The Disincentives to Combat Concussions in Professional Sports

Curator's Note

As increased medical research has demonstrated the nature of and dangers related to concussions, sports leagues have moved to protect their players from the long term health risks associated with sustained brain damage. However, as steps are taken to protect athletes from concussions, the greatest obstacle to progress may come from an unlikely source: the athletes themselves.

Though measures taken to protect concussed athletes are done primarily to protect the players themselves, many of these athletes are likely to view their interests differently. The Associated Press found that nearly 25 percent of surveyed NFL players admitted to hiding or playing down head injuries.

There are a multitude of reasons for athletes to play down and disregard head injuries. In many of the sports where head injuries are most prevalent, there is a culture of toughness where athletes take pride in playing through injuries. Complaining, worrying and reporting problems are viewed as weaknesses.

Perhaps more importantly, there are strong financial incentives for athletes to disregard concussions. In sports like football and hockey, even the lowest paid players are making hundreds of thousands of dollars and their ability to make a comparable amount of money in another line of work is practically nil. Players who report head injuries are less likely to be re-signed in the short term and in the long term are more likely to be branded injury prone.

These problems are magnified in sports where athletes are paid less. Combat sports such as boxing, mixed martial arts and kickboxing don’t pay low end competitors hundreds of thousands of dollars. They often have to keep taking fights just to make ends meet, which creates every incentive to ignore the risks of repeated concussions.

Finally, there is the natural human instinct to value short term considerations over long term considerations. Top level athletes spend many years perfecting their craft and only have a finite amount of time that they can compete at a high level. Weighed against that are serious health consequences that will gradually get worse over time. Fame, fortune and glory are in the immediate future, while the worst of the downside is far off in the distance.

Given the strong disincentives for many athletes to concern themselves with concussions, research and education becomes all the more imperative. Athletes need to fully understand the health risks associated with severe head trauma in order to become sufficiently concerned.


Great tie-in to a point I made in my entry, Todd, about how male athletes are told to cherish the risk-taking as part of their masculinity.  I remember the week that Ben Roethlisberger took off (when the Steelers had a big divisional game vs. the Ravens) and was "called out" by Hines Ward for being soft (for lack of a better word).  That led to a too-quick debate about the ethics of calling out your teammates for erring on the side of caution. 

And the point about finity is equally well-taken.  It's perhaps an indelicate way to put it, but I often wonder if this can be tied to portrayals of aging in the media.  We are constantly in a quest to be young (such that people who actually DO age gracefully and with no health problems still obsess over not looking/feeling young enough).  This, in turn, creates an impression that it is the life we live in our younger years that is more important than when we age.  Thus (and this is strictly conjecture but something to ponder) the average athlete may be taken to think "what do we care how this affects my brain?  I'm going to be old and feeble one day regardless!  I want to make the most of now!"  

Education on the health risks is imperative, as Todd stated, but also, it might be best for more retired athletes to speak up about the fact that life doesn't have to end in the arena.

Good job Todd, really interesting read. I think an interesting point that ties in with the increased education about brain injury in sports is the inherent invisibility of head trauma. It's not a broken arm or leg that the live or television audience could see (Could you imagine anyone calling out Joe Thiesmann or Tim Krumrie for being soft?), and maybe more importantly, not one that the majority of others players are willing to empathize with.  

Empathy on the part of teammates requires some level of submitting to shared experience, and the simple admission by a fellow teammate that they've had their "bells rung" so badly that they should come out of a game is already in their eyes an admission of weakness. Not only do you have the athetes themselves unwilling to admit to traumatic brain injury, but you have a culture of fellow teammates who will avoid supporting that message also. Not exactly the enviroment that breeds a more free flowing conversation about the seriousness of the issue.

When we have an invisible injury, it's that much more likely to be doubted and dismissed by the viewing public and sadly enough, teammates as well. Not only do you have the Hines Ward incident, but you have the entire city of Chicago attacking Jay Cutler for a leg injury in the NFC championship game that they weren't convinced was bad enough for him to be on the sidelines. Maybe he wasn't limping enough for their liking.

As a Buffalo Bills fan (cue the sad music) the images of Jim Kelly being helped off the field in Super Bowl XXVII after suffering a concussion are about as obvious as a picture I can conjure up of an athlete suffering head trauma..

Even then I remember wondering when he'd come back in the game. 

A fascinating discussion that highlights the seemingly overwhelming (impossible?) challenge of changing this culture of toughness given how many reasons athletes have for downplaying the presence and significance of head injuries.  As Todd points out, this is further complicated when there is financial reward/penalty tied to these injuries. 

