Game-changers off the playing field

The people who just might be able to save the sport of football from its own self-destructive ways don't wear whistles or hold clipboards. They don't file lawsuits, and they don't dole out suspensions for helmet-to-helmet hits.

Instead, they tend to wear lab coats. They might spend their days poking and prodding mice, interviewing patients involved in a study, or gathering data and obsessing over it. Some of them are men, and others are women. Some of them follow football closely, while others couldn't tell you the difference between Peyton Manning and Peyton Hillis.

Typically, though, they have a few things in common: They try to focus on facts, not emotion, when it comes to a debate about head injuries in football. And they tend to work at a research university.

There will be plenty of football games played on college campuses across the country this season, games that will help decide conference championships and lucrative bowl bids. But on some of those same campuses -- in buildings that oblivious fans stroll past on their way to the stadium -- scientists will be working hard on helping map out the minefield of football's uncertain future. These days, colleges aren't just the place the NFL is hoping to find the next Aaron Rodgers. They're also the place most likely to come up with a solution that will save his brain from permanent damage, and publish their findings for everyone to see.

"There are real advantages to doing brain injury research at an academic university," said Dr. Jonathan Lifshitz, who is now the Director of Translational Neurotrauma Research at Phoenix Children's Hospital, but previously worked with football players as part of the University of Kentucky's Spinal Cord & Brain Injury Research Center. "It gives you access to athletes in a fairly controlled manner. And if a trainer suspects an athlete has suffered a brain injury, it's fairly easy to follow up with an investigation and see that they've received additional testing. And when awareness of head injuries goes up, the number of head injuries that occur actually goes down."

In recent years, athletic departments have been increasingly willing to open their doors to the research departments on campus, hoping to find the right balance between prevention and properly diagnosing head injuries. Take Virginia Tech, for example. In 25 seasons under coach Frank Beamer, the Hokies have built one of the best football programs in the country. But the school's highly regarded Department of Biomedical Engineering might go down in history as having made a more important contribution to the game.

Since 2003, thanks to engineering professor and department head Stefan Duma, all Virginia Tech football players have been outfitted with sensors in their helmets that can measure the number of the collisions they are involved in during the course of a football game, as well as the severity of them. It's technology that was originally designed for soldiers in the military, but Duma immediately recognized the potential benefits for football players as well, and made his pitch to the athletic department.

"Coach Beamer was very receptive," Duma said. "He was not a hard sell at all. I think it helps that we had such a successful and long-term coach behind us, because there is obviously a lot of stress over this issue."

The data is collected by the sensors, and then uploaded in real time to a computer on the sideline where it can trigger an alert, warning the team's medical staff any time a player is involved in a major collision. The Hokies don't pull players from the game based solely on the sensor's readings, Duma says, but it does help them immediately look for signs of a concussion. Schools like North Carolina, Oklahoma, Dartmouth and Brown have already implemented the system, which costs between $50,000 and $75,000, and Duma said several NFL teams have shown interest.

"We know every single head impact that has happened to all of our football players in the last 10 years," Duma said. "We know the exact exposure. We know how many times they've been hit, how hard, and what direction the hit came from. That's much more powerful than talking about hits without knowing how many actual exposures there were, because exposure is the key. It's like cigarettes. It doesn't matter how packs of cigarettes are in your pocket, it matters how many you smoke."

The research data, as well as 2,000 crash tests done in the department's 25,000-square-foot lab in Blacksburg, Va., also helped the school come up with a five-star rating system for all football helmets sold in the United States. The ratings, the first of their kind, were so influential, according to Duma, the lowest-rated helmets -- the Riddell VSR-4 and the Adams A2000 -- were taken off the market by their manufacturers.

"When we switched from the VSR-4s to the Riddell Revolution, it was like a light switch," Duma said. "Concussions were reduced by [more than] 31 percent."

Virginia Tech isn't the only major program welcoming scientists into their locker room to study brain trauma. For the second straight year, Stanford football players will be wearing mouth guards that have tiny sensors implanted in them to measure the severity and frequency of hits they endure. The data is collected, stored and then studied in a hundred different ways by budding young scientists.

And unlike the NFL, where players have shown a reluctance to participate in studies that aren't yet part of the collective bargaining agreement, Stanford football players have mostly been happy to serve as guinea pigs.

"I think we have a really unique situation where we have undergraduates who are participating in a study, but they're also responsible for doing research while they're here," said Scott Anderson, Stanford's head athletic trainer. "The idea we're doing research on them is not a foreign concept to them. It's something they actually embrace. A number of student-athletes are here to pursue medicine in general, to get their degree in pre-med or to pursue a career in medicine, so it's not a concept that's lost to them."

A lot of Division I coaches might have also been reluctant to have scientists poking around their practices. Not Cardinal coach David Shaw, who was once a Stanford student himself.

