“I always said I would play ‘til the wheels fell off, and they basically did.”
Matt Dunigan remembers the game that ended his career. He was playing with the Canadian Football League’s Hamilton Tiger-Cats in September of 1996, having just made it to the sidelines after a series of big hits and pile-ups that saw the Ti-Cats run out of downs. It was a short reprieve for the quarterback who spent 13 years in the CFL; back on the field, under center, he was ear-holed on two consecutive plays.
“When I was helped off the field that day, I knew that my career was over with,” says Dunigan. “Something drastically had changed inside of me. I felt like my armor had been pierced wide open.”
Concussions have become a game changer in football as both the CFL and the NFL, where the sports’ biggest, baddest, and best play every Sunday, grapple how to handle its devastating effects that could very well threaten the leagues’ survival. But it’s the little league north of the 49th parallel that could become a vessel for meaningful change in the NFL.
Much has been written about traumatic brain injuries since the discovery of chronic traumatic encephalopathy, or CTE, in 2008. CTE, which can only be diagnosed post mortem, is believed to lead to neurodegenerative conditions like memory loss, depression and dementia. As of September, 96 percent of NFL players that were tested for the disease were diagnosed with CTE. Although the first international concussion guidelines were introduced in 2001, only since the revelations of Dr. Bennet Omalu—who's played by Will Smith in Columbia Pictures' upcoming film Concussion—and Dr. Ann McKee has the dialogue around brain injuries escalated.
Both leagues have ramped up their concussion protocol efforts over the last decade. For their part, the NFL has implemented nearly 40 rule changes and penalties related to traumatic collisions, including moving the kickoff up five yards, and penalizing helmet-to-helmet contact. Since 2012, there has been a 34 percent drop in concussions during regular season games, and a 37 percent drop in concussions caused by helmet-to-helmet hits, according to the 2015 NFL Health and Safety Report. During the 2014 season, the NFL reported that less than half a concussion occurred per game.
Earlier this year, another partnership was announced between the CFL and NFL, one which Dunigan may have benefitted from during his time on the field. In August, the leagues announced a partnership to implement a sideline test to help athletic trainers and doctors more easily identify and treat concussions in real time.
“I knew that my career was over with. Something drastically had changed inside of me. I felt like my armor had been
pierced wide open."
—Matt Dunigan, cfl veteran
The King-Devick test is a timed visual examination in which a player rapidly reads aloud a series of lines of non-sequential and irregularly spaced numbers, which are then measured against a baseline test performed at the beginning of the season. The test, created in 1976 and performed on the sidelines, is setup to remove the player from the game if the player’s test scores are below their baseline. So far, the K-D test has been heralded as a “highly accurate” tool to pick up brain injury, and is being employed in the NHL, as well as in minor and amateur sports.
Four out of the CFL’s nine teams are currently using the K-D test: The Edmonton Eskimos, the Calgary Stampeders, the B.C. Lions and the Winnipeg Blue Bombers. The baseline tests were conducted during spring training camp, and the preliminary data will be mined and shared with both the NFL and NHL once the season comes to a close this weekend, after the 103rd Grey Cup. If the teams feel that the test contributed greater understanding of concussion identification, they’ll move to the next steps of implementing it into their respective protocols.
Jeff Miller, senior vice president of health and safety policy at the NFL, said that discussion around implementing the K-D test came out of the NFL’s Head, Neck and Spine Committee’s annual meeting at the NFL Combine. Approaching the CFL as their North American counterpart was a natural choice, and the NFL discovered that the CFL had also been considering using the sideline test in their protocols, too.
“[The CFL] put together a research protocol, both at CFL games and universities, to see whether or not the addition of the K-D test, used with current concussion diagnosis protocols, would make for a better and more accurate evaluation,” says Miller. “And so we joined together with them to participate in the research by contributing some funds.”
Kevin McDonald, the CFL’s vice president of football operations, said the teams are happy to implement a relatively easy test to provide trainers with additional information about potentially serious injuries.
“This is something that’s been around a long time, so the idea was, is this something that applies to adult males playing tackle football?” says McDonald. “If it’s an additional tool, it helps us better assess and evaluate, and we want to understand that.”
