly likely that genetic predispositions to concussions affect susceptibility and severity, Holmberg said.

Koutures said recovery is difficult for athletes who are progressing slower than they expect.

“I had two athletes who hit heads, so they got concussed the same time, date and place,” Koutures said. “One got better quicker. When athletes are trying to come back and there’s that direct comparison, that can be frustrating.”

It only takes one hit

Senior defensive lineman Adam O’Shea has played football since he was about six years old. In that time, he had one concussion, while playing at Fullerton College.

O’Shea’s parents said he was immersed in sports growing up. He wrestled, played baseball and football, yet only sustained one concussion and no serious injuries. Their older son, Austin, was not as fortunate.

During his freshman year at the University of Puget Sound, Tacoma, Austin O’Shea suffered a spinal compression, which he’d suffered once before, in high school. The injury was essentially a concussion to the spinal cord, his father, Mike O’Shea, said.

Junior linebacker Matt Layton tackles a Claremont-Mudd-Scripps player in Chapman’s 48-38 win Nov. 4. Panther Archives

The doctor who examined Austin O’Shea told his father it didn’t matter if his son was a professional athlete, he needed to stop playing or risk permanent paralysis.

“It was horrendous,” Christy O’Shea said. “It rocked us to our core.”

Mike O’Shea had already made his decision about his son’s future, he said. He told Austin O’Shea that he needed to “be done.”

“You’re too big to have me wheel you around in a wheelchair the rest of your life,’” Mike O’Shea said he told his son.

Many athletes and their families often react poorly to the news that their career as an athlete should be over, Koutures said.

“I’ve been yelled at, I’ve had people threaten to go get other opinions, I’ve had people question my judgment,” Koutures said.

Kruse said it’s very difficult for athletes to accept their careers should be over.

“It can be a devastating conversation,” Kruse said. “No athlete wants to end their career with an injury.”

Problems start in high school

Cablay’s worst concussion came when he was returning a punt for Newport Harbor High School in Newport Beach, California. He caught the ball and was immediately “leveled,” knocking him unconscious and breaking his jaw.

“(The hit) broke my helmet from the top air hole down to my ear hole, it bent my facemask and I bit through my mouth piece,” Cablay said. “I was out of football for probably two months.”

Briglio knowingly suffered a concussion in the first quarter of his high school championship game when playing for Chaminade High School in New York, but returned for the remainder of the game, he said.

“I felt like I was OK to play,” Briglio said. “We didn’t really have much of a concussion protocol, but our trainer kind of knew something was up and I said I was fine and he was like, ‘Alright, whatever, it’s the championship.’”

Briglio’s return to the game could have been fatal, Koutures said. Returning to play while concussed can cause second-impact syndrome, which is a rare, but fatal syndrome that occurs when an initial concussion is compounded.

Cablay, like Briglio, played through a concussion in his last high school game, but unlike Briglio, sustained another concussion. He said he felt a pressure to continue because it was his last game.

“I was aware that I was not OK, but I went back in and I got another (concussion),” Cablay said. “I had a really long recovery.”

The main things that can turn a concussion into a life-threatening situation is the potential of a cervical injury, a brain bleed and second impact syndrome, Gibbons said.

Briglio isn’t sure how many concussions he’s sustained, because the testing at the high school and youth football levels was essentially nonexistent, he said.

“They didn’t really test you or do any type of protocol,” Briglio said. “The trainers are usually not that good, so they either don’t tell you (that) you shouldn’t be playing, or aren’t that attentive.”

Cablay, who joined Chapman’s coaching staff as an unpaid assistant after his eighth concussion, and now coaches part-time at a high school in Orange County, said some high school coaches treat their teenage players as if they were professionals.

“You have a bunch of high school coaches, who, for one reason or another, this is their life,” Cablay said. “That should not be life for your student-athletes.”

This was the case with one of Austin O’Shea’s football coaches at Servite High School in Yorba Linda, California, Christy O’Shea said.

“(He) looked at children, players, as a commodity,” Christy O’Shea said. “He would squeak every ounce of activity that he could and it scares me that there are people that don’t look at a child or a high schooler as somebody that’s going to have a future.”

