“As terrible as it sounds, I get my words mixed up and I can’t even remember my son’s name sometimes.” That’s what Keith ‘Ruffneck’ Colwill considers the worst results of suffering 13 registered concussions. While wrestling was by no means the only source of such injuries — the harsh reality of working as a nightclub doorman has been responsible for many — Colwill’s in-ring career provided his first and in many senses his worst concussion. It’s a story that’s shared among many wrestlers to a greater or lesser extent and has left the industry wondering what changes it is realistic to make to improve safety in such a physical business.
“The first concussion I had was at GPW. All I can remember is immediately upon coming to I was feeling sick, like my head was full of ginger beer or something. I got this burning behind the back of my eyes. It wiped me out to the point where I was in a bad way for weeks and weeks to the point where it cost me my job.”
Doug Williams learned to recognise the symptoms after an estimated 10 concussions during his two decades in the ring, albeit with them only occurring sporadically. “One sign is disorientation and not being aware what’s going on: you can’t really think straight and if somebody asks you a question you don’t really know the answer. Oddly when it happens in a match you don’t really know what’s going on but you go through the motions of the match; it’s only when you get backstage when you don’t really know what’s going on and can’t remember anything that happened in the match, your opponent’s name or anything like that. I’d associate that with a severe concussion.
“Slightly less severe is where you get not quite blurred eyesight but almost a tunnel vision. The peripheral vision is cloudy and you get shooting lights in front of your eyes.”
Measuring concussions has always been a difficult task, thanks largely to a misunderstanding of what actually constitutes a concussion. Writing for The Conversation, neuropathologist William Stewart, who advises both World Rugby and the FA on concussions, explained that “In truth, as little as 10% of concussion is associated with loss of consciousness. Concussion is any disturbance in brain function caused by injury, either through direct contact or through whiplash as a result of a blow somewhere else on the body.”
For years, long-term effects of concussions were seen as a condition specific to boxing, even getting the medical name dementia pugilistica, commonly known as punch-drunk syndrome. It’s only in the past decade or so that the results of concussions have been classed as a distinct medical event, now known as Chronic Traumatic Encephalopathy or CTE. Medical attention to the issue has only really stepped up with the realisation and acceptance that it’s the brain trauma itself that is the risk factor with CTE, rather than the specific activity of boxing.
The book Sports-Related Concussions in Youth: Improving the Science, Changing the Culture defines the potential results of CTE as “the progressive decline of memory and cognition, depression, suicidal behaviour, poor impulse control, aggressiveness, Parkinsonism, and dementia.”
Andrew Dickinson, a British doctor who once wrestled part-time as Dirk Feelgood, notes that head injuries pose a particular problem for healthcare. “With a concussion, there’s not a lot really that you can do medically. Once it’s done, it’s done. There’s no magic medicine that will reverse it”
Exactly how concussions and the resulting brain trauma cause long-lasting damage is something the medical profession is still uncovering, though a study written by William Stewart among others and published earlier this year concluded that the results can be similar whether they are caused by a single moderate to severe brain trauma, or from repetitive mild traumas.
That seems to be because concussions can cause damage in several different ways. Chris Nowinski is a former WWE wrestler who retired after a series of concussions and now runs the Concussion Legacy Foundation which researches the effects of head injuries. In his book Head Games he notes that a head injury has two distinct effects on the brain. The first is the actual impact when the brain collides with the skull. The result of this can be highly unpredictable, partly because the inside of the skull is an irregular surface, and partly because different areas of the brain perform different functions, so the precise point of impact will often affect the specific symptoms.
The second effect is on the neurotransmitters, which pass chemical signals around the brain. A concussive blow can effectively send the brain into overdrive, with all neurotransmitters firing their chemical signals at once. This can cause damage in several ways.
Perhaps the best documented is damage to axonal microtubules, the tubes along which neurons travel, making them effectively the brain’s roadways. A brain injury can cause an excess build-up of molecules called Tau proteins that can restrict and even break the axonal microtubules. Studies suggest it takes at least a month for this process to happen, meaning it can’t be diagnosed immediately after a concussion.
