By Steven Schlozman, MD

Posted in: Grade School, Hot Topics, Teenagers, You & Your Family

Topics: Child + Adolescent Development

In 2013, we at The Clay Center decided to tackle the dilemmas surrounding American football.

Sorry.

That’s a really bad pun.  We tackled football…

Still, I guess a really bad pun is a good place to start our revisit to the controversial issues surrounding America’s most popular team sport.  We’ll get to the significance of the pun in the minute; let’s first review what we said back in 2013.

Two years ago, we noted that clinicians who treat children and adolescents, and especially clinicians who treat the brains of children and adolescents, were being asked more and more about the wisdom of letting kids play football (to be fair,  we were also being asked about hockey, lacrosse, and even boxing, but football came up most often).  Football and head injuries were big news then.  And, it turns out that even when you control for the added publicity that football itself receives, the game accounted for then—and continues to account for today—a huge percentage of sports-related head injuries among student athletes.  In fact, according to the CDC, in 2007 there were more than 20,000 non-fatal traumatic brain injuries in the U.S. that were directly related to pre-high-school or high-school football.  Other studies continue to suggest that more than 60% of high-school-aged, sports-related brain injuries stem from football alone.  Remember, too, that as high schools become more vigilant about concussions and other brain injuries, there is concern that some adolescents will hide their symptoms in order to keep playing.

So, when we decided to express our concern about football in 2013, we were hardly leading the parade.  Instead, we were responding to the sea of change imparted on the attitudes toward one of America’s most cherished traditions.

If you look back at that article and the accompanying podcast, you’ll notice that we did NOT advise against letting kids play.  We simply reported on the current CDC and sports medicine recommendations that any indication of a potential head injury should result in the player sitting out until he or she has been medically cleared to play again—and we noted that medical clearance usually comes days, if not weeks, later. You can refer to those recommendations from the CDC here: http://www.cdc.gov/headsup/

Here’s where writing this article gets difficult:  I love football.  In fact, I still dream about high school football.  I find the increasing evidence of the risks associated with tackle football disturbing for all sorts of reasons, including the fact that the cause for concern this evidence raises messes with my hard earned nostalgia for a game that means so much to me, and to countless others.

Indeed, many have noted that organized football is unique in that it’s the only game where 11 individuals must pursue a common and unifying choreography to achieve a given goal—and, at the same time, be ready to veer from that choreography if the play develops in such a way that change is needed.  In other words, some have made a convincing case for football as the ultimate team sport.  Even the best player on the team is only as good as his or her teammates.  A running back can’t run without a good offensive line; a lineman can’t win without a good running back.

You get the point.  Football does a lot of good for a lot of people and a lot of communities.  Throughout the U.S., football literally unites towns and municipalities.  This isn’t the place to argue about whether that kind of power ought to belong to any sport.  For the purpose of this article, the community benefits of football are a fact, as are the sport’s many potential downfalls.  If we do give up football—and some have called for a complete ban on the sport for all children and adolescents—then we give up the significant risk of head injury and lasting brain damage on young, developing skulls.  But, we also give up the teamwork, the challenge, and the social currency that the sport has afforded this country for over 75 years.

This year, linebacker Chris Borland of the San Francisco 49ers made the highly publicized (and for him, painfully difficult) decision to retire from football after only one year.  Mr. Borland, a gifted football player, noted that he has suffered two diagnosed concussions in his life: one in middle school soccer, and one in high school football.  Neither was particularly damaging, so he was choosing to make this decision proactively.  He, at this time, has no symptoms of brain damage—and he wanted to keep it that way.

But what, you might ask, is Mr. Borland worried about?  He’s in fantastic shape, he’s a heck of a player, and, by all accounts, he had a fruitful pro career ahead of him.

This is where we can come back to the terrible pun at the beginning of this article.  Earlier, I said that we had “tackled” football in a piece that we wrote back in 2013.

Understanding a pun requires the capacity to sense nuance in a seemingly concrete sentence.  It requires a quick and near-seamless conversation between different brain regions that can appreciate the potency of more than one meaning in a given word.  It requires a balancing of subtlety and obviousness.

A pun, to put it differently, requires an intact brain. 

And, someone suffering from chronic traumatic encephalopathy (CTE), a disease being associated with tackle football even more so now than in 2013, would not understand a pun.  People with CTE have suffered repeated head injuries, perhaps without ever losing consciousness, and have been found on autopsy to have similar brain pathologies to those seen in forms of early onset dementia.

CTE is even the subject of a major motion picture later this year.  That fact alone should tell you that the disease has shaken the foundation of American culture.  The movie is due to be released on Christmas Day, and has an all-star cast.  This is, without a question, an issue on America’s mind.

So, where does this leave us?  In 2013, there was evidence for the risk of injury to the developing brain as a result of American football—and, in 2015, that risk seems to be more clearly delineated.

I’d argue, as you might expect, for increased and ongoing caution and vigilance.  Every youth football squad in the U.S. now diligently and stringently enforces the do-not-play guidelines (as noted previously, you can find these guidelines summarized on the CDC’s website).  Parents will quickly realize that they are very much a part of the surveillance system in place for these symptoms.  If you are worried AT ALL, take your child out of the game, and make an appointment with a doctor.  Brains are just too precious.

I’d also argue that while I am still comfortable saying yes to those who ask me whether they should allow their sons or daughters to play contact sports (assuming it’s what their sons or daughters actually want), that now, more than ever, the impetus is on the industry of contact sports to make the games safer.  Parents of those who play these sports need to hold the industries accountable for necessary changes.  Many schools have already changed the way practices are conducted, and some have considered new technology that calculates the amount of force a given hit to the helmet absorbs as a means of determining when to pull someone from a game.  Even the helmets themselves could use upgrades, including the rare but at least promising trend of designing helmets with padding on the outside.

Statistics also have a way of belying common sense.  20,000 non-traumatic head injuries seems like a lot, and for each of those individuals, those head injuries have significant meaning.  Still, according to the National Federation of State High School Associations, between 2013 and 2014, over a million boys and over a thousand girls played 11-person-tackle football.  That 20,000 might seem a lot smaller when compared to the still unparalleled participation in the game itself.  We just don’t know who among those who play are likely to sustain injury—and, based on recent data, the vast majority will not.

Furthermore (and I know some will disagree with me), I’d argue that these games DO have a place in our society.  The teamwork, the discipline, the pride, and the self-worth have real value.  Yes, they can be found in other sports, but that doesn’t mean that these values aren’t also in football.

But, those who promote these games need to continue to earn their place in our children’s worlds.  Without significant changes downstream, it isn’t hard to imagine that all contact sports may suffer and eventually die.