‘Woodpeckers Don’t Play Football’: The Concussion Repercussion | Skeptical Inquirer (original) (raw)

I dislocated my shoulder during wrestling practice in 2015. The nature of this type of injury leaves an indelible mark, and I can still recall it vividly nearly a decade later. I’d toppled backward, arm outstretched and externally rotated to break my fall—an amateur mistake. The pain was instant and searing. I felt a “fizzing” sensation up and down my arm from the nerve damage, and my ligaments screamed at being forced beyond their natural range of motion. My shoulder felt “out of place.” Because it was. Despite it being my first dislocation, I knew immediately what I’d done.

“Can someone find me a doctor,” I said calmly, as though asking to borrow a pen, “and tell them I’ve dislocated my shoulder.” I lay motionless until the paramedics arrived, fearing that any movement would distend my shoulder from its socket like a life-size Stretch Armstrong.

Most traumatic musculoskeletal injuries can be described with similar precision. But if you ask someone with a concussion to recall their experiences, you get something less exact. Some American football players describe how the world was spinning, like being drunk but without the fun part. Others report seeing stars, feeling like their legs were “independent of their bodies,” or feeling “distant” and watching the remainder of the game through a dense, unrelenting fog.

Donald Parham Jr., tight end for the LA Chargers, fell to the floor in a televised game after failing to catch a touchdown pass, landing awkwardly and snapping his head back on the turf. His body went rigid, he convulsed, and his arms stiffened into what neurologists call the “fencing position”—an abnormal, involuntary posturing reflex caused by damage to the brainstem or surrounding structures. Fortunately, Parham recovered, which is more than can be said for game commentator Joe Buck, who received fierce backlash for overlooking the seriousness of the injury and suggesting the player was suffering from the cold. Former Green Bay Packers cornerback Sam Shields, who missed nearly fourteen months with concussions between 2016 and 2017, described how his brain felt like it was cramping: “[I]t was trying to break out of my skull,” he told CNN. And for every five to ten concussions with telltale signs, at least one will have no immediate symptoms, only for athletes to be hit with waves of headaches, vomiting, or worse hours or days later.

There’s good and bad news. The good news is that a one-off concussion is rarely a career-ending injury, and most recover within a few weeks.

Cumulative Damage

The bad news is that a concussion is rarely a one-off injury. Ask Tua Tagovailoa, the Miami Dolphins quarterback who this month became the NFL’s latest concussion statistic when he sustained his career fourth. A concussion is a brain injury. Impact forces from a tackle or a fall damage brain cells and cause chemical imbalances and inflammation—neurological damage that remains long after the superficial symptoms have resolved. Prize athletes, like prize horses, are valuable commodities, and they’re often rushed back into the fray before they’ve fully healed, making them vulnerable in the subsequent collision. When they return to the sport, athletes may suffer from slowed reaction times and poor spatial awareness—fertile grounds for re-injury, even if they follow strict return-to-play protocols.

How many concussions are too many? We don’t know for sure. Some research suggests that individuals suffering three or more in a lifetime have a worse long-term prognosis. But, with so many variables and confounding factors, pinning down a number is like catching a leaf in a hurricane. What we can say with confidence is that damage is cumulative. Each head injury increases the risk of long-term cognitive decline, memory loss, and mood swings. Concussions are also linked with chronic traumatic encephalopathy (CTE), a severe neurodegenerative condition that can only be diagnosed postmortem. When the brains of deceased American footballers were donated to medical science, evidence of CTE was found in 99 percent of former NFL players, 91 percent of former college football players, and 21 percent of former high school football players. There’s no frequency “threshold,” but each successive concussion inches the athlete closer to the point of no return.

The Q-Collar: The Only Equipment ‘Proven to Help Protect the Brain’

Innovation stems from the necessity to solve real-world problems. And a concussion in contact sports is a real problem. Head injury rates are highest in rugby and American football—possibly higher in the former where they don’t use headgear—and lowest in soccer and non-contact sports. Ice hockey is somewhere in the middle. But such a burgeoning public health problem creates a frustrating conundrum: it demands urgent and credible solutions to prevent concussions from destroying lives, yet those solutions are so financially lucrative they incentivize bad science and baseless claims, obstructing genuine progress. It’s a twisted paradox that’s disturbingly common in the Wild West of commercial health and wellness. Potential pioneers in this space better have their ducks lined up before wading into turgid waters.

Enter Q30 Innovations, a research and product development company based in Westport, Connecticut. Their Q-Collar, formerly called Neuroshield, is a C-shaped device that hugs the neck like an emaciated travel pillow, providing gentle compression to blood vessels that supply the head. It was the brain baby of Dr. David Smith, a former internal medicine practitioner who cites two sources of inspiration for his design.

First, the humble woodpecker. Smith was fascinated at how the bird, famous for punching holes in wooden surfaces using only its beak, could perform its duties without sustaining chronic head injuries. Supposedly, natural selection endowed the bird with neck muscles that contract on impact, trapping blood in the skull and creating a layer of protection around the brain to stop it from rattling in its container. Evolution’s bubble wrap.

Smith’s other influence was a study he authored in 2013, showing a 30 percent reduced concussion rate in contact sports contested above 600 feet (183 m). He speculated that increased blood flow to the brain at “altitude” slightly increased its mass and reduced the excess space in which the brain would “slosh” around on impact. He called it the “tighter fit” hypothesis.

