by Glenn Stout
Football is fun. And football means eating dirt. That’s the trade-off. Always has been. The game is inherently dangerous, rooted in violence and physical domination, hitting and tackling, knocking your opponent on their ass before they do the same to you. Football breaks bones, shreds ligaments, ruptures internal organs. Occasionally, it kills.
And yet for just about forever, the harm has seemed manageable. Perfectly acceptable. A reasonable price to pay for both Friday Night Lights and weekend tailgating. Because bones heal, and ligaments can be fixed. Deaths are horrific, but freaky and rare. Week after week, season after season, the sport teaches life lessons, rallies communities, provides excitement and entertainment for millions, inspires military flyovers and breast cancer awareness drives. It helps define American masculinity and pays NFL commissioner Roger Goodell’s $29.5 million salary. At the youth level, most players walk away from the game with fond memories and without serious, lasting harm; for parents and society alike, football’s rewards largely have outweighed its risks, so much so that even in an era of helicopter parenting and school safety zones, more than four million American children play high school and youth football.
Because of brain damage, that calculus is changing.
Scott Hallenbeck is sweating. Profusely. Like a human lawn sprinkler. I can’t blame him. It’s an early November morning in Washington, DC, and the Aspen Institute’s “Sport and Society” program is hosting a roundtable discussion on youth football safety and the sport’s future. The NFL’s top lobbyist is here. So is the head of the players’ union. There are journalists and academics, lawyers and school officials, coaches and scientists.
Almost everyone is a parent.
Sports concussion expert Robert Cantu proposes that children under age 14 not play tackle football, largely because both their brains and bodies are still developing and therefore more vulnerable to serious injury. This puts Hallenbeck in a tight spot. He’s the executive director of USA Football, the NFL’s national youth arm. His day job involves telling America why its children should play tackle football, the same way his 16-year-old son does.
“I think we all recognize there are challenges,” Hallenbeck says. “We’re all looking for ways to try to create a better and safer environment for parents and players. I also hope that we’re in this to provide accurate and whenever possible evidence-based data for parents. I think we have to be careful certainly not to scare parents.”
Too late. A recent Marist College poll found that roughly one in three Americans say that knowing about the damage concussions cause would make them less likely to allow their sons to play football. Earlier this year, a Washington Post survey of more than 500 NFL retirees found that less than half would recommend that children play. According to the National Sports Goods Association, tackle football participation has dropped 11 percent between 2011 and now. The National Federation of State High School Associations reports decreasing football participation numbers since 2008–2009. And according to ESPN’s Outside the Lines, Pop Warner—the nation’s largest youth football program—saw participation drop 9.5 percent between 2010 and 2012. Even President Obama has expressed doubts about letting his hypothetical son play the sport.
Still, fear is not the problem. Physics and biology are the problem.
Reliable youth sports brain injury statistics are hard to come by. A USA Football study of almost 2,000 youth football players reported a concussion rate of 4 percent; however, non-industry-funded research suggests that concussions are chronically under-diagnosed and -reported. Meanwhile, the American Association of Neurological Surgeons estimates that between 4 percent and 20 percent of college and high school football players will sustain a brain injury during the course of one season. The Institute of Medicine reports that football consistently has the highest concussion rate of any high school sport (11.2 percent), and that the concussion rate in prep football is nearly double that in the college game (6.2 percent). The Centers for Disease Control and Prevention, which has labeled sports concussions “an epidemic,” reported in 2011 that roughly 122,000 children between the ages of 10 and 19 went to emergency rooms annually for nonfatal brain injuries—and for boys, the top cause was playing football.
This is no coincidence.
Football isn’t NASCAR. It’s demolition derby. The collisions aren’t accidents. Head trauma is baked into the game. Boston University researchers estimate that the average high school football player absorbs 1,000 blows to the head per season. In a pair of studies, Virginia Tech and Wake Forest researchers recently found that seven- and eight-year-old boys received an average of 80 head hits per season, while boys ages nine through twelve received 240 hits. Some of the impacts were 80 g’s of force or greater, equivalent to a serious car crash.
