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The counter-intuitive idea that could drastically reduce football’s concussions

San Francisco 49ers’ quarterback Steve Young lies motionless on field after suffering a concussion against the Arizona Cardinals in 1999. He never played again. (AP/Scott Troyanos)

The hit didn’t look that bad. The coach had seen his star defensive player withstand far worse. But still, there Chris Beranger was, laying on the turf after colliding with a teammate near the goal line.

“Discombobulated,” is the description that Sean McDonnell, coach of the University of New Hampshire’s football team, uses when describing players in these moments. “He wanted to play still, and we said, ‘No, you can’t.” That was the last down Beranger, who had suffered a concussion, would play. “The effects kept lingering and linger and lingering,” McDonnell recalls. “He had headaches and couldn’t concentrate in class. Sunlight was bothering him.”

There’s got to be some way to alleviate this, McDonnell said he wondered as he watched Beranger, who had the fourth most tackles in school history his sophomore year, slowly realize he would never play again. But how do you do it?

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That was in 2011. Less than two years later, a man who looked more soldier than academic arrived at McDonnell’s office with a possible answer. McDonnell thought Erik Swartz, a University of New Hampshire professor of kinesiology, was crazy at first. But the two struck a fast rapport. Swartz had spent years on the sidelines of football games as an athletic trainer. He understood the sport inside and out. And he said he had an idea that could make players safer and perhaps save a game that, besieged by research linking brain damage and concussions, has reached its most perilous moment in decades.

To decrease the risk of concussive injuries, Swartz told the coach, remove players’ greatest protection. Take away helmets.

The pitfall of protection

The idea has roots in years of scientific research, even in the mythology of football itself. Called risk compensation or risk homeostasis, it’s a theory that holds that protections can actually increase reckless behavior. Every day, people arrive at hundreds of decisions — whether consciously or not — based on perceptions of risk. Those decisions govern action.

In 2009, Pope Bennedict XVI traveled into the heart of Cameroon — and the African AIDs epidemic — and proclaimed condoms “increases the problem” of HIV transmission. The backlash was immediate and absolute. The Washington Post even reprinted a cartoon that depicted the Pope lauding Africans dying of disease: “Blessed are the sick, for they have not used condoms.”

But some social scientists — who disagreed with his politics — said the pontiff may have been referring to risk compensation. “When people think they’re made safe by using condoms at least some of the time, they actually engage in riskier sex,” Harvard researcher Edward C. Green wrote in an editorial in the Post. The same, some research has shown shown, goes for skiing with a helmet. One study, which analyzed more than 700 skiers and was published in Wilderness & Environmental Medicine, said “helmet use is one of the factors influencing risk-taking on the slopes” for men younger than 35.

But could be the same be true for football? That was a question Swartz found himself wondering while he was still in grad school at the University of Toledo. At the time, he also was working as an athletic trainer for the football team and playing on a local rugby team. Every football season, he said, there came a moment when he had to rush onto the field in fear a player had sustained a catastrophic injury.

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“It was the thing that scared me the most,” he said. “The implications if you messed it up and didn’t do [the treatment] right. It could mean they’re a quadriplegic. It could mean death. Everything is on on the line.”

Swartz then compared that terror with what he saw on the rugby field, a sport equal in aggression and violence and aesthetic, but different in two crucial categories — there were fewer head impacts in rugby and its players wore less protective gear. Were the two related? How did a sport with fewer pads somehow seem safer?

So Swartz started looking into the football helmet, analyzing its trajectory from novelty to cultural behemoth. By the 1950s, the helmet morphed from padded leather to polymer equipped with a mask. Around that time, convinced this new technology had ameliorated the risk of head injury, coaches started counseling a new technique: lead with the head. Another tackling style, called “spearing” — a lunging tackle that leads with the helmet’s crown — soon rose in prominence. These evolutions precipitated a surge in catastrophic injuries. In the late 1960s, more than 20 players died every year of brain injuries, before league rules prohibited that style.

The helmet, Swartz realized, had convinced players they were safer than they were.

‘I felt much safer’

The helmet is omnipresent in football. Not just in games, but in practice and culture. It’s the earliest right of passage in every peewee league — sign here, get your helmet over there. And that helmet doesn’t leave the players side until they leave the game. “In any practice, you’ll have players who are injured and aren’t supposed to participate in full contact drills, and they’ll still have their helmets on,” Swartz said. “It’s part of the culture. Everyone has a helmet on.”

And that’s where, as coach McDonnell heard that day in his office, Swartz thought there might be opportunity for change. The bulk of research up until that point had focused on making stronger, safer helmets that can reduce the risk of head injuries. But Swartz said that didn’t address the fundamental cause of concussions — behavior. He thought the simple act of removing the helmet during training drills could train players to tackle with greater caution. The idea was to heighten their instinct to protect their heads, then hope that caution would carry over into real games when they wore their helmets, thereby diminishing the chance of a concussion.

This video from the CDC illustrates and explains the science behind a concussion and the importance of recovery time for the human brain. (Video: CDC via YouTube)

McDonnell agreed to the idea as long as no one participated in a live-tackling scrimmage without a helmet: “I was very worried if we tackled without helmets someone could break a nose or something.” So at the beginning of the 2014 season, Swartz showed up with dozens of sensors that players could fit behind their ear that would measure impacts on the brain in games and practice. He divided 50 players into two groups — one that wouldn’t change its behavior, the other that would drill without helmets.

One defensive player who volunteered to go without a helmet was Daniel Rowe. It was the beginning of his junior season, and he was concerned about what football was doing to his body. He had sustained a severe concussion each of his last three seasons. He understood he wasn’t going pro, and he didn’t want to risk missing any games because of another concussion. So every week, and sometimes twice a week, he and the others practiced their tackling techniques on an upright pad — without a helmet.

The process, he said, shifted his perception. “When you took the helmet off, you’re highly conscious, like, ‘I can’t get a scratch,'” he said, recalling “hundreds of tackling drills.” “You don’t want to do anything damaging above the shoulders.”

That season, which he said was his best, Rowe didn’t sustain any concussions. Neither did he this past season. “The techniques carried over into the game,” he said. “I felt much safer and I left games feeling more confident about my health. … It took away the factor of, ‘Am I okay? Or am I not okay?'”

The results of the season-long study, published last month in the Journal of Athletic Training, found that players who had participated in the training experienced 28 percent fewer head impacts at the end of the season than they did at the beginning. It taught “not using the helmet as a weapon,” McDonnell said. “What’s happened is that the helmet is so well designed that kids feel like they wouldn’t get hurt no matter what.”

The preliminary study, however, has its limitations. In addition to a limited sample size, it’s possible the added drills reduced the head impacts — not the extra time playing without a helmet. But either way, Swartz says the hypothesis is worthy of further study. He’s since taken his sensors to the high school level, when players are still forming behaviors that will dictate their playing styles, to see if the same thing happens again.

The ultimate goal, he said, is make football as cognitively safe as rugby. “We can’t focus on just making the perfect helmet,” he said. “… We have to address the behavior.”

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