Glaring Shortfall of Catastrophic Casualties Grows in Ongoing Review 

Spinal Cases Might Reach Hundreds Annually in American Football

Mueller and Cantu Gathered Mere 24 Catastrophic Cases for Year 2010 

News commentary by Matt Chaney

ChaneysBlog.com

Posted Wednesday, January 4, 2012

Football-funded researchers Frederick Mueller and Dr. Robert Cantu are ignoring interview requests concerning their under-reporting of catastrophic casualties in the American sport, injuries they classify as severe trauma involving brain, skull, vertebral column and/or spinal cord.

Or Mueller and Cantu aren’t talking to me, at least, perhaps understandably from their perspective, facing now their likely decades of bad data in cases shortfall, erroneous rates, and even baseless claims about trending “safer” football in the United States.

And all because my electronic searches through Google banks continue to produce cases and rates of catastrophic football injury that bury Mueller-Cantu numbers, which are widely accepted and republished at face value, including by medical journals and the CDC.

Mueller and Cantu work under auspices of the National Center for Catastrophic Sport Injury Research, University of North Carolina. The NCAA provides major funding.

Most importantly, America faces prospect the large majority of catastrophic football injuries go unreported in public, besides a minor portion emerging in news information, the stream fished heavily by Mueller and Cantu for cases they catch.

In the class of vertebral fractures involving no paralysis, for example, there’s probability at least hundreds such “walking” cases go unreported or missed every year in American football, based on sound estimates and etiology outside UNC, along with expert and witness opinion on injuries.

For survivors of all catastrophic categories, I’ve now collected almost a hundred candidate cases for 2011 and should find more. For 80 annotated cases and further discussion, see my Dec. 21 post.

My final qualified number for 2011 should far exceed any on record by Mueller and Cantu, whose 2008 tally of 63 cases is apparently their high mark.

For 2010, the current Mueller-Cantu report lists mere 24 survivors of catastrophic football injury nationwide, including 13 in “complete” recovery.

By stark contrast, my ongoing searches have located some 70 survivors for 2010 football, including over 20 in the past week, and I expect to hit more cases through Google.

About 50 cases I’ve gathered for 2010 remain omitted from the current UNC data.

I have at least 7 detected brain bleeds missed by Mueller and Cantu, of 2010, along with about 35 reported spinal fractures, some cases involving lasting paralysis.

Epidemiologist Charles Yesalis empathizes with Mueller and Cantu. Yesalis, ScD, a professor emeritus of health policy and administration at Penn State University, says challenges are immense for producing representative or accurate accounting on bodily catastrophes in vast American football, a high-risk population of upwards five million active participants.

“I think the key thing is this notion that they (Mueller and Cantu) are only picking up a small percent of cases,” Yesalis said in a phone interview. “And given my experience as an epidemiologist, that just doesn’t surprise me at all.”

“When you go farming for these data—and that’s a good a term as any—boy, it’s a lot of hit and miss.”

The Mueller-Cantu approach for gathering catastrophic cases is characterized in annual UNC reports, depicting a patchwork of football sources and other spotters, coaches, trainers, organizers, doctors and media like me, who forward candidate finds such as online news stories.

Granted, the Mueller-Cantu method picks up some information, but little else is certain beyond invalidity as epidemiological study, pending revisions.

For briefing on the research team, Mueller is director and a former football coach who’s compiled injury cases since the 1970s. “Dr. Mueller,” as Cantu addresses him, holds a PhD in education and works as a UNC professor of sport administration and science. Cantu, the well-known neural sport surgeon and researcher based in Boston, is medical director of the studies.

Yesalis has not performed scholarly critique of the Mueller-Cantu reports at UNC, but he says the inexact approach for gathering football’s worst injuries is nothing new in aspiring research.

“When you’re dealing with (data) as what might get reported in the news, versus trying to identify accurately what’s reported in emergency rooms, or hospital records, that’s problematic,” says Yesalis, co-author of acclaimed national surveys on steroid use by teenagers, among his scientific credits on sport doping and more epidemic disease.

