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Necessary Roughness

December 17, 2018
by Coby McDonald

A century ago, football was in big trouble. History has a way of repeating.

It was a sunny November Saturday at California Field and the stands brimmed with 20,000 boisterous fans. Banners waved, blue-and-gold streamers unfurled, and the usual cheers of “Oski Wow Wow! Whiskey Wee Wee!” went up as players took the field.

Until the crack of the referee’s starter pistol that day, the 1906 Big Game between Cal and Stanford seemed much like the 15 annual Big Games that preceded it. But this time the contest of chief rivals was missing one very key feature—football. When the shot rang out, the bodies on the field collided in a scrummage rather than a scrimmage. Which is to say, the game was rugby: a sport that few in the stands—or even on the field—knew much about.

Controversy turned to crisis in the 1905 season, when 18 football players were killed in games across the country. Critics called for the sport to be abolished.

At the turn of the last century, American football had come under intense scrutiny for cheating and extreme violence, leading some schools to jettison it. And though rugby is hardly a gentle game, many considered it preferable to the savagery of the American sport.

“Football is more brutalizing than prizefighting, cockfighting, or bullfighting,” wrote Harvard President Charles Eliot at the time. “The game sets up the wrong kind of hero—the man who uses his strength brutally, with a reckless disregard both of the injuries he may suffer and of the injuries he may inflict on others.”

Today’s football fans would hardly recognize the game as it was played back then. The forward pass had yet to be conceived, so the ball was inched down the field in a slow, bloody grind across the gridiron. At the bottom of dogpiles, eyes were jabbed and blows thrown. Dangerous maneuvers like the “flying wedge” were used to mow down defenders. Players were often grievously injured, even killed. In 1899, University of California student Jesse Hicks died after his neck was broken in an intramural football game. It wasn’t an isolated incident.

Controversy turned to crisis in the 1905 season, when 18 football players were killed in games across the country. Critics called for the sport to be abolished. Football boosters, meanwhile, scrambled to instigate rule changes that would save the sport by cleaning it up. Modern American football—the game today’s fans know and love—owes its existence to those reforms. Many of the features we now take for granted, such as the ten-yard first down, the forward pass, and penalties for unnecessary roughness were born of that period.

More than a century later, however, football is again in crisis. The issues of violence and injury have roared back to public consciousness in the form of chronic traumatic encephalopathy (CTE), a degenerative brain disease linked to head trauma and previously thought to be confined to aging, punch-drunk boxers. An alarming number of former players with CTE have commited suicide, including well-known NFL veterans Junior Seau and Dave Duerson. Both men shot themselves in the chest, Duerson specifically to preserve his brain for autopsy. Last January, Washington State quarterback Tyler Hilinski killed himself at age 21. His autopsy showed early-stage CTE.

As the number of cases mounts, an increasing number of parents are questioning the wisdom of allowing their sons to suit up.

Cal has not gone unscathed in what has come to be known as “the concussion crisis.” Former Golden Bears star running back Jahvid Best’s pro career was cut short by a series of concussions, the most dramatic of which he suffered previously at Memorial Stadium. And legendary Cal quarterback Joe Kapp, the last man to lead the Bears to the Rose Bowl, now suffers from Alzheimer’s disease. It’s true that Kapp, now 80, might have developed the disease in any case. It’s also true that NFL veterans are four times more likely to develop Alzheimer’s than the general population. Kapp, who suspects he has CTE, plans to donate his brain to UCSF. “When I cash in, they will take the brain and study it,” he told the San Jose Mercury News.

The concussion crisis has been mostly associated with the NFL, but the problem takes on an added dimension at the college and scholastic level, for the simple reason that schools are in the business of educating minds, not damaging them. Now, as the number of cases mounts and class action lawsuits fly, an increasing number of parents are questioning the wisdom of allowing their sons to suit up. As in 1906, critics are demanding reform. Back then, it was President Teddy Roosevelt who led the charge to save football, while several college presidents, including the University of California’s Benjamin Ide Wheeler, found the sport bankrupt beyond salvation.