Inspired by nature and based on science, the Q-Collar was a marketing company’s dream. The device was proposed as the only equipment “proven to reduce concussion risk,” a claim later tempered to “the only equipment proven to help protect the brain.” Athletes at dozens of college and NFL teams are using the device, and Co-Founder/CEO Tom Hoey (real name) predicted 100millioninsalesbytheendof2026fromjust1percentofitstargetaudience.In2022,Q30Innovationssecureda100 million in sales by the end of 2026 from just 1 percent of its target audience. In 2022, Q30 Innovations secured a 100millioninsalesbytheendof2026fromjust1percentofitstargetaudience.In2022,Q30Innovationssecureda2.8 million collaboration with U.S. Army medical research to aid in the fight against traumatic brain injury in the military.

‘Woodpecker’s Don’t Play Football’

But the criticism swells like a rising tide, and many scientists are demanding we pump the breaks on Q-Collar. Among them is Dr. James Smoliga, a professor in the Department of Rehabilitation Sciences at Tufts University. He and ornithologist Lizhen Wang found that the woodpecker analogy didn’t withstand scrutiny. Myriad factors explain the woodpecker’s seemingly miraculous ability to escape head injury in the course of its curious vocation: spongy shock-absorbing bones in the skull; thick neck muscles that stabilize the head; a smaller brain with smaller relative mass that sits at an angle, allowing impact forces to be more equally distributed; less space in the skull for the brain to slosh; very short-duration impacts when drilling; and a hyoid bone that wraps around the skull like a seatbelt. Conspicuously absent from all the ornithology literature from the 1700s to the present day was any evidence of a muscle that compresses veins in the neck, trapping blood in the brain and protecting it from injury. These are speculative mechanisms at best.

Then, the altitude research was grounded. The “tighter fit” hypothesis proposed by Smith and colleagues was criticized for its numerous statistical flaws and arbitrary altitude cutoffs. Most experts agree that 600 feet (183 m) isn’t nearly high enough to meaningfully alter blood flow to the brain and that a “threshold” for concussion protection, if one exists, would need to exceed 8202 ft (2,500 m)—far higher than any modern-day NFL stadium. In fact, the association between altitude and concussion was so tenuous and likely coincidental that researchers showed an equally robust correlation between an athlete’s concussion risk and the animal featured on their team logo. A comprehensive meta-analysis has since shown “no difference in the relative risk of concussion at sea level compared with at higher altitude.”

Lastly, the FDA noted concerns of their own in the Q-Collar’s literature. Many of the benefits of the device stem from studies published by Q30 Innovations—the company behind the product—or by researchers listed as investors. In addition, a decision summary published online by the FDA in 2020 noted that (i) “The Q-Collar has not been demonstrated to prevent long-term cognitive function deficits, and the ultimate impact on clinical outcomes has not been evaluated,” and (ii) “Data do not demonstrate that the device can prevent concussion or serious brain injury.” The FDA authorized Q-Collar for commercial sale the following year.

“I’ve been investigating Q-collar for years,” said Prof. Smoliga. “The initial premise that the device replicated the natural protective mechanisms of woodpeckers turned out to be untrue. And clinical trials showing that it ‘protected the brain’ had major flaws and invalid results. Actually, there’s no good evidence of reduced concussion risk when using the device, even though that’s what it was originally intended to do. Despite all these issues, the FDA still authorized it. More recently, we’ve identified concerning anomalies in published studies, including numerous ‘errors’ and inconsistencies across multiple publications. How many other concerns must be raised before we stop trusting these devices to deliver on their extraordinary claims?”

Combining Preventative and Curative Methods

Very few innovators are comfortable claiming they can “protect the brain from injury” or “reduce concussion risk,” hence how Q-Collar successfully jumped the line, perhaps to the detriment of athletes placing undue trust in the device. Still, there are evidence-based strategies that offer a semblance of hope in reducing concussion risk and severity.

Charlotte Voss, Clinical Director at Active Body Clinic in Hertfordshire, England, uses a combination of preventative and curative strategies in her practice, primarily in rugby.

“We coach fundamentals like good tackling technique to reduce the risk of head injury. We also incorporate exercises that strengthen the neck and trunk and ensure all players have a correctly fitted gum shield.” Indeed, various studies in contact sports show that mouthguards are important for more than protecting the teeth. By absorbing impact forces from tackling and mitigating how much is transferred to the base of the skull, mouthguards may reduce concussion rates, just as a car’s suspension prevents shock from the road from being transmitted to the passengers.

Voss, who has over a decade of experience working with high-level rugby athletes, also advocates for fast and effective management of head injuries when they inevitably occur.

“All our pitchside medics, coaches, and players are educated on the risks, what to look for, and how to manage these injuries when they occur. We use a standardized tool to assess our team every preseason. If a player receives a head injury, we assess them on the pitch using a validated checklist (Maddocks questions) and check their symptoms. If we’re in any doubt, they’re immediately removed from the field, assessed by medical staff, and put onto the governing body’s concussion management protocol. They’re sent to hospital if they display any red flags.”

When it comes to concussions, there’s no magic bullet. The risks will never be eliminated, only mitigated. What’s more, progress in reducing the frequency and severity of concussions will be incremental, dependent on long-term programming and education, strategic use of resources, and fast and effective injury management. There may be few places in sporting competition where forgoing culturally ingrained quick fixes is more critical.

Oh, and woodpeckers do get concussed, after all.

Nick Tiller

Dr Nick Tiller is an exercise scientist and author of The Skeptic’s Guide to Sports Science, named one of Book Authority’s “Best Sports Science Books of All Time.” He’s a columnist at Skeptical Inquirer and an elected Fellow of the Committee for Skeptical Inquiry. www.nbtiller.com