Posted on 10/12/2017 5:23:55 AM PDT by Colonel Kangaroo
We need more research of CTE, but the relationship between brain injury risk and contact football before age 12 is clear.
Note to readers: Last weekend I attended a ceremonial event, and paid no attention to sports. But how can you miss me when I won’t go away? Please note that I wrote today’s column in advance, not knowing what happened last weekend in sports or current events.
In our increasingly polarized society, too often discussion is compressed into “for” and “against” positions. But a person can endorse or admire something while simultaneously feeling change is needed. That’s how many regard the United States, and it’s how we ought to regard football, America’s preeminent sport.
The big question in football is traumatic brain injury: concussions from dramatic knockout hits, gradual accumulation of damage from subconcussive impacts (this probably does more total harm), early-onset dementia in former football players, and hanging over it all, increasing indicators of chronic traumatic encephalopathy in deceased former players.
The evolution of language on this issue is revealing. A generation ago, “concussion” was a taboo word. Coaches and players spoke of “getting your bell rung,” which had a badge-of-honor connotation. It was seen as unmanly to admit head pain, especially since, while a bruise or swollen joint is easily observed, no one but you really knows whether the inside of your head hurts. Now the word concussion is employed regularly by sportswriters, broadcasters, coaches, athletic trainers, and high school nurses. And the language evolution may not be finished. The former football player and professional wrestler Chris Nowinski contends that “brain injury” should be the proper term.
Neurological harm, ignored or actively covered up for decades by the football establishment, has become the subject of extensive research since around the year 2000. That research boils down to this sentence: Professional football may be less dangerous than generally believed, while youth football is far more hazardous than expected, and must be banned.
Surely you’ve seen frightening reports about neurological harm among former football players. Three months ago, Boston University researchers found that 87 percent of all deceased former football players, and 99 percent of former NFL players, exhibited CTE. This can sound like an open-and-shut case against the sport.
But the study was a “convenience sample”—not scientific. Researchers autopsied the gray matter of former concussion sufferers who had exhibited early-onset dementia, and had also decided to leave their brains to science. That is, the only brains studied were those of persons who were very likely to have a degenerative neurological condition.
Autopsying brains is difficult and expensive, and few dying people ask that their brains be studied. Researchers need to obtain a large randomized sample of brains from many people who did and did not play contact sports, and who did and did not exhibit dementia, and that is easier said than done. This 2015 study, led by Kevin Bieniek, a postdoctoral student at the Mayo Clinic’s graduate school, found an association between contact sports and CTE, and also between CTE and two genetic markers. More such study is needed: For now, knowing that a high percentage of deceased persons who displayed the symptoms of brain harm did, in fact, have brain harm doesn’t settle much.
The 2015 Will Smith movie Concussion, loosely based on the life of Bennet Omalu, a forensic pathologist who now teaches at the University of California, Davis, concerns Omalu’s horror at discovering, in 2002, that the brain of a deceased former Pittsburgh Steeler exhibited what has since been named chronic traumatic encephalopathy. Omalu has since said he believes all contact sports, including girls’ soccer, should be banned before age 18, then unregulated after age 18. That is, contact sports should be treated like cigarettes and alcohol: forbidden for minors, and for adults, well, you’ve been warned. Here is me, Omalu, and two other guests discussing this on WAMU’s terrific new show 1A, the follow-on for The Diane Rehm Show.
Omalu may have made what will eventually be seen as a major medical discovery. The problem is that it’s not clear exactly what Omalu discovered, beyond the neurological indicators of CTE. Does this condition develop only in those who play contact sports? Only in those who play football? In anyone who experiences hard impacts to the head and exposure to overpressure, as often happens to soldiers and sailors? Is CTE simply caused by being alive, a chronic condition of decline like so many associated with aging, and will eventually be detected in millions of people? Until there are answers, the significance of Omalu’s finding is hard to weight.
Given this, let’s turn to what seems clearer. Professional football is assumed to be terrible for long-term health, but this view may not be correct. Research published in 2012 by the National Institute for Occupational Safety and Health, a division of the federal Centers for Disease Control, found that aging former NFL players live longer than other men of their birth years, have fewer cardiovascular problems, suffer less cancer, suffer dramatically less diabetes, and despite the media impression, are less likely to commit suicide than same-aged men.
No one wants NFL players to be harmed. But professional football players are few in number, are adults who knowingly assumed a risk, and are well-compensated in money and status. Media coverage focuses on aging NFL stars, because their names are known, their profiles are high, and stories can be spun as the shocking truth about how America’s game betrayed those who played it.
This approach is wrong for two reasons. One is that most who appeared in the NFL were better off playing than they would have been not playing, even taking into account that pay was much lower in past decades. The second and more important reason is that focusing on former NFL stars distracts attention from the real worry—youth players.
There are about 700 boys, and a few girls, in youth tackle leagues for each one man in the NFL. That’s 700 times as many victims as the worst-case view of the NFL. Youth players are too young to consent to risk, and their adolescent brain cases and necks are more vulnerable than those of adult athletes. Society does not allow cigarettes to be marketed to 10 year olds. Yet the NFL actively markets tackle football to the very young.
A bombshell Mayo Clinic study found that from high school age onward, playing football is not particularly associated with late-life mental disability—it’s bashing heads before high school age, when the neck and brain case aren’t finished forming, that sets in motion bad neurological outcomes. This study, completed in 2011, had a control group, unlike the recent Boston University study, and followed up on the late-life outcomes of males who played high school football in Minnesota from 1946 to 1956. Researchers concluded, “We found no increased risk of dementia, Parkinson’s disease or ALS among the 438 football players compared with the 140 non-football-playing male classmates. Parkinson’s disease and ALS were slightly less frequent in the football group, whereas dementia was slightly more frequent, but not significantly so. When we compared these results with the expected incidence rates in the general population, only Parkinson’s disease was significantly increased.”
