I have written on this subject in the past, and many medical experts have weighed in on this topic over the past year. An excellent collection of expert responses to the question “Would you let your son play football?” can be read here on Dr. David Geier’s blog. Since President Obama was recently asked about the violence in American football in an interview in The New Republic magazine, it seemed like a good time to revisit this topic. President Obama touched on several topics in his answer, but perhaps the most important line was “…if I had a son, I’d have to think long and hard before I let him play football.”
As an orthopaedic surgeon with subspecialty certification in sports medicine, football injuries make up a significant part of my practice. I spend nearly every Friday night from September to November on the sidelines of local high school football games. I deal mostly with the musculoskeletal injuries that occur – the ACL ruptures, meniscus tears, dislocated shoulders, sprained ankles, etc. While most of these injuries can be fixed and I can get these young men back on the field after they are healed, there is certainly some long-term joint injury that cannot be reversed with many of these injuries. I see many men in their 30’s and 40’s who are dealing with pre-mature arthritis in their knees, ankles, or other joints as a result of “old football injuries.”
While these musculoskeletal problems can be significant, they are not the reason that the safety of football has been brought into question recently. It is the neurologic injuries, both immediate and chronic, that have people concerned about the violence of our country’s most popular sport. Returning to play after concussion has been a hot topic for years now, and guidelines have been getting stricter at all levels of play for some time. Even more recently, there has been a concern for the chronic brain injury that occurs over time with repeated head trauma at a sub-concussive level. New evidence is mounting that real brain injury can occur from the numerous blows to the head that a player takes during the course of a game, or practice for that matter.
To date, there have been 33 former NFL players that were diagnosed (postmortem) with chronic traumatic encephalopathy (CTE). CTE is a progressive, degenerative disease of the brain that can cause psychosis, confusion, vertigo, chronic headaches, impaired judgement, dementia, slowed muscle movements, gait disorders, and speech problems. Some of the more high-profile cases were former NFL players Dave Duerson and Junior Seau, both of whom committed suicide. CTE has been seen in younger players as well, and 2 notable cases were 26 year-old Cincinnati Bengals WR Chris Henry and 21 year-old University of Pennsylvania lineman Owen Thomas. Henry died in an automobile accident, and Thomas committed suicide, but no definite link between his early CTE and his suicide has been established.
At the professional level, the argument can be made that these men are being compensated for the damage that they are doing to their bodies. That argument does not apply to the much larger number of players playing at the collegiate and high school levels. And what about all the kids playing middle school, Pop Warner, or Pee-Wee League football? Many of these kids don’t even have helmets that fit properly or the helmets may have been handed down for the past 15 years. Granted the game at this level is played at much lower speeds, but is damage still being caused to these young athletes’ developing brains? This article from the Baltimore Sun suggests that it is.
How can we make football safer for our kids? One way would be to eliminate full-contact football below the high school level. Many middle schools already have flag football programs that are much cheaper for the schools because of reduced equipment costs. Another would be to group children in football leagues based more on size and weight than on chronological age; however this probably only increases safety for the smaller kids. If full contact football is being played, we need to have rules that ensure the kids have proper-fitting equipment, especially helmets. Requiring athletic trainers to be on the field during practice and games, as well as providing injury recognition and management training to coaches should be priorities for programs. The NFL has enacted stricter rules and penalties on helmet-to-helmet hits in the past few years, but I believe more can be done and it will take many years for these changes to trickle down and actually change the culture of the sport at all levels.
I am as much of a football fan as anyone you will find, but I am worried about the safety of the athletes and the future of the sport. If changes are not made to improve the safety and remove some of the violence from the game, many parents will guide their young athletes to choose other sports. It is somewhat of a catch-22 for the sport of football, because the violence is one aspect of the game that draws in a lot of fans. I don’t have a son, but if I did I would agree with President Obama and would probably guide him toward another sport.