The final point in the post is the one that fascinates me the most, as I agree 100% that further research and education is paramount in combating this issue.  The question, however, is if that research and education could alleviate some of these disincentives highlighted in this discussion.  And even if it reaches the athletes, what about those fans who love these sports the way they are, including the inherent dangers?  After all, these audiences are ultimately the source of the revenue for all levels of sports organizations, whether they are in the form of live attendance figures at the gate or eyeballs on a television screen that are being sold to advertisers.  Can these audiences be educated enough to enact a noticeable shift in this culture of toughness?  Do they (we) even want to be?


I think the invisibility of head trauma is a very important point, Steve. We are going to tend to empathize more with pain we can see and understand. And it applies not only to other players as you point out, but also to fans. That to me has been one of many factors involved in the decline of boxing. Seeing someone like Muhammad Ali in such a declined state really brings home the dangers of the sport and takes away some of the fun of the event for average fans. By contrast, you hear about Steve Young or Troy Aikman having to retire due to concussions, but there aren't the same number of players suffering from clear dementia or Parkinson's. Instead, Young and Aikman are out there commenting on games, so a lot of average fans are going to have trouble relating to the real damage that they took over the course of their careers.

As to the importance of education going forward, I wonder about the effect on fans as well as the players themselves going forward. Fans may indeed just say they enjoy the competition enough that they are fine in their minds with the injuries suffered by the players. It helps when you can correctly point out that these players are making millions of dollars, want to do it, have the tough macho ethos Bryce observes, and are going to do it regardless of individual opinions. Then there's also the issue of parents with kids. I've heard Tony Kornheiser make this point a number of times, that parents when more aware of the dangers will discourage their kids from playing more violent sports. I wonder about that, not only because kids are going to want to do it on their own but also because of the incentives. There's a class issue involved with poor folks who don't perceive themselves to have a lot of opportunities to move up in life, particularly as a college education becomes increasingly expensive.

Excellent piece Todd. An issue that I know you're more than familiar with, but something others may not, which are the literal incentives for athletes. In the UFC, for example, bonuses of up to $129,000 (typically a minimum of 60,000) have been paid out to fighters who engage in the so called "Fight of the Night" (this same amount is paid out to those who receive what is known as the "Knockout of the Night"): while a FOTN doesn't imply the kind of striking battle that leaves athletes concussed, this is what fighters typically associate a FOTN with - a round of Rock'Em Sock'Em robots. For an athlete making just 10,000 to show, and an extra 10,000 if they win, there's every incentive to put your health in harm's way for the sake of entertainment.

Athletes of mixed martial arts (like Chris Lytle, for example), have been explicit about fighting purely for these bonuses; especially for fighters like Lytle, who likely understand, but will never admit, that they'll never contend for a title. I don't think the UFC is being nefarious about these bonuses, and they're fundamentally noble (bonuses sometimes do go to fantastic fights with little to no striking, like George Sotiropoulas vs. Joe Stevenson, for example), but they create a situation that encourages fighters to take risks where they otherwise might not.

This bonus structure exists in the NFL too: teams that make the postseason win an extra few thousand dollars, whiler winners can make up to 80+ thousand per man. Nothing says 'incentive' more than being able to buy a new Audi by playing through injuries in order to make the playoffs. I've never heard of an NFL player getting a few thousand "underneath the table", and in the locker room for smashing the hell out of an opposing team member with a brutal hit, but it's not out of the realm of possibility, especially in sports where grudges are held, and rarely let go. For example, the Todd Bertuzzi/Steve Moore incident comes to mind: the word "bounty" was even used in the press, as Moore had injured Bertuzzi's teammate, Markus Naslund, just a few days prior. So it's safe to say that Incentives exist not just to ignore concucssions, but to incur them.   



Todd -

 It’s striking to me how much of the logic that you articulate echoes that of the logic for why athletes should take performance-enhancing drugs, regardless of the health consequences involved with taking them.

You call this desire to privilege the short-term benefits over the long-term consequences a “natural human instinct,” but I wonder about that. There is choice involved, after all. One can come out of the game or quit playing. Donald Driver can tell Aaron Rodgers that his long-term health isn’t worth it when he tries to play through a concussion. Troy Aikman can decide he’s had enough. The desire to play doesn’t sound like instinct to me, it sounds like choice.

 When you bring up class as a relevant factor in how individuals respond to that choice, you are raising a crucial question. Class matters A LOT. It's one of the main things we haven't really addressed this week. How does all of this play out in rural communities? In urban communities? I think it has to do quite a bit with choice, informed about the potential hazards or not.

It's somewhat fundamental to the notion of  the American Dream that suggests that we can create our own destiny, our own future, if we want it enough and and work hard enough. I wonder how many athletes think to themselves (or something akin to this): "Personal injuries be damned, or I can overcome them - I'm that good, I'm that special." It wouldn't be surprising if they did. After all, their training and the media coverage of them implies/insists that this is the case.

 All of which is to say, I agree that there are reasons to not talk about concussions if you're an athlete. But that makes it all the more imperative for those of us invested in the game to talk about it.



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