Patrick Hruby (writer, Sports on Earth and The Atlantic), Hampton Stevens (writer, ESPN and The Atlantic), and Jake Simpson (writer, The Atlantic) discuss what can and should be done to address concussions and safety in youth football.
Hruby: From Super Bowl Sunday to Friday Night Lights to the totally gonzo— yet somehow predictable—spectacle of Colin Powell and Roger Goodell joining forces to recite the Declaration of Independence (because ... 'Merica?), football is our de facto national pastime. That said, the game is in trouble. Not at the top, where the National Football League rolls along as an unstoppable entertainment Ozymandias. Gaze upon Vikings-Giants, ye World Series ratings, and despair! No, the sport's problems are at the grassroots level, where participation is either stagnant or declining.
Call it the "League of Denial" effect.
According ESPN's "Outside the Lines," the nation's largest youth football program, Pop Warner, saw participation drop 9.5 percent between 2010-12. Similarly, USA Football—a national governing body partially funded by the NFL—reported a 6.7-percent participation decline among players ages 6 to 14 in 2011. A National Sports Goods Association report found that tackle football participation as a whole has dropped 11 percent between 2011 and now. And the National Federation of State High School Associations reports decreasing football participation numbers since 2008-2009.
Why the dip? As Pop Warner's medical director told ESPN, concerns about brain injuries are "the No. 1 cause."
This makes sense. Football is fun. Brain damage is anything but. Parents and families are rightfully wary. Already this year, seven high-school football players have died from either head or neck injures. Thousands more have been concussed. While exact numbers are hard to come by, 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. Scarier still, Purdue University researchers have found that high school players exhibit brain function changes long before they have recognizable signs of a concussion. The more hits a player endures on the field, the more their brain function changes.
Granted, the sport can teach life lessons. But playing chess or volunteering at a soup kitchen can teach life lessons, too, without participants getting hit in the head an average of 240 to 1,000 times a season.
The question, then is obvious: What can football do to change this calculus? Can the sport be made safer? More vexingly, how much risk is acceptable when we're talking about children's brains?
The answer to the first question, I think, is yes. Not safe, but safer. To a point. If we take the right steps. Foremost: There's no good reason for children to play tackle football before they enter high school and/or hit puberty. None whatsoever. Flag football can suffice. Sports concussion expert Robert Cantu notes that young children's brains are physically immature and in some ways uniquely vulnerable to head-rattling damage. He also notes that many NFL players, such as New England quarterback Tom Brady, didn't play tackle until high school, and that doing so did not retard their long-term skill development. Cantu is right on both counts. Hockey Canada recently outlawed body-checking 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. Why not follow suit?
Second, every high-school football team—every youth collision sports team, period—needs a certified athletic trainer with concussion recognition and management skills on its sideline at every game and practice. No exceptions. The majority of concussions will resolve themselves with adequate rest and recovery. But if you can't spot and treat them properly, huge problems can arise. And players and coaches can't—shouldn't—be counted on to diagnose themselves.
As for the Heads Up, "safer tackling" methods being pushed by the NFL? I'm very skeptical. Others disagree. That's a topic all its own, and you can read more here.
The second question—how much risk is acceptable?—is trickier. Because it's ethical. And it isn't just for individual families. It's for schools, communities, society. The brain-damage risks of football are impossible to quantify. Much is unknown. But we know they exist, and that they can be life-altering. Life-ending even. How comfortable are we, collectively, with that fact? Do we want schools—which exist for the double-duty of nurturing and protecting young minds—to sponsor and support an activity with a significant risk of brain trauma? Should children be allowed to participate without being able to give informed consent? Last year, the Consumer Product Safety Commission banned the sale of Buckyballs, small magnetic toys that can pinch intestines and require surgery when swallowed by children. Federal regulators enacted the ban following 22 swallowing cases over a three-year span. What makes football, a far more dangerous activity, so different?
These are thorny questions. Hampton, Jake, give me your takes.
Stevens: My first take is sadness, Patrick, because I adore football. Yet it's almost impossible for anyone to argue with the dire safety issues facing the game.
There is, to answer your question, a vital distinction between the Buckyball and youth football—or soccer, hockey, and cheerleading. That's the difference between an unsafe product and an unsafe activity. Consumers are rightfully protected from the former. Free citizens must be allowed to pursue the latter. In other words, there's a big difference between telling a company they can't sell a shoddy product and telling an individual they can't let their kids play a dangerous game. If a majority people in a community decide they don't want a school-sponsored football team, they have that right.
But I'm deeply uncomfortable with football being declared unsafe for kids by some sort of governmental fiat. Ultimately one of the costs of a free society is that people must be able to make their own choices—even if those choices are bad ones.But let's first reiterate that football isn’t the only sport with this issue. As noted by Mike Gilleran, executive director of the Santa Clara University Institute of Sports Law and Ethics at a recent conference on concussions in sports, the gridiron gets most of the media attention, but soccer is no safe haven. Concussions also occur in hockey, as you noted. For that matter, let's talk about cheerleading—which a recent study found was behind 66 percent of "catastrophic" sports injuries among women.
Like yours, my solutions are nothing new. Flag football for kids is one of them. Rule changes, along with Heads Up safer tackling techniques, are important too. As is having athletic trainers on staff. Another idea is bringing back leather helmets. Or at least using softer ones. Counter-intuitive though it may seem, a softer helmet might actually preclude the kind of head-to-head contact that creates so much brain trauma.
My answer, then, is a hedge. Using a combination of better medical care, more effective equipment, and safer technique, we should do what we can to make all youth sports safer—not just football. Yet we can never pretend that life—even for public schoolchildren—can or should be made completely free of risk.
Jake, how about you? Should youth football be saved? If so, how best we save it? Tell us your vision for the future of the game.
Simpson: I don't know if youth football should be saved in the long run, Hampton. At least not what we consider football.
Pop Warner participation is down because parents don't want to expose their children to potential long-term brain damage, or even worse, dying on the field. Prepubescent children are, by nature, less coordinated and careful than even high schoolers. And while the kids aren't Patrick Willis or Ndamukong Suh in the force department, they are wearing weapons on their heads.
Patrick's answer is simple and effective to me: Don't let kids play tackle football before high school, or at least junior high. Flag football? Sure. Two-hand touch? Absolutely. But no more of six-year-olds playing the same basic sport as NFLers. For that matter, the league has its share of stars who didn't get tackled before middle school, including Brady, who started playing at 14. Not exactly a wimp, that one.
But that's an unlikely outcome for youth football, not when Hampton's free citizen argument is so prevalent. We won’t know until years from now whether the half -measures taken by Pop Warner and other leagues (no three-point stances, heads up tackling techniques, etc.) were enough to keep the new generation of wannabe NFL stars from long-term brain damage. But it’s likely that for now, Pop Warner participation will continue to decline gradually for a while, then level off at a new normal. Maybe 10 percent fewer kids will play tackle football. Maybe even 20 percent. But absent concrete proof that youth football causes CTE, the institution itself will go on.
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