“You’re trying to glue all this together, which is what it appears they’re doing (at UNC),” Yesalis says. “And they’re not the first people to do this on a variety of disease states, and emergency-room conditions, injuries and all that.”

Heavy limitations virtually quash the Mueller-Cantu approach at outset, for bearing solid data and rates, and the absolute numbers they typically present or imply are impossible. Their documents always contain a pair of obscured same sentences, disclaimers for inadequate data, but there’s no formal statement of study limitations. Scant literature review doesn’t mention pertinent research, including studies outside UNC on spinal injuries in general population that rank the sport of football among causes.

An informed schoolteacher would revise the Mueller-Cantu study at first draft, proposal stage, and apparently the UNC readers of graduate and doctoral theses never have the opportunity, given shoddy final data and presumptions that are published and disseminated worldwide, thanks to witless journal editors, government officials and news media.

Obstacles for Mueller and Cantu begin on likelihood that most catastrophic football cases remain unreported in any fashion, for factors such as injured players’ ignorance or resistance of seeking treatment. Cases are also withheld for patient privacy, doctor misdiagnoses and faulty medical coding.

“And if you rely on the fact that it might be in the news?” Yesalis poses. “Well, you know…”

Attritional effects on information don’t end with a case’s publicity by news reporters. Much daily print and broadcast content is culled out before reaching online posting, and cyber pages are routinely taken down in as soon as weeks. Subscription-only access blocks readers from many online news publications, particularly of rural areas.

Indeed, I cannot declare that my vigilant Google review, based on revolving Boolean word searches over hundreds of hours, produces a representative sampling of catastrophic football casualties for a given year. No known reference can affirm, and I find that even news of football fatalities slips by, a few cases, through cross-checking my own lists and those of Mueller-Cantu.

Meanwhile, Yesalis confirms medical databases are no catchall method, no resolution for limitations, and the human variable can skew electronic data in translation.

“If you’re using in any way of automated medical records, then (the question becomes): How is a condition diagnosed?” Yesalis says. “You may have a condition that should be included that is not… That would be a false-negative (case).”

“You could have a false-positive. You might count something as an athletic injury, having to do with (brain injury) or the like, that isn’t. Again, (problems) because of miscoding, or you have diagnosis that’s in gray area.”

“That can be affected by what the physician writes,” Yesalis adds. “Somebody might be (hospitalized) and it may not even be in the report that it had to do with football. What you’re picking up, in an electronic medical-records search, is the primary diagnosis and the cause. If it’s a trauma, it wouldn’t surprise me if often football, or the cause, is left off the chart.”

“Trying to harvest (epidemiological data), looking at medical records and diagnoses, it’s not a walk in the park to be sure.”

Football Spinal Cases Become Black Hole for Disclosure, Research

Based on my intuition of e-searching and -sifting countless thousands of news texts involving football health issues, conducted since graduate study in 1996—along with my experience in football as player, coach and journalist since 1976—I believe Google currently accesses the large majority in actual game cases of death, survivor brain bleeds requiring surgery, and spinal-cord traumas causing permanent paralysis. Those represent the sensational or “newsworthy” casualties of American football.

Bets are off for other categories, though, particularly football cases of severe injury to vertebral column without paralysis, like bone fracture. If anything, I’d wager that hundreds of these casualties are missed every year, if not more, given various insurmountable factors, correlating studies outside North Carolina, and the fact I’ve found 50 and counting for year 2011.

After the untold amount of football spinal injuries undisclosed, the cases involving treatment often require CT or MRI radiology and subjective judgment for rendering diagnosis—“What is one specialist’s picture of a cervical vein is the next one’s image of stress fracture,” a technician tells me—then the variable of prominence influences public revelation or silence.

Starting football players on school teams comprise the majority of publicized spinal cases through all levels, especially prep standouts at the offensive “skill” positions of quarterback, running back and receiver. The story of a juvenile backup player with mere vertebral fracture rarely reaches public airing, from youth levels encompassing about 98 percent of football population. Sportswriters and editors don’t qualify such non-paralysis cases as newsworthy, if even alerted.

Thus news quantity is no vetted indicator of spinal injury’s scope in athletics, but credible estimates suggest how big the problem might manifest for tackle football in the United States.

