Our next speaker is Dr. John Carbons. His first job after high school was working as an orderly at the Burke Rehab Center in White Plains, New York. He earned his BS with a major in biology and minor in chemistry at Buena Vista College in Iowa and his MS in environmental biology from Long Island University. Prior to attending the New England College of Osteopathic Medicine, he worked for Sperry Univac Corporation, state and county government, as a biologist in Florida and taught mostly anatomy with some public health and chemistry at Palmer Chiropractic College, Norwalk Community College and University of New England. He served his internship in the Mount Sinai system in New York and his residency in the Sinai John Hopkins program in physical medicine and rehabilitation. He served as an attendee for a multi-specialty group in Baltimore, a medical and orthopedic group in Connecticut, and worked his own practice primarily in interventional PM&R. He served as medical director for an inpatient rehab unit for a 300-bed hospital on Rhode Island. Presently, he is semi-retired, enjoying helping patients on an inpatient 36-bed unit on weekends. And the title of his talk will be, Making American Football Safer, Hop Warner to the Pros. Hello, everybody. I hope you're having a good time in Florida and I hope the weather's nice. Unfortunately, we're doing this by Zoom and we weren't able to attend. My name is John Carbon, I'm a physiatrist, board certified at one point in time for 10 years by the American Board of PM&R and life membership or certification with the American Board of PM&R. And I thank the American Osteopathic College of Occupational and Preventive Medicine for this opportunity. And I have nothing to divest. Okay, I'm semi-retired, working two days a week, Saturday and Sunday, in a freestanding acute rehab hospital at this point. This topic is Making American Football Safer, from Pop Warner to the Pros. You see a football here on screen and the name is Wilson, just like Tom Hanks and Castaway, his soccer ball was Wilson. This football is also named Wilson. The purpose of this presentation is to show the history and development of American football. And this is primarily concerning the status and rules of the game and how it evolved over the past close to 150 years or more. And the players, who plays football? We're not going to talk about betting odds, your favorite team or tailgate parties or anything like that. We're also going to review common age-related injuries from young players all the way through the pros and define who really plays American football. The third thing we're going to look at are the simple and practical ways of preventing serious injuries. And using common sense, there are things I think and others can be done for all the football players. Now, we're looking at a brief history of American football. In 1869, the first college game between Rutgers and Princeton was played in New Jersey. Football evolved in the UK from soccer through rugby. So you can see there were 15 men on a side and the game, we're moving up to 1876, was played on a field that was 140 yards long and 70 yards wide. This is over two acres. This is a big field. In Massachusetts, in Massasoit Springfield, the Massasoit Convention was held and four colleges participated, or universities, Yale, Harvard, Columbia, and Princeton. And what the point was, was to try to define and establish rules of the game. As it evolved from rugby. In 1892, in western Pennsylvania, and the panhandle of New York, there were many athletic clubs which picked up football, American football, still in a stage of being similar to rugby. The first pro player was a Yale graduate called William Heffelfinger, who was paid $500 a game. Now $500 a game then is probably close to about $7,500, $7,800 now. But he was recorded as the first pro player. In 1896, it was an Allegheny Athletic Association. Now they were athletic clubs, similar to YMCA's, but this was the first recorded professional team that had a three-game season out in western Pennsylvania. In 1897, it was a Latrobe Athletic Association, and it had the first full professional league season of six games. Now Latrobe, Pennsylvania is famous for a couple of other things, three come to mind. And I'll give you five seconds to think about Latrobe, Pennsylvania and why it's a little bit famous. The first is Arnold Palmer grew up in Latrobe, Pennsylvania. The second is Mr. Rogers, Fred Rogers was also from Latrobe, and Rolling Rock beer is still being brewed in Latrobe, Pennsylvania. Now continuing in 1902, the first professional league was experimented with, with football. Connie Mack, some of you may have heard of him, his real name is Cornelius McGillicuddy. He was involved in professional baseball, and we're looking at the year 1902 now, but Connie Mack was the manager and eventually