Now consider the human brain. It’s essentially a blob of Jell-O, floating inside the skull like an egg yolk. Getting hit in the head—or just experiencing a sudden change in momentum, like the kind that comes from a blindside tackle—can cause the brain to stretch, warp, and collide with the bony inner surface of the skull. This produces damage. The damage can be structural, akin to a cracked microchip in a laptop computer. It can be metabolic, like the same computer suddenly losing its electrical supply. Some damage is obvious, visible from the sidelines. Other damage is subtle, almost impossible to detect, even for trained experts in a clinical setting.
With adequate rest and recovery, most concussions resolve themselves in a relatively short period of time. But other damage—such as neurodegenerative diseases and severe cases of postconcussion syndrome—never does. Current research indicates that damage can be cumulative; that getting hit in the head repeatedly is worse than getting hit once or twice; that both concussive and subconcussive blows are dangerous; and that getting hit while recovering from a previous blow or concussion is particularly risky. There currently is no definitive causal link between youth football and long-term neurodegenerative disease. Yet depending on duration and severity, brain damage can mean missed games. Missed classes. Learning disabilities. Changes in mood, memory, personality. It can permanently alter who you are, and who you have a chance of becoming.
Three years ago, Purdue University researchers compared brain scans of concussed and nonconcussed high school football players. They found changes in brain function—evidence of damage—in both groups. The results were stunning, so much so that the researchers initially thought their scanners were broken. The changes appeared to subside in the off-season. However, the researchers still don’t know what that means, or if those same players’ brains suffered lasting harm. In a subsequent study, they found that high school players exhibit brain function changes long before they have recognizable signs of a concussion—and that the more hits a player endured on the field, the more their brain function changed.
“No brain trauma is good brain trauma,” Cantu says. “We’re not paranoid about it, but when you can reduce it—or every chance you get to eliminate it short of stopping something completely—it’s a good thing.”
Should your child play football? Start with a simple fact: no helmet can prevent any of the above.
As a child, Monet didn’t worry about what football helmets can’t prevent. She enjoyed what the sport could provide. The game took her father, Mel Sr., from a home without indoor plumbing in segregated Beaumont, Texas, to his first drink of cold water from a refrigerated fountain on the UCLA campus. He parlayed his standout career with the Lions—two Pro Bowl selections and the 1967 Rookie of the Year Award—into an off-season job with Ford, later building a network of car dealerships that eventually became one of the largest black-owned businesses in the U.S.
“When I went to college, I shrunk my first comforter,” Monet says. “Because I didn’t know how to do laundry. I had never bothered to learn. That’s when I realized I grew up rich.”
Monet grew up with money, and she grew up with football. Lions running back Billy Sims was a frequent guest at her family’s suburban Detroit home. Hall of Famer B
arry Sanders showed up to watch one of her high school plays. Dad had a box at the Pontiac Silverdome. Monet was there with him for every Lions home game. When her brothers played at UCLA, Monet would get out of school on Friday afternoons, hop on her father’s plane, and fly to wherever the Bruins were playing. When her brother Mel Jr. played for the Los Angeles Rams, she went to the American Bowl in Germany, right after the fall of the Berlin Wall. “I had pieces of it,” she says. “I can’t find them. That’s how carefree we were. It’s all a blur. We were always at a game. Every single weekend.”
In high school, Monet played tennis. It was a choice made out of chromosomal necessity. Her uncle, Miller, played 10 seasons in the NFL and the American Football League. Cousins Jerry Ball and D’Marco Farr also played in the NFL. When Mel Sr. met Monet’s mother, Mae, he told her that he wanted 11 sons. An entire football team. Some of Monet’s earliest memories are of her father coaching her brothers in Pee Wee football. Dad was a drill sergeant. Every morning, he ran the boys through backyard agility exercises. He would sit in a sled and have his sons drag it up a large hill. On the sidelines, he wore a leather visor and pork chop sideburns. He smoked Kool Milds. The Birmingham-Bloomfield Vikings went undefeated. Didn’t give up a single point. Monet was a cheerleader—and again, it wasn’t her first choice.