Data sets of the National Spinal Cord Injury Statistical Center at University of Alabama-Birmingham suggest American football could annually produce 36 to 72 paralyzing injuries, defined for database criteria as “temporary or permanent sensory and/or motor deficit.”

I base that range on the UAB system’s intake of about 13 percent of the estimated 12,000 cervical-cord traumas each year in the United States, and football’s ranking as 15^th in etiology for 27,526 patients in the database, having caused 0.5 percent of the injuries to lead all sports.

By contrast, Mueller and Cantu list 8 total spinal-cord traumas for football 2010, along with 12 for 2009 and 17 for 2008.

For all vertebral fractures, an estimated 700,000 occur in the general population, with as many as two-thirds undiagnosed. The field is dominated by people with degenerative bone conditions, but football’s ranking in etiology of spinal-cord trauma signals it could produce thousands of cases with vertebral fracture.

In comparison, the Mueller-Cantu 2010 report lists 13 cases of vertebral fracture in football, cases ranging from quadriplegia to no paralysis and strong recovery.

Juvenile players comprise 9 of the cases, for an injury rate of about 1-in-500,000 athletes by UNC data, despite other literature indicating rate closer to 1-in-1,000.

Meanwhile, among NFL players in 2011, known catastrophic spinal casualties occurred at rate of about 1-in-200 players or less. And that accounts for only the cases in news media.

Sportswriters certainly miss severe neck and back injuries of the high-profile NFL, for communication blocks ranging from  no diagnosis to privacy. Unreported catastrophic spinal injury likely occurred in 2011 among NFL players, beyond at least 6 known candidate cases requiring operations and 1 of non-surgical neck immobilization lasting three months for the athlete.

Browns linebacker Scott Fujita, a 10-year NFL veteran, wonders of true epidemiological scope for his notorious work environment. “A lot of us (players) are walking around with so much damage to our necks, and our spines, and you never know what might turn up,” he said, speaking in a phone interview.

Much of the damage to NFL players is likely residual, dating back to college and prep football. Fujita had neck surgery as a college player at Cal, for his severe case of stenosis or narrowing of the spinal canal that crimped the nerve-bundle cord. Not only was surgery imperative for continuing his playing career, but for resuming normal lifestyle as well.

“I was getting (nerve) stingers pretty much every time I hit somebody “ in football, Fujita recalls. “Then I’d be typing a term paper and turn my head too fast, and give myself a stinger. I was starting to have significant (muscle) atrophy on my left side, over my trap and delts and down my arm. It was noticeable in pictures.”

For a year of football news online, I’ll find a few cases like the collegiate Fujita’s, severe spinal stenosis leading doctors to recommend corrective surgery. Some players take the option, others don’t.

Mueller-Cantu annuals list a single case in recent years, a “complete” recovery of 2009, but Fujita and I believe there are undisclosed severe cases. And symptoms of minor spinal stenosis affect a football multitude, as many as 50 percent of players, studies find.

Myself, nearing 52 years old and 28 removed from battering collisions in college football, I experience symptoms of neck stenosis, the shooting numbness, radiating pain and trademark interior “coldness” overtaking my C5 to C7 vertebrae range. The episodic inflammation strikes regularly, often weekly, especially while driving or at a computer, and I gobble ibuprofen for the discomfort, or agony.

“(Spinal) stenosis is extremely common,” Fujita says of pro players. “Most guys get a stinger here and there. I imagine once you get a few, then it becomes worse and worse, then it becomes chronic.”

At least 8 NFL players had neck surgeries in 2011, including the aforementioned 6 solid cases for catastrophic designation. Sometimes a surgery is driven by the player’s desire to continue his career, but I find most are necessary for stabilizing spinal damage that acutely threatens nerves and normal function.

“Throughout my playing career, college and pros, I occasionally hear about a guy with a broken neck that requires surgery,” Fujita says. “I’d say more often than not, if it is a pretty serious break or operation, I don’t seem to recall those guys coming back and playing. But that’s just me shooting from the hip.”