the full owner of a baseball team called the Philadelphia Athletics for 50 years from the year 1900 to 1950. The Phillies, excuse me, the Philadelphia Athletics eventually moved to Kansas City and now reside in Oakland for the past 40 years or thereabout. He took offseason professional baseball players from the Philadelphia Phillies and the Athletics and started a professional football league in Western New York State, the metro area, Pennsylvania and New Jersey. By 1904, teams extended into Ohio. Keep in mind, Canton and Massillon, there's a big rivalry started between these two cities that are both in the vicinity of Akron, Ohio, which was growing as an industrial area. So we're looking at mining communities, we're looking at early industry, manufacturing, a population which started to get involved in football. After a while, interest fell, it was betting, there was game fixing, and players were able to skip teams that go to the team that paid them the highest per game. So it's very disorganized, and this league failed. It did not make it. But there was a gentleman by the name of James Francis Thorpe, who in 1913, started to play professional football. Jim Thorpe was the most lauded American athlete, probably in the first 50 years of the 20th century. He was a Sauk Indian, and was born in Indian Territory, which became the state of Oklahoma in 1909. And he was called a half-breed because his parents were half European and half American Indian. And in those days, kids with talent were taken to government schools, and he was sent to high school and college in Carlisle, Pennsylvania, from Oklahoma. He played football for this school. But in the 1912 Olympics in Stockholm, Sweden, he won two gold medals. He won the pentathlon and the decathlon, and became the most famous American athlete. Now this was running events, sprint, distance, hurdle, shot put, javelin, events of this type. But he won the two biggest events for the men in these Olympics. He came back, he was a hero. He picked up playing pro football for the Canton, Ohio Bulldogs for $250 a game, which by this time was about $7,500 a game in today's money. And by 1915, he signed a baseball contract with the New York Giants for $5,000 a year, which was probably over $150,000 a year in today's money. He was the best overall athlete, and he was accredited for saving American football as the league stabilized. So did the teams and players, and rivalries developed. Okay, this is a picture of James Thorpe. You notice he has a C for Canton, Ohio. You see he doesn't have shoulder pads on. He's holding a leather helmet with no face guard. The shoes were leather with metal cleats like old baseball shoes used to be. You see also on the jersey, the bottom portion has hip protectors and apparent thigh protectors. The middle picture is Jim Thorpe holding a bat. That's how they did it in the old days, Ty Cobb days, for the New York Giants. You can see the NY monogram, which looks similar now to the New York Mets. The right picture shows Jim Thorpe later on in years as an assistant coach at a college level back at Carlisle College in Pennsylvania. Now, that's a little bit about the beginnings of football, but by 1920, the American Professional Football Association was founded, and in a few years, the name was changed to the National Football League. Of the 10 original teams, two still survive. The Decatur Stalys, and I don't know what a Staly is, became the Chicago Bears, and the Chicago Cardinals moved to St. Louis, became the St. Louis Cardinals, and then for the past 30 years, they've been out in Arizona. The Green Bay Packers, Green Bay Acme Packers of Green Bay, Wisconsin, joined the NFL the following year in 1922, or two years after. They were a professional team in 1919, joined the NFL in 22, and it is the only team to have played in the same city over this time span. In 1933, the first, quote, championship game was played, but Blacks were banned from playing in the NFL in 1927. After World War II, showing their valence and citizenship, they were reintegrated into the NFL in 1946. That's surprising. In baseball, looking at it, Larry Doby in the American League, Jackie Robinson in the National League, entered in about 1948, so this is a big, this is after the World War II years. In 1950, two current teams, the Cleveland Browns and San Francisco 49ers, were absorbed from another league, a competitive football league, the All-American Football League. In 1960, the American Football League started. This is with teams such as the New York Titans, later the Jets, the New England Patriots, Kansas City Chiefs, Oakland Raiders, Houston Oilers, and the like. By the end of the 60s, there was talk of merger of the two leagues, the NFL and the AFL, because they were both financially growing. They had a fan base, and they were drawing from colleges. The