The Most Ridiculous Thing Ever Said About Football-Related Brain Trauma

Knee injuries can be very damaging. They are not, however, comparable to head injuries. (Getty Images)

Knee injuries can be very damaging. They are not, however, comparable to head injuries. (Getty Images)

Football makes people say some pretty gobsmacking things. Like National Football League commissioner Roger Goodell aiming to “take the head out of the game.” (Did the league give General Electric $40 million to work on detachable noggin technology?) Or USA Football executive Scott Hallenbeck insisting that “there is no question that the game can be played safely and is safe, as long as it is taught properly and the players execute it properly.” (Ahem. There are plenty of questions. Does Hallenbeck not have a television or an Internet connection?) Or former NFL concussion committee co-chair Ira Casson denying that there is any evidence linking multiple head injuries among pro football players with long-term cognitive damage.

Still, when it comes to the single most head-scratching public statement I’ve seen regarding brain trauma and football, University of Missouri neuropsychologist Thomas Martin takes the pole position. Hands-down. In a piece about youth football and cognitive risks published this week in the Columbia Missourian, Martin compares brain damage to … knee injuries (bold added):

Martin feels for the families [whose children suffer concussions]. He recognizes the blurry nature of concussions causes tension in itself. But he also worries their risks are overstated.

Now 47, Martin played college football and then won several national semi-pro championships with a team in Racine, Wis. He sometimes wonders if he should have quit playing earlier because of health issues he faces today. But it’s not the “three or four” concussions he suffered that concern him. It’s his knees. He’s had 18 knee surgeries to date, and he struggles to stand up from a sitting position.

Martin doesn’t see why people should react differently to the two types of injuries.

“If you play the sport, you have a chance of blowing out your knee,” he says. “Does that mean that no one should play this sport? Of course not, but you do have to consider whether you want to go back to the game. You might do some long-term damage.

“The same goes for concussions.”

Martin even has a mystique-killing analogy for the repeated subconcussive hits that are thought to cause long-term brain damage.

“My feeling is that it’s like running on a knee,” he says. “You eventually wear out a joint.” 

This blew my mind. I had to read it twice. And then a half-dozen more times. It still blows my mind as I’m typing this. Here’s why people react differently to brain and knee injuries, and why football is in a world of potential trouble: because the potential harm resulting from a brain injury is nothing like that resulting from a knee injury.

Hurt your knee? Best-case scenario is medical repair, followed by complete return to previous function. Think Adrian Peterson. Worst-case scenarios are not being able to play football again; not being able to run; not being able to walk; chronic pain; degenerative issues; significant decrease or loss of function; life with a cane or in a wheelchair. Now, none of those are desirable outcomes. Frankly, they all stink. But they don’t change how you think. They don’t change who you are.

Brain injuries are different. They can change both. They can change both for a few days. A few weeks. A few months. The rest of your life. The worst-case scenarios are heartbreakingly, unspeakably, infinitely worse. Ask Mary Ann Easterling. Ask Junior Seau’s friends and family. Ask George Visger, or Gil and Michelle Trenum. Like eventually wearing out a joint? Dealing with dementia in your 80s is different than dealing with it in your 50s; dying in your teens is different than dying as a grandfather.

Thing is, Martin knows better. As a trained neuropsychologist whose self-professed research interests include dementia and traumatic brain injury, it’s his job to know better. In fact, the Missourian reports that Martin helped write a state law that more strictly regulates how soon high school athletes suspected of suffering concussions can return to play.

Oh, and here’s Martin describing brain trauma in 2011:

… so this injury, the brain controls everything we do. And this injury to the brain can impact every aspect of what an individual does …

… [symptoms] may be enduring, they may last, they may rob the individual of opportunity, they may impact vocational performance, educational performance, social functioning …

In the above speech, Martin makes a valid point: when their concussions are properly diagnosed and treated, most people make full recoveries. Putting aside open questions about what proper concussion diagnosis and treatment actually entails, that’s important to note, and something to consider when deciding whether playing football is worth the physical and cognitive risks inherent to the sport.

Also important? Acknowledging that physical and cognitive risks are not the same. A knee injury is not a brain injury. Suggesting even a crude equivalence is preposterous. Why would anyone do so? I really have no idea. I just know it’s wrong. Or, to put it another way: one kind of injury can make it hard for a 47-year-old neuropsychologist to stand up from a sitting position; the other can make it impossible to become a 47-year-old neuropsychologist in the first place. Which one do you find more alarming?

9 thoughts on “The Most Ridiculous Thing Ever Said About Football-Related Brain Trauma

  1. The neuropsychologist made the statement because it’s correct. It’s not obviously correct, but it’s correct.

    I’ve had a concussion. I suffer absolutely no long-term effects from it. I’ve broken my ribs. I suffer long-term effects from that injury. Mild effects, but I still suffer.

    What you’re missing and what most people are missing is that we can’t classify one injury as worse than another simply because we feel that the maximum effects of one type of injury are greater than the maximum effects of another type of injury. We need to look at the likelihood of recurrence, of long-term disability, of the most probable path to recovery, the length of recovery time required, the costs required, etc. and so on. Chances are Martin made the statement based on his interpretation of the cumulative total of factors as opposed to the mainstream media excessive focus on the single seemingly most devastating factor.

    That’s why people shouldn’t react differently…both injuries can be devastating, and both injuries can be minor, and there are all sorts of points in between. What Martin said made all kinds of sense when you strip the hysteria and the FUD out of the equation.

