At an NFL summit meeting on concussions three years ago in Chicago, Dr. Julian Bailes made an extraordinary proposal: Take the three-point stance out of the game, he said, and take the head out of the sport.
"There was no support for that when I first brought it up," said Bailes, chairman of the department of neurological surgery at West Virginia University. But commissioner [ Roger] Goodell did mention that around the Super Bowl this past year. Whether it was a trial balloon, I don't know."
In a rush to make up for lost time on the concussion front, the NFL is listening to lots of suggestions these days about how to make its game safer and purge itself of violent helmet-to-helmet collisions. Those suggestions include the elimination of the three-point stance, modifications of ever-dangerous special teams plays, banning helmets in practice, and more.
The Ravens were in the middle of the brouhaha last month when Week 6 produced three particularly violent collisions that had the NFL scurrying to clean up the dark images on ESPN's "Sports Center." Tight end Todd Heap was on the wrong end of one of those hits, and even though he had head and neck pain through the week, he maintained a player's perspective.
"It's football," Heap said. "We all know the sport that we play. We all know the risks of playing football. And I think over the years, they've been trying to more and more make it a safer game."
For all of the league's attempts to address the issue, there is hope that the threat of suspension and heavy fine will prove more of a deterrent than the mandated poster in every locker room and the pamphlets passed out at the beginning of the season.
While league insiders scoff at the idea of changing the way the game is played in the trenches, there are studies that predict head trauma in the collisions that result from the three-point stance.
Kevin Guskiewicz, the director for the Center of the Study of Retired Athletes at the University of North Carolina, points to a six-year study of college players who wore accelerometers in their helmets that measured the location and severity of head impacts sustained during practice. Guskiewicz said that on average, North Carolina players had 950 impacts per player per season at practice. (The study was sponsored by the Centers for Disease Control and Prevention, and by the National Operating Committee in Standards for Athletic Equipment (NOCSAE).
"The good news is that a very small percentage result in concussive injury," he said. "But the big question is, what happens when you begin to add up all the sub-concussive impacts over a career? Add those up and I think there's an important piece of the concussion puzzle that can be explained."
Guskiewicz said it was not just the number of concussions that was important, but the effect of sub-concussive impacts over an extended time, such as those sustained by NFL players.
"If a player has 950 impacts for 10 seasons in a row, that may mean something," he said. "It may not mean much at 35 when he retires, but over time it may mean a whole lot at 55 or 65."
At the Center for the Study of Retired Athletes, Guskiewicz has already formulated the risk factor for retired players with a history of concussions.
He said that a player who has sustained three or more concussions during his pro career is at five times the risk of being diagnosed with cognitive impairment after the age 50 over players who didn't have three. And the same player is three times more likely to be diagnosed with depression at age 50.
Bailes drew similar conclusions after Oklahoma University did the accelerometer study to measure impacts on its players. He said the big hits — like those on defenseless wide receivers and quarterbacks — drew 90 to 100 g's. And that was defined as the threshold for losing consciousness.
"So the Oklahoma data established the threshold for humans being knocked out," Bailes said. "But what was amazing to me, they showed also that linemen were getting [impacts of] 20 to 30 g's on every play."
Bailes then issued a chilling postscript to that study that may or may not have a connection.
"[Neuropathologist] Bennet Omalu and I have autopsied seven NFL linemen, none with the history of concussion, and all had CTE [chronic traumatic encephalopathy]," Bailes said. "They had it in the brain at autopsy and they had it clinically — failed marriages, business failures, depression, drug and alcohol use and suicide."
Bailes said the Oklahoma study also showed that a lot of big hits did not result in concussion, so "it's an incompletely defined or understood part of the science. The study hasn't solved all the issues, but it has yielded some interesting results."
Guskiewicz is a member of the NFL's restructured head, neck and spine committee. He also chairs a sub-committee on equipment safety and rules changes and in that capacity, he hopes to take the accelerometer into the NFL next season.
"One of the questions we have is, are there certain locations that need to be considered for helmet technology, making materials better?" Guskiewicz said. "Another thing, it will help us learn whether certain positions sustain greater impact than other positions. As we're thinking about rules changes, it will help with that, too."
Guskiewicz said the next wave of NFL testing will be determined at another summit meeting in December.
Asked if the NFL was receptive to this kind of dialog, he said, "I know they are."