“Yeah, I would kind of put the neck and spine in same (regard) as head injury,” Fujita continues, focusing on the NFL. “There’s a lot of gray area involved, and no one knows exactly how to diagnose it, how to describe it, how to talk about it. They know it’s serious, they just almost don’t want to touch the issue.”

Fujita, 32, is an intelligent and thoughtful athlete, husband and father. He holds a master’s degree in education from UC-Berkeley and serves on the NFL players union executive committee.

But Fujita currently wears a cast on his right hand, after shattering bones of two knuckles and fingers while hitting ground in a game last month. Complicated surgery pieced together the bone fragments in Fujita’s fingers, hopefully, lashing everything back in place with steel screws, 22 tiny bolts. This season Fujita also spent two weeks on the Cleveland disabled list for diagnosed concussion. That’s his brutal job however lucrative, until further notice.

Fujita treks the jungle of pro football in America, long has, and he always runs. Physical threat and unspoken boundary are everywhere, like stiff resistance to report bodily damages of the NFL. The stillness stands pragmatically for every insider concerned, all parties, league, management, union, players, families, agents, with fortunes riding the line over health risk, outcome, and especially liability, who ends up paying.

“A lot of times when guys are having neck stingers, or even some back issues, in many cases the clubs won’t even want to take a good look at it, especially on the MRI,” Fujita says. “And I know a lot of times the player doesn’t want to take a good look, either, because you don’t want to know what’s going on.”

“Maybe that’s stupid and irresponsible, but I think that’s the reality that a lot guys are living with right now.”

So-called safer football is wholly unrealistic, meanwhile, a national joke that nevertheless occupies national dialogue for the game’s epic health crisis at hand, blowing up over brain-injury revelations and lawsuits compounding for all levels.

Thus the data of catastrophic injury enter play, and inadequate numbers serve to nurture a popular, resilient myth, the one how an individual player faces just “rare” chance for sustaining “freak” violent mishap resulting in death or permanent dysfunction.

Parents and novice players buy that falsehood by the millions. I did as a boy.

Actually, catastrophic football injury—which by definition must be expanded to include lethal categories such as heatstroke, blood clotting, organ destruction, artery rupture, staph infection and peripheral paralysis that comprise scores of survivor cases I’ve located for 2011—is quite predictable and possibly occurring daily on average, somewhere.

The American gridiron’s goriest, most risky stretches are the regular season from late summer into winter and “spring practice,” when many states allow full-contact drills and scrimmaging at schools, along with collegiate programs nationwide. Conditioning and weightlifting sessions of January and February also kill and severely wound players, particularly at colleges.

Yet some American opinion leaders say it isn’t really so, this picture of brutal football, not any longer. People like NFL commissioner Roger Goodell, who promotes neo-fandom terms like “culture change” and “concussion awareness.”

Today, football advocates insist they’re seeing a safer brand of tackle football, and Mueller and Cantu join Goodell at campaign front, citing their decades of catastrophic-injury numbers as evidence.

Mueller and Cantu claim their data have been instrumental in a game trend since the 1970s, steering players away from head contact.

Ridiculous, retorts Fujita, the NFL linebacker who’s flabbergasted the foolishness is mentioned in straight face. “Absolutely not, if anything I would say there’s more head contact in football today.”

“There’s increased emphasis on trying to clean up the game,” Fujita acknowledges. “You know, coaching guys up in ‘proper technique’ and all these catch phrases, and paying lip-service to everything. So when it comes down to it, this remains a violent game.”

Pro players certainly grasp their risks, and the genetic violence of football for all ages. And helmet or head-to-head colliding is the rule rather than exception for modern football, particularly with skull-preserving helmet technology among forces that channel combatants into zero contact, every player, from “Tiny Mite” to NFL linebacker.

Fujita has to laugh when I ask whether he feels safer playing football these days, definitely a stupid question.

“Um, no, I don’t feel any safer,” he replies. “I think in some respects you see the game changing. Some ways. Like a guy (of the NFL) coming across the middle, catching a pass for a 15-yard dig, and the safety will pull off (for the cameras), whereas before, more likely, the safety would blow the guy up.”

“It’s just a brutal game, and I don’t think you can technique—using ‘technique’ as a verb here—you can’t technique the game into becoming safer. You can’t even (player) fine the game into becoming safer. And that’s just the reality.”