The NFL perspective

Aaron Hernandez was among a number of NFL players with CTE – like linebacker Junior Seau – to commit suicide. Hernandez, 27, was serving a life sentence in prison for murder when he hung himself.

Hernandez was found to have had the most severe CTE ever observed in someone his age. There is not yet a scientific consensus on exactly what CTE does to the brain.

Cablay said his father, Ken, was involved with the Junior Seau Foundation and introduced him to Seau on a few occasions.

“With that experience, my experience (with concussions), this CTE thing freaks me out,” Cablay said. “You can get a lot of concussions now and you won’t see the effects until you’re older.”

Na’il Diggs, a former NFL linebacker for the Green Bay Packers, Carolina Panthers, St. Louis Rams and San Diego Chargers from 2000-2011, said Seau’s suicide was the impetus for him to retire.

“Once I started reading more into it about his behavior and his undiagnosed concussions and head trauma, that’s when it really kind of set in,” Diggs said. “I was 32 or 33 years old and I was like, ‘There’s way too much life to live to continue doing what I’m doing to myself.’”

Diggs was not officially diagnosed with a single concussion in his career, he said.

“I’ve had god knows how many “little dingers” where you’re woozy, you get up slow, or you’re seeing double or stars or you forget where you are,” Diggs said. “I remember a few games where I have literally forgotten what team I played for.”

Along with chronic pain, Diggs has struggled with depression, memory loss and confusion – sometimes forgetting how to get home, he said.

“I remember a few games where I have literally forgotten what team I played for.”

“There is no way that I don’t have some level of (CTE),” Diggs said. “I can’t even go to the doctor. Go to the doctor for what? They can’t find it. I’m stuck now with this progressive disease that I can literally do nothing about.”

Over his 12-year NFL career, Diggs said he took some sort of painkiller to play through pain roughly two to five games per season.

“I chose to take something that’s going to probably harm me internally, knowing that, to go out to continue to harm myself physically,” Diggs said. “That’s how screwed up in the head (NFL players) are. We’re addicted to crazy.”

The NFL attempted to interfere with concussion research, according to a U.S. Committee on Energy and Commerce finding, and settled a $765 million dollar lawsuit in January 2017. While the NFL has pledged $100 million to studying concussion research, that research is being conducted internally and has so far only funded one study of horse-racing jockeys, not NFL players.

John Branch, a New York Times sports writer, who has written about concussions, said he does not believe the NFL will make changes to the sport if they will damage its value.

“In some ways, they’re like climate change deniers,” Branch said. “The evidence shows it’s all going one direction. It’s all pretty apparent that football is bad for your brain, but they will try to point to the people that say, ‘Well, maybe it’s not that bad,’ or ‘Maybe it’s not bad at all.’”

The danger of Division I

Before the NFL, Diggs played Division I college football at the Ohio State University. The Ohio State Football program was the third most profitable in the country in the 2015-2016 season, bringing in more than $170 million in revenue, according to USA Today.

According to a 2014 study conducted by Harvard University and Boston University researchers, for every diagnosed concussion in Division I football, there were 26 other unreported head injuries.

Diggs said Division III schools like Chapman are better at protecting their players because their academic departments don’t count on football programs for most of their revenue.

“A Division III school is not worried about going to the Rose Bowl, so if their quarterback gets knocked out, he’s out,” Diggs said. “At a Division I school, it is more likely that they will say, ‘Take a smelling salt,’ or whatever. Go win the game and everything’s fine.”

Ben Wadors, a ‘17 Chapman alumnus, played four years at Chapman, but transferred to Division I Fresno State University for the fall semester of his junior year. He returned to Chapman that spring semester.

“It was always a dream growing up to play Division I football, so I thought I should try it out,” Wadors said. “You quickly realize once you’re there that the grass isn’t always greener on the other side. At Division I, it’s wins or losses to them. If they lose, then they’re fired.”

Why play Division III?

For the majority of Division III football players – unlike many Division I players – an NFL career is not likely. There are seven current NFL players from Division III programs, and Division III schools cannot offer athletic scholarships.

