As we learn more about the long-term risks associated with football and repeated concussions, many have begun to question whether the sport is still safe enough to allow in schools.
The question is at the center of a discussion recently published in the medical journal Pediatrics, where experts and physicians from several institutions debated both sides of the issue.
To do this, the journal selected three experts from the University of North Carolina and Children’s Mercy Hospital in Kansas City to answer their solution to a hypothetical scenario where a small-town pediatrician was in the position to advise whether to cancel a school football program.
Youth football participation levels are down and many have called for an outright ban on school football programs, citing the dangers of experiencing brain injuries and potentially developing chronic traumatic encephalopathy (CTE). CTE is a degenerative brain disease linked to repeated brain injuries which has been found in a number of professional football players in autopsies.
However, because CTE can only be diagnosed in post-mortem autopsies, it is unclear how much of a danger is poses to high school athletes.
Dr. Lewis Margolis, a pediatrician and epidemiologist at the University of North Carolina took the strongest stance in the commentary. He argued that the current findings suggest football poses a unique risk to the brain and that there is not enough evidence of its benefits – both mental and physical – to warrant allowing the sport to continue.
“High school football players have, by far, the highest risk of concussion of any sport,” Margolis wrote. “In football, the rate of concussion is 60 percent higher than in the second ranking sport, lacrosse.”
Margolis also noted that he was concerned that a disproportionately large number of players are African American, which could cause them to “face a disproportionate exposure to the risk of concussions and their consequences.”
Based on this, the pediatrician advised that pediatricians should urge “discontinuation of high school football programs” until research can further determine the long-term risks for young players.
“At present, there does not seem to be a way to reduce the number of head injuries in high school football,” Margolis wrote. “There is no question that football is deeply imbedded in this community, as in U.S. culture. Our society has, however, researched other harms, such as tobacco use, alcohol-related driving, and obesity-related unhealthy diets and exercise, and successfully changed social norms.”
Other participants in the discussion, such as Dr. Greg Canty, a medical director for the Center for Sports Medicine at the Children’s Mercy Hospital in Kansas City, took more moderate stances. Canty agreed that both schools and the medical community should take leading roles in making the sport safer, however, there is not enough evidence of the risks of high school football to discontinue the sport entirely.
“If we eliminate football, what sport is next and what is our threshold?” Canty asked in the commentary. “Who is going to be responsible for defining ‘safe play?'”
He also urged caution about taking the current findings from brains of former professional athletes to brain banks as being indicative of the overall risk of CTE.
“It has been found in a hundred or so deceased athletes when the sample size of former athletes is in the millions,” Canty noted. “We have no idea how to apply current information about CTE to youth or living athletes. We have concerns, but no definitive answers.”
Canty also cited the rising number of concussions being diagnosed among athletes as signs that the sport is actually becoming safer. He believes the numbers indicate more schools are taking brain injuries seriously, not an increase in the actual number of injuries.
In his opinion, banning football would make schools begin to question all sports they sponsor, such as soccer, hockey, basketball, and lacrosse – all of which involve a level of risk for concussions. Ultimately, it is too broad of an approach to a more nuanced issue.
“I encourage pediatricians to look for ways to make all sports safer for our patients,” Canty said. “Start by demanding certified athletic trainers at all sporting events. Be a resource for educating your community on sporting topics.”
Dr. Mark Halstead, a sports medicine physician at Washington University found himself in agreement with Canty, saying there are already many steps that schools can take to reduce the danger of concussions in athletics. Specifically, he encouraged key staff members to work with licensed athletic trainers on site and to develop and emergency action plan.
“I am often asked if I would allow either of my 2 sons to play football knowing what I do about concussions. Yes, I would,” Halstead wrote in the commentary, qualifying it would only be in a program where safety was a priority. “I would only let them play in a program that encourages safety and puts an athlete’s health above winning.”
We are finding out more about the long and short-term risks of concussions in high school athletes, but there are still many questions without answers. While football does pose a specifically high risk for concussions, it is up to parents to decide whether these risks outweigh the physical and character building benefits of the sport.