The NFL's Concussion Crisis

0:00 Described derisively,

0:02 the National Football League acts as a structure through which young men

0:05 can sell the entertainment value derived from the destruction of their brains.

0:09 Detractors and fans would debate that statement endlessly,

0:12 but to the league itself, what's true hardly matters.

0:16 What matters is what people believe.

0:19 One can hardly overstate just how colossal the NFL is.

0:24 Whether by revenue per team, revenue per game, or just revenue outright,

0:28 it is by far the largest sports league in the [music] world.

0:32 Its annual revenue is similar to that of McDonald's.

0:35 Just one team, the Dallas Cowboys,

0:38 is about as big financially as Planet [music] Fitness,

0:41 the largest gym chain in the world.

0:43 The only live broadcast to have ever been viewed by more

0:46 Americans than a Super Bowl was the Apollo 11 moon landing.

0:50 Well, each week about one in every 16 Americans

0:52 tunes [music] in to their Sunday Night Football broadcast,

0:55 making it the most successful TV program to have ever existed.

1:00 But this supremacy is facing a reckoning because more and more

1:03 people are coming to believe that American football is bad.

1:07 More and more people are being convinced by the scientific

1:09 evidence that American football frequently causes permanent damage to the brain,

1:14 leading to debilitating cognitive dysfunction later in life.

1:18 The immediate risk to the league's financial

1:19 [music] interests is not that people are going

1:21 to tune out on mass out of discomfort

1:23 with the way their dollars incentivize neural destruction.

1:26 Football has always been perceived as a dangerous sport.

1:29 It's something different, but something that the NFL is taking seriously as one

1:33 of the biggest long-term threats to America's most popular contact sport.

1:38 But as a point of comparison, take ice hockey,

1:41 America's [music] second most popular contact sport.

1:43 While the National Hockey League has admitted the danger of brain

1:46 injuries in its sport and implemented changes to mitigate their impact,

1:49 the league appears far less concerned than

1:51 the NFL in the threat to its financials.

1:54 But on the surface level, it looks like they should be.

1:57 According to Harvard research into the matter,

1:59 the NFL has a per game per player concussion

2:01 rate that's 3.8 times higher than that of the NHL.

2:05 In a given game, a professional football player is far

2:08 likelier to get a concussion than a professional hockey player.

2:11 But what that actually means in practice is that in a season,

2:14 the hockey player is likelier to get a concussion since

2:17 the NHL schedule includes 4.8 times more games than the NFL.

2:22 Other studies back this up.

2:23 Ice hockey has a similar,

2:25 if not slightly higher rate of concussions than American football.

2:28 The thing is though, a single concussion is rarely a long-term issue.

2:33 Typically, although not always,

2:35 it's a short-term problem involving short-term cognitive impairment.

2:38 A high school athlete might struggle to retain knowledge for a test.

2:42 They might become irritable more often with their parents.

2:44 They might be highly sensitive to light and noise.

2:46 But typically, these symptoms subside within a couple of weeks.

2:49 A subset of concussions do lead to long-term or permanent issues.

2:53 And the likelihood of these goes

2:55 up with each additional concussion one receives,

2:57 but permanent cognitive [music] impairment,

2:59 specifically from sports induced concussions, is rare.

3:02 And it's even rarer that these permanent impairments are [music] significant.

3:07 Concussion rates are a misleading indicator for the volume

3:10 of cognitive disability a sport is likely to create.

3:13 Ice hockey players frequently skate faster than 20 m or 32 km/h,

3:18 which leads to some very big hits.

3:20 But compared to football, these hits happen at a different rate.

3:23 Checks are only legal against a player in possession of a puck

3:26 and can only be made from the front or to the [music] side.

3:29 Checking from behind is strictly prohibited,

3:31 punished with some of the costliest penalties in the sport,

3:33 as it can lead to one's head or spine

3:35 absorbing the brunt of the impact into the boards.

3:38 Typically, checking is also focused against

3:40 the boards whose glass flexes and absorbs some of the impact since offense can

3:44 more effectively evade defense in center ice.

3:46 When put into practice, this means that hits are relatively infrequent.

3:50 One study found that men's college hockey players experienced

3:53 an average of 287 head impacts in [music] a season.

3:57 In football though, head impacts occur between 1,00 and 1,500

4:02 times a season and potentially even more with certain positions.

4:05 To those that know the game, this makes sense.