Human Toll, Medical Damages, ‘Public’ Football and Vital Statistics

Independent journalist Irvin Muchnick laughs, too, when I broach the theory of safer football, the central talking point of football advocates for their increasing problems over injury epidemic and monetary damages.

“Anyone with two eyes on a Sunday afternoon can see that’s not so,” he says, dismissing assertions a fundamental reduction is possible for football risk and casualty.

Muchnick, the author, alternative columnist and indie blogger with cunning for banging on sport-entertainment conglomerates, bristles at the idea of faulty research, funded by football, as a catalyst for safer sport over 34 years of publication.

“If Cantu and the North Carolina people are claiming some credit here, about what their data have wrought, that’s so patently a false claim,” says Muchnick, a leading voice of our growing faction against “public” football financed by government, schools and colleges and largely carried for damages by general insurance consumers of health and liability coverage.

Muchnick said, speaking with me by phone, that UNC’s glaring under-reporting of football injury makes news on two levels.

“One is the statistics themselves, knowledge is power, and the information is important,” he says. “For a sport system out of control, I don’t know exactly at what point the (germane) statistics move people, to take our master points seriously, but clearly it’s part of it.”

“Which brings us to the second point, the process,” Muchnick continues, “and the idea that these kind of data are being collected by people who aren’t doing the job right. Not so much that they’re doing it in bad faith, but that it’s not a priority and it’s supporting some agenda other than getting everything out there.”

Muchnick sees football advocates in stall tactic amid dread crisis, recalcitrant to accept looming reform of their blood sport, if not abolishment. He scoffs at supporters’ rhetoric overall but does detect a shift in public conscience, related to their talk.

“One good thing about ‘concussion awareness’ is that it is pointing the markers in only one direction,” Muchnick says. “Even if people are not buying into this football problem as speedily and as conscientiously as we would hope, there’s only one place this story is going. And it’s not going toward reduced deaths, reduced disability, reduced public-health costs for our country.”

“Even if the NFL threads the PR needle in all this stuff, and they do a pretty good damn job on that, it still doesn’t add up to answering for the feeder levels of this activity, amateurs in public high schools, colleges and so forth. The economic numbers just can’t sustain themselves.”

“Football,” Muchnick says, “still doesn’t get its arms around the fact that seven- and eight-figure lawsuits, and imbalanced budgets, are going to be inevitable as our public awareness increases.”

Finally, of the data mess at UNC on catastrophic football injuries, Muchnick wants real response from the researchers, besides their short email replies to me, thanking me for my "interest" and noting they're busy evaluating their data for 2011.

Right. Mueller and Cantu are presently bombarded by about 95 cases I’ve dropped on them, including over a dozen since my Dec. 21 post.

Mueller and Cantu also cannot yet address their second overdue task, revising their bad data and assumptions of 2010, while also gauging the infestation back through decades of their reports.

For 2010, I’m still awaiting Mueller’s green light for loading them with the 70-some survivor cases I’ve pulled from Google, surely to obliterate their paltry year data currently posted at www.unc.edu/depts/nccsi.

Muchnick is bored already, seeking open discussion on the matter, quickly.

“It’s very important for Cantu and Mueller to talk about why their methodology failed to catch these cases that you did catch, as a lone, independent, unfunded researcher and journalist,” he told me.

“I’m not qualified to say everything you’ve written is perfect, but I’ve seen enough of your work to know that it’s conscientious and it’s based on a coherent method. And it’s found things that are at odds with what the public’s being told, so we need to resolve those contradictions.”

Matt Chaney is a writer, editor, teacher and restaurant worker living in Missouri, USA. His 2001 graduate thesis for an MA degree at the University of Central Missouri is qualitative media analysis of 466 football reports, historical print coverage of anabolic steroids and HGH in American football, largely based on electronic search among thousands of news texts from the 1970s through 1999. Email him at mattchaney@fourwallspublishing.com. For more information, including about his 2009 book,Spiral of Denial: Muscle Doping in American Football, visit the homepage at www.fourwallspublishing.com.