To Wheeler, football was more militaristic spectacle than sport. He described the scrimmage as “two rampart-like lines of human flesh … one of the defense, the other of offense,” and the offensive rush as “a missile composed of four or five human bodies globulated around a football.” The solution to the football crisis, he firmly believed, was to abolish it and replace it with rugby, which he described as “the heartiest and manliest of the Anglo Saxon sports”—the game from which American football had only recently evolved.

Wheeler found a powerful ally in Stanford University President David Starr Jordan. The two believed that by establishing rugby on the West Coast, they could spark a movement. After a months-long influence campaign, which included an exhibition match in Berkeley between squads from New Zealand and British Columbia, they convinced the conference committee of California and Stanford to vote unanimously in March of 1906 to make the switch.

The Daily Californian announced with finality, “The game of intercollegiate football will be played no more upon this coast.”

IT USED TO BE that getting your bell rung was just part of the game. A concussion was viewed within football as an inevitable and relatively mild injury. “There was simply no awareness that concussions were anything more than a bruise to the brain,” says retired NFL lineman Michael Oriard. A professor emeritus of English at Oregon State University, Oriard is the author of several scholarly books on football.

“[Concussions] would heal completely in the same way other bruises healed. With time.”

Our understanding of the injury was shaken up in 2005 when forensic pathologist Bennet Omalu published his autopsy results for former Pittsburgh Steeler Mike Webster. “Iron Mike” had suffered from Alzheimer’s-like symptoms including delusions, memory loss, and dementia before his 2002 death of a heart attack at age 50. When Omalu examined Webster’s brain, he found splotchy buildups of tau proteins, a telltale sign of CTE. It was the first time the disease had been identified in a former football player, and the implication was clear: If Webster had CTE due to head impacts, it was likely that many other players were at risk. Perhaps equally disturbing: The diagnosis could only be made in autopsy.

Players are particularly vulnerable while still recovering from a previous concussion. But knowing when a player has fully recovered is tricky.

As the NFL pushed back on his findings, Omalu went on to diagnose CTE in several more deceased NFL veterans, including Terry Long, Justin Strzelczyk, and Tom McHale. The most stunning findings came last year when Boston University’s Dr. Ann McKee found CTE in 110 of 111 donated brains of deceased former NFL players who had been suffering from CTE-like symptoms.

McKee acknowledges that her study sample was not representative and thus does not address the prevalence of CTE in NFL veterans (although she says the study suggests a low-end estimate of around ten percent), let alone the general population. And in the absence of more definitive research, some experts, including UCLA neurologist Christopher Giza, caution against drawing a causal link between football and the disease.

For now, though, authorities such as the Centers for Disease Control and the Mayo Clinic agree that repeated head trauma is considered a likely cause of CTE. More studies are clearly needed. In the meantime, the most urgent question may be, How can today’s players avoid the fate of Iron Mike?

CONCUSSION IS A COMPLEX INJURY to the body’s most complex organ. Like a yolk surrounded in egg white, the brain rests in a protective buffer of cerebrospinal fluid. An impact of sufficient force to the head can cause the brain to shift around in that fluid, rapidly twisting or colliding with the inside of the skull. With concussion, there is no structural damage to the brain, so the injury very rarely shows up on scans.

“Concussion is tough to diagnose. It’s really tough,” says Jeremy Shumaker, chief of the Sports Vision Clinic at Berkeley’s Optometry School. “And it’s frustrating because you might see a patient on day one and they look fine. But on day seven, they could be having all kinds of symptoms.”

2017 Big Game // Photo courtesy of David Madison/Getty Images

Indeed, concussion symptoms can occur minutes, days, or even weeks following a head impact. They range from nausea, lack of coordination, and confusion, to mood and behavior changes such as anxiety, depression, and anger. Importantly in the football context, the long-term negative impacts of concussions are believed to be cumulative. Players are particularly vulnerable while still recovering from a previous concussion. But knowing when a player has fully recovered is tricky for doctors, trainers, and coaches, who often must rely on the subjective reporting of athletes eager to get back on the field.

