Theaters of Pain

What do NFL football players have in common with developing countries?

“As far as official injuries, well, I’ve had surgeries. And I had, like, seven shoulder injuries. If you count scopes, like, 13 knee surgeries. I’ve broken my legs, my hands, my fingers, my elbow I had to have repaired, my left wrist, knocked a bunch of teeth out. I always break a couple fingers. My hand is – your hands always feel bad.” – Tre Johnson, former NFL player (NPR)

 

 

At first glance there’s not too much of a comparison between national football league (NFL) players and developing countries, but an article by Tom Junod in Esquire magazine called “Theater of Pain” makes a pretty good case that the two have a lot more in common when it comes to the prevalence, severity and long-term effects of injuries.

To begin, Junod’s article details the painful, long-term consequences of repeated injuries sustained by NFL players and compares them injuries sustained by the general public.

  • According to a 2011 study by the NFL, about 2,000 NFL players sustained almost 4,500 injuries that kept them off the field of play for at least two weeks, which resulted in an injury rate of 225% among NFL players, while the rest of the U.S. population had an injury rate of less than 10%.

  • Conversely, if you were to classify NFL injuries according to categories commonly used by injury epidemiologists, the health status of NFL players has more in common with the average citizen in a low-income country than with the average North American, whether you were to categorize these non-fatal injuries as falls, interpersonal violence, or workplace-related causes. Take, for example, Latin America where:

    — Males in Latin American countries sustained nearly four times as many fall-related injuries than males in North America in 2002

    — They suffered approximately nine times as many non-fatal injuries from interpersonal violence

    — And, while reliable data for workplace-related injuries in Latin America is harder to come by, it’s probably pretty safe to assume that these numbers are far higher outside of North America (though probably not 225% worse)

One such injury, described here by Matt Hassleback, a 3-time All-Pro Quarterback, sounded nearly identical to scenes that many EMS providers have experienced, albeit at the scene of a car wreck: “[Someone] hit me, and twenty minutes later I’m in an ambulance on my way to Stanford Medical. I’d broken a rib on the left and I’d broken a rib on the right. The rib on the right was right next to my aorta, and it was really dangerous for my health. I couldn’t breathe. It was like there was a weight on top of me. It’s a scary thing, because it feels like you’re drowning. I couldn’t breathe at all … and when the trainers met me they saw I was, like, purple in the face. And they immediately put me on the ground. Sometimes they’ll put you on the ground to evaluate you and sometimes to give the backup quarterback a chance to get loose. They put me on the ground because I was purple.”

Paramedics and EMTs put people on the ground if they think they’re going into shock, or may have a spinal cord injury. In the average football game, the potential for this happens for each player on each play – approximately 120 times per game.

The Financial and Social Impact of Injuries

A sense of duty, and the necessity of breadwinners to keep working despite their injuries is another common theme mentioned that we’ve seen ourselves. In developing countries, huge, extended families often depend on a single person for steady income, so there’s often little chance for the injured to stay home and recover if they can still get to work, therefore often exacerbating the injury by not allowing it time to heal. In the case of an NFL player, feeding a large family may not be the primary motivator to getting back on the field, but the sentiments shared for the “team” and the “family” are still very similar. According to Junod, “For players … injuries are a day-to-day reality, indeed both the central reality of their lives and an alternate reality that turns life into a theater of pain. Experienced in public and endured almost entirely in private, injuries are what players think about and try to put out of their minds; what they talk about to one another and what they make a point to suffer without complaint; what they’re proud of and what they’re ashamed by; what they are never able to count and always able to remember. …But he’s playing, because he’s better hurt than his replacement is healthy, and he’s helping his team more by playing than he would help his team by sitting down and trying to heal. He’s playing because he can, and because — no matter how much attention the issue of injury receives and no matter how many changes the NFL faces — the second cardinal rule of the NFL is that you play unless you can’t.” If you were to re-read that same section and simply replace the subject pronouns of “NFL players” and “team” with “the working class in low-income countries” and “their dependents”, the same realities could be said for the regular citizens of impoverished countries who are suffering from skyrocketing injury rates – in fact, sustaining nearly 90% of the world’s total injuries.