4:08 The action that most commonly ends a play

4:10 is a player on defense tackling the ball carrier,

4:13 which frequently involves a head impact.

4:15 The primary way the offensive side stops

4:17 that from happening is by physically blocking opposing players,

4:20 once again, frequently involving a head impact.

4:23 The data suggests that a given head impact in football might

4:26 be less likely than one in hockey to cause a concussion,

4:29 perhaps due to the higher speeds on the ice.

4:31 But each one of those more frequent impacts in football

4:33 adds to a hefty accumulated sum of head trauma.

4:37 And this cumulative head impact has been found to be far more

4:41 correlated with the chances of future

4:42 cognitive disability than simple concussion rates.

4:46 The subtleties of that conclusion matter

4:48 a tremendous amount to tackle football's future.

4:52 If concussions alone were the problem, there'd be more the sport could do.

4:56 It'd be easier to manufacture a rule set that reduced the likelihood

4:59 of the high impact collisions likeliest to lead to a concussion.

5:03 And the consequences of concussions can

5:05 be genuinely reduced through proper identification,

5:07 [music] treatment, and return to play protocols.

5:10 But the growing academic consensus that total accumulated head trauma is

5:14 what matters most suggests that the most iconic feature of the sport,

5:18 the contact is inextricably linked to future cognitive dysfunction.

5:23 [music] The chain of events that dominoed into that conclusion kicked

5:27 off here at Pittsburgh's Alagany County

5:30 Medical Examiner's Office in September 2002.

5:33 The neuropathologist on call, Dr.

5:35 Bentomalu knew little of American football,

5:37 having immigrated from Nigeria less than a decade prior,

5:40 making him one of the few people in the office who

5:42 didn't recognize the name attached to the corpse that arrived overnight.

5:45 [music] Mike Webster, former Pittsburgh Steelers legend.

5:49 Back in the 70s, Webster had nationwide name recognition thanks

5:53 to his central role in the Steelers

5:55 fourtime Super Bowlinning offensive [music] line.

5:57 In almost every play of every game of each

6:00 of his 17 seasons as a professional football player,

6:03 he started by snapping the ball back to the quarterback,

6:06 then charging forward and colliding head-on

6:08 with the opposing team's defensive [music] line, adding up to hit after hit.

6:12 But game after game, season after season, no matter how hard the hit,

6:17 he'd keep lining up, earning him the nickname [music] Iron Mike.

6:21 Once his career ended, though, so did his durability.

6:24 Progressively, cognitive dysfunction crept in, and eventually,

6:28 Webster struggled with basic memory and decision-making.

6:31 He went through massive mood swings.

6:32 He'd break into wild outbursts, and as his symptoms got worse,

6:36 he withdrew from his family and began living out of his pickup truck.

6:39 He'd stay awake for days at a time as his brain

6:42 was stuck in an endless state of fight or flight.

6:44 Then, out of desperation, he'd use a taser to shock himself,

6:47 essentially resetting his nervous system in a way

6:49 that allowed him to drift into sleep.

6:52 As his ability to function dwindled further,

6:54 a local hospital allowed him to sleep in one of their unused rooms.

6:57 And it was there where he died in September 2002 from cardiac arrest.

7:01 The following morning, as Webster's corpse waited for its autopsy, Dr.

7:05 Benalu learned his story through co-workers in the news.

7:08 But as the doctor retells it,

7:09 he was left unconvinced that Webster just spontaneously went from two

7:13 decades of disciplined professional athlete life to one of homelessness,

7:16 drug addiction, and petty crime.

7:18 He thought there must have been a cause.

7:21 So despite no obvious signs of brain disease in the initial autopsy,

7:24 Amalu brought a brain tissue sample

7:26 to the department of neurology at the University

7:28 of Pittsburgh where a deeper examination

7:30 found abnormal accumulations of [music] tow proteins.

7:33 The same abnormal accumulations found in patients with Alzheimer's.

7:37 But Webster was too young to have Alzheimer's.

7:39 It's exceedingly rare for a 50-year-old.

7:41 And a deeper look at the tissue showed distinct pathology.

7:44 This was something different,

7:46 something that had never yet been found in a football player.

7:49 This was chronic traumatic [music] encphylopathy.

7:53 CTE is a hard disease to diagnose.

7:55 [music] While symptoms exhibit in a person's actions, as of today,

7:59 the only way to definitively diagnose it is after death in an autopsy.

