Can Football Survive in the Age of Concussion Awareness?

I was talking with my son this week, watching the Monday Night Football game, and he asked if I thought football would be around in the future as we learn more and more about the impact of concussions on NFL and other high level football players.   The NFL is such huge business with over $9 billion in annual revenue, and with major fortunes being made by players and others that it is not likely to just disappear anytime soon.  The same is not true of football at the high school and younger levels.  Any  advantages of youth and high school football are not financial for the vast majority of participants, despite the hope of college scholarships for the few select athletes.  Paul Butler MD, a retired surgeon school board member in Dover, NH brought up to the school board as a matter to consider whether the district should discontinue its high school football program in light of the ever-increasing and progressively convincing evidence of the frequency and consequences of concussions on football players brains.  Dr. Paul Butler has become a regional if not national lightening rod for those on both sides of this issue.

I am an interested observer at this time, partly because I casually enjoy watching football, but also as a past high school and college football player who played prior to the current recognition of the seriousness of concussions.  I can distinctly recall at least three occasions of what I now as a family physician would consider fairly major concussions, and several other times when I was knocked unconscious but within a few seconds came around.  In none of these, the three bigger events, nor the others did I miss more than a few plays of a game, and never missed a practice the next week. I say this not to sound tough, but as an example of how things have changed.  In those days the player was asked if they felt OK to play or practice.  If you said yes, you generally played. If you said no you were looked at as a wimp and not tough enough for the game.  Today it is clear that the athlete cannot be the one primary person making the decision about when they are safe to return to play.

In Washington we have a strict policy for management of concussions, and this is likely to help reduce the odds of recurrent and major brain trauma. Recognition of second impact syndrome as a rare but sometimes fatal consequence of return to contact sports too early as well as the consequences of recurrent concussions has led to guidelines that I see being followed conscientiously in our state.  The CDC has made efforts to reach out to all stake holders with clear guidelines for coaches, trainers and physicians.  Still the question remains.  Is the inherent risk of concussion and brain injury worth whatever benefits playing football brings to a young male at the Pop Warner or high school level?  Also is the potential risk of catastrophic injury and the legal consequences more than a school district can or should bear? These are more than a rhetorical questions.

I’m as aware of the impact participation in team sports can have on youth.  I lived that life and raised both a son and a daughter who were active in premier level sports. Also in just the time I’ve lived in Puyallup, WA several graduates of the local school district have gone on to fame and relative fortune in the NFL.  How many others have sustained concussions?  How many will or have had mild or worse cognitive impairment?  Will any develop chronic traumatic encephalopathy?  These are not questions with available answers but it is clear that for our boy’s football is the sport with the highest risk of concussion. The American College of Neurologic Surgeons estimates that 34% of college football players report having sustained a concussion, and 20% more than one concussion (1).

Personally I do not see much chance that high school football will cease to exist due to thoughtful consideration of the risks and benefits by school board members or community involvement.  Football is far too engrained in the American culture to have an unemotional and rational discourse on this subject.  I do think that litigation or fear of litigation could lead to a decision to stop high school football.  So the question remains.  Can football long survive in the current legal environment as the evidence become more clear that it puts players at risk of traumatic brain injury and the short and long term consequences?  I think there is a reasonable chance the answer is no. What do you think? Leave a comment and joint the discussion.

You may enjoy related information:

Concussion Facts  from the Sports Concussion Institute.

Injury Prevention & Control: Traumatic Brain Injury  from the CDC

Heads Up: Concussion in Football    from the CDC and USA Football

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