Prior to their partnership, the CFL and NFL practiced their own concussion protocols, including the use of the widely employed Sports Concussion Assessment Tool (SCATIII), now in it’s third iteration. Dr. Dhiren Naidu is the head team physician for both the CFL’s Edmonton Eskimos and the NHL’s Edmonton Oilers. He likes that the K-D test puts the player under a different sort of stress than a simple balance or memory test, hopes that the K-D test will be a good addition, but isn’t ready to fully commit to it as the be all and end all of concussion tests.
“You still need to get someone to medically evaluate them…but I’ve been quite impressed with what information I can get out of watching an athlete go through this,” says Naidu.
The CFL had an average of just over eight concussions per team in 2014, according to Naidu. And while its still working to present data as extensively as the NFL has done over the last few years, the CFL could confirm that reported concussions dropped 25 percent in 2015.
“If concussion treatment advances because football has an opportunity to pursue it or the identification of concussions advances because of the work we’re doing with the CFL, that’s going to have a huge benefit for public health in general,” says Miller.
“We don’t have any drugs to treat concussions, we don’t know why 10 percent of people don’t recover.”
—DR. CARMELA TARTAGLIA
That’s especially important to the leagues’ respective alumni, who have become huge advocates for brain study and concussion awareness. Along with nearly 100 other athletes, Dunigan has already pledged to donate his brain to the Canadian Sports Concussion Project and the Brain Campaign, a longitudinal study headed by Dr. Charles Tator and the Toronto Western Hospital in Canada. Launched in 2011, the project is the first of its kind in the world.
Unlike the programs at Boston University and Harvard University, which provide important study on posthumous brains, the Canadian Sports Concussion Project works with both current and former athletes, as well as the general public, to study what happens to people’s brains in vivo, while they’re still alive–and by extension, whether the existence of CTE is in fact correlated to repetitive concussions.
Dr. Carmela Tartaglia, a neurodegenerative disease researcher on the project, says the ability to find out what’s going on in brains before death is incredibly important to the treatment and prevention of concussions. While the CTE literature is important, once the disease is diagnosed, it’s too late to help the person who developed it. The Brain Campaign’s findings also suggested that not every brain studied post mortem presented CTE; only half of the 18 brains procured by the Canadian group had the disease.
“We’re not saying that hitting your head multiple times is good for you,” says Tartaglia. “Nobody is saying that. What we’re saying is that we need to study it better. We need to understand why some people get this disease and why some don’t.”
Education is a big sticking point for Tartaglia and the doctors at the Brain Campaign. She says a lot of the rhetoric around concussions tends to gloss over the serious issue that in addition to concussions, a lot of treatable ailments–motor deficiencies, chronic pain, obstructive sleep apnea, depression, to name just a few–aren’t being treated because physicians rush to the conclusion that contact sport players must have this disease. She worries that while this disease could be a very real thing to fear, many players’ quality of life is affected by thinking they have CTE before showing any signs. Part of that, she says, is that concussion field is plagued by lack of evidence-based practice. Her research team, in partnership with the CFL Alumni Association, will watch the implementation of the K-D testing to see what they can learn about living brains in real time.
“We don’t have any drugs to treat concussions, we don’t know why 10 percent of people don’t recover from a concussion and sometimes from just one,” says Tartaglia. “There’s a lot of gaps in our knowledge…huge, fundamental gaps, and if you’re in a field and you act as though you know everything already, then there’s no impetus to search for the answer. It’s not that exciting to say, ‘Well, we don’t actually know the answer.’ It’s much more exciting to say, ‘We know what’s going on,’ even if that’s not entirely true.”
It would seem that not knowing the root cause of the problems faced by a lot of CFL alumni is not deterring them from participating in the study. In fact, as Leo Ezerins, the Executive Director of the CFL Alumni Association said, it spurs them on.
“I’ve made the phone call to ask families post mortem in all of those [18 cases],” says Ezerins. “People understand the importance of the research that’s required, and the idea of leaving a legacy for their loved ones is very important.
"It’s much more exciting to say, ‘We know what’s going on,’ even if that’s
not entirely true.”
