Steelers' Ben Roethlisberger Should Know Better

Mahercor .comCorrespondent IJanuary 11, 2009

NFL's Ben Roethlisberger and others should be asking, "Why?"

Head injuries, such as the concussion sustained Sunday by Steelers quarterback Ben Roethlisberger, are a scary reminder of the human body's limitations for millionaire professional athletes.

"Knock on wood, just one bad one," Cooke said Monday of his concussion history. "I got caught off guard with an elbow to the chin, hit my face on the ice when I fell and I was out.

"It's something as an athlete you don't really think of, but if you sit back and watch another sport or watch your sport after you are done playing, you think, 'Holy cow! I'm surprised how (violent) that looks.'"

Cooke attended the NFL game between the Steelers and Cleveland Browns with his children. The sight of Roethlisberger strapped to a stretcher, his head and neck immobilized as a medical crew transported him to an ambulance, provided him with a reminder of thoughts he will strive to avoid when the Pittsburgh Penguins face the Boston Bruins tonight at Mellon Arena.

"I've never once thought about injuries," Cooke said. "Not until after they've happened, at least."

Concussions are on the rise in the NHL. A study by the Orange County Register prior to the 2007-'08 season determined league players missed 760 games in 2006-'07 due to concussions and related symptoms.

In Boston last week, Dr. Robert Cantu related to Bergeron that “99 percent” of NHL players would have similarly suffered a significant concussion in the manner of collision that saw the side of Bergeron’s face smack into the unforgiving shoulder pads of Dennis Seidenberg with such violent force.

Cantu’s statement was meant to assure Bergeron that his second concussion wasn’t the sign of a player that’s becoming more and more susceptible to head injuries and hockey dings.

What it really was was an affirmation that blows to the chin and jaw are related to a new origin of concussion recently identified by military research. The finding is important because many such brain injuries have been missed in the past, especially when more severe or obvious wounds demanded attention.

Military researchers report observations recognizing this phenomenon in a letter to the New England Journal of Medicine.

Diagnosing brain injury, especially mild damage, is based largely on subjective symptoms like irritability and forgetfulness. Imaging tests like CAT scans do not help, and neurological function tests are not very useful without baseline information. All methods in place today, other than helmets, do nothing to protect our youth and professionals in real time.

Hitting "up" in the NHL has become an accepted manner of hitting. Perhaps it shouldn't be. It hasn't always been that way.

Hitting in the NHL and NFL today may be analogous to boxing. Given the high incidence of retired players developing the same displayed types of dementia—frontal temporal dementia as found in boxers—one needs only to do the math.

It's well documented. Boxers with a "glass jaw" are more prone to concussion with each event. This runs in line with conventional research from UPMC, which indicates that  once you have one "event" you are more prone to the next.

In the sweet science of boxing, body blows have always been used to wear down and weaken an opponent's will. That is the hockey equivalent of bodychecking.

But in boxing, when you want to deliver a knockout punch and put your opponent down and out on the canvas, you go for the headshot. And what punch is the most dangerous knockout punch?

An uppercut, that's what. Delivered at a 45 degree angle at the opponent's jaw, it seemingly comes out of nowhere because the victim often never sees it coming. Clearly, hitting "up" in the NHL is the hockey equivalent of a vicious uppercut, designed to deliver a knock-out blow.

Dr. Johnny Benjamin, director of Medical Specialty Procedures Surgery Center, Vero Beach, has worked with light heavyweight champion Antonio Tarver and many other boxers.

"If you look at Peyton Manning's helmet, it comes down lower than jaw line. Part of the problem is taking a punch to chin," Benjamin said. "As we've seen with boxers, a guy who takes a punch to the chin goes down. It's the same with a football player. A key brain stem lives behind the jaw, and controls many functions of the body. So helmets should protect below the chin."

But a helmet can't, because chin-strap anchoring systems channel forces to the skull base via the mandible.

Patriots team dentist Gerald Maher said that NFL research showed 70 percent of concussions are the result of blows to the jaw. But he said not a single jaw expert was invited to the conference.

Maher has been in contact with NFL Commissioner Roger Goodell and had been asked to submit his research to a group out of Ottawa, Canada, called Biokinetics. Still, he feels his efforts have been stymied.

"They are working on dummies, and I am 100 percent opposed to working on dummies with this device," he said. "You need to individualize this, and you can't do that with a dummy. I think working with them will be a waste of time."

Maher has been outfitting Patriots players with his mouth guards since the early 1980s and said that 40 current members of the team wear them. Johnson wore one and has stated he has no neurofibulary tangles, known precursors to Parkinson and dementia.

This could be a marker crucial to soldiers in Iraq subject to the same type of chin strap forces on the jaw.

Depression, suicide, and concussion rates in soldiers have been the highest in the history of warfare, due in part to repeated exposure to unexpected IED blasts.

"To not have a TMJ [temporomandibular joint] expert on the panel is extremely shortsighted," said Maher. "I don't understand why they don't. It's one of the pieces that we should be looking at. We should be looking at prevention."

Omitting this widely-accepted theory in their rhetoric, which is supported by a documented history of use within the NFL, is extremely dangerous to the general public.

Part of the NFL's concussion crackdown, which includes neurological baseline testing for all players, will be to enforce the use of chin straps. Maher said that's more likely to hurt than help, as it locks the jaw in a position where the end of the jawbone can strike the temporal lobe of the brain.

"That's the worst possible physiological position they can put it in," said Maher.

The exact place where Roethlisberger broke his jaw could determine how long healing takes, said Dr. Gerald J. Maher, dentist for the New England Patriots. Jones said Roethlisberger broke his upper and lower jaw.

Maher, who also has worked with injured boxers, said broken jaws can take three to six weeks to heal. However, compromised cartilage structures within the temporal mandibular will never repair themselves.

Only a corrective procedure developed to align and correct these structures will help reduce the odds of reoccurring injury. The President of the NHL dental association, along with many other NHL, NFL, NBA and major college dentists, have signed on to this accredited certification program. It's a step in the right direction.

A poster presentation prepared by an NIH consultant was recently accepted by UPMC concussion conference officials. It outlines in detail this very procedure, yet Roethlisberger has not been fitted with the retainer-like mouth guard used by the NE Patriots for over two decades.

Big Ben should be asking why not?


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