Super Bowl developed in 1967, when the championship of the two leagues, the AFL champion, Kansas City Chiefs played the Green Bay Packers, 1967. The Packers won that, and they won the second, what became the Super Bowl the following year, beating the Oakland Raiders. The third year, Joe Namath and the Jets made the league, fourth year, the Kansas City Chiefs came back. Now, the leagues were deemed at equity, the players, salaries, and management all started to become equitable and equal. Going back to college, whoa, going back to college, in 1916, the Rose Bowl became established as an annual college event after the new year, so January 1st, January 2nd. It's the oldest of the bowl games. By the 1930s, other bowl games entered, and you've heard of these, the Orange Bowl, Sugar Bowl, Cotton Bowl, Sun Bowl. In the 40s, the Gator and Citrus Bowls started, and these were taking, these bowl games took top college teams in Division I with area rivalry. For example, the Rose Bowl was always the Pacific Pac-10 schools against the Big Ten schools, so the bowl games developed to, at this point, there were about 35 bowl games, so we're talking not only of a number of players, but school involvement, the money involved is probably in the billions of dollars for bowl games. This past year, for example, in the Southeast Conference, we have Georgia, that's the one with the G, and Alabama, where Alabama beat Georgia in the season game and then in the conference game, but Georgia came back to win the championship bowl game in January beating Alabama. You've all heard of Army-Navy games around Thanksgiving time, heard of states, schools, Ohio State, Texas, Oklahoma, Florida, Florida State, Notre Dame, Penn State, Michigan, Michigan State, Iowa, Nebraska, on and on, Clemson and Auburn, I left out a lot of West Coast teams because I don't live on the West Coast, but USC was a big one. I believe Jackie Robinson played for USC before playing baseball. From this picture, you can see Georgia on the left of the screen, you see the Alabama helmet on the right. Now, this was the play up before the national championship this past year. These guys are gladiators. They go all out to win, the school spends millions, it makes millions, the advertisements and all the other bowl games, recruiting and every alumni donations, this is big business, but they're gladiators. And with gladiatorial bouts, a lot of people get hurt. Now, one of the things that made me pick this topic was about four years ago, my middle son was looking at colleges, we were in the process of moving from the Northeast, a wonderful state of Rhode Island, down to Charleston, South Carolina. So, my son was being interviewed and looking for a lacrosse ride. He was a lacrosse goalie and a good one. So, my wife and I are taking a walk down the lovely southern town of Rome, Georgia. Georgia has Athens, the University of Georgia, and it also has a town called Rome. So, at an intersection downtown on a beautiful early summer day, I come across this written in the cement, right at an intersection where the stoplight is and a couple of bus stops with benches and stores. So, this, I'm going to say young man, Bonoblatti Gammon. They called him Bon Gammon. He was born in 1879. He was a native of Rome, Georgia. He entered the University of Georgia and he quarterbacked the University of Georgia's undefeated team, coached by Pop Warner. We already mentioned him. The little league in football was called the Pop Warner League. Anyhow, Bon Gammon played against Auburn that was coached by John Heisman. That's the guy the Heisman Trophy Award is named after. But, in a game against University of Virginia on October 30th, 1897, Bon crashed the line behind the tackle and was rendered unconscious. He died at Grady Hospital the following day in November, following day period. In November, Georgia lawmakers tried to ban football in the state of Georgia. So, it says here, Bon Gammon is buried in Rome's historic Myrtle Hill Cemetery. So, we cross the street. I point this out to my wife. She's interested a little bit. We cross the street and here's another grounded piece in the sidewalk. The woman who saved football in Georgia. So, Rosalind Burns Gammon did not believe her son died in vain and did not want the game of football to come to an end in the state of Georgia. So, she wrote a letter to her representative, this guy James Nevin, and she said, please grant me the right to request that my boy's death should not be used to defeat the game that was the most cherished object of his life. So, the governor of Georgia read this letter, vetoed the bill, and she became the mother who saved football in Georgia. But, she lost her son. I also read that it was pointed out, she had as part of her argument that many, many young men would die in various farm accidents. Farming is a hazard and back