Concussion: How the NFL came to shape the issue that plagued it

Concussion has dogged the NFL since the 1990s, and its initial response -- avoidance and superficial gestures to mollify critics -- damaged its public image. However, in recent years, the league has repositioned itself as a leader in concussion prevention and research, a new University of Michigan study shows.

The study found that the NFL's newly proactive stance shows how a large organization can wrest control of and shape the very issue that haunted it.

"They said, 'We'll change, but it's going to be on our terms. We want to be the leaders in concussion,'" said study author Kathryn Heinze, U-M assistant professor of kinesiology. "They said, 'If we have to change, we'll take credit. We'll create the funding. We'll create the partnerships with other organizations. We'll work to pass new laws.' When they finally realized they had to do something they realized they had to be the leaders."

The NFL is likely one of the few organizations that could achieve this, largely because it's so influential, Heinze said. Still, the league would have been better off implementing these changes years earlier.

"There's a lesson here around getting ahead of these changes sooner and avoiding the intermediate stages where organizations resist or avoid change," Heinze said. "They may have avoided some of those lawsuits, or the Judiciary Hearings on concussion, yet we still see this path very often."

The study's purpose wasn't to judge the NFL's handling of concussion, but rather to look at how one organization reacted to demands for institutional change. Heinze stressed that findings in no way suggest that the NFL has done all it can to protect players from concussion, only that it has now adopted a leadership role in addressing the problem.

Researchers looked at the NFL's response to concussion from the early 1990s to 2015. From the 1990s to 2008, the NFL either dismissed concussion as a non-issue or made superficial gestures that didn't yield substantial change, a strategy called decoupling. Later the league made significant but incremental changes that didn't yield fundamental shifts.

For instance, in 1994 the league created a concussion study committee, but most members were affiliated with the league and weren't concussion experts. Later, it appointed an independent director, but 10 of the 14 members remained tied to the league in some way.

However, from 2009 to 2015, the league responded to intense, coercive internal and external pressure by making fundamental organizational shifts, the study says. For instance, it abolished the existing, much-criticized concussion committee and established the Head, Neck and Spine committee, which consisted only of concussion experts unaffiliated with the NFL.

More importantly, Heinze said, the league changed its ideology and also engaged in advocacy, which enabled it to shape the agenda regarding the concussion issue. It finally acknowledged the long-term effects of concussion. It served as a broker, forming partnerships with academia, government and business. It was instrumental in passing a law in 50 states to protect youth athletes who experience concussion; only four states passed this law prior to NFL involvement.

Heinze said researchers were surprised by how dramatically an organization's position could shift in a relatively short time.

"I know it took a while, but once they decided to go in that direction, they attacked it from multiple perspectives," she said.

Whether other large organizations model the NFL and take a leadership role on controversial issues remains to be seen. Heinze said the NFL's initial response of denial and avoidance is much more typical.