Concussion Focus Needs to Shift from NFL to Youth and High School Football

Two American football players colliding, with both brains visible through helmets.
Two American football players colliding, with both brains visible through helmets.

The movie Concussion, starring Will Smith, opens in theaters nationwide on Christmas. For anyone who cares about safety in sports this is a welcomed development.

Concussion is the story of forensic pathologist Dr. Bennet Omalu (played by Smith), who while conducting an autopsy of the brain of former Pittsburgh Steelers' All-Pro Mike Webster discovers a neurological disorder, which he calls chronic traumatic encephalopathy (CTE). Omalu publishes his findings and the rest of the movie centers around the drama involving Omalu and NFL powerbrokers.

Concussion will reach a larger general audience (including a lot of mothers who often make the family decision about which sports their children will and won't play) than previous documentaries and TV specials on football's impact on the brain. The excellent Frontline documentary, League of Denial, did the hardcore reporting on football, the brain and the NFL's irresponsible and unethical behavior. But the audience for a PBS movie is minuscule compared to a major Hollywood production, with a large marketing budget, and starring a superstar actor in the lead role.

Many of those entering theaters this holiday season to watch this highly-promoted movie will only be marginally aware of the link between football, concussions, and CTE, the neurological disease resulting from repetitive brain trauma. A lot of them will be leave shocked at what they discovered. As a result, Concussion will likely spark a broad national discussion about the safety of our country's favorite sport.

As a society, we need to take the attention this film will generate and move it off the NFL and refocus it on youth and high school football. There are less than 2,000 players in the NFL. The number of youth and high school players in this country is greater than three million.

Our children are playing football while their brains are still developing, increasing the risk of serious brain injuries. These kids are allowed on football fields by the parents and guardians in their lives before they reach the age of legal consent, and before they are capable of fully understanding the short and long-term risks football represents to their brains.

Those risks are scary to contemplate. Consider:

According to the Brain Injury Research Institute, in any given season, 20 percent of high school players sustain brain injuries. Additionally, over 40.5 percent of high school athletes who have suffered concussions return to action prematurely, which can lead to death from Second Impact Syndrome (SIS), a condition in which the brain swells, shutting down the brain stem and resulting in respiratory failure.

It's important to be aware that it's not just concussions we're concerned about today. Purdue researchers recently compared changes in the brains of high school football players who had suffered concussions with the brains of football players who were concussion free and found brain tissue damage in both. That means brain injuries are occurring without players, coaches or parents even being aware of it.

Repetitive sub-concussive hits to the head can cause as much damage as concussion-causing hits. CTE has many symptoms similar to Alzheimer's and other neurological diseases, however it isn't the result of some endogenous disease but due to brain injury -being hit too many times in the head. To that point, consider that the average high school football lineman receives 1,000 - 1,500 shots to the head during a single football season, based on estimates by Boston University researchers.

Unfortunately, there isn't a magic football helmet on the market today -- or likely in the future -- that will make them game safer from a brain standpoint. Helmets are great at preventing skull fractures and lacerations but terrible at preventing brain damage. The reason is that the brain is like Jell-O bouncing up against the walls of the skull. It's the whiplash effect that leads to concussions. That's why players can receive concussions without even being hit in the head. A blow to the chest can send the brain splashing against the skull with as much force as a head-to-head shot.

Schutt Sports, a manufacturer of sports equipment, openly admits the limitations of their helmets and now puts the following warning on the company's football helmets:

"No helmet system can protect you from serious brain and/or neck injuries including paralysis or death. To avoid these risks, do not engage in the sport of football."

Perhaps a similar Surgeon General-type of warning should be placed in every permission slip that parents must sign to allow their youth league or high school football players to participate in this sport.

"In terms of youth and high school football, we're in a race against the clock," says former NFL defensive back Keith Smith, who now manages a youth sports league. "This is a very serious matter. We need to change what we're doing fast. We need to make football safer, especially at the younger ages."

But how much safer can football, an inherently dangerous sport, be?

There are numerous benefits to youth sports participation, including fitness and a long list of life lessons that are best learned via sports. But there are safer alternatives to tackle football for our children, including flag football. And if the idea of playing flag football is too hard to stomach for some athletes and their parents, there are tens of other sports available which provide the same benefits as tackle football.

One thing we can count on, the market for safety-first youth sports leagues will undoubtedly grow as parents learn more about the risks high-contact sports like football represent to a child's brain.

"Concussions, or injuries in general, should not be viewed as a natural and acceptable consequence of playing youth sports," says Brian Sanders, CEO of i9Sports, a safety-first national youth sports organization that offers flag football, soccer (no heading), basketball and baseball. "As such, we provide healthy alternatives to situations where children are unnecessarily put in harm's way."

Dr. Omalu is on board with that approach.

"It is our moral duty as a society to protect the most vulnerable of us," wrote Omalu in a New York Times op-ed this week. "The human brain becomes fully developed at about 18 to 25 years old. We should at least wait for our children to grow up, be provided with the information and education on the risk of play, and let them make their own decisions. No adult, not a parent or a coach, should be allowed to make this potentially life-altering decision for a child."

Maybe, just maybe, Omalu's right.

At one time we allowed kids to smoke in public schools. In retrospect, that seems crazy now. In 25 years or so, will we look back at today's world and think it was just as crazy that we once allowed our kids to bang their brains around playing football, risking life-altering brain damage in the process?