at those times, they had these big steam engines that would dehusk corn or gin cotton and she used this. You're not going to outlaw farming for the deaths caused by that type of work. Please do not get rid of football. Now, let's take a look. Who plays football? Okay, we're looking at data from the year 2006, going across the top in four year increments, 2006, 10, 14, and 18. I don't have data past 18 and this is pre-COVID, so I would imagine it'd be a dramatic change in these numbers. But, in 2006, all people playing tackle American football registered officially, not pick up games, not intramural games or anything like that, but pop water, junior high school, high school, college and pro in millions was 8.4 million. In 2010, it dips to 7 million. 2014, 6 million. 2018, 5.2 million. I bet you it's a lot less now. No data currently available. Interestingly, in high school in the year 2009, there were 1,250 girls playing tackle football at a high school level across the country. In 1914, this increases by about 500 to 1,750. Then by 2019, out of a million kids playing football, we have over 2,000, almost 2,500 girls playing football. Now, at a college university level, there are three divisions. Division one, usually smaller college, D2 and D3, D3 being the largest schools. Of these million plus kids playing football up through a high school level, only 73,000 to 75,000 maybe max play at a college level. So we're looking here down at the bottom, we're looking at about 700 colleges and universities. The bulk of these are four-year schools. However, some junior or community colleges, two-year schools do sponsor football teams. Now, we're going from millions being drafted down to a total of 32 NFL teams for the pros in the National Football League. So coming up shortly, right now as I'm speaking to you, today's April 27th, but very shortly there'll be the college drafts. Each of the pro teams in the NFL goes through seven rounds of drafting various players, which the team wants. So the worst team record, this is before they finagle with trading positions on the draft and whatnot, but the team with the worst record gets the first pick. The team with the best record the previous year gets the last of the 32 picks, and they go through one through 32 seven times. So if I'm not mistaken, that's about 250 players are drafted, right? Of those, these remaining ones, about 500 players, maybe more or less, are invited for tryouts. Some of those players make it, some don't. Most of them don't. So you have about 400 players a year from college level entering the NFL. Okay, now the NFL is not including pro leagues like the Canadian Football League. Many players play there. There are teams. I don't know how long the Canadian Football League has been around. I'm going to say at least 50 years or more. And teams range like from the Montreal Owlets to the Edmonton Eskimos. But the rules are a little bit different than American football, but it is a similar, similar game. It's football, not rugby. There's indoor football, arena football. There is an armed service football league. These are for guys who are out of places like Fort Bragg or places like Parris Island and the like. And there is a new USFL. Remember I said there was a USFL back in the 70s? Well, it's resurfaced and it has eight pro teams. So I'm not counting this in all these data because I'm going through the NFL and I'm going through NCAA data. But it gives an idea of who's playing and how many and how competitive it gets. Keep in mind, the average National Football League career for a player is about three years. That's it. There were about 27,000 high schools, this is before COVID, about 700 colleges and universities and 32 NFL teams. So the gladiatorial field is really narrowing down the Erlenmeyer flask, if you will, or the funnel. Okay, let's take a look. See if I can go forward instead of backwards. Now, how many football deaths are there a year? I'm going to skip, hold on. Okay, I'm back here. How are football injuries defined? Now, this is data that's collected by the NCAA Injury Surveillance System. About 60 of the 700 some odd colleges and universities responded and gave data. Injuries were defined as occurring in practice or in a game, number one. Two, needing a physician or an athletic trainer to assist the player. And number three, resulting in missing at least one day of football or practice. Okay, now we look at data here. According to the NCAA data, 56% of the injuries occur in practice. About 40%, 39% occur during a game, 4% occur in scrimmages. Scrimmages is a practice play where team members square off against each other. So that is kind of practice. But when one looks at this, a football game, college or pro, even though, believe it or not, you watch it for three and a half hours, the actual playing time is one hour. But from