The key, Shumaker says, is the hunt for a biomarker, a physiological indicator of the presence and severity of a concussion. At the Sports Vision Clinic inside Berkeley’s Simpson Center for Student-Athlete High Performance, Shumaker and his colleagues have focused on a surprising one: the eyes. “That might seem weird,” Shumaker says. “But the eye is a natural biomarker.” That’s because the array of systems that govern eye movement and vision are enmeshed in every region of the brain. So no matter where in the brain an injury has occurred, it is likely to be reflected in the function of the eyes.

The Sports Vision Clinic was created in 2015 in partnership with Cal Athletics to advance this new area of research. Cal athletes who have experienced head impacts undergo a rigorous visual screening that can identify concussion, allowing for treatment and hopefully preventing a player from reentering the game injured. The clinic has become a community resource, accepting referrals from hospitals around the Bay Area, including UCSF and Stanford, for concussed patients of all ages.

BUT WHAT IF concussion isn’t the only cause of CTE? Or even the main one?

A major multi-university study published this year presented the strongest case yet that repeated subconcussive hits to the head likely cause the disease. The implication is unnerving: Head impacts that show few, if any, symptoms may be inflicting undetectable damage to players’ brains—damage that will only manifest years later as neurological disease. Seemingly harmless tackling drills from high school days might haunt a player in middle age.

If science could save football, it might also dig its grave.

And it’s not just football. CTE has been found in the brains of former players from an array of sports—including ones not generally considered to be contact sports, such as baseball and soccer. In the case of soccer, there is speculation that the culprit is the rapid acceleration and deceleration of the brain while heading the ball.

According to Berkeley neuroscientist Daniela Kaufer, a co-investigator on the aforementioned study, the greatest challenge to addressing CTE is that we don’t understand the mechanics linking the initial injury to the resulting disease. “We’re missing this fantastic therapeutic window where we could block the disease progression,” she says. Kaufer and her colleague, Alon Friedman of Dalhousie University, spent the last decade zeroing in on what they believe may be a mechanism that causes CTE. Using animal models, they discovered that sub-concussive head impacts were often followed by blood-brain barrier dysfunction; proteins that are normally confined to the blood cross over into the brain, causing an inflammatory response that wreaks havoc on neural connections.

Think of it as “rewiring of neural circuits that end up in a very excitable state,” she says. “How we keep our brain working is this balance between excitation and inhibition. And when the brain becomes more excitable, this is when you see things like seizures and cognitive impairment.”

The most promising aspect of the research, Kaufer says, is that “knowing the chain of events [allows us] to think about a biomarker and about a drug.” The scientists have developed both. Using an IV-injected dye and a specialized MRI technique, they can detect blood-brain barrier disruption, potentially allowing them to predict who is at risk for later neurological disease. And a drug they developed, now in preclinical trials, has successfully blocked the disease progression in animal models.

Head impacts that show few, if any, symptoms may be inflicting undetectable damage to players’ brains—damage that will only manifest years later.

It’s too soon to say whether the drug will be successful in humans, but Kaufer’s work hints at a future in which high-risk athletes might be identified and treated before brain injury leads to CTE. “If you have a drug, then everyone can play as much as they want,” she says. “You just block the development of the disease.”

But if science could save football, it might also dig the sport’s grave. The holy grail of CTE research, after all, is the ability to diagnose the disease in living patients. Imagine that living diagnoses become possible next year. Maybe we discover that the crisis was overblown. Or maybe we learn that CTE is even more widespread than feared. Now imagine that a cure like the drug Kaufer is investigating takes 10 or even 20 years to develop—if it develops at all. Could football (and for that matter, any other sport in which CTE turns out to be prevalent) survive?

WHEN CAL GAVE UP FOOTBALL for rugby in 1906, fans groused and players quit. A San Francisco Examiner columnist wrote that Cal’s athletes couldn’t be more disgusted if they’d been asked to give up baseball for the “gentle art of cricket.” Rugby was “the English apology for a manly sport,” wrote Daily Cal editor Sam Hellman. “Rugby is no good. It never will be, and we hope that it is dropped off the campus as soon as our tearful prayers pierce the hearts of the alleged reformers who forced it down our throats.”

