But now the sport stands at a crossroads. The profound effects of concussions and traumatic brain injuries have many questioning the future and the viability of America's most popular sport.
Enter the Head Health Initiative, a four-year, $60 million collaboration between the National Football League and General Electric. The initiative aims to increase the accuracy and speed of traumatic brain injury diagnosis, accelerate concussion research, develop a new game plan for treatment and ultimately, improve the safety for athletes.
Perhaps it's fitting then, given the state's immense football culture, that the Head Health Initiative will be based in Wisconsin.
GE Healthcare's global headquarters for Magnetic Resonance (MR) in Waukesha will be the primary development site for the partnership with the NFL. There, plans to produce a state-of-the- art MR brain scanner will be put into action.
"Here in Waukesha, we focus on the high-tech and the top-of-the-line products, the premium products, which is exactly this," said Richard Hausmann, president and chief executive officer of GE MR. "I would guess that when it's fully under steam that there will be around 150 top-notch engineers, enthusiasts and technicians working on it. This is a significant project for us."
The size of the project also will create jobs at the MR headquarters, where 600 people are currently employed.
"The team that we will add – and we are going to hire people to help expand and do this faster – will be based here," said Mark Phillips, GE Healthcare chief marketing officer.
The Head Health Initiative was officially announced at a press conference in March, when NFL Commissioner Roger Goodell and GE chairman and chief executive officer Jeff Immelt introduced the partnership – the NFL's largest private industry partnership to date.
It is split into two parts. The first is a four-year, $40 million research and development-centered partnership between GE and the NFL that will be based in Waukesha.
For the second part, $20 million is also being put toward an innovation challenge where GE and the NFL will also partner with Under Armour for a two-part, open-entry challenge aimed at generating ideas for new and improved safety equipment. The first part of this challenge is currently accepting entries at NFLGEBrainChallenge.com.
The project's four year, $40 million joint investment is devoted in large part to develop a next-generation MRI scanner that GE Healthcare is aiming to complete in four years.
"At GE, one of the powerful things we can do is to produce something and get something out into the field quickly, something people can start using," said Phillips. "Within four years, we can put something in doctors' hands that they can start using, start learning from and start developing from."
Dr. William Cullinan, dean of the Marquette University College of Health Sciences, called this a "powerful collaboration."
"You couldn't go to a better company than GE, which is at the forefront of the technology," he said.
Dr. Michael McCrea, professor of neurosurgery and neurology and director of brain injury research at the Medical College of Wisconsin, said the initiative could have a "huge" impact.
"These programs inevitably push the science forward," he said. "They're competitive. They're not looking for mundane or esoteric science. They're looking for groundbreaking discoveries, in this case, the discovery of a brain injury biomarker that would have pretty immediate translation to the clinical setting. That's what's exciting to us. This isn't a million years away. This is the discovery of biomarkers using advanced MR technology that would have immediate translation to a clinical setting for diagnosis, measuring recovery and future prognosis after concussion."
Both Cullinan and McCrea were part of a forum on sports-related concussions held at Marquette University in January. Also on the panel was former Green Bay Packers linebacker, Dr. George Koonce Jr., who played in the NFL from 1992 to 2000 and now works at Marquette.
Koonce said the initiative is a good path for the NFL to take.
"I think it's a great partnership," he said. "Whatever we can do to find solutions to help science catch up to the symptoms."
The science of diagnosing and treating a concussion has come a long way since Koonce played in the NFL.
"When I played in the '90s and I came to the sideline, I remember one of the coaches asking me, "George, do you know where you're at? Do you know what you're doing?" And I said, "Well yeah, I think I'm in a football stadium." And he said, "Yeah, you're good. You can still play." And I don't think that's the proper diagnosis of a concussion," said Koonce.
New protocols for when a player can return to the field after sustaining a concussion have been implemented in recent years. Rule changes that penalize and sometimes fine helmet-to-helmet hits and hits on a defenseless player have gone into effect. Not long after the GE-NFL partnership was announced, league owners also approved a rule that will ban ball carriers from initiating contact with the crown of their helmets in the open field.
Resistance to change
There has been a level of backlash to rule changes from current and former NFL players. For the most recent rule change, which largely applies to running backs, Hall-of-Famer Emmitt Smith spoke out against the changes, and current Chicago Bears running back Matt Forte lashed out at the rule in a series of tweets, saying, among other things, "Last time I checked, football was a contact sport."
Others, like Hall-of-Famer Jim Brown, have spoken out in favor of the rule, but the controversy that stems from each rule change speaks to the changing nature of the game and the resistance to change within certain NFL circles.
"We have to take the head out of the game, but also, we want football to resemble the sport we all love," said Koonce.
Rule changes or not, concussion and traumatic brain injury have many worried about the future of the sport. Some, like safety Bernard Pollard, who was on the Baltimore Ravens' Super Bowl team, have said football will not be in existence in 20 to 30 years.
"Football is here to stay for the long haul," Koonce said. "The rules may not be the same as they were when I played in the '90s or early 2000's, but football is here for the long haul. It is – without a doubt – the number one sport in America."
Phillips also said that the NFL has received an "unfair share of attention" on concussions because of its popularity.
"There's no doubt football is going to be here in 30 years," he said. "When things get to a certain point, that's when we start to act. And now we're acting. We'll figure it out."
Nevertheless, there is still a great deal of concern amongst former NFL players over concussions and traumatic brain injuries.
"A lot of guys that I played with, especially guys in the '90s, are really, really concerned because they're starting to feel some of the effects," said Koonce. "I talked to several teammates that are starting to have issues such as memory loss, not being able to sleep, up and down emotions, and extreme headaches, so they are concerned."