the snap of the ball, hike to when the plays whistle dead, you add that all up, it's only 15 minutes. So you have one game a week that lasts an hour. And usually, there are five practices at college or high school level. There's a game day, the day after the game is usually an off day. And then you have five days of practice. So practices generally run easily two hours. Five times two is 10 hours of practice a week with 56% of the injuries. You have 39% of the injuries in a one-hour game. So you can see how more dangerous the game is going top notch in the competition. Now, how many football-related deaths are there a year? We're looking at data 20 years from 1990 to 2010. And this is from a group out of the University of North Carolina National Center for Catastrophic Sport Injuries research group from July 1990 through 2010, 20-year spread. So looking at football-related deaths in high school and college level. So on the average, there were 2.2 deaths per year for high school and college. That's one out of 100,000 players. There are indirect deaths, which are much higher, double direct deaths. What does that mean? A direct death, hard to define, but usually the direct result of a hit, a tackle, a fall. And we're looking at something that's catastrophic right on the field. Indirect deaths are a little bit different. Now, the bottom line here, I'm blending the two. The risk of fatality in college football is higher than high school. You have 73,000 players instead of maybe half a million or more. But indirect deaths are heat stroke, hypovolemia, coaches who will not allow their players to cool off or drink. You have cryptic cardiac things like a valvular problem that's not picked up or a conduction problem, cardiac, sickle cell crisis, and traumatic brain injury. A person can be hit and develop problems after the hit down. When 50 years ago, when I was in high school and eventually college, head injuries were called. He's got his bell rung. A thoracic injury could have been, oh, he has the wind knocked out of him. Any injury to the ankle or foot was called, oh, turf foot, turf toe. Kind of indescript and injuries were overlooked. And so were these indirect causes of death. Now, common football injuries range from very minor things to life-threatening things. Most common strains and sprains, muscle and ligament injuries, hand, wrist, knees, hamstring, shoulder, neck. Of all of these, the most vulnerable area is the neck. There are overuse syndromes like shin splints, the anterior portion of the leg, then the tibia, which can involve the periosteum and microfractures even. Plantar fasciitis, if any of you have had that, you know, it's difficult to walk. Rotator cuff injuries, shoulder injuries, skin problems are overlooked. Infections, boils. You have guys playing football. Many of them are jocks. They wear supportive equipment. They have bands on them, dirty clothes. You have the grit and dust. The hygiene may not be the greatest. It's a quick shower after the game. My experience, I've had many friends playing football who develop skin problems, maceration, abrasion, boils and the like from infection, from breakdown of skin. You have neural injuries, peripheral compression, tears, compartment syndrome. Up here, TBI. His bell was rung. He had a dinger. We'll look more about TBI and brain injury. Spinal cord injury, the most devastating injury I have seen other than major burns in a burn center are high spinal cord injuries, quadriplegic. There were organ injuries. The chest, sternum, pneumothorax, injury to the mediastinum, cardiac involving, liver spleen, herniations. A few years ago, and I couldn't find it, a high school player hit or was hit. I believe he was carrying the ball and was hit. He came to the side. He had the wind knocked out of him. He died on the field. He didn't play again. He died on the field after sitting down. He had a ruptured spleen and bled out. So these others are the non-contact injuries, dehydration, heat stroke, hypoglycemia, cryptic or cryptocardiac problems. You see this in basketball also. So these are the indirect injuries. Of all this, the indirect injuries, these others are two-thirds of the causes of death. Okay, moving onwards. So I break this down. Again, the most serious injuries are the metabolic ones, the indirect ones. Sickle cell crisis is big. Hypoglycemia. How many times have you seen kids on a field with the coach screaming at them? They can't take a drink of water. No run laps. Around the quarter mile, come back. And they start in August. We live in the south. Even up north, August, 95 degrees, 95 humidity. It's not fun. Major organ injury, I think we spoke about. Chest wall is big. Various hemorrhages. Central nervous system. Spinal cord. We'll look at a couple of people who had this. Intracranial hemorrhages, epidural hemorrhages, or in the parenchyma