8:03 The degree of examination needed is not one included in most autopsies.

8:07 So to even have a shot at diagnosis, brain tissue needs to be sampled,

8:11 preserved, and sent to a specialist within hours of death.

8:14 Even then there's a degree of subjectivity

8:16 to diagnosis as CTE is identified not based

8:19 on the presence or quantity of tow proteins

8:21 but [music] rather their placement and layout in the brain.

8:24 In practice that means that the vast majority of CTE cases go undiagnosed

8:28 and therefore researchers have little data

8:30 to help to determine the disease's cause.

8:34 While Dr.

8:34 Omalu and his collaborators were able to publish a paper about their diagnosis,

8:38 the revelation alone had limited consequences for the NFL.

8:41 That was until a few years later

8:43 when another Steelers offensive lineman, Terry Long,

8:46 died, leading to his body arriving once

8:48 again at the Alagany County Medical Examiner's Office.

8:52 Dr.

8:52 Amalu took another sample for study [music] and there was evidence of CTE.

8:57 A pattern was starting to form and Amalu went on the offensive,

9:01 accumulating permission to examine samples

9:03 from more and more former football players.

9:05 Time and again, he and his partners diagnosed

9:07 CTE in these brains at an extraordinary rate, and the evidence mounted.

9:11 With each new positive specimen,

9:13 the correlation between football participation and CTE was growing irrefutable.

9:18 That didn't stop the NFL from refuting it, though.

9:21 They rolled out the big tobacco strategy and started with denial,

9:24 hiring their own researchers to put out their own

9:27 papers discrediting the work of Amalu and others.

9:30 Behind the scenes, the league orchestrated

9:31 pressure campaigns on the academic journals publishing

9:34 the CTE research using their hired academics

9:36 to sew doubt into methodologies and conclusions.

9:39 But towards the end of the 2000s,

9:40 Congress caught on to this and the House Judiciary Committee

9:43 summoned NFL Commissioner Roger Goodell to testify on the matter,

9:46 bringing media attention and public pressure on the matter to its zenith.

9:49 Despite the NFL's best efforts,

9:51 a wide swath of America now believed the truth that football caused CTE.

9:57 And the pervasiveness of this knowledge is what convinced

9:59 the NFL that it could no longer prevent the crisis.

10:03 Rather, they had no choice but to address it.

10:07 In the boardroom, however, the crisis was not exactly one of player health.

10:11 The league's executives repeatedly demonstrated

10:13 that they considered bodily damage

10:15 the cost of doing business for both them and the players.

10:18 Rather, the league recognized that it risked a disruption in their pipeline.

10:23 Youth football is critically important to the NFL's financial interests.

10:27 Not only is it where their future stars are born, but perhaps more importantly,

10:30 the 999 out of a thousand players who don't make it

10:33 to the NFL are the likeliest future purchasers of NFL tickets,

10:37 merch, and cable [music] packages.

10:39 High school sports participation data was beginning to show

10:41 a plateau in football participation starting in 2007

10:44 as head trauma awareness increased and parents grew more

10:47 hesitant to get their kids hooked on a dangerous sport.

10:50 And in 2011, this plateau [music] turned into an outright decline.

10:54 The NFL treats youth football participation as a leading indicator,

10:57 meaning this was perceived as potentially the start of a slow decadesl

11:01 long cycle that threatened their supremacy

11:03 over the American spectator sports industry.

11:06 Therefore, the league kicked off a campaign

11:08 to mitigate the risks of that happening.

11:10 Now, if the American fan base was going to contract,

11:13 then one obvious solution was just to find new fans.

11:17 The NFL has long dabbled with international expansion.

11:20 They played preseason games outside the US for decades,

11:23 and they even ran a spring development league

11:25 in Europe for much of the 90s and 2000s.

11:27 While they eventually shuttered this out of lack of financial success,

11:30 they replace it with an annual regular season

11:32 fixture in London for the following few years.

11:34 [music] Now, this was fairly unique.

11:36 A true regular season game occurring on a different

11:39 continent from where sports league was based,

11:41 but it proved an instrumental component of growing the burgeoning UK market.

11:45 [music] So, as the concussion crisis reached its peak,

11:48 the league doubled down on this strategy.

