Taking Traumatic Brain Injuries Seriously – Lessons from the NFL

By Cory Bilton

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When I was about 10 years old, I once made the mistake of slamming on my front-wheel brake on my bicycle. I launched up over the handlebars and crashed head-first into the street, wearing no helmet. I don’t remember hitting the ground. Fortunately, neighbors saw my crash and called 911 as I lay unconscious in the roadway. For weeks after the incident, I had a huge knot on the side of my head. My doctor said that after a concussion such as mine, I should go slow, limit my activities, and rest my brain as much as possible.

I remember having to sit on the sidelines each day in gym class while I recovered. My gym teacher openly mocked me in front of my classmates, calling me “hematoma boy.” My gym teacher must have thought that my forced-nonactivity was unnecessary or a maybe a ruse. Maybe he thought the magnitude of my injury was too small to warrant any limitation on my physical activity. Maybe he thought I should just “walk it off.”

Even today, more than 20 years later, there is a still tension between people that think all head injuries should be taken very seriously and those that think concussions aren’t a big deal. However, the debate is increasingly one-sided. Evidence is building that shows my doctor was right and my gym teacher was wrong: concussions should be taken very seriously.

During the last two decades, this debate has been playing out in real-time in the NFL. About 10 years ago, a handful of doctors participating with the NFL and its teams published academic research showing players’ brain functioning did not decline after a concussion and that multiple concussions had no long term effects. However, further, more independent, research has refuted those results and shown that many ex-NFL players suffer extensive brain disease as a result of concussions (PBS Frontline has excellent resources in its League of Denial coverage). The prior research had been part of the NFL’s attempt to avoid the consequences: liability to players, limitations on the way football is played, and steering children away from football altogether.

The NFL has recently started changing its tune. Last weekend I read a NY Times article about the NFL’s new concussion management protocol. As I read, I realized that a lot of the protocols the NFL is adopting are methods similar to those from another group that takes injuries seriously; personal injury lawyers. Here are some familiar lessons from the shared playbook:

Changing the Conversation

Football players used to use the word “dinged” every time a player suffered a concussion. The word implies that concussions have a minor or temporary effect. Now, team leaders like Ronnie Barnes, the New York Giants’ senior vice president for medical services, remind players to stop using the word “dinged” and replace it with “traumatic brain injury” (or “TBI”). He reminds players that “Each time you get a concussion, you’ve injured your brain.” This change of language is necessary to reflect the truth, but also to stop others from verbally minimizing the effect of a concussion. The damage to the injured person is real and needs to be taken seriously.

Looking for Signs

The symptoms of traumatic brain injury are not always easy to recognize. Some common symptoms give a clear appearance of injury, such as loss of consciousness, headache, and slurred speech. But other symptoms, such as amnesia, ringing in the ears, fatigue, and delayed response, are not easily noticeable to others. So the NFL has started employing concussion spotters in the upper level booths and more trained personnel on the sidelines to watch for and immediately respond to head injuries. These spotters watch for plays that result in concussions and then watch those players for signs of confusion, repetitive motions, or body ticks that indicate something is not right. To see the damage caused by a traumatic brain injury, one has to know what to look for.

Independent Testing

Another new policy being implemented by the NFL is on-the-field independent testing when a player has suffered a concussion. On the sidelines, team doctors will test the player’s senses and ask a series of standardized questions to test the player’s mental functions. This is an attempt to measure the magnitude of the traumatic brain injury. Unlike a broken arm or a laceration, impaired mental functioning is not always evident to outsiders. As the seriousness of traumatic brain injuries has been realize, this testing has become more comprehensive than just “How many fingers am I holding up?” If there is no testing or measurement, most people will believe the person is not injured.

Encouraging the Injured to Speak Up

In addition to training professionals to look for the signs of injury, it is important to educate normal people about traumatic brain injuries, too. People need to know the signs and symptoms so that they will speak up if they are experiencing them. NFL players, for example, need to know that symptoms such as changes in mood, difficulty remembering new information, and trouble falling asleep can be symptoms of traumatic brain injury. These symptoms may not happen immediately or all at once, but instead can show up in the weeks or months after the concussion. More players are likely to speak up and self-report head injuries when they know the warning signs.


Fortunately, traumatic brain injuries are getting more serious attention by the NFL and the public at large. Having worked with clients that were suffering from traumatic brain injuries before, I have seen the damage it causes to a person’s life and wellbeing. Ironically, many of the symptoms go unnoticed by the person suffering from them. And these symptoms are sometimes permanent. So not only does the injured person suffer, but friends and family members suffer because their injured loved one requires more assistance or seems to have become a completely different person. Reading through many of the stories about ex-NFL players in the League of Denial coverage shines light on this same truth. Whether you are playing football or injured in an accident, approach any concussion with the seriousness it deserves.

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