of the brain. Loss of consciousness. That's the neuronal shearing. That's big now. It's a TBI. But back in the old days, it was having his bell rung. Now, there's an entity, chronic traumatic encephalopathy, line four here. I like, instead of chronic, I like repetitive traumatic encephalopathy, CTE. This is a, it's like being punch drunk. Repetitive micro-insults or micro-TBIs to a brain that start to take effect and progress as the ex-player advances in life. So you hear stories of football players, their personality changes. They can't function. They become dangerous and everything else. it's a scary thing. So, speaking of crippling, advanced osteoarthritis affecting hips, knees, shoulders, spine, and everything else. Two things, there was a player called Jim Otto, O-T-T-O, who's in the Hall of Fame. He played for the Oakland Raiders when they were, who was a center for the Oakland Raiders. And a fearsome guy, double O. And I saw him, a picture of him later on in life. The poor guy was crippled using Swedish crutches and just gimping along from his multiple injuries playing football. My wife's cousin is married to a guy who's an athletic director to the high school in Connecticut. He played football in high school and he played for the University of Miami back in the 80s. And he is younger than I am. He's about 64, maybe 65. And he's already had both hips and both knees replaced from just playing high school and college ball. Now let's take a look and compare then here with kind of now, but this is then also. So we're looking at a guy who was famous, Red Grange. Some of you may have heard of him. He was a running back for the Chicago Bears back in the 1920s, maybe extending into the 30s. So you see, again, no face mask. He has shoulder pads. You can perceive that, but a leather helmet carrying the ball. He has thigh pads here. I can't, it looks like he has a hip pad. He's got the metal cleats. And this guy is 5'9", 175 pounds. Back then, I guess that was kind of big. I believe in World War I or World War II, the height of the average American male through the military, that's where the data was procured. The average height of the America was about 5'6 or something. Now here's Bo Jackson. He played pro baseball and football. Guy was good. He could climb walls and do everything. So he was, look at the difference. He's 6'2". So four inches, no, about five inches higher. And he's about what? 30 plus 25, 55, 60 pounds heavier. So just comparing the body size, mass and size, he has the full face guard, the full shoulder pads. The guy's ripped, thigh pads and everything. So the players are different. They're a different size, a different weight, a different height and a different speed. Here's a quarterback in the 1920s, 5'10", 175 pounds. Now here's Drew Brees from the Saints, 6'3", 235. Again, that's 55 pounds bigger. These guys are monsters. They're big. So they're running faster. There was another Olympian I liked, Jesse Owens. Some of you may have heard of Jesse Owens. He won for the United States four gold medals in the 1936 Olympics, which was significant because it was played in Berlin, Germany. So Jesse Owens was a black guy. He goes over there and he wins the 100 meter dash, the 200 meter dash. He wins the 400 meter relay. And I think the long jump. Now his time in the 100 meter, it wasn't yards, it was meters, it was in Europe. His time in the 100 meter was, I believe, 10.3 or 10.4 seconds. High school kids now are running faster than that. So looking at this, this was what, 90 years ago or less than that, 85 years ago, they're running faster than Olympians now. So are the football players. The guys are bigger, faster, and much more massive. Now here's something that I was thinking about and spoke to a bunch of guys who played football who I'll talk to you about. Here's my son, Chris. Okay, so he's my model here. So he's not a football player. He was my model. Chris was a swimmer in high school and college. So he's wearing his brother Terrence's lacrosse jersey and his goalie lacrosse helmet. But the point of this is, in football, what I think would be a sane and reasonable thing to do is have a level on the jersey. I don't know if you call it a thoracic four level, a T4 level, or through the dermatome, the T4, the nipple line, if you will. But there's an obvious line through the jersey. You cannot hit or tackle an opposing player. That would get rid of upper thoracic injuries, mediastinal injuries, shoulder, shoulder, neck and head injuries, or greatly reduce them. The way it is now, rules have changed. It's trying to be made safer. But still, I think the person is most vulnerable right through here. Barring the shoulders, which are very, believe it or not, delicate. The head of the humerus just sits in the cup of the glenoid fossa and it's held in place by muscles, the rotator