    • I appreciate your response, but obviously, I completely disagree. You write:

      “What you’re missing and what most people are missing is that we can’t classify one injury as worse than another simply because we feel that the maximum effects of one type of injury are greater than the maximum effects of another type of injury.”

      1. The maximum effects of brain injury on any given individual are greater than the maximum effects of knee injury. I consider that a fact, not a matter of “feel.”

      If that’s truly your stance – that dementia being worse than, say, amputation is simply a matter of “feel” – then, yeah, our conversation won’t go anywhere.

      2. Why can’t injuries be classified according to their maximum effects on an individual? That seems like an incredibly reasonable way to classify them, especially if you’re assessing risk.

      I agree with your that both types of injuries can be minor, both can be devastating, and both can have points in between. I wrote as much. My point is the worst-case scenarios for brain trauma – the points approaching and/or reaching the devastation end of the spectrum – are worse than those for knee injuries.

      Again, if you want to argue that’s not true or that it’s not relevant, I’ll listen, but I can’t imagine you’ll convince me.

      When you use terms like “mainstream media excessive focus,”
      single seemingly most devastating factor,” and “hysteria and FUD,” you sound like you don’t think brain trauma in football is a particularly serious problem. It’s up to you to decide what to dismiss by using frames like “hysteria,” “FUD,” “excessive,” and “seemingly.” I know that every single person I’ve met who is suffering as a result of football-induced brain trauma would disagree with you.

      As for your concussion, I’m truly glad that you’ve made a full recovery. Along the same lines, I’m truly sorry you continue to have rib problems. Suffering sucks. Still, I’ll leave you with this thought: do you think your current life would be better or worse if your ribs were fine and you were still having brain problems?

      • I’d answer that question with “that depends.”

        What are my symptoms?
        Are they treatable?
        How much would I suffer?
        What are the long-term effects?
        What is my quality of life?

        It may be a case that everything can be treated and I can live normally. It may be that I’m a vegetable. I could be anywhere in between. There’s no conclusive way to answer that question.

        To put it differently, two football players are in a game. A cornerback attempts to tackle a wide receiver. The cornerback stumbles a bit and catches his helmet on the wide receiver’s knee. The wide receiver’s knee buckles under him and he can’t get up. The cornerback is knocked woozy. if you’re a triage nurse at a hospital and both of these patients are wheeled in, who gets priority? You’d have to look at the circumstances, examine each player, then figure out who should be first in line to see a doctor. That’s why picking one factor and saying “this is how we determine that one injury is worse than another” is dangerous.

        I’m not saying that any of the guys who suffer from brain injuries are less important as people. No one should suffer. It’s not that they can’t be serious. It’s that other injuries can be just as serious.

        • Okay, I think I better understand what you’re talking about – it’s something totally different than what I’m talking about.

          You’re saying that a particular knee injury could be worse than a particular brain injury. Sure. I agree. Never would say otherwise. A concussion someone completely recovers from is not as bad as a knee injury that leaves them using a cane for the rest of their life.

          I’m saying that the worst-case scenario for a brain injury is much, much worse than the worst-case scenario for a knee injury, and as such, comparing the two in the context of an interview and article about the cognitive health risks football poses to the children who play the sport is ridiculous.

  2. Unless the intent was to downplay the importance of brain injury (and I think he was trying to do the opposite – point out that other injuries can be serious), I don’t have a problem with what he said. I’d expect that someone who has been through dozens of surgeries and struggles to stand at age 47 has been through enough pain and anguish to understand what he’s saying.

    Having known people who deal with chronic pain and limited mobility (not from football injuries), I think it does them a terrible disservice to say “of course brain injuries are worse.”

    • Chronic pain and limited mobility are terrible. I’m not discounting those. Not in the least. If anything, they both seem to be under-appreciated risks of playing football. I had no problem with Martin bringing up his knee surgeries; I did have a problem with comparing it to brain trauma. I think they constitute different types of risk, and to make them sound equivalent is to downplay the latter.

  3. To Dr. Martin, and Adam, and Steve, and all other brain injury/orthopedic injury experts, I have one question.

    I’ve had several knee surgeries, experimental GoreTex ACL transplants and stainless steel moly bolts in my knee. I also have compression fractures in my C6, C7 and S8 vertebrae and had my left radial head removed from my elbow after crushing it.

    The absolute worst case scenario of a knee injury would be amputation.
    But with an amputation you can run, work, speak, communicate with your loved ones, drive to the store, shop for groceries, balance a check book, climb Mt Kilamanjaro (been done), and still maintain a normal life while causing major anxiety, pain and worry for your family. Sure you will be in pain, and your family will worry their heads off, but you still have your life, and your family still has their love one.

    A “mild” TBI can leave one unable to find their way home, unable recognize their family members, unable to work, unable to track a conversation, unable to speak, unable to return to your life, unable to communicate in any way, and completely devastates the family as that “person” they loved no longer exists.

    KVIE Channel 6 Sidelined: Concussions In Sports 12/19/12
    http://vids.kvie.org/video/2318744182

    Channel 13 News Sacramento 10/29/12 Terry Tuatolo interview
    http://sacramento.cbslocal.com/video/7898539-former-nfl-linebacker-falls-into-homelessness/

    Now tell me again Dr. Martin and you other TBI/Orthopedic injury experts how that compares?

    George Visger

  4. Pingback: Downplaying brain injury is not the way to attack this | The Concussion Blog

  5. Perhaps if the Sports Docs could work with the insurance companies to set up codes for billable brain injury treatment, surgery and rehab like Orthopedics enjoy with knees, hips and shoulders they’d have some motivation to properly diagnose and treat brain injuries. But rest? That’s not paying for the kid’s college tuition.