The Neurosurgeon to Professional Athletes

Neurosurgeon Joseph Maroon, MD, co-developed the most widely used and most scientifically validated computerized concussion evaluation system while working with the Pittsburgh Steelers.

Bridgeport, Ohio is a small town on the Ohio River, on the eastern edges of Appalachia, where in the 1970s adolescent boys played football to escape the coalmines and steel mills. The region was a hotbed for athletics and recruitment to major colleges. It was also a hotbed for spinal cord injuries — about 1 in 12,000 at that time.

Joseph Maroon, MD, a leading neurosurgeon nationally, grew up in those trenches and had his share of broken ribs and concussions to prove it. He would eventually make it to the NFL, but not as a player — he was hired by the Pittsburgh Steelers as the first team neurosurgeon in league history in 1981. Since, he has initiated programs associated with proper blocking and tackling techniques, as well as head and neck protection, to greatly reduce the incidence of neck and head injuries.

Today, at age 72, Maroon has become a noted international speaker and author on aging. He is also preparing to compete in his eighth Ironman Triathlon in Kona, Hawaii. But his career journey has been anything but a trip through paradise.

Making an impact

Maroon recalls early in his career when he would be on call and a high school football player would be brought in quadriplegic from making a bad tackle. Immediately, he recognized the challenge, but also the opportunity, to reduce those types of career-, and sometimes, life-ending injuries.

“I became pretty zealous about that,” Maroon recalls. “Epocrates said that the first role of a physician is to prevent disease. Well, one of the things that physicians don’t do a whole lot of is preventive medicine. And in the field of head injury, the low-lying fruit was all over the place, so that’s what I gravitated to.”

Not long thereafter, as the Steelers’ neurosurgeon, he had a sideline conversation with head coach Chuck Noll. Maroon told Noll that the starting quarterback could not play that week against the Dallas Cowboys because the player had a concussion and the guidelines stated he needed to stay out for two weeks.

Noll said his quarterback looked fine, and told Maroon that if he wanted the coach to keep a player out of the lineup, he needed hard data. Maroon got the data.

Working with Mark Lovell, PhD, in the early 1990s, Maroon co-developed ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), the most widely used and most scientifically validated computerized concussion evaluation system today. The Steelers were the first team to use it, and soon it was adopted for all NFL teams.

Avoid the red zone

However, life is about balance, and for a while Maroon’s had none. It was all work.

“I had no idea how bad I was until my father died, my wife left, and I quit (temporarily) neurosurgery,” Maroon says. “I was laying on the ground and couldn’t figure out why.”

Then he looked at his square, an approach to life he picked up from reading the book I Dare You written by William Danforth, founder of the Ralston Purina Company in St. Louis. The book recommended drawing a square, then labeling the top line work, the right line family and social, the bottom one spiritual, and the left line physical.

“Well, when I sat down and drew my square, it was a flat line EKG,” Maroon recalls. “There was no family, no spirituality, and nothing physical.”

He began running at a high school track, starting with a mile, and recalling that, “I thought I was going to die.” But his body responded, each day pushing a little further.

“That track, that run around the track … the best anti-depressant is physical activity,” Maroon says. “And studies have shown much better than SSRIs and all the junk and pharmaceutical agents we give people for depression. If you can get them out and consistently walk five to six days a week, that’s the best approach to depression — physical activity.”

Maroon talks about good stress and bad stress, and quotes Friedrich Nietzsche: “That which does not kill us makes us stronger.”

“You have to stay out of the red zone of your tachometer or you get sick,” Maroon says. “Since that first run around the track, I’ve incrementally continued to increase the stress, and my body responded and became stronger. I think the message is that stress helps us get better as long as we don’t go into the red zone.”

The blue zone

Today, in addition to his continued work with the Steelers’ organization, Maroon is the medical director for the World Wrestling Entertainment Corporation, and serves on the NFL’s Head, Neck and Spine Committee. Also, he still performs approximately 400 operations a year, an ability he attributes to having balance in his life.

“Each day I wake up, I think, okay, am I going to touch my family … call my daughters … touch that base,” he explains. “Spirituality, I think can permeate everything you do. It’s probably the most overlooked thing that people don’t talk about.”

Maroon is an advocate of blue zone living, referring to those places on the planet where people routinely live to 100 years of age. He says there are four things these centenarians do that clearly lead to longevity: They have a good diet, work physically hard, live in an uncontaminated environment, and have strong family units. They are usually very religious or spiritual, which Maroon says reduces stress.

“Emotional stress is so destructive to everything in our brain,” he explains. “It kills brain cells; it impairs memory. Exercise, on the other hand, increases a hormone called BDNF (brain-derived neurotrophic factor), which causes an increase in new brain cells. So, unknowingly, when I ran around that track I was releasing a whole log of good things that were self-curing.” And then I got addicted. I felt good, and I wanted to continue feeling good. It was a positive addiction.”

Maroon got addicted to the physical activity because he wanted to continue feeling that good — he kept on running.

“It’s a real blessing to be able to make a huge difference in the lives of people who are in pain or who have significant disability,” he says. “That’s really what keeps me going.”