So when the day of the Big Game arrived, rugby’s future at the two universities hung in the balance. As the contest got underway, fans of the “old game” were overheard by a reporter commenting on the “silly scrum” and calling rugby “more like a game of tag than a game of good old American football.” But another columnist observed that the action was faster and more unpredictable than football.

“At the old game you grew tenser and dug your nails deeper into your palms as the agony went on,” wrote San Francisco Chronicle’s Archie Rice. “But in the rugby game yesterday, you knew nothing positively longer than a few seconds, for visions of a glorious run would change like the shifting views in a stereopticon and your startled yell would end in a gasp and gloom. Rugby has probably won first place as a college team sport in the far West.”

1912 Big Game // Photo courtesy of Stanford University Archives

At the bottom of the full-page Chronicle spread devoted to the Big Game was a small, grim reminder of what was at stake: In Great Falls, Montana, a 25-year-old fullback named James Curtis had been killed in a football game that very day.

In his pitch for rugby, President Wheeler implored football players to “take off the headgear and the nose guards and the thigh padding and the knee padding” and take up the English sport. In the early decades of football, mounting injuries prompted the quick adoption of safety equipment, which included the aforementioned nose guard, a strange piece of headgear that made the wearer look like a cross between a koala and Hannibal Lecter. The leather helmet soon followed. But it was the advent of plastic helmets in the 1950s that made Wheeler’s plea seem particularly prescient.

Helmets, Michael Oriard says, “do a terrific job of preventing skull fractures, as they’re meant to do.”  Unfortunately, “protecting the skull is completely different than protecting the brain that’s sloshing around inside.” A further problem with helmets is “that once players felt safe, they started using the helmet as a weapon.” High-speed head-to-head collisions became part of the game. Some experts today still hope a better-designed helmet can help solve the problem.

“Pretty much all helmets deal with impact force. Straight, direct impact to your head,” says Berkeley neurologist Robert Knight. “But if you get hit a little off center, the brain rotates.” The resulting sheering forces cause many concussions.

Along with two Cal engineers, Knight, former chair of Cal’s Helen Wills Neuroscience Institute, has developed a novel helmet design, called Brain Guard. Typical in size and weight, it has a key difference: a shell within a shell, and a slip layer in between. “When the outer layer gets hit, it turns, and the energy is dissipated,” he says. According to Knight, in lab tests the Brain Guard helmet beat out helmets typically used in the NCAA by 35 to 50 percent.

Football is unlikely to ditch the helmets anytime soon, but the sport is looking to rugby for ways to play more safely.

Studies placing accelerometers in the helmets of college football players have shown that better helmet designs can indeed reduce concussions. However, the same studies also underscored the sheer number of powerful impacts to the head that football players experience.

“All of this is ridiculous,” writes Bennet Omalu in his book Truth Doesn’t Have a Side, of the quest to fix the CTE problem with helmets. “The human brain suffers serious microscopic injuries from both concussive and subconcussive blows to the head. No helmet can prevent this damage, for no helmet can stop the brain from moving around and colliding with the inside of the skull at the moment of impact.”

Of course, there is another, more extreme, solution. “Take off their helmets,” says Oriard. Because then the players won’t be using their heads as weapons. “You go back to playing basically rugby, like Cal and Stanford did in 1906.”

Football is unlikely to ditch the helmets anytime soon, but the sport is looking to rugby for ways to play more safely. In a trend that appears to have started with the Seattle Seahawks, many teams are now espousing the rugby style of tackling.

“When we teach tackling, we show clips of rugby players and how they’re effective tacklers using their shoulders,” says Cal head football coach Justin Wilcox. Without helmets, rugby players are forced to protect their head from injury. Not long ago, Cal football coaches consulted with famed Cal rugby coach Jack Clark to learn more about how his players do it. “We’re a shoulder tackling team,” says Wilcox. “So every technique we talk about starts with contact with your shoulder. We talk about our own bodies, and then we talk about the ball carriers’ bodies.”

And according to Wilcox, protecting the players goes well beyond teaching proper technique. They are monitored at all times by coaches, the medical staff, and even the referees. And when injuries do happen, health decisions are entirely in the hands of the medical staff. It’s not up to a player whether he goes back in or not, Wilcox says. “We take directions from [the medical staff] and that’s it.”