11:50 In 2013, they expanded from one London game to two, then the next year to three,

11:54 and they even went so far as to contribute

11:56 to the construction cost of the new Tottenham

11:58 Hotspur Stadium in exchange for the inclusion

11:59 of a retractable synthetic American football pitch for their use.

12:02 Today, the league has its biggest international portfolio ever

12:06 with seven regular season games in 2025 across Sa Paulo,

12:09 Dublin, London, Berlin, and Madrid.

12:11 And of course, the games are only the tentpoles

12:13 of a deeper strategy shift towards the rest of the world,

12:16 encompassing broadcast deals, merchandising expansions,

12:19 and other efforts to monetize and grow

12:20 the clusters of American football fans outside of America.

12:25 But in addition to finding new blood, the NFL also tried to stop the bleeding.

12:29 To fix the youth football problem,

12:30 the NFL's efforts coalesed around one particular solution, flag football.

12:35 In this version of the sport, contact is prohibited or highly restricted.

12:39 And rather than tackling acting as the inhibitor to the ball carrier's progress,

12:42 the defensive side attempts to pull a flag from a belt.

12:45 Until the concussion crisis,

12:47 flag football was rarely played at a genuinely competitive level.

12:50 It was primarily a PE class activity,

12:53 but the NFL has poured considerable resources into making

12:56 flag football a viable alternative for tackle football.

12:59 To provide structure, it started a youth league called NFL Flag,

13:03 and that's grown to more than 1,600 teams across America.

13:07 Some data indicates that flag football is now

13:09 played by more youth in America than tackle football.

13:12 Undoubtedly, the low injury risk and minimal

13:15 equipment requirements allow for plenty of casual participation.

13:18 And as these kids age,

13:20 there are increasing opportunities at the collegiate level,

13:22 particularly on the women's side,

13:23 where there's never been a mature tackle football ecosystem.

13:26 And the NFL recently announced its intentions to take it to the next

13:30 level by launching its own professional flag

13:32 football league for both men and women.

13:34 But beyond this, the NFL coordinated a campaign

13:37 to include flag football in the Olympics.

13:39 As a proof of concept, they sponsored its inclusion in the World Games,

13:43 which is an Olympics-like event

13:45 facilitating international competition for non-Olympic sports.

13:48 [music] The league also got their own stars in on the effort

13:51 by transforming their pro ball format into a series of skills exhibitions,

13:54 including flag football matches.

13:56 And finally, they flexed the full PR muscle of the league into getting

13:59 the message of support for Olympics flag football out to the [music] world.

14:03 Ultimately, it worked.

14:04 The International Olympic Committee approved the bid to add

14:07 it to the 2028 Summer Games in Los Angeles.

14:10 Although this is only a one-off inclusion,

14:12 it still lends serious legitimacy to the idea

14:14 that flag football is a proper sport, not just a PE activity.

14:20 But for as much as flag football might be a sport,

14:22 the NFL still faces the issue that it's a very [music] different sport.

14:26 While the rules are similar to those of tackle football,

14:29 the strategy and incentives are fundamentally different.

14:32 [music] It's not like the difference between no contact and contact ice hockey.

14:36 Flag football is a game of agility and speed.

14:39 Tackle football is a game of positioning and force.

14:41 [music] Elite flag football players have the leaner builds of soccer

14:45 players rather than the big bulky

14:47 bodies synonymous with tackle football players.

14:49 So, that's to say, the skills from flag

14:51 football are only partially transferable to tackle football.

14:54 So, it's far from guaranteed that people will perceive it as enough the same

14:58 sport for it to act as a true

15:00 alternative in the shrinking youth football pipeline.

15:03 It [music] might create flag football fans, but will it create football fans?

15:08 Of course, the one solution that's almost guaranteed

15:10 to work is actually reducing football's injury risks.

15:13 [music] If the NFL can innovate the sport

15:15 in a way that dramatically reduces CTE and concussion rates,

15:18 all their troubles would melt away.

15:20 For over a decade now,

15:22 the league has rolled out a series of rules that create more

15:24 nuanced conditions for what types of contact is and is not allowed.

15:28 But the biggest rule change came in 2024

15:30 with the league completely revamping how kickoffs worked.

15:33 Previously, [music] the team started a possession

15:35 by lining up on opposite sides of the field.

15:37 The kicker would launch the ball far into the other

15:39 side and his team would sprint towards the receiving team,

15:42 attempting to block their progress as soon as possible.

15:45 This resulted in massive high-speed collisions given the speed

15:48 accumulated from such a long run towards each other.

