American football is a thrilling spectacle, a display of athleticism, strategy, and raw power that captivates millions across the United States. According to Statista, the NFL is one of the most viewed sports globally, with a viewership of 17.9 million in 2023.

From high school fields to packed stadiums, the gridiron is where legends are made and dreams are pursued. But beneath the crowd’s roar and the excitement of the game, football is a physically demanding sport with inherent risks.

While broken bones and concussions often dominate the headlines, there are hidden dangers that are rare but life-threatening. These conditions might not be as common as ankle sprains or hamstring pulls, but their consequences can be devastating.

Let’s examine these rare conditions, shedding light on their causes, potential impacts, and the importance of early detection.

Commotio Cordis

Commotio cordis is an uncommon, often deadly condition caused by a sudden blow to the chest that interferes with the heart’s normal rhythm. If the impact happens at a precise moment in the heart’s electrical cycle, it can trigger ventricular fibrillation, preventing the heart from pumping blood.

A short study (published in BMJ) found that commotio cordis happens when an object (like a ball) or another player hits it. It was found that American football had the highest death rate, especially when the impact came from another player. This might be because it’s harder to do CPR on a player with pads.

Sadly, over half the cases resulted in death. However, survival has improved significantly in the last 15 years, likely due to better awareness and faster access to defibrillators (AEDs). While the odds are low, the consequences can be devastating, often leading to sudden cardiac arrest.

Damar Hamlin’s collapse during the Bills-Bengals game is an example of the potential for commotio cordis in American football. NPR covered the news, saying Hamlin collapsed on the field during a game against the Cincinnati Bengals. Medical professionals suspect he experienced commotio cordis.

Hamlin received immediate CPR and defibrillation on the field, which restored his heartbeat. While his prognosis remains uncertain, his youth and the quick medical response increase his chances of recovery.

What sport has the highest instance of commotio cordis?

Commotio cordis occurs most frequently in baseball. This is due to the high velocity of baseballs and their potential for impact with the chest. Young athletes are particularly vulnerable. Other notable instances include lacrosse and football. In these sports, wearing protective gear and having access to immediate medical attention is crucial.

Thyroid Eye Disease

Thyroid eye disease (TED) is a condition that causes inflammation and swelling of the tissues around the eyes, including the muscles and fat. This can lead to a range of symptoms, including bulging eyes, double vision, and, in severe cases, vision loss. While it might seem unrelated to the high-impact world of professional football, TED can pose challenges for football players.

High-impact sports, like American football, can cause systemic inflammation and influence the immune system. Since TED is an autoimmune condition, these changes in the immune response could contribute to the disease process.

It’s important to remember that TED is more common than you might think. According to NIH, it affects roughly 16 out of every 100,000 women and 2.9 out of every 100,000 men. Early detection is key. Regular eye exams are crucial for USFL or NFL players, allowing for prompt diagnosis and management of TED.

Treatment options vary depending on the severity of the condition. Steroids and immunosuppressants can help reduce inflammation. One medication that has been used to treat TED is Tepezza or Teprotumumab.

While it can be effective, it’s important to be aware of potential side effects. TorHoerman Law highlights that Tepezza is FDA-approved for treating TED. However, some patients have experienced hearing loss or tinnitus after taking it. Due to the increase in such cases, the FDA has now added a warning about this side effect to the drug’s label (Opthalmology Times).

This warning came after many people sued Horizon Pharmaceuticals, the drug maker. The plaintiffs allege that the manufacturer failed to warn about the drug’s side effects, which led to severe health issues. The lawsuits are currently ongoing in the district court. While rare, if an athlete is diagnosed with hearing issues after consuming medicine, they can file a Tepezza lawsuit. 

The takeaway is that American football players must be proactive about their eye health. Regular checkups and open communication with medical staff can help identify and manage conditions like TED.

Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy (HCM) is a concerning heart condition characterized by abnormal heart muscle thickening. This thickened heart muscle struggles to pump blood efficiently, compromising the heart’s normal function. The thickened muscle can also disrupt the heart’s electrical signaling, potentially causing dangerous irregular heart rhythms.

According to the American Heart Association, HCM is a relatively common condition, estimated to affect 1 in 500 people. It’s a leading cause of sudden cardiac arrest in young athletes, including those in high-intensity sports like American football. The demands of the game, with its intense exertion, put a significant strain on the heart. This strain can trigger serious problems in individuals with HCM, especially during strenuous activities like tackling or running.

Early detection of HCM is vital. Pre-participation screenings, including electrocardiograms (ECGs) and echocardiograms, can help identify athletes with this condition.

Can you play football with hypertrophic cardiomyopathy?

Generally, playing football with hypertrophic cardiomyopathy is not recommended. This condition causes heart muscle thickening, making strenuous exercise risky. It can lead to abnormal heart rhythms or even sudden cardiac arrest.  However, individual cases vary, so consulting a doctor is crucial for personalized advice.

Pulmonary Contusions

Pulmonary contusions are a type of lung injury that can occur in American football. Essentially, they are bruises to the lung tissue. This bruising happens when a forceful impact to the chest, such as a hard tackle or collision, causes the lung to hit the ribcage. The impact can damage the small blood vessels and air sacs within the lung, leading to bleeding and swelling.

According to a study in Sage Journal, a player with a pulmonary contusion might experience shortness of breath, rapid breathing, or coughing up blood. If a player has these symptoms, they must immediately be removed from the game. However, if there are no complications, the player might be able to return to the competition in about 7 to 10 days.

Do lungs repair themselves after injury?

Yes, lungs generally can repair themselves after minor injuries. This is due to specialized lung cells that regenerate and replace damaged tissue. However, the extent of repair depends on the severity and type of injury. Severe or chronic damage can lead to permanent scarring and reduced lung function.  

Cervical Spine Injuries

The neck, or cervical spine, is a complex structure composed of bones, discs, muscles, and ligaments. Its primary functions include supporting the head, facilitating movement, and safeguarding the spinal cord. The spinal cord is a crucial nerve pathway that transmits signals between the brain and the rest of the body.

American football injuries can harm the cervical spine. Forceful impacts can cause fractures or breaks in the neck’s bones, and dislocations occur when the bones are moved out of their normal alignment. The most serious type of cervical spine injury is a spinal cord injury. This occurs when the spinal cord is damaged, potentially causing paralysis or other neurological issues.

The consequences of a cervical spine injury can be devastating. Paralysis, loss of sensation, and difficulty breathing are just some potential outcomes. This is why coaches emphasize proper tackling techniques. By teaching players to lead with the shoulder and avoid head-first contact, they aim to reduce the risk of these catastrophic injuries.

American football league organizations must continue investing in research, education, and proactive measures to protect their athletes. This means supporting advancements in protective equipment, promoting proper training techniques, and ensuring access to top-notch medical care.

By taking these steps, American football can set a professional safety standard for players. This will benefit the athletes, enhance their reputation, and attract top talent.