Another documented cause of damage is a build-up of amyloid precursor protein which can then form amyloid plaques. In simple terms these are tiny rigid lumps that can block or even damage parts of the brain. Unlike with Tau proteins it appears these form rapidly after trauma. There also appears to be a genetic element by which some people’s brains are naturally less able to slow of clear the build-ups.
Perhaps the most worrying element of recent research for the wrestling industry is the risk of repeat concussions. Keith Colwill notes that “I would say about four or five of my concussions maximum have come from wrestling, but getting that one the first time was a direct factor in me being susceptible to them. These days it only takes one shot and it can bring on those concussive like symptoms. Everytime I wrestle now I’m prepared for receiving a concussion or feel some sort of symptoms.”
That is certainly borne out by medical research. Sports-Related Concussions in Youth notes that “Athletes with a history of concussion may have more severe subsequent concussions and may take longer to recover. Preliminary evidence suggests that, in addition to the number of concussions an individual has sustained, the time interval between concussions may be an important factor in the risk for and the severity of subsequent concussions… a repeat injury while recovering from a prior concussion may occur with less force, take longer to resolve, and in rare cases lead to catastrophic results.”
Meanwhile Nowinski quotes studies showing that an athlete who has suffered one concussion becomes three to six times more likely to suffer a second one, and that somebody with a history of concussions is four to seven times more likely to be knocked unconscious after a second concussion.
Why this is the case remains uncertain, though the common thread in the various medical theories is that the structure of the brain takes time to recover from a concussion. During this recovery it is less able to cope with the overload of chemical activity that comes from a second concussion, which greatly increases the likelihood of brain cells dying and thus causing severe and permanent damage.
That’s particularly relevant to wrestling thanks to both its nature and schedule. Jackie Turpin, who boxed professionally 28 times before turning to wrestling, notes a long-standing difference between the ‘sport’ and the ‘show.’ “In boxing, if you were knocked out, the doctor saw you that night, then you’d have to see your own doctor at home, then you’d have to be out 21 days before you can have a medical to decide if you could come back. With wrestling you might be working the next night and the only restriction was your own common sense: if the promoter says he wants you to do what you’re paid for, it’s up to you to make the choice.”
Another issue is that with wrestlers often repeating the same sequence of moves across bouts, particularly with the same opponent, there’s an inherent risk that something which caused a concussion (other than a freak accident) might well occur again shortly after.
WWE has particular cause to be concerned about concussions, not merely for the natural empathy for the health of their workers, but for the potential legal consequences. Last year a judge finally approved a settlement in a lawsuit brought on behalf of 5,000 former American football players against the NFL that could mean some players receive up to $5 million in compensation. The total cost is unknown, though the judge rejected an initial attempt to cap the total compensation bill at $675 million.
That case no doubt inspired a series of lawsuits brought by eight former WWE wrestlers or their surviving families which have now been combined into a single case. WWE has also issued its own preemptive countersuits against four wrestlers who it believed were considering bringing their own action.
On the face of it, the cases are far from slam dunks, with the big question being the extent to which WWE knew the specific risks associated with concussions and hid them from the wrestlers — the same claim which led the NFL to conclude a settlement was a safer bet than losing a judgment.
Whatever its policies in the past (some of the cases date back to the mid 1980s), WWE is certainly taking concussions very seriously today. The company has barred “Any blow to the head that is deemed an INTENTIONAL act” and ” The intentional use of a folding metal chair to “strike” an opponent in the head.” Both Undertaker and Triple H were fined for a chairshot in their WrestleMania 27 bout, as were Randy Orton and Daniel Bryan for a 2013 Raw match.
WWE policy also requires any concussed wrestler to pass a neurocognitive test before returning to action, while those who suffer two concussions in a year must be cleared in a “one on one neuropsychological evaluation.”