“You don’t play Division III football unless you love it,” Wadors said.

Briglio, whose favorite aspect of the sport is the contact, intends to use his last year of eligibility next year. He said he feels a rush when he plays.

“The collisions are pretty intense (in college),” Briglio said. “Depending on what it is, it almost feels like you’re in a car crash.”

Junior tight end Ben Bruce hits the ground headfirst after being tackled following a reception Oct. 28. Panther Archives

The experience of being a college football player – the camaraderie, balancing of school and practice, regimentation, experience with losing, working with a team – adds up to a practical set of skills that can apply in the workplace, said head coach Bob Owens.

After consulting Chapman football alumni, Wadors declined a job offer from Goldman Sachs to work in a more senior role at LifeLock as a strategy and business development analyst.

“I’m here at the office at 7 a.m. and on a good day, I leave at 5 p.m.,” Wadors said. “A lot of people aren’t prepared for that right away, but having a football background, I was not afraid to work or really feel that pressure.”

Weighing the grey

Because CTE was discovered in 2005, the research surrounding it is in its infancy. This makes doing an accurate cost-benefit analysis about playing football extremely difficult, Branch said.

“We know just enough to be scared, but not really enough to make informed decisions,” Branch said. “If you’re a college player, or a high school player or the parent of one of these players, you’re trying to weigh what is really the risk of long-term effects versus the positive sides of playing football.”

Even CARE researchers are unable to reliably determine what the long-term effects of head trauma are, Holmberg said.

“Someone who is macho and loves to the meathead, they’re going to answer the question as in, ‘No, it’s not a big deal, it’s worth it,’” Cablay said. “But it’s always easy to make that comment when you’re not struggling with CTE. The onset of CTE won’t happen until you’re older.”

Gibbons said while players generally understand the risks of playing football, they feel they won’t be the ones to get injured.

“They have seen what has happened to their teammates, but I think there’s that whole immortality mentality of, ‘I know the risks, I see what happened to the other guy, but that’s not going to happen to me,'” Gibbons said.

The future of football

Since the 2011-12 school years, 41 total states have seen a decline in participation in 11-player high school football, according to the National Federation of State High School Associations.

Branch said while there’s no clear ratio between years played and the likelihood of developing CTE, the research has caused some people to stay away from the sport.

“We know enough that a lot of parents and a lot kids are saying, ‘You know what? Whatever that ratio is, it’s enough to scare me away right now, I’m not going to play,’” Branch said.

Had the research about youth concussions been available when her sons were playing football, Christy O’Shea would have likely prevented them from playing until they were older, she said.

Owens said he and his coaching staff put an emphasis on player safety by teaching players to tackle with their shoulders and avoid leading with their heads. Coaches teach quarterbacks to throw the ball in places that don’t leave receivers vulnerable to blind hits, and receivers are taught how to fall properly to avoid concussions, Owens said.

“In spite of how well you design things, (are injuries) going to happen?” Owens said. “Yes, that’s the nature of the game.”

“This is going to get worse before it gets any better.”

Owens is unsure of what the future of football is. “Everything” in the sport is being re-examined, he said, from the type of turf used on fields to materials used in shoulderpads.

“It’s something that is being talked about daily and yearly in our circle of coaches and administrators at the NCAA level,” Owens said.

Changes in helmets, like moving to softer shells or implementing in-helmet sensors, are among the many remedies being discussed. About $60 million of the $100 million the NFL has pledged to concussion research goes towards creating a “safer” helmet, though Gibbons and Koutures said no helmet can prevent concussions.

Diggs won’t allow his 9-year-old son to play football due to the gap in technology and impacts on the football field, he said. He does not expect the safety of players to improve any time soon.

“This is going to get worse before it gets any better,” Diggs said. We’re going to continue to see people turning their cheek against all the stuff that’s happening and the money (in football) is going to continue to grow.”

Owens expects the sport to survive, but wonders how it will change.

“Will (football) continue to have the presence and impact and entertainment value that it has on our society now?” Owens said. “Or will it be a Greek tragedy 40 years from now?”

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