Another 2015 study, also from Boston University, found that aging former players who entered full-pads tackle leagues before age 12 performed “significantly worse” on tests of mental acuity than aging former players who did not don helmets until middle school. For those who waited until they were more than 12 twelve years old, late-life drop-off in mental faculties was not much different from the norm.
If the above studies were bombshells, this research paper, published last month, is a guided missile. Researchers led by Robert Stern of Boston University found yet another association between tackle football before age 12, and neurological problems later in life: “The study showed that participation in youth football before age 12 increased the risk of problems with behavioral regulation, apathy and executive functioning by two-fold and increased the risk of clinically elevated depression scores by three-fold.”
This and other research tends to show, though cannot be said yet to have proven, that for those who wait until they are more than age 12 to don helmets and play the tackle version of the sport, late-life drop-off in mental faculties was not much different from the norm.
Such research suggests a bright line. Organized tackle football before age twelve does engage tremendous neurological risk; but don’t start football until middle school and the sport’s neurological hazards are roughly the same as those associated with soccer, diving, and bicycling. Maybe someday soccer, diving, bicycling, and football all will be banned as too dangerous. Based on what’s known today, football is not notably more dangerous—so long as you don’t start until middle school age.
If youth tackle football were abolished by legislation—or if parents and guardians refused to allow young children to join full-pads leagues and endure helmet-to-helmet hits—the societal harm caused by football would decline dramatically.
There are complex arguments about the risk-reward situation for high-school players who learn life lessons through sports, for college players who receive scholarships in return for donning pads, and for pros whose participation brings them large amounts of money and a glamorous lifestyle. There is no complexity about the risk-reward situation for youth tackle football. It’s all risk, no benefit, and should end.
Beyond this, the problems of aging professional football players should be placed in context. Former NFL star Frank Gifford died in summer 2015. Because Gifford declined mentally in his final years, his surviving family authorized a brain autopsy, which showed he had chronic traumatic encephalopathy. Gifford’s CTE was headline news, including on major network evening newscasts, and presented as a deplorable indictment of the sport.
The missing context is that Gifford died at 84, an age when dementia is sadly common. Gifford was born in 1930. An American male of that birth year had a life expectancy of 60, while an American male born in 1930 who had reached age 65 had a life expectancy of 76. Battered by a long career in football, including during the decades when water was forbidden at practices and “headhunting” (deliberate helmet-to-helmet hits) was encouraged by coaches, Gifford nonetheless surpassed his longevity projection by nearly a quarter of a century. He appeared on national television as a Monday Night Football analyst until he was 67 years old—sharp enough mentally at that age to handle three-hour live television events.
Gifford lived a long, full life, then developed dementia at the last. Many American families experience the sadness of someone’s bright promise of youth giving way to mental disability at the last. Would Gifford really have been better off if he had foregone all the good things that football brought him in exchange for a slight improvement in his odds against late-life mental decline—something that might have happened anyway?
There have been cases of football players who are not old who exhibit mental debilitation, and such cases are heartbreaking. But many who are not old develop heartbreaking health problems: society only notices if the person is an athletic star or other kind of celebrity.
Looking at the big picture, football is not especially dangerous—except to children. That’s a problem that can be solved by banning youth tackle leagues.
Till age 12, flag football is just as much fun as tackle, a better teacher—youth flag players learn how to be in the right place at the right time, and tackling can be learned later—and a way to cut risk, to say nothing of pain. Tackle football hurts; flag doesn’t hurt. Why should 10 year olds accept brain risk and experience pain to learn a sport they could learn nearly risk- and pain-free?
But don’t take my word for it, take Archie Manning’s. He did not allow Peyton and Eli to don pads and helmets till they reached seventh grade. Before that, these quarterbacks who would go on to four Super Bowl rings played flag, a game in which heads are not bashed. Everyone else, including legislators, and parents, and guardians of young boys and girls eager to play football, should follow this example
This thread exemplifies what’s wrong with America and on Free Republic
Pussy Nation
And not in a good way....
We did not have Pop warner yet (early 1950s), but my grade school had a football team, for seventh and eighth graders. They played a 7 or 8 game schedule, mostly against high school freshman teams. Only a few grade schools had teams.
Some of us did the same, a few of us into our 30s. I remember a couple of knockouts, lots of cuts and bruises and a few sprains, but we all survived. Mrs. JimRed made me quit when I kept coming home bloody and dirty. As a 74 year old I still miss the hitting. Doing rec B'ball 2-4 times a week now, and those 40-50year old kids are killin' me!
Back in the day when I was of age to play Pop Warner football, they did have teams in the area I lived, but due to their age/weight limit restrictions, I couldn't play because I was too big, so I didn't start playing football until high school and freshman football. Here's a link to the matrix of the age/weight limits:
POP WARNER LITTLE SCHOLARS AGES & WEIGHTS
The reason Pop Warner Football institutes the age/weight scale is to match up kids around the same size to limit injuries and balance the competition.
My sons played both Pop Warner Football and high school football and when they moved up to the high school team, they excelled because they already knew the fundamentals and had 4-5 years experience playing. My younger son starred on defense on his college football team and he was also the long snapper and played special teams and playing Pop Warner Football laid the foundation for him.
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