cuff muscles. It's very easy to rip, break, tear apart. But the head through the neck and upper area under the sternum is a lethal area for gunshot. If you're trained to get somebody, this is the area, and this is where people are getting hit in football. So no hits allowed in this area. Guy could be kicked out of the game, penalties, does it again, he could forfeit his right to play. Now, let's take a look here. This is my son, Chris. And this gentleman here, his name is Ralph Dawkins. He was from Jacksonville, Florida. He went to college, University of St. Louis. And I met him serendipitously about a month ago at the Toyota dealership. So he played for the New Orleans Saints. He was a running back. Now, when he played, his weight was only about 190, 195 maybe, and his height is only about 5'11, 5'10. So he was a very small back. Now, he was with the New Orleans Saints for three years, but he was one of those players who never got in a pro game. He was a backup. He played scrimmages. He could have sat on the bench if a back, one of the first, second string backs got hurt. He was there, but he never played in the game. After doing that for three years, his knees gave out and he showed me the surgery on his left knee and that ended his career. So I asked him about this idea of a across the chest T4, thoracic floor, dermatome level, no strikes or you can't go north of that. And he said, it sounds good, but he'd bring it down to the belt line because backs, a lot of people when they're running, they're flexed forward at the trunk or at the hips. So he thought the line should be lowered. On the right side, 84 here on the bottom of the pile is a buddy of mine from college. I spoke to him about this. He played three years of high school football for DeWitt Clinton High School in the Bronx and played four years of division three football when he went to school out in Iowa. He played on the line against two guys who played pro ball. One was Wilbur Wood from James Madison High School in the Bronx and also in the then Iowa Conference. He played for Simpson College and then played for the Kansas City Chiefs. And he also played the line against a guy called Vern Denherter who was from Iowa, went to Central College and played about 12 years for the Miami Dolphins and won two Super Bowls. So I asked Mike McGowan about that. And he said, it's a good idea to have a line like that, but the pros won't go for it. So I said, good. Place to start is with the little league kids. It's like wearing a batting helmet. You have to start somewhere. When I was a kid, the pros didn't wear batting helmets. It started with kids. In hockey, there were no helmets. So I think a no hit line as described can be looked into a little bit more. I'm gonna finish with this player here. Some of you may know him. His name is Nick Bonacani. He was from Springfield, Mass. He's an Irish, no, he's an Italian guy. Played in a Catholic high school and then played for University of Notre Dame. He played for the Patriots in the mid 60s. He was traded to the Miami Dolphins. He was a linebacker and was on two Super Bowl winning teams. When he retired from football, he went to Suffolk Law School in the Boston area and became a lawyer. His son, Mark Bonacani, played for the Citadel University in Charleston, South Carolina, the Military Academy of South Carolina. It's a division one football team. His son, as a freshman, made a tackle. He wasn't hit, he's a linebacker. And right there in the field, fell out, fell down. And he's now about 55, 56 years old. And as you can tell, he's a quadriplegic. About a year ago, his father, Nick Bonacani, passed away. They were involved with spinal cord injury programs and drives and things of that nature, but it's a devastating injury. And you can tell by his habitus. You see his pants, there's no muscle mass here. His hands are flat. It looks like he has a control rig here to move his wheelchair. It's heartbreaking. There were other players too who've had bad ends. So Singletary, a player for the Patriots in a preseason game was hit by a back, John Tatum, and was a quad also. Darryl Stingley from the Patriots, sad. So with that being said, we're gonna wrap it up, but with a couple of questions. Question number one, the highest percentage of deaths related to football at all levels is traumatic brain injuries, traumatic spinal cord injuries, illicit drug use or related metabolic deaths. Two, football is a big business at all levels. The major responsibility for player and athlete lives with parents, the sponsoring institution, coaching staff, all of the above. It's all of the above. The parents try to get kids into colleges. They try to get rides. It's a big financial boost for the kids. Getting into the pros, if you play your cards right, you should do well. The sponsoring institution, whether it's college, high