“I would have played [football] if I could have, absolutely,” she says. “Even today, I’ve never sat and watched my nephew play. My brother Mike coaches him, and I’m on the sideline, yelling at him.”
“I stand on the sideline too,” says Monet’s mother, Mae.
“The other moms drink wine from coffee cups,” Monet says. “I don’t dress up cute. I’m there for the game.”
When Parker turned four, Monet searched for a local youth football league that would take children that young. She wanted him to play. Get his first taste of the family business. No question in her mind. When she found one, she was pumped. God bless the South. “Our coach’s son was three years old when he first came out,” she says. The boys went through spring training—no, really—doing bear crawls and running through tires. They had full-contact practices, complete with Oklahoma drills, coaches screaming Knock his lights out! The actual games were full-fledged events, with packed stands and tailgating adults.
For Monet, all of it felt familiar. Like an old childhood blanket. Was she worried about brain trauma?
“No,” she says. “I was getting mad at [Parker] if he didn’t tackle, like, ‘What are you doing out there?’”
University of North Carolina researcher Kevin Guskiewicz studies football collisions for a living. Big hits and little ones. Full-speed human missile strikes. Mundane helmet-to-helmet blows delivered across the line of scrimmage after every snap of the ball. Much of his analysis involves using sensor-equipped helmets to measure impact forces and locations. Guskiewicz has been doing this since the 1990s, and his campus office is home to one of the world’s most extensive databases of football brain-rattling.
He also has three sons. One of them, a high school junior, plays football. The other two have given up the sport in favor of baseball and basketball.
“I never pushed or pulled them to play,” he says. “As long as I knew there was a coach out there who cared about health and safety, it was fine.”
Guskiewicz published some of the earliest research linking football to long-term cognitive harm. At one point in time, he was an outspoken critic of the NFL’s decades-long campaign to deny and minimize that connection. While working as an athletic trainer for the Pittsburgh Steelers, he saw the sport’s brutality up close.
That said, he coached his sons in youth football, and says he would do so again.
“For some reason everybody thinks there is a concussion epidemic,” he says. “That frustrates me. I sustained two concussions playing football in high school myself. There’s not an epidemic. We just know a lot more about them and care more about them than we ever have. We need to be smart about how we’re doing this.”
Should your child play football? In most cases, Guskiewicz isn’t against it. But he can’t really answer for anyone else. Not his place. There are too many variables to consider. Besides, his work focuses on a different question: what, if anything, can be done to make football safer?
The NFL, some college conferences, and a number of high school and youth leagues have mandated limits on full-contact practice, the better to reduce the total number of head hits that players absorb. Guskiewicz believes that’s a good first step. So do many others. He also advocates for state laws requiring that players who show signs of being concussed be removed from games or practices and not be allowed to return until they’re cleared by a health care professional—largely because research indicates that unresolved concussions leave the brain more vulnerable to additional damage and concussions, which in turn increase the risk of long-term harm. The worst-case scenario? A condition called second-impact syndrome, in which an athlete suffers a second concussion while still recovering from a previous one. Though the precise physiological cause is uncertain, the outcome is not: the brain swells rapidly and catastrophically, causing severe disability or death.
Of course, there’s a problem with said laws, a problem that dogs football at every level. How do you spot concussions in the first place? Self-reporting is unreliable. Players are conditioned to hide injuries. The sport’s entire ethos revolves around playing through pain. Moreover, brain damage affects the seat of awareness, so even a player who wants to report a concussion may not realize that he has one. As for coaches? They’re distracted. Mostly unqualified. Asking them to consistently diagnose a mysterious, invisible injury is foolhardy. Would you ask a neurologist to draw up a goal line defensive play?
