Many consider it America’s game. In the fall and into the early winter months, football owns Friday night (high school), Saturday night (college), and Sunday night (NFL)—and some would argue Thursday and Monday nights as well (NFL). However, in the past few years and certainly within the last few months, which I’ll highlight in this article, the heat has been turned up on the topic of safety of football.
Much of this stems from the “concussion crisis” of the NFL (for an overview, I recommend the PBS documentary ‘League of Denial’, a documentary based on the book by Mark Fainaru-Wada and Steve Fainaru). But this controversy has trickled down to youth tackle football, amidst concerns of not only concussion but also sub-concussive head impacts and the potential short- and long-term consequences of playing football, including Chronic Traumatic Encephalopathy or CTE. CTE is a progressive degenerative disease of the brain, and much of the concern around CTE has been raised by the Boston University/Concussion Legacy Foundation “brain bank” group led by Drs. Ann McKee, Robert Cantu, and Chris Nowinski.
Most, if not all, of the headlines from this past fall through today stem from the research of "the BU group." In July 2017, just days before the start of the NFL training camp and the youth and high school pre-season, the group published a report showing that CTE was identified in 110 of 111 former NFL players and 48 of the 53 college players who donated their brain to the study. This research paper created a firestorm of newspaper articles, radio and TV interviews, and podcasts. Most of the headlines and dialogue centered on the report’s key finding: CTE in 99% of former NFL players' brains.
However, some individuals, including respected neuroscientists and other researchers, called attention to some of the methodological limitations of the study—or flaws in how the study was carried out. These included:
- The study involved a convenient and biased sample, based off of brains donated from deceased players who had already been previously showing symptoms
- The study was essentially a case report—in other words, there was no control or comparison group
- The study did not control for confounding variables or other things that could lead to brain damage such as drug use
- No firm conclusions about CTE risk can be drawn from the study, especially for younger athletes
Despite these limitations, the prevailing headlines, tweets, and “sound bites” convinced 83% of Americans that “there is a settled science that playing football causes brain injuries,” as indicated in a Oct 20th poll conducted by the Washington Post. A month earlier, another BU study linking age of first exposure to football with emotional, behavioral, and cognitive impairments in later life was published. This study began fueling the argument for eliminating tackle football prior to high school.
As the concerns for youth football safety were mounting during the fall, I was travelling across the country representing USA Football as the Director of High Performance & Education observing and collecting data related to initial efforts in implementing “Rookie Tackle." Rookie Tackle is a small-sided, modified game that serves as a bridge-game between flag football and 11-player tackle and is part of USA Football’s adoption of the United States Olympic Committee’s American Development Model (ADM). Key aspects of Rookie Tackle include: 6 to 8 players per side and reduced roster sizes, improved coach:player ratio, focus on skill development and participation, smaller playing field, and position sampling—all modifications that several youth leagues across the country have previously used. The 2017 pilot season included ten leagues across the United States. USA Football has plans to expand efforts in Rookie Tackle in 2018, and also offer padded flag football. Padded flag football would be an intermediary between flag and tackle football, whereby players would wear equipment and be allowed contact at the line of scrimmage but the play would stop when the flag is pulled. This game type was played in a league in Iowa. This allowed coaches to introduce tackling during practice a full year prior to competing in a tackle football game. (Note: I resigned my position in December 2017).
In late October, members of the congressional Energy and Commerce Committee sent a letter to USA Football seeking details on how it evaluates the safety of tackle football programs for kids after hearing from the BU researchers and former NFL players about the aforementioned research. Information on a response to this letter from USA Football has not yet been reported.
As the youth and high school seasons finished and the holiday season brought college bowl games and the onset of the NFL playoffs, it also brought another research paper from the BU group. In this study, the researchers looked at the brains of four teenage athletes who had sustained head injuries and died shortly thereafter, and also used mice to recreate head trauma. On the following day, the Concussion Legacy Foundation launched Flag Football Under 14, a program to educate parents on the benefits of waiting to enroll their child in tackle football until age 14.
In the following week, two states—New York and Illinois—introduced bills to ban youth tackle football for children under 12 years old.
All of this brings us to the Aspen Institute Sports & Society Program’s panel conversation titled, "Future of Football: Reimagining the Game's Pipeline” on Jan 25th. The event was moderated by Tom Farrey, former ESPN writer and author of Game On: The All-American Race to Make Champions of Our Children, who has previously been outspoken about the safety of youth tackle football. The underpinning theme of the event was “What if flag—not tackle—was the standard way of playing football until high school?”
Here are a few key highlights from the panel discussion. Full a complete overview see #AspenSportsLab.
And here are a few of my thoughts from the event:
What are your thoughts? What are the implications if there was no tackle football, and only flag, until high school? What are the public health ramifications? Economic impact? How would it impact your community? What are possible solutions?
If you are a football fan, stay tuned. A final report from the recent Future of Football panel will be released in March by the Aspen Institute.
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Learn more about Dr. Eisenmann | @Joe_Eisenmann