Stephen H. Landy, MD, has two sons who weren’t allowed to play football. A wise decision, it seems, in light of all that has come to be known about the dangers of head injuries suffered in contact sports.
As founding partner and director since 1992 of Wesley Neurology Clinic, Landy is acutely aware of the long-term effects of repeated head trauma.
Yet it was Landy’s wife – his sons’ mother – who said no to football. Landy, a former track athlete at the University of South Carolina, would have given his boys the go-ahead.
“I believe that most of us who were and continue to be committed and involved with competitive athletics feel that the benefits of the ‘game’ outweigh the potential risks,” he said.
Landy’s view may be increasingly less popular as the medical community, the media, schools and the public at large engage in a national debate about head injuries in football and other contact sports.
At the forefront of the debate is the National Football League. More than 4,000 former players have joined in litigation against the league, alleging fraudulent misrepresentations of the dangers of concussions. The NFL has given repeated assurances that player safety is a top priority, and the league has donated $30 million to the National Institutes of Health for brain injury research.
As a neurologist with a subspecialty headache practice, Landy says he has evaluated hundreds of post-traumatic headache patients, including many current and former high school, college and professional athletes.
“Most of the recent press and medical literature related to head injuries and football revolves around concussions and chronic traumatic encephalopathy,” he said. “Based on this information, there is little doubt that multiple head traumas and concussions increase an athlete’s risk of developing permanent brain disease.
“A recent article in the journal Neurology established a definite increased association of NFL players’ deaths secondary to neurodegenerative disorders, including Alzheimer disease and amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. Whether this is a cause-effect relationship has yet to be determined, but it is definitive information supporting NFL players’ increased risk of death from neurodegenerative causes possibly secondary to repeated head trauma and concussions.”
Yet concern about the risks of football is nearly as old as the sport itself. As Landy said, some believe the potential rewards outweigh the risks.
“Many of my former (track) teammates at South Carolina played football in high school, and their children have played high school and college football,” Landy said. “A close friend, pole vaulter, sprinter and college roommate of mine attended Permian High School in Odessa, Texas – the high school that inspired Friday Night Lights, the non-fiction book and (TV) series. He allowed his son to continue playing.
“Buzz Bissinger, the author of Friday Night Lights, wrote, ‘Violence is not only embedded in football, it is the very celebration of it. It is why we like it. Take it away, continue efforts to curtail the savagery, and the game will be nothing, regardless of age or skill.’
“Both of my sons are now in medical school,” Landy added, “and it will be interesting to follow the evolution of the concussion and CTE science and what they recommend for their children, since many of us now consider competitive tackle football as collision, smash-mouth football.”
Having said that, Landy allows that football can be made more safe.
“The key is to decrease the likelihood of getting your ‘bell rung,’” he said. “The NFL has already changed kickoff and tackling rules and is in the process of changing helmets, including adding telemetric feedback from accelerometers for trainers and doctors on the sidelines to provide real-time assessment, monitoring and measurement of head trauma impact in practice and games.
“They have also implemented simple written or computerized cognitive tests to assess concussions. Limiting contact during practice, fewer games, and forbidding children to tackle until adolescence or beyond are other safety steps worth consideration.”
While head injuries and performance-enhancing drugs are generally considered separate topics in sports, Landy sees the potential for some correlation.
“By enhancing athletic prowess,” he said, “it would be reasonable to conclude that in contact sports, PEDs potentially make athletes more dangerous. Also, the effect of PEDs on the brain and immune system possibly mask clinically relevant symptoms such as pain, fatigue and inflammation.”
For Landy, first-hand knowledge of the effects of PEDs comes from Steve Courson, a friend for four years at South Carolina. He was an offensive guard with the Gamecocks and later with the Pittsburgh Steelers.
“I remember him returning after his freshman year in college about 50 pounds heavier and much stronger, faster and meaner,” Landy said. “His book, about his football life and steroids, False Glory: Steelers and Steroids, the Steve Courson Story, is an informative read for anybody contemplating using anabolic steroids and for those interested in a forthright opinion of the mindset of some athletes and coaches regarding PEDs.”
Not to be left out of the discussion of head injuries is soccer, with growing concern, in particular, about the cumulative effects on girls when they strike the ball with their heads.
“Women seem to be more prone to concussion, possibly secondary to weaker necks or more honesty in self-diagnosis,” Landy said. “Soccer players’ heads sometime collide, and proper heading of the ball has become a point of emphasis.
“Soon, it should be no big surprise to see everybody playing competitive soccer wearing appropriate headgear.”