The issue of testing for concussions and recovery has also been a challenge for the wrestling industry among others. Early tests, including those used to assess Chris Nowinski, were relatively crude checklists in which differing symptoms scored points, with an overall total determining the diagnosis.
WWE now uses a computer package called ImPACT, co-developed by its current medical director Dr Joseph Maroon. The test involve a series of computer games with the participant clicking a mouse button while attempting to remember words and shapes, with the results scoring “motor processing speed, reaction time, visual memory, impulse control, and verbal memory.”
The way WWE uses ImPACT is to have each wrestler take the test once a year (and immediately upon signing with the company) to establish a baseline score. After suffering a concussion, the wrestler is not cleared until they have first taken the test and matched or exceeded their baseline score, then been put through a series of physical exertions to see if they trigger post-concussive symptoms.
Critics of the test cite two potential problems. Firstly, independent assessment suggests that a healthy athlete’s score may naturally vary enough from day to day that it’s difficult to read too much into them “recovering” enough after concussion to meet their baseline. Secondly, there’s a possibility that a wrestler who is particularly determined to avoid missing action might deliberately underperform on the baseline test.
To make things even more challenging, such cognitive tests can be undermined by the way an injured brain will reroute signals across its neural network to avoid the damaged areas. This “false recovery” means the patient may appear to have a brain operating as normal and may be the reason that so many of his peers found it difficult to reconcile Chris Benoit’s ability to function normally with the fact that posthumous scans showed damage that “resembled the brain of an 85-year-old Alzheimer’s patient.” It could also explain the confusion about both Nigel McGuinness and Daniel Bryan having concussive damage while still remaining highly intelligent.
Until recently, such assessments were one of the only options for diagnosing concussion recovery. The other is to take a scan such as an electroencephalogram or MRI, but these can only reveal the physical signs of severe damage. However, one of the biggest developments in recent years is the Evox machine from Evoke Neuroscience. This combines both approaches and involves measuring a flow of electricity through nerve cells, the heart, muscles and the brain while the patient performs cognitive tasks. This can reveal unusual activity in the brain’s pathways suggesting serious and even permanent damage to parts of the brain. It was after hearing of an Inside MMA report on the technology that Daniel Bryan took the Evox test that prompted his decision to retire.
That news has prompted many in the wrestling industry to question what, if anything, can be done to reduce the risks of suffering concussions in the first place. Andrew Dickinson is realistic about the limits of such efforts. “If the greatest wrestler of his generation isn’t able to protect himself working for the biggest, safest company in the world, then what’s happening to Dirk Feelgood wrestling for GPW or Futureshock? It’s impossible [to completely avoid head injuries], it’s just part of the risk of the show.”
That said, he and others point to several steps that are realistic to take within the demands of the business. For example, the use of chairshots to the head and stiff headbutts have been heavily reduced, though by no means totally eliminated. Keith Colwill says improvements in other aspects of the game have helped. “The level of athleticism in wrestling now is overcoming that thing where you’d be fearful of saying ‘I wont take this, I won’t take that.’ Like chairshots and stuff, if you don’t want to do something you find something else to do. I think across the board that athleticism and the faster pace means that you don’t have to so many crazy things with gimmicks.”
Meanwhile Doug Williams believes the entire industry is benefitting from WWE’s lead. “Nearly everybody now is taking [chairs] square across the back as opposed to over the head. When you go back to the Attitude Era and when ECW was popular, all that kind of style filters down to the independents and everybody’s taking headshots. People understand the dangers now and the longterm effects and the absence of it on a high level has filtered down to the indies.” He also points to the diving headbutt as a move that has an unacceptable risk — if not a certainty — of causing at least some minor head trauma.
Taking bumps — falling and landing on the mat — is another risk area. For Colwill this became an extreme measure: “At one point just taking a flat back bump, if I didn’t tuck my head in I was susceptible to receiving a concussion. As crazy as it sounds I would try to take as many front bumps as possible. But you can’t go through a full match without taking a back bump.”