15:50 While kickoffs represented only 6% of all plays,

15:53 they were accountable for 12% of all concussions.

15:56 The new system is called the dynamic kickoff.

15:58 And while its rules are more complex,

16:00 the consequence is that the majority of players start just 5 yards apart,

16:04 massively reducing the speeds at which they encounter each other.

16:07 [music] According to the league's concussion data,

16:09 this correlated with a 43% reduction in concussions during kickoffs,

16:13 contributing to a 17% reduction in concussions overall during the 2024 season.

16:18 This change certainly had its detractors,

16:20 including American President Donald Trump.

16:22 And it certainly was a highly visible

16:24 change to one of football's most iconic plays,

16:26 [music] but when the sport has a fundamental issue,

16:29 fundamental change is perhaps the only real fix.

16:33 Today, [music] two decades on from the first paper linking CTE to football,

16:37 one decade on from a Golden Globe nominated Hollywood movie depicting the saga,

16:41 and mere months on from a mass shooting in New York

16:43 perpetrated by a former football player with CTE targeting NFL headquarters.

16:47 Understanding and awareness of CT's prevalence

16:50 and severity is only progressing further.

16:53 On the academic side, in 2018,

16:55 Boston University did a study on 164 brains from the general

16:58 population and found no evidence of CTE in 163 of them.

17:03 The one with CTE was from a college football player.

17:08 Among the 376 brains they've studied from NFL players,

17:11 345 were diagnosed with CTE,

17:14 a 91.7% prevalence rate, albeit amongst a biased sample.

17:19 [music] A growing number of states have seriously

17:21 considered a ban on tackle football for young kids.

17:24 And while proposed legislation has always been stunted by strong push back,

17:27 the trend line suggests it could only be

17:29 a matter of time until some states consider

17:31 it so dangerous to play tackle football

17:33 that it should be treated like alcohol or tobacco.

17:36 But despite more people understanding the degree

17:38 of danger of football than ever,

17:40 all signs suggest that the NFL has successfully navigated

17:43 the threat to its financial interests, at least for now.

17:46 After more than a decade of decline,

17:48 the emergence from CO coincided with a reversal

17:50 in trend in youth football participation.

17:53 It's still nowhere near its peak, but the bleeding has stopped.

17:56 [music] Meanwhile, league revenue is growing as fast as ever,

17:59 having cleanly doubled over the past decade,

18:02 and the 2025 Super Bowl was the most

18:04 watched in history with 128 million Americans tuning in.

18:10 But even if the recent moment was not

18:12 the reckoning that the NFL's executives so feared,

18:14 [music] and even as the league is making genuine

18:17 progress at reducing the frequency of high impact collisions,

18:20 there are still more subtle trend lines that are pointing

18:22 the league towards a form that a future world might not accept.

18:25 [music] Since the revelations into CTE, the socioeconomic background of youth

18:30 tackle football players has tilted downward.

18:33 More and more, it's a sport played by those from poorer families.

18:37 Meanwhile, the background of NFL consumers is growing wealthier.

18:41 It's [music] successfully catering to a richer demographic.

18:44 Combining a better understanding of the debilitating health consequences,

18:47 [music] talent coming from poorer backgrounds,

18:49 and fans coming from richer backgrounds,

18:51 the comparisons between football players

18:53 and Roman gladiators are becoming increasingly literal.

18:57 For many, football is not purely a pursuit of passion,

19:00 but rather their most realistic chance

19:02 at escaping the generational cycles of poverty.

19:05 Nobody's forced to play professional football,

19:07 but when lacking good alternatives, their circumstances can be coercive.

19:12 Getting to an elite level in any

19:13 sport requires a tremendous degree of sacrifice.

19:16 Isolation from normal life, physical and emotional pain,

19:19 dedication to a career path that could end with a single injury.

19:22 But the distinction with football and contact sports like

19:24 it is near inescapable damage to the most critical,

19:28 most irreplaceable organ in the body.

19:30 The NFL brings some of the most

19:32 life-changing wealth one can earn in professional sports,

19:35 but it involves some of the most life-changing consequences.

19:38 So, even if inertia has won out for now,

19:40 the question for the NFL's future is how much longer

19:43 people will be comfortable with what they watch on their couch

19:46 dictating how many young men get condemned to a life

19:48 of psychological torment once they hang up the cleats.

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