Hours before kickoff of the National Football League's 93rd season, troubling headlines rang out. Former NFL players, according to a new study, were three times more likely to die from brain disease. It was the latest evidence on threats of sports-related head injury to long-term health; the latest chapter in a nightmarish public image story for the league. The NFL opened its coffers, pledging $30 million to support related research. Public outcry rekindled. Concerned mothers pulled their kids out of Pop Warner. A prominent class-action lawsuit appeared to gain strength.
Here's what you might have missed. The same study found former NFL players less likely to die from cancer (by 37 percent), cardiovascular disease (29 percent), injuries (31 percent), violence (74 percent) and all other causes (63 percent). Altogether, they were roughly half as likely to die during the study, compared to age- and race-matched peers. Alzheimer's, Lou Gehrig's, and Parkinson's disease mortality were substantially higher, but together accounted for just 2 percent of deaths. For 98 percent of the things people died from, football players were actually better off.
Scientists urged caution, reminding us that these athletes played between 1959 and 1988. Today's bigger, faster, stronger NFL could be more dangerous. Certainly, those 2 percent of deaths -- and attention to head injury in general -- are vitally important. Awareness from similar studies, and advocacy by organizations like the Sports Legacy Institute, have dramatically changed the concussion conversation. The status quo has evolved from minimization (when you "got your bell rung" you "manned up" and went back in the game) to formal advocacy and legal accountability for evidence-based care, developed and supervised by medical professionals. This is a good thing.
Still, the science of sports concussion is young. Leading experts issued a consensus statement in 2008 emphasizing education, identification, and proper management of concussion to reduce health risk. Following last month's International Consensus Conference, the guidelines will be updated with new evidence, including potential for long-term damage and the importance of personalized, conservative return-to-play decisions. The fundamental message, however, is unlikely to change. Concussion is critically important to understand, prevent, and manage. Continued research, education, and advocacy are essential to that end. But concussion does not single-handedly determine an athlete's health and well-being.
Ironically, the alarm surrounding head injury has disserviced retired athletes by distracting attention from broader health concerns. Former athletes have rightly brought awareness to the under recognition and under treatment of their lifetime health. This includes diverse issues; joint injury, heart disease, diet, exercise, health care, and the profound physical, psychological and social challenges of end-of-career transition. They've challenged sports institutions and organizations to better understand and promote their long-term well being, and questioned the ethics of treating competitive athletes as expendable commodities. Unfortunately, evaluating these issues in piecemeal -- and particularly assigning concussion as a scapegoat -- fails to adequately address the complex, holistic health needs of retired athletes.
A prime example is the death of former University of Southern California (USC) and NFL linebacker Junior Seau. Following his suicide in May, Seau's legacy was immediately turned into a call-to-arms on concussion. Before any evidence emerged, an explanation was assumed. It had to be all the hits to his head. However, as triathlon great Scott Tinley aptly noted in Sports Illustrated, suicide is one of humanity's most complex challenges. Maybe head injury was a factor. Perhaps it exacerbated other complex health issues that Seau faced. But defining the entire context of someone's life and their tragic decision to end it according to a concussion, or even a series of them, is a gross oversimplification, and a mistake. Our health is much more complicated, inconvenient and perplexing as that may be.
Research on lifetime health in modern athletes is remarkably sparse. A 2009 University of Michigan study found that former NFL players had substantial health challenges; more arthritis, pain, dementia, and depression than their peers. They also had benefits; less heart attacks, strokes, and diabetes. They were more likely to be married and college-educated, and expressed a positive view of their NFL experience. This dichotomy, good juxtaposed against bad, is striking. In studying former NCAA student-athletes at USC, we found similar contrasts. These athletes had more joint health concerns than their peers, but similar quality of life. They exercised more during college, but not after graduation. The most common health issues were diverse; knee and shoulder concerns alongside challenges in personal relationships, life adjustment, and body image. All of these issues began before college.
The full picture of an athlete's health is complicated, counterintuitive, and at times perplexing. Only in appreciating an interdependent, whole-person perspective, however, can we act decisively, proactively, and appropriately to serve their well-being.
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