IN THE AFTERMATH of the football-less Big Game of 1906, many former rugby critics changed their tune. Team captain Curtis Haffey, who had previously declared rugby unfit for Americans, told The Daily Californian, “It is new to us and we may not show up as cracks at it, but every ounce of strength and all the intelligence at our command is being given to the playing of this new rugby game.”

The first domino had fallen, and soon other West Coast colleges and universities dropped football for rugby, including the University of Nevada, the University of Southern California, and Saint Mary’s College. High schools up and down the coast followed suit. Wheeler also arranged to have West Coast universities go up against squads from countries like New Zealand, Australia, and Canada.

How safe can you make football and have it still be football?

It was a good plan—in theory. Unfortunately, the foreign teams regularly trounced Cal and the other West Coast teams so severely that newly minted rugby fans were demoralized. And no sooner had the new game been adopted than the old antics began creeping in. Cheating and foul play reemerged. Wheeler fretted that perhaps Americans were simply morally defective.

Meanwhile, in the East, a new, improved football game had emerged from the 1905 crisis. Most significantly, the forward pass had arrived. Rather than a brawl at the line of scrimmage, football was becoming a wide-open, fast-paced game.

Now the rules are changing again, even on the practice field. Since 2012, the Pac-12 Conference has allowed only two days of full-contact practice per week, and the NCAA issued similar guidelines last year. The NCAA and NFL have also recently changed rules governing hits, including restrictions on hitting defenseless opponents and striking with the crown of the helmet.

Not everyone is a fan.

“What used to be considered a great tackle, a violent, head-on … it was incredible to watch, right?” said Donald Trump at a campaign rally in 2016, to uproarious applause. Then, affecting an effeminate voice, “Now they tackle, ‘Oh, head-on-head collision. Fifteen yards.’ The whole game is all screwed up.” Like the president, many believe any attempt to curb risk in the game is an assault on the integrity of football itself. But according to Wilcox, there’s a united front from players, coaches, and medical personnel in the Pac-12 and the NCAA, all committed to keeping players as safe as possible.

“I try to be a rational person in all parts of my life, but I think my love of the game clouds the rationality I should have in considering my long-term health.”

“Everybody I know is trying to do the right thing by the players, and do the right thing in terms of teaching and treatment and trying to mitigate the risk as best we can,” Wilcox says. “We’re all open to finding the best way to play the game without losing the fabric of the game.” There’s the dilemma. As Oriard puts it: “How safe can you make football and have it still be football?”

“The appeal of football is dependent to a considerable degree on the tension between the violence and the artistry,” says Oriard. “That is the essence of football that makes it different from other sports.”

Meanwhile, young players and their parents face a tough question, one that California asked Cal team captain and running back Patrick Laird about last summer. Was he concerned about the risks to his long-term neurological health?

“I think there are many ways people can rationalize the data that’s coming out to say it’s better now,” he responded, “Safer helmets, different playing style than before, more protective rules, etc. In whatever way you look at it, it’s still a risk. I try to be a rational person in all parts of my life, but I think my love of the game clouds the rationality I should have in considering my long-term health. It’s a weird thing; we all (or most) know the risk but continue to play anyway.”

Asked whether he would let a son of his own play, Laird answered, “I think golf is a great sport. I hope he enjoys it.”

AFTER 1906, rugby persisted as the main sporting attraction at Cal for nearly a decade until, in 1914, Cal and Stanford fell into a dispute, ostensibly over freshman eligibility. According to Berkeley historian Roberta Park, however, the disagreement was a ruse by Cal to “engineer a break in order to return to American Football.” It worked. Negotiations broke down, and Cal announced that in 1916 football would be back.

“California has had enough of the dribbling and scuffling scrums [of rugby],” wrote Andy Smith, coach of Cal’s national champion Wonder Teams, in the 1916 yearbook. “And she turns once more with renewed vigor to the good old sturdy game developed by red-blooded Americans.” 

Coby McDonald is a frequent contributor to California and an expert on Berkeley’s Adventure Playground.

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