Featuring Dr. Kenton Fibel in "Chris Borland’s retirement takes some concussion experts by surprise" by Jerry McDonald
March 17, 2015
Chris Borland’s retirement at age 24 caught even some leading concussion experts by surprise.
While they understood why the promising 49ers linebacker would be troubled by an increasing list of post NFL-career horror stories, some doctors cautioned that the high-profile cases overshadow recent breakthroughs in the treatment of sports-related brain injuries.
“The concern over chronic brain injuries in sports is an important concern and I’m glad it’s finally being recognized,” said Barry Jordan, the assistant medical director of the Burke Rehabilitation Hospital in White Plains, New York. “But I just hope that the pendulum doesn’t swing too far in the other direction.”
Micky Collins of the University of Pittsburgh Medical Center said: “There’s so much worry and concern about concussions out there that I’m afraid that we’re not getting the right information to patients.”
Borland stepped away from the game Monday, citing his own long look into the fate of players who suffered concussions in the NFL. Most troubling to him were the suicides of players such as Dave Duerson and Ray Easterling, who were later discovered to have chronic traumatic encephalopathy.
Borland’s brief look into the head-banging that goes on in the NFL was enough for him to give up the game — even after a sensational, and healthy, rookie season in San Francisco. Borland told ESPN: “I’m concerned that if you wait till you have symptoms, it’s too late.”
Collins was sympathetic –“Obviously it’s his life and his well being. I respect that” — but he was thrown by the player taking such a dramatic stance before seeing signs of trouble.
“Don’t get me wrong. There are definitely more problems that can arise from concussions. And we see it every day in this clinic — there are kids who are sick and not doing well,” he said.
“But I think the story that hasn’t been told is that there have been a lot of advances in how we treat it. I think we’re getting better and better and better at the management of the injury. I actually think there’s never been a safer time to play than right now because of all the advances.”
Collins is the executive director of the Sports Medicine Concussion Program, which estimates it saw more than 17,000 patients last year. His clients included Giants players Brandon Belt and Hector Sanchez as well as catcher John Jaso, who spent last year with the A’s.
Collins said the diagnostic tools and treatment options are getting better, and he’s seen the uptick in his own clinic. He estimated that about five years ago, he had to end the playing careers of 100 of the 10,000 patients he saw. Last year, it was only five of the 17,000.
“The best way to deal with concussions,” he said, “is to manage it effectively when you have one.”
But Borland’s choice resonated more deeply with Christopher Nowinski, the co-director of the BU CTE Center. A former Harvard football player who became a professional wrestler, Nowinski retired early from the WWE because of concussion-related issues.
He read that Borland was unnerved by players such as Dave Duerson and other players who were diagnosed with chronic traumatic encephalopathy after they committed suicide.
“I was surprised at (Borland) news initially, but when I read about how he visited researchers and spent months looking into this, I can’t say I’m surprised by his conclusion,” Nowinski said.
“He knows Dave Duerson story. He knows Ray Easterling’s story. He knows Mike Webster’s story. He understands the downside to all those hits to the head. Nobody would want to put their family through that.
“If he’s done his homework, he knows that the number of diagnosed concussions doesn’t correlate well with risk of CTE. The number of concussions shouldn’t necessarily weigh into his decision if he’s concerned about CTE.”
Kenton Fibel, the team physician for the New York Rangers, was among the doctors who indicated that a pre-existing condition — perhaps a genetic component — could be a factor for those who suffer the after-career effects of brain trauma.
“I think as imaging improves and we improve the research in the future, I think we could see who would be someone to counsel regarding further risk,’ he said. “At this time, it would be a little premature to feel that you’re still at increased risk for the future if you’re not feeling symptoms.”
Better NFL protocol
Fibel also said that the NFL’s stricter concussion protocol offers a dramatic improvement over previous eras.
“We used to say that players got ‘dinged’ or ‘got their bell rung.’ These are classic things, where you wouldn’t be tough if you didn’t play through them. You could just get back out there,” said Fibel, the assistant attending physician at Hospital for Special Surgery in White Plains. “I think the real education has come that all these instances should really be closely monitored and should be closely evaluated.”
Roger Craig, who made four Pro Bowls with the 49ers, can see the cultural shift. He said in the early 80s, players were naïve to the risks, and he said he respected why Borland would be unnerved by the fallout.
“I think gladiators think they can overcome a lot of adversity and not really think about later on in life,” Craig said. “But nowadays, kids are a lot smarter.
“They’re starting to see what happens to some of these players, like the Tony Dorsett, who has memory loss. Jim McMahon. I could go on and on and on. … So you can understand what goes through kids’ minds these days. They’re saying, ‘This is what happens to these guys. I don’t want that to happen to me.’ So you get spooked a little bit, you know? … You have to respect (Borland) and his beliefs as far as not wanting to take football to the next level.”
There are signs that the landscape is changing. In January, the NFL pointed to a University of Michigan study designed to evaluate the impact of new concussion laws. The study found a 92 percent increase in school-age children whose families that sought medical assistance for concussions in states with the legislation in place.
Jon Alston, a former Stanford linebacker whose NFL career included playing for the Raiders from 2007-09, echoed Craig’s viewpoint that players are better equipped with information.
“Guys now are realizing that even though you can’t specifically see that injury, like a broken hand or a broken leg, the dangers and implications of going forward are very, very serious,” Alston said. “My hat is off to (Borland). I have to applaud this guy. He’s a stud.
“He was the defensive leader of the San Francisco 49ers. … He had a great season, a great rookie year, and comes in at this point and says, ‘Look, my future and my long-term health are just more important.”
More and more parents are deciding to end their child’s playing career before it starts. Fifty percent of Americans said they wouldn’t want their son to play football and only 17 percent believed the sport would grow in popularity over the next 20 years, according to a Bloomberg Politics poll released in December.
Bloomberg noted that brain issues were only part of the hesitation after a 2014 rife with negative headlines for the NFL. But in all, 62 percent of college-educated respondents said they don’t want their children playing the sport and 62 percent of those making $100,000 or more a year agree.
It’s tempting to see Borland’s early retirement as another black eye for the NFL. But Hall of Fame executive Bill Polian told Sirius XM NFL Radio he disagreed.
“No, I think it’s an isolated incident that’s getting a lot of attention,” Polian said Tuesday. “You’re seeing a lot Chris’s teammates saying we respect his decision, we think it’s the right decision for him, but it’s not the decision that I would make.
“So there’s a whole spectrum of opinion here and Chris has his point of view, again, not caused by any immediate trauma, but the fear of trauma going forward, and that’s perfectly reasonable. But I don’t think you will get a lot of other players who feel that way.”