However, some forms of bump can be particularly risky and perhaps worth avoiding, even though they might not appear dangerous to the untrained eye. Jackie Turpin recalls that even back in the much tamer 1970s, a high back-bodydrop posed a significant chance of a bad landing on the head. Williams shares that view today. “I always found I got concussions off high elevated backbumps like when you fell backwards off a second or top rope. You’re rolling backwards over your head so if you land at a very high elevation you get a whiplash effect.
“The safer sort of bumps are like a vertical suplex where its your feet and lower body that’s moving towards the earth first and your head is moving away from the canvas when you land. I used get concussions from doing a spinning DDT as a finisher: when I landed, I was jumping up and turning and coming down with my head hitting the canvas first.”
Indeed, even relatively straightforward seeming moves can be risky in the wrong circumstances as Dickinson recalls. “I got a knock on my head from a spinebuster. You’re taking a high back bump and you’re not in control of it: you’re relying solely on the other person’s coordination. You get yourself up in position but you rely on them to put you down in the right position. Towards the end I got really wary about people saying they were going to do a spinebuster. I was quite notorious for getting people to run through with me and saying ‘Tell me how you do that move so I know what to prepare for.’ Unless you know somebody really well and have worked with them before… what somebody says is a spinebuster is different for four different people.”
However, all wrestlers FSM interviewed for this article agreed that simply avoiding risky moves is neither realistic nor sufficient in itself to keep concussions to a minimum. Instead Colwill and Williams both cite the common veteran advice of slowing things down in the ring as a benefit.
To Colwill it’s a simple numbers game: “The more [moves] you put in there, the more chance there is of getting injured, it’s just the law of averages. I tend to work in tag team matches because you’re lightening the load considerably. It’s common sense, it’s lightening the load but still having the opportunity to participate in something I love. It’s always good to know that there’s somebody there that I can tag.”
Williams points to another benefit of a more controlled pace. “I think a lot of people rush and they’re so keen to get the move over or get through the sequence of moves, they rush and not take the bump properly. They’ll bump on their head, they’ll bump high up on their shoulders, rather than take their time and bump correctly in the way that they’ve been taught. That’s just a case of people disciplining themselves.”
He notes that his own background in judo before getting into wrestling was a major benefit. “I knew how to bump before I even got into a professional wrestling ring. I knew how to be thrown, I knew how to land properly, I knew that if I tripped up and fell forward I would roll instinctively. It all becomes second nature.
“I always tell people at seminars that there’s two things that you need to make second nature before you do anything else: bumping correctly and selling. Certainly knowing how to fall properly in all situations has to be as normal as riding a bike or walking down the street. People need to get that down first.”
Dickinson also points to a couple of steps wrestlers can take outside the ring to mitigate the effects of concussions. “Because of adrenaline, you don’t really notice the booming headache [from concussion] until you’re back stage and calmed down. And then people drink all these energy drinks laden with caffeine and that doesn’t help the concussion headaches at all.”
He also recalls concern over wrestlers who drove home after taking a blow to the head that may have affected their cognitive abilities. For that reason it would be a prudent safety measure to make sure every carload of wrestlers travelling to a show had at least two potential drivers. “Good luck with that one though: it’s amazing how many British wrestlers can’t drive.”
Given that the risks of both concussions and particularly repeated concussions can no longer be ignored, the wrestling industry faces an ongoing challenge in maximising safety without undermining the product that fans have come to expect. Ultimately, Dickinson believes it comes down to risk mitigation.
“There’s such a variety of different moves that you do that you can’t eliminate all the ones that have potential head injury risks. I think it really comes down to better training and better awareness of the risks involved. Wrestlers need an awareness of the moves that they are doing and to understand that it’s OK to ask the people that they are wrestling with to explain in more detail if you’ve not worked with them before. Ask what they’re doing and how they are going to protect you.
“And we need to make everybody aware that its OK to not wrestle if you’ve got a concussion and that’s a good idea and you need to look after yourself.”