—Dr. Carmela Tartaglia
Ninety to 95 percent of players or players’ families commit to donating their brains for observation. Even players who feel completely normal, Tartaglia explains, will volunteer just to prove their brains are operating normally. That helps to form a better control group than just studying dead, diseased brains, she says.
Players will take a two-day trip to be studied extensively in order to give researchers more insight into whether or not brain changes (perhaps by repetitive trauma) are correlated with behavioral and physical changes in the subject. Tartaglia says the CFLAA’s cooperation in the project has been incredible.
But while a lot of players are invested in the idea of donating their brain to science, many of them are feeling the repercussions of the hits they suffered in the days when head injuries were treated like ankle injuries and are seeking remuneration through litigation.
The NFL recently settled a two-year, $1 billion lawsuit with over 4,000 retired players who accused the league of failing to educate them on the dangers of football. The CFL is currently facing two separate lawsuits, one from 2014 for unspecified monetary damages, the second in June 2015 for $200 million (the latter is seeking class action status).
Neither the leagues, Dunigan, nor Ezerins (named as a defendant in the first case) would comment on the lawsuits, but all parties agreed that the continued partnership between the CFL and NFL would only benefit the educational materials disseminated throughout the sport and beyond.
“Everybody understands where we’re at,” says Dunigan. “They’re very dialed into the seriousness of not only head trauma in our sport, but in all of sport, and they’re taking it seriously. [The CFL] I think, has been in front of it for the most part.”
Naidu commended the leagues for cracking down on headshots, citing that while studies showed helmet-to-helmet contact is not required to sustain a concussion, one third of all concussions come from direct blow. Both Naidu and Tartaglia vehemently agreed that headshots need to be eliminated.
The free-flow of data between the two leagues may also come in handy if the CFL decides to eventually employ individual spotters at each of their games, as the NFL does now. Currently, the NFL has one skybox spotter and two sideline spotters (one per team, provided by the league) whose sole job is to alert medical and coaching personnel to potentially threatening injuries that might have been missed in the melee of the game. These unaffiliated neuro-trauma consultants, or UNCs, work with team doctors to spot potential problems early and deal with them immediately. Trainers can now directly call medical timeouts if they see a player not receiving the attention he needs.
Miller would not provide figures on what it costs to employ the UNCs or run the K-D testing trial with the CFL, but Ezerins, who played 10 seasons in the league with the Winnipeg Blue Bombers and the Hamilton Tiger-Cats, could not imagine the CFL carrying out this kind of research without the NFL’s help. Running an arms-length organization that operates separately from the CFL but still receives some funding from it, he knows what having a big league on board can do financially.
“It won’t take a lot to impact in Canada,” says Ezerins. “We’re a nine-team league versus a 32-team league. It’s a $10 billion plus business versus probably a $250 million business. It’s always good to have that kind of partnership, where we can share resources and leverage resources they provide to do a lot more than we’d otherwise be able to do.”
Fundamental differences exist between the two leagues, however, that may skew the data in favor of a safer Canadian game; field size (the Canadian version is much larger), player size (Canadian teams tend to be slightly smaller in stature), and game play rules (one example is that the defensive line in the Canadian game must line up no nearer than a yard to the line of scrimmage, the Americans are just beyond it) are a few.
No legitimate studies have been conducted on whether these differences effect incidence of injury, but both leagues admitted they might play a part. The leagues realize that if certain protocols can have a positive impact on a small scale, they would be worth applying at whatever the cost.
“I think this collaboration will prove to be successful, regardless of the outcome of the research,” says Miller. “I’m optimistic that there will be more opportunities for us to work with them, with a trusted partner on these issues related to the safety of our sport.”
Dunigan, who now spends his time commentating for TSN in Canada, is just thankful that things have changed since his final snaps. He’s thankful that he can see colleagues being treated with the proper care that the league and players weren’t privy to years ago. The current partnership with the NFL will only help that.
“I think we’re going to be in a much better place,” says Dunigan. “We’re making the game safer with better equipment, better strategies and protocols in place. It’s a process. We’re part of that process, and we’re doing what we can."