school, or pro team, the player comes first. The coaching staff, especially at lower levels in Pop Warner, Little League, football, if you will, junior high, high school, have got to know and take precautions against these metabolic problems. Sickle cell, heat stroke, hypoglycemia, dehydration, and things like that, because they are lethal. So the answer is all of the above. References, always. Grey's Anatomy, this is what I used when I went. Guyton, I met Guyton's son. He's an ophthalmologist at Hopkins. Physical medicine, rehab, and essentials of orthopedic stuff. And here are some listings, history of American football. Look up Wikipedia or history.com. It's all over the place. Statistica, where I got some data. We have Ortho Journal of Sports Med, and we also have the American Journal of Sports Medicine. So you have an Orthopedic Journal of Sports Med and an American Journal of Sports Med, and National Center for Catastrophic Sports Injuries. I think that's about it, but I think we need a common head approach, a common sense approach. Kids are motivated for the fame and glory, parents for the money, schools for their reputation, and they're gladiators. They're gladiators, and I think it could be made safer medically and the way it's played. Okay, so I think that wraps it up. Let me see if I can go in the right direction here. Yeah, Charlie Brown. See what she does to him? Hey, Charlie Brown kicked the ball, boom. That could happen to anybody. So I thank you for the opportunity. I hope I didn't speak too long, and hope you all enjoy your course and your colleagues. It's good seeing colleagues. We miss it. Unfortunately, my wife Mary Beth and I couldn't make it, but next time we hope to, okay? Take care, y'all. If you have any questions, I'll be around, okay? Thank you. If I may, though, Jeff, the first thing I wish to say is that Mary Beth, the previous speaker, offered $10 to anybody who could identify that beachfront, and that's at the Breachway in Charlestown, Rhode Island. So Mary Beth, my wife, owes me 10 bucks, unless anybody else came in before I did. She may take that out of your half of the account. Okay. Okay, we have a question from our live audience. I'll step out the way. Good morning, thanks. Thanks for that overview of football and football injuries. You didn't speak to, there's been some research on helmets, and it really draws from looking at woodpeckers and how woodpeckers were able to peck insects on trees and not end up with TBI. And there's been some revolution in helmet design. Can you speak to that? And maybe there's other things in equipment that braces or supports that perhaps we could institute at the Pop Warner level that would make a difference. Yes, I purposely neglected equipment other than the comparison between, say, the early days of the 20s to modern days. Helmets are fine, woodpeckers, yes. Helmets have been adopted with face masks, which can be held for a penalty, face mask grabbing, and you could whip and break somebody's neck. Helmets in the past, the posterior portion over the occiput was elevated because in hyperextension, lower helmets in the back would snap necks. So bracing, the most common non-fatal injury is to knees, so you can think of supports. So aside from helmets and carbon fiber things, a lot of development always happens with orthoses and prostheses during times of war, as we have seen over the past too long, what, 10, 15, 20 years. But in any event, what I was trying to do, despite physical armor for protection, which can also be used as a weapon, you can't spear with the helmet, but people tend to do that, is a common sense approach. So you eliminate the upper body hits, then you kind of cut back a lot of the serious injuries, head, neck, mediastinum, and things of that nature. Good morning. I have a question for Dr. Harbin. I've had a couple of disappointing presenters for my conference. Oh, that's probably, I'm sorry, yes, we're on here. Sorry, so I'm going to mute that person. I don't think he was trying to ask a question. Can you hear me, Jeff? Am I here? I can, yeah, you're there. I hope I answered that first question. Yeah, somebody's bragging on Kirk's Hill and said they had a football team called the Osteopaths in 1903 and played great teams such as Notre Dame. When I went to visit the school, I was a grad student at Missouri at the time, and I noticed that they beat Missouri a couple of years in a row. And at the time, the football team in Columbia wasn't much better than it was back when it was losing to Kirksville. All right, I don't see any other questions in the chat. So thank you, Dr. Harbin, very much. All right, thank you, Jeff. Take care, bye all.

American football

history

injuries

safety improvements

traumatic brain injuries

chronic traumatic encephalopathy

player participation

rule changes

athlete protection