Koonce earned his Ph.D in 2012, and wrote his dissertation on transitioning from the NFL, which he is now expanding into a book, set to release this December, titled, "Is There life After Football: Surviving the NFL and Retirement." The day Koonce submitted his dissertation at Marquette University happened to be the day former All-Pro linebacker Junior Seau took his own life.
"It jarred the NFL," said Koonce. "We're still shaken up by that. Junior was an icon."
What further complicates the situation is that Seau never officially sustained a diagnosed concussion. Neither did Koonce, who played the same position as Seau, but said looking back that he probably had several concussions.
"I remember when I got hit during training camp, and I saw all kinds of floaters," he said. "In retrospect, that was a concussion, but back then, it was like, 'You're good.'"
The next generation
A major focus for the Head Health Initiative is to gain a better understanding of subtle changes caused by concussions, things like mild traumatic brain injury, sub-concussive impact and CTE (chronic traumatic encephalopathy), the neurodegenerative disease found in dozens of deceased former NFL players, including Seau (Note: Read sidebar for more on the impact of concussions on the human brain).
"If you have a concussion or mild traumatic brain injury, typically on a normal CT scanner or a regular MR scan, you wouldn't really see the subtle changes," said Hausmann. "Subtle changes happen with concussions. Those changes usually are transient, they go away, but if you do this repetitively, you can have continued damage."
GE and the NFL determined that the best way to make advancements to better understand these subtle changes is to focus the project on MR, the most effective method for imaging the brain, and also a procedure that "is without any side effects," said Hausmann.
While "MRI" is not unfamiliar medical terminology in this day and age – especially if you follow sports – it's still a relatively young technology.
"Two years ago, we celebrated our 25th year in the building," said GE Healthcare Premium MR Segment manager Baldev Ahluwalia of the MR headquarters in Waukesha. "This is where the first high-performance MR scanners in the world (were developed)."
This project represents the next step in a long line of advancement in MR technology at GE Healthcare.
"MR is the most sensitive and decisive tool for finding subtle changes in the brain tissue," said Hausmann. "Because the human brain is the most complex object on earth, you need the best tool you can imagine and that tool is Magnetic Resonance."
By advancing the MR technology as it applies to the brain, doctors will be able to evaluate traumatic brain injury more scientifically.
"The goal of this project is to find biomarkers to detect early on," said Hausmann. "You have to find early indicators so that trainers or coaches or teachers in school or whoever can say, 'Wait a second, we now have an objective sign.' Not just qualitative, 'How do you feel?' and those kinds of things, but a biomarker to say, 'Here, we have to stop.'"
Dr. McCrea said the initiative's pursuit of biomarkers in traumatic brain injury is incredibly exciting.
"We are now on the cusp of identifying biomarkers of this injury that are more objective and more biologically based, and move us away from relying solely on symptoms and sometimes subjective clinical tools," he said.
In addition to finding the biomarkers, finding new ways to study traumatic brain injury over time is another important component to the project.
"What we have to do is implement new tools into the product to better understand the brain's current activity and activity post-concussion," said Ahluwalia. "It's not only about understanding what the tools are at a single time point, we also need to be able to monitor that patient over time."
The research for the project will be guided by an advisory board consisting of a cross-disciplinary team of medical professionals from various institutions, including Col. Jamie Grimes, national director of the Defense and Veterans Brain Injury Center, Dr. Brian Hainline, chief medical officer at the NCAA and several other leaders from across the country.
"We're focused on the brightest minds in the industry," said Ahluwalia.
On May 15, those bright minds convened in Chicago for a two-day meeting to set the groundwork for much of what's to come on the clinical side of the project. And though the project is focused on sports-related concussions in the NFL, its impact will be felt well beyond football.
"Traumatic brain injury is a huge thing," said Hausmann. "There are an estimated 1.7 million people that have a traumatic brain injury just in the United States each year."
"This is much bigger than professional sports," said Ahluwalia. "It has a big impact with the military, automobile accidents and youth sports and youth injuries in general…There are many tools that will be optimized for the evaluation of traumatic brain injury, but those tools we believe will be applicable to Alzheimer's, Parkinson's, stroke, etc."
The project will open up new avenues for research and discovery, and the developments made at the professional level will impact football on every level.
"We have about 6 million young people playing Pop Warner flag football, about 1.2 million playing in high school, about 75,000 playing in college and about 1,800 that's currently playing in the National Football League," Koonce said. "I know this partnership is between GE and the NFL, but whatever their findings are, there's going to be a trickle-down effect to eventually go down to colleges and high school and Pop Warner."
The potential effects on every level of the sport – and on brain injuries overall – are a big reason why there's so much enthusiasm about this initiative among those at GE Healthcare in southeastern Wisconsin. It's an opportunity to solve a problem that affects people from all walks of life.
"Everybody has a personal story or contact that's been impacted by traumatic brain injury," Ahluwalia said. "We're very proud to work closely with the NFL, but they understand that this will have much broader penetration."
"People are extremely excited to work on this," said Hausmann. "Everybody has somebody at home who plays some sport where there's a danger for those kinds of things, so there's a high motivation for that."
"Excitement-wise, it's great," said Phillips. "I've never had so many volunteers to come participate their spare time on a project like they have with this one."
The initiative is in its very early stages. It will be a few years before the impacts of the final results are felt. But there's much that will be happening this year. The first part of the open innovation challenge is already seeking entries, and the second part will be unveiled around the beginning of the NFL season, said Phillips.
And when next season begins, and the concussion debate inevitably makes its way back into headlines, the people at MR headquarters in Waukesha like Hausmann and Ahluwalia will be busy at the cutting edge, working toward a solution.