"At Stanford, we don't like to follow people. We want to be at the forefront," Shaw said. "So if there is something we can do, if there is a way we can learn to make the game safer and better, we want to get that technology in our hands. If we could reach a point where every single team had sensors in their helmets, and it could measure when someone was involved in an impact that can cause a concussion, and we could take a player out so that no one ever goes back into a game with a concussion, I think that would be huge. We're not there yet, but I think we all want to find a way to make this game as safe as it can be."

Shaw said, in addition to the mouthpiece sensors, Stanford has also installed $100,000 high speed cameras at the team's practice facility. They've used the cameras in cooperation with doctors and researchers from the medical school to study what the collisions look like when you slow them down to a hundred frames per second, like you're watching a hummingbird flap its wings.

"It's really taught me a lot, just about the nature of concussions," Shaw said. "I don't think you can completely see everything that happens, exactly what's going on, until you see it in super slow motion. We can apply what we're seeing as coaches. We can teach better tackling technique. We can show a player the exact moment when he starts to drop his head."

Dr. Dan Garza, an assistant professor of orthopaedic surgery at Stanford School of Medicine, who is also the San Francisco 49ers' team doctor, oversees the study, a collaborative project between Stanford medical school and the athletic department. He says he understands the desire to find some answers, to come up with a way to make the game safer so fans don't have to feel guilty about enjoying it. But science tends to move slower than a 350-pound lineman.

"People get really frustrated because they want conclusions, but it takes time and numbers," Garza said. "When you hear about some of these potential neurological disorders, are those the result of concussions? Or what we call subconcussive events? It isn't clear which is more important, short-term or long-term. And when people say we should be counting the number of hits that kids and players receive, you then have to say, 'OK, define a hit.' That's part of the problem. If I hit you in the chest and your head whips back and forth, is that a hit? What acceleration constitutes a hit?"

That's a question scientists like Dr. Jacob Resch -- an assistant professor in the Department of Kinesiology at the University of Texas-Arlington, and the director of the school's Brain Injury Laboratory -- have been trying to answer for several years. Resch recently published a study that found the popular ImPACT test, a computerized memory and motor skills program athletic trainers often use to determine when an athlete can return to the field after suffering a concussion, was misclassifying nearly 30 percent of participants. The test showed patients were either significantly worse, or significantly better, than they actually were.

We're trying to educate people about concussions, and there are conversations you need to have with athletes. You need to say: These are the risks. Because unfortunately concussions are inherent in the sport. There is no way to eliminate this injury from the game. It's just going to be there.

--Dr. Jacob Resch, professor at the University of Texas-Arlington

"We believe it's an OK test, but it's not the end-all, be-all," Resch said. "It has to be used with multiple tests. … We're trying to educate people about concussions, and there are conversations you need to have with athletes. You need to say: These are the risks. Because unfortunately concussions are inherent in the sport. There is no way to eliminate this injury from the game. It's just going to be there."

That unfortunate truth -- that we can't eliminate concussions in football, no matter how hard we try -- just might make the research Dr. Mayland Chang is doing at the University of Notre Dame the most important study of them all. Instead of using better equipment to prevent concussions, Chang is hopeful she's found a way to halt the death of brain cells that occurs when an athlete takes a concussive blow to the head.

"When a traumatic brain injury [TBI] takes place, there are two types of damage that occur," Chang said. "There is the primary injury, and that occurs from the initial trauma. Immediately after the trauma, nothing can be done to rescue the brain cells. But there is a second wave of injury that occurs, anything from hours to days later depending on severity of the TBI. There are ways we can intervene during that time and prevent that secondary wave of injury."

When someone suffers a concussion, there are enzymes released by the brain that start a "biological cascade of events" that kills brain cells. Chang and her team of researchers have developed a water-soluble inhibitor that halts the destructive actions of those enzymes. Someday, thanks to Chang's research, doctors might be able to inject a concussed athlete with a drug that would literally prevent their brain cells from dying.

"We know it works in animals right now," Chang said. "We have used it with mice and it works. But there are a lot of additional studies that need to be done before we take it into humans."

Additional studies will cost money, Chang said. A lot of money, to be frank. Universities are a great environment for innovation, she adds. They're the places that are eventually going to come up with the creative, therapeutic solutions, she believes. That's one of the reasons why she received a grant from NFL Charities to fund some of her research. But getting approval from the Food and Drug Administration for something like this can take more than a decade, and close to $100 million in funding. Eventually, some entity with a significant amount of money is going to need to invest in this research -- even if the motive is profit -- to make it a reality.

"The problem right now is many of the studies needed are toxicology studies," Chang said. "We need to know the compound is safe in animals before we can go to humans. And to do that, we would need to manufacture kilograms of it. Those really aren't studies that can be done in an academic setting. They require funding, and usually federal funding is not available."

Could Chang ever envision the NFL and the NFL Players Association working together to fund that kind of research, considering they each have a vested interest in the outcome?

"That would be nice," Chang said. "Right now, the grants the NFL gives are really geared more toward basic research. They're small pots of money. But it bridges the gap to something."