Speaking of neurologists: the NFL recently required teams to have an independent one on the sideline at every game. During Philadelphia Eagles home games, said neurologist is joined by an orthopedic surgeon, an internal medicine specialist, a spine specialist, a chiropractor, a dentist, a podiatrist, an ophthalmologist, and an anesthesiologist.
By contrast, a recent survey of Chicago public high school football teams found that only 10.5 percent had a physician present during games. Only 8.5 percent had an athletic trainer. During practices, no school had a physician, and only one school had a trainer. This is hardly unique. According to the National Athletic Trainers’ Association, only 42 percent of high schools nationwide in 2010 had access to a certified athletic trainer educated in concussion care—and while the numbers for junior varsity, middle school, and youth squads are unknown, they unquestionably are far lower.
“If I said that one in ten middle schools has an athletic trainer, I’d probably be overestimating,” Guskiewicz says. “Having a trainer isn’t going to prevent every injury or solve every problem. But it’s important. Some people say this is extreme, but I think that at the high school level, if you can’t afford to hire a certified athletic trainer, then you shouldn’t field contact sports at your school.”
No trainer? No contact sports for kids. A simple formula. But doesn’t it imply that the vast majority of youth football programs—short of trainers but stocked with vulnerable young brains—ought to be shut down?
Guskiewicz winces.
“It’s a problem,” he says.
Cantu has written an entire book arguing that children under 14 shouldn’t play contact sports. NFL Hall of Famer Ron Mix thinks the prohibition on youth football should extend to age 15. Hockey Canada recently outlawed bodychecking for 11- and 12-year-old players, citing a study that showed that youth players in checking leagues were four times more likely to suffer concussions than players in leagues without contact. Numerous NFL players—including New England Patriots quarterback Tom Brady—didn’t start playing tackle football until high school, and New Orleans Saints quarterback Drew Brees says he won’t consider allowing his three sons to play tackle until they’re teenagers. Should children be playing flag football exclusively?
Guskiewicz says no.
/> “I’m adamantly opposed to the suggestion of banning contact sports for kids under some age,” he says. “One, we don’t even know what that age should be. Two, if the first time a kid is going to strap on a helmet or shoulder pads and play football or hockey is at age 15 or 16 when the weight differential between players [colliding] could potentially be 80 to 90 pounds—like a 210-pound senior linebacker tackling a 130-pound freshman—that is when you’re going to have problems, if it’s the first time you’re trying to protect yourself. I’m a proponent of teaching kids how to tackle and block properly at younger ages.”
Guskiewicz brings up a football video on his desktop computer. A North Carolina player lowers his head while making a block. Thwack! The collision delivers 104 g’s of force to the side of his helmet. He sustains a concussion. Up comes a second video, this from a game that took place a month later. The same player makes another block—only this time, he strikes his opponent with his left shoulder, remaining mostly upright and turning his body to shield his head.
“See that?” Guskiewicz says. “It’s an entirely different approach. We taught him to do that. We can change behavior. And that’s in a college player. It’s a hell of a lot easier to do with a high school team.”
This, according to Guskiewicz, is the future. Behavior modification. Teaching players to tackle without hitting their heads, assuming that’s possible. Guskiewicz is a member of the NFL’s Head, Neck and Spine Committee. In conjunction with USA Football, the league is aggressively pushing the safe tackling concept on youth coaches and nervous parents through a program called “Heads Up.” Goodell himself insists that it works, that it makes the sport “safer than it has ever been” and moves closer to “taking the head out of the game” entirely.
I have doubts.
In USA Football’s glossy tutorial videos, boys practice their new-and-improved tackles against empty air, foam pads, and stationary opponents who seem to be imitating scarecrows. Tackling is broken down into five distinct stages. There’s plenty of time and space to take just the right angle, launch into a tackle, maintain perfect form, keep one’s head from getting bashed by tucking it under an opponent’s armpit. Football becomes an exercise in aggressive, studied chest-bumping. It really does look safer.