Credit: WHO

Credit: WHO

In a 2002 article from the International Journal of Epidemiology, Dinesh Mohan reported similar findings among the effects of road traffic injuries on poor communities: “Road traffic injuries are also a major cause of orthopaedic and mental disabilities. The experience of poor communities in coping with medical catastrophes is very different than that experienced by well off communities [and include]: inappropriate or absence of treatment leading to complications and longer treatment time; re-allocation of labour of family members and reduced productivity of whole family; permanent loss of job for the victim even if he/she survives; … and dissolution or reconstitution of household.”

If this seems too much of a stretch, consider the sub-headline of an article in the San Diego Union-Tribune describing the last days of NFL linebacker Junior Seau before his suicide: “After his retirement from the NFL, a troubled Seau tried to keep up appearances with his vast networks of friends and acquaintances. But his inner life was in shambles.” This is true for many of the other NFL players who have taken their own lives, but not before taking pains to ensure their brains would be studied scientifically – i.e., “donated to science”. After reading the Seau article, it becomes hard to tell who Mohan is writing about – NFL players or impoverished families in low-income countries – when he states, “It is clear that the outcome of a serious injury… has many long-term effects, socially, economically and psychologically, on all the other family members and the community. Many of these outcomes are permanent and soul destroying for individuals and possibly for the larger community. There is very little work done to understand these issues.”

Consider also this diagram by the World Health Organization (WHO) describing the consequences of injuries and violence, which reads very similar to the risk factors attributed to careers in the NFL. According to another article by the Union-Tribune on Seau’s suicide: “Within 12 to 24 months of retiring, three out of four NFL players will be one or more of the following: alcohol or drug addicted; divorced; or financially distressed/bankrupt.” One may not need to be knocked around like an NFL player to see how devastating the effects injury can be on individuals and communities.

The Golden Parachute or the Desert Mirage

The biggest difference between NFL players and LMICs, however, is fairly obvious – insurance – and a parallel that won’t be drawn between NFL players and poor countries anytime soon. Compare this story to the average bus rollover in an poor country:

“The kind of V-shaped angle a healthy knee forms when you flex your leg, McGahee’s knee formed backward. Three ligaments connecting his thigh to his shin no longer connected his thigh to his shin. When the trainers came out, they held his hands, but McGahee, who went into what he describes as “shock,” does not remember them. When I asked him over the phone who was the first person he remembers talking to, he said, “The team pastor.” And when I asked if he remembers what he thought as he lay stricken, he said, ‘My mind was all over the place,’ but ‘I was wondering if I could ever play football again.’ … He could. He had a $2.5 million insurance policy that he was eligible to collect if he never played again.”

However, with the suicide rates increasing among NFL players, it’s becoming harder to say whether or not the golden parachute is an actual reality, or just a mirage.

In February 2013, right around Super Bowl weekend, Tom Junod was interviewed on U.S National Public Radio (NPR) with former NFL player, Tre Johnson, who was asked what the long-term health effects of an NFL career have been. Johnson replied, “with this much time having passed, you definitely see the full extent of the injuries because you’re not on the drugs anymore. You know, every week and every day, I was taking something so I can get through practice, I can go to sleep, I can go for the game. You know, there’s different levels of drugs depending on whatever I needed to do. But now, you know, when I stop – I don’t take anything now, except the medicines I need, like, for blood pressure and stuff. But you can definitely feel, like, I have to say, I appreciate you guys for turning the lights down. I don’t like the bright light. You know, you do get the headache. And it’s just the achiness, the – you know, I have a bad head, so it’s hard to stand up straight. Everything aches. It’s hard to sleep for me more than maybe two, three hours at a pop. … You know, I’m tired now. You know, I’m just exhausted.”

It’s difficult to make exact comparisons between NFL injuries and civilian injuries, and we’re far from being epidemiological experts, but we think these are still some statistical parallels worth looking at. If you wanted to compare the burden of injury among NFL players to that of the rest of the world, than you could say that the consequences of injury for NFL players versus the average North American citizen is comparable to the consequences of injury for South America versus North America. The numbers aren’t exact, but the outlook is grim – for both NFL players and developing countries – and while there may be some objections to our admittedly inaccurate scientific calculations, we think that these comparisons are tame compared to those already made between NFL players and fight dogs.

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