“Would I let my son play football?”
It’s a question that more and more parents are asking themselves these days. There are some people out there who say, “No way!”
Football is way too violent and should be abolished as a sport. Even some NFL players admit that they would not let their own sons play football. Then there are others, fierce advocates who think football is a wonderful game with tremendous benefits to its participants and think all of the media hype about injuries are just overrated scare tactics and headline grabbers.
But the majority of us are probably somewhere in the middle and aren’t quite sure what to think. So why don’t we spend a little time sifting through all the facts and emotions and see if we can make some logical decisions about the subject. I have an interesting perspective in that I am a sports medicine physician who is a true fan of the game, has played the game, has sustained injuries and has a son of my own.
Thus I can see the argument from all sides. Let’s start with the physician side. My job is taking care of injured athletes. I see patients with fractures, sprains, strains, overuse injuries, head injuries, concussions, trauma, you name it. During the months of August, September, October and November, I probably see more patients than I do for the entire remainder of the year. Why? Football season.
I make a living off of injured football players. I see the devastating injuries that come in and sideline a football player for a week or a month or a year or even end his athletic career. I see the injuries acutely on the sidelines of games, I see them later in my office, and I even see them years after that.
I see the ex-football players who are in their 40s who have the arthritic knees of an 80-year-old. I see them in their 50s after five or six spine surgeries. And what about the growing numbers of middle-aged ex-football players who are developing cognitive decline from the multiple concussions and head trauma?Dementia, CTE, chronic headaches, depression, the list goes on and on. It’s not just long-term orthopedic problems anymore. It’s not just the chronic knee pain or back pain. These athletes suffer from cognitive, psychological, psychiatric, social, emotional and daily functional problems that even lead some to take their own lives. From this perspective it is easy to ask oneself the simple question: Is it worth it?Especially when I have a 4-year-old son who is so innocent and has his whole life ahead of him. I ask myself: Is this what I want for him? On the other hand, football is a beautiful game. It is the No. 1 sport in America for a reason. Not only is there the physical strength, speed, technique and skill that it develops in its athletes, but it also provides a structure to develop other skills. Learning about hard work, strategy, teamwork, social and trust building skills, these are all life lessons that provide our youngsters with tools to not only tackle their opponent, but to tackle life.
From a spectator perspective it is also a fascinating game to watch. The strategy of the play calling and the intricacy of the formations, the feat of skill of an amazing catch, the excitement of an interception and of course the energizing violence of a hard fumble-causing tackle. Finally, for the athletes themselves there is also the social status of being a football player on the high school or collegiate level. And for some there is the lure of playing professional football with all of the fame and fortune and opportunity that it provides. For many it is the last hope and a way out of an otherwise troublesome life. So how do we balance these two perspectives?
Well, as with any decision in life we must weigh the risks and rewards. So let’s take a logical look at the risks. There is tremendous risk in football. Every year football players in this country die from head trauma or sudden cardiac death or heat illness. Also injuries leading to paralysis and permanent disability are not as rare as we would hope. But what are the true relative risks? It is a fact that head trauma is more common in bicycling than it is in football. Football is then closely followed by playground accidents. Concussions may have a higher incidence in girls soccer than in football. What about the risk of death?
There is a higher risk of dying in a car accident on the way to football practice than there is of dying at practice. So what do we do? If we hold our kids out of football, do we then also stop them from riding their bikes, playing in playgrounds, playing soccer and driving in cars? That would be a very radical and overprotective decision. If we can’t eliminate risk, then we should try to reduce the risks as much as possible. How do we reduce risks in football? There are many ways.
Perhaps the greatest is education and awareness. Proper pre-participation screening, heat illness prevention, proper equipment, proper tackling technique, concussion baseline testing and injury monitoring, and there are many others. We also reduce risk by reducing exposure. Limiting the number of hits by limiting full contact practices will reduce injury rates. Rule changes such as on kickoffs will change play dynamics and reduce injury exposure as well. Penalizing dangerous technique such as hits to the head and hits on defenseless receivers and fining flagrant acts of dangerous unsportsmanlike conduct will also reduce risk.
Changing the culture of the game will also go a long way toward limiting violence and increasing injury reporting and monitoring. Should the violence completely disappear? Should the game be more about pure skill and less about physicality? It probably shouldn’t. After all, what does a non-violent, non-physical football game look like: It’s called the Pro Bowl. And nobody watches it. So I don’t think the game needs to be radically changed and the violence completely eliminated, but clearly there does need to be change. Luckily that change has finally arrived.
Football has gone through periods of significant change in the past. From being saved from extinction by Teddy Roosevelt in 1905, to the development of the forward pass, to the fearlessness of the hard-helmeted athlete, there have certainly