Technology can’t save football players' brains

Safer helmets and smart mouth guards can help, but it’s the game that needs to change.

Tregg Duerson was 25 years old when his father committed suicide in 2011. A former defensive back for the Chicago Bears, New York Giants and Phoenix Cardinals, David "Dave" Duerson made a career out of being one of the most feared tacklers during his 11-year stint in the National Football League. His skill set helped him win two Super Bowl championship rings, one with the Bears in 1985 and another with the Giants in 1990, cementing his legacy as one of the NFL's all-time greats. Along the way, he was also selected to the Pro Bowl, a postseason game that rewards the league's best players, four consecutive times from 1985 to 1988. Duerson had the NFL career most players can only dream of, but it ultimately cost him his life.

At age 50, more than 15 years after his NFL retirement, Duerson was found dead from a self-inflicted gunshot wound to the chest at his home in Sunny Isles Beach, Florida. After years of battling with symptoms that he suspected were a sign of chronic traumatic encephalopathy (CTE), he decided he couldn't cope with the effects any longer and chose to take his own life. Prior to his death, however, Duerson told friends and family he wanted his brain to be studied. By donating his remains to science, his hope was that doctors would learn more about a disease that we now know has plagued hundreds of deceased NFL players -- including a handful who also committed suicide once their football careers were over.

In May 2011, two months after Duerson's death, doctors at Boston University officially diagnosed what he seemingly knew and feared for years: He suffered from CTE, a progressive neurodegenerative brain disease often found in people with a history of repetitive head trauma. Symptoms include blurred vision, dementia, depression, headaches, memory loss and mood swings, and these only get worse over time. There's no cure for CTE, making the disease unbearable for anyone who suffers from it.

Doctor Ann McKee, the neuropathologist who examined Duerson's brain, said there was indisputable evidence of CTE in the tissue samples she tested, adding that there was "no evidence of any other disorder" in him. "It's tragic that Dave Duerson took his own life," she said at the time, "but it's very meaningful that he recognized the symptoms of the disorder. It validates this condition."

"This bill honors my family's hopes and my father's legacy to protect future athletes and the future of football."

Tregg's story is an unimaginably tough one for him to tell, but he's now using it as the basis to promote a safer way to play the game of football. That game gave so much to him and his family growing up in Chicago, leading up to his days as a player at one of the most prestigious college-football programs in the world: Notre Dame. And that game ultimately played a major role in taking his father away. But Tregg's focus isn't to spread that message by advocating the use of custom-made helmets with better padding or smart mouth guards that can monitor head impacts in real time. Because as helpful as technology innovations can be to mitigate the issue, Tregg believes the best way to reduce the risk of brain injuries is to eliminate physical contact altogether. At least for players who are just starting off.

With the Duerson Act, which he wrote alongside Democratic State Representative Carol Sente, Tregg is proposing to ban tackle football for kids under the age of 12 in Illinois. "Thanks to increased attention and research on brain trauma, we know that part of the solution is to guard young children's developing brains from the risks of tackle football," he said in a statement introducing the Duerson Act. "This bill honors my family's hopes and my father's legacy to protect future athletes and the future of football."

While there's no scientific proof that setting an age threshold for tackle football can reduce the risk of long-term brain injuries in players, the idea that limiting physical contact could be a solution to the problem doesn't seem farfetched. The challenge ahead for Tregg is to make parents and coaches understand that their kids can fully develop skills without tackling, which has historically been a core element of the game. Tregg said in an interview that the key is to educate young people on what can happen when they play a contact sport and the effects that this can have on them being able to live a normal life beyond football.

Tregg added that although the Duerson Act is solely about protecting players from physical hits, technology can be key to keeping better track of when someone's been hit and accurately measuring impact levels, particularly around the head. Companies like Prevent Biometrics are already working on products designed to address these issues. With the Head Impact Monitor System (HIMS), for example, Prevent has created a sensor-laden mouth guard that can detect collisions immediately, the idea being that this would prompt players and coaches to seek medical treatment on the sidelines.

If the HIMS works as advertised, it has the potential to substitute methods such as observational tests, which have proved time and time again to be ineffective. Those traditional diagnostic methods often fail because it's tough to convince a player to get off the field and at times, team doctors don't do their due diligence, as their priorities lie with the club rather than the individual.

The NFL has tried to address this by implementing a concussion protocol that employs independent doctors on the field, but the system isn't perfect. Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, called the protocol a "fraud" last November after an incident in which Indianapolis Colts quarterback Jacoby Brissett took a helmet-to-helmet hit during a game. Brissett was allowed to continue playing, despite going limp and showing what Nowinski called one of the "clearest concussions signs of the season."

Helmet makers like Riddell, meanwhile, have been working on solutions of their own. The company's Precision-Fit tech is used to make customized helmets for each player. To do so, Riddell scans the surface of a player's head and uses that image and exact surface to create a helmet that fits him exclusively. That can in turn create better protection, since literally every curve is covered.

In addition, Riddell has also developed its InSite training tool, a helmet-based sensor system that can measure impact data and upload it to a server where coaches and athletic trainers can view the results. Riddell emphasizes that the idea behind InSite isn't to be a diagnostic tool or a medical device but rather to simply act as a monitoring system that can help staff proactively reduce the head-impact exposure of players. It could, for instance, show if a player's hitting technique is poor or if his playing style needs to be adjusted.

InSite isn't being used in the NFL right now, but there's a chance we'll see it make its way to the league in the near future. For now, Riddell says 20 players from the Philadelphia Eagles will be wearing Precision-Fit helmets when they face the New England Patriots this weekend during Super Bowl LII. You may also see players using the VICIS Zero1 that night, a helmet designed by engineers and neurosurgeons that garnered investment from the NFL for being one of the most impact-reducing products for its players. The Zero1 features multiple layers of foam that are meant to slow down impact forces and mitigate collisions by offering players the widest possible field of view.

The NFL has made more than 50 league changes that are intended to reduce the amount of contact players have to deal with.

Innovation in protective gear is one of the areas the NFL has been heavily investing in since 2016, when it launched Play Smart, Play Safe, an initiative intended to drive progress in the prevention, diagnosis and treatment of head injuries. As part of that, the league has pledged $100 million to the cause, promising to support independent medical research and engineering advancements that help protect players and make the sport generally safer.

Of the $100 million the league has committed, $60 million will go to the league's Engineering Roadmap. It first plans to borrow successful injury-prevention techniques from the auto industry to create a robust head-protection program for players. It then plans to develop accurate impact sensors and work on helmet tech that can make hits less excruciating. Last but not least, it will create incentives for companies to use this research to create a new breed of protective equipment.

Most importantly, perhaps, the NFL has made more than 50 league changes that are intended to reduce the amount of contact players have to deal with, especially when they're not playing actual games.

For starters, the off-season program was reduced from 14 to 9 weeks, during which teams are only allowed to make players wear helmets for four of those. Then, in the preseason, the NFL eliminated two-a-day practices, forcing teams to only conduct one padded practice per day. As for the actual season, one of the biggest changes was limiting permissible padded practices to 14 for the entire 17-week season, compared to the unlimited number prior to 2011. Players can now also only have two padded practices per week during the season, and every team is required to film all practices, which helps the NFL health officials review tape in case there are any concussions recorded.

Why did it take the NFL this long to take action, considering that the issue surrounding brain injuries caused by the sport is decades old? Jeff Miller, the NFL's executive vice president of health and safety initiatives, told Engadget that as the league learns more about the topic from researchers, clinicians, coaches and, of course, players, it can do its part to try to solve the issue as best as it can.

Miller pointed to the NFL's ongoing medical and engineering research efforts as proof that the league is instituting changes to how the game is taught as well as the way it is helping "take the head out of the game." He said the NFL is fully committed to understanding diseases like CTE and traumatic brain injury, noting that the league is constantly working with innovators across the world to come up with the best diagnosis, treatment and injury prevention for players. "Awareness of and interest in this issue only continue to increase," he said. "We think that is critical to continuing to advance progress, and we intend to remain at the center of the effort and the discussion."

Tregg said that people should take the NFL's word with a grain of salt. After all, he said, the league has its own agenda and public image to protect. "The NFL is an entertainment business," he said. "They make billions of dollars and pay people a lot of money, and a lot of [the] decisions that they're going to make along these lines are tied to entertainment." He added that at the end of the day, the NFL is going to do what's best for its bottom line, even if it comes at the expense of players' health. "Some players," said Tregg, "are willing to take the health risks to be compensated."

"They make billions of dollars and pay people a lot of money, and a lot of [the] decisions that they're going to make along these lines are tied to entertainment."

Still, even with improvements in technology, science and rule changes, the main issue continues to be the lack of players' self-care. A high school player who may have a concussion, for example, may not want to come out of a game because his time on the field could mean a college scholarship. The same goes for someone who plays in college, with the only difference being that what's at stake is an NFL contract. And for players in the NFL, being out with a concussion could end up affecting time on the field in the next game or, at worst, losing out on a contract extension.

"I would say that where technology can be very helpful is in finding those individuals that are concussed," said Tregg. "Because quite frankly, there's not going to be many players who are going to raise their hand and say, 'I'm willing to leave the field because I have a concussion.'"

That's a cultural problem that Tregg said involves a lot of social factors, too, like players not wanting to let themselves or their teammates down. "They are so competitive, and they're driven by that competitiveness to win the game or even to sustain their starting position," he said. "The likelihood that we think the average [player] is going to say, 'Yes, I'm concussed, can you take me out of the game?' is probably pretty low. And I think with the help of technology, we can find objective ways to identify those individuals."

Doctor Robert C. Cantu, co-founder and medical director of the Concussion Legacy Foundation and a clinical professor of neurosurgery at Boston University School of Medicine, said the other main problem is the common misconception that concussions are the primary cause of CTE. Cantu and other researchers believe that even mild head injuries can pose a major risk for developing the disease.

The challenge with CTE is that it can only be diagnosed through a posthumous study of a patient's brain tissue. That said, a study from Evanston's NorthShore University HealthSystem in 2017 claimed to have found CTE in a living ex-NFL player for the first time ever, though the doctors behind it said further research is needed to corroborate these results. To make matters worse, there's no proven treatment for CTE, making the disease basically impossible to control.

Cantu said that even the most protective, tech-forward helmets may not be enough to help save a player from the long-term effects of CTE. "Think of an egg that hasn't been cooked. Now wrap it in Bubble Wrap and drop it on the floor. The shell of the egg will not break because it's been protected by the Bubble Wrap, but the yolk will be scrambled when you open it," he said. "That's the problem you have with helmets. You can build bigger and better helmets, and you can get mouth guards that are somewhat helpful, because it gives something to bite down on and tense your neck muscles without breaking your teeth. But the forces are too great. It's like that Bubble Wrap. You're going to prevent the skull fracture, but you're not going to prevent a shaking of the brain inside the skull from the head. That's what we're up against."

For Cantu, technology is still important, especially if it can actually make a difference in players' lives. But he said the real difference will have to come from outlawing hits to the head and practicing differently, whether it's at the youth, college or professional levels. "What's going to save football," he said, "is when that type of reduction is put in place and there will be far fewer head blows administered."

That's hard to ask of a sport whose charms, for better or worse, are its aggressiveness and physicality. But this change in behavior and the belief of players, schools and leagues that there needs to be a cultural shift will, ultimately, be crucial for the future of the sport. And teaching that mindset of self-awareness and self-care starts from the bottom, with young kids playing at the youth or high school levels, as Tregg Duerson hopes to accomplish with his efforts.

It may not be easy and it may not happen overnight, but everyone involved seems to have figured out what's at stake: lives. Even if it took longer than it should have.

Images: USA Today Sports/Reuters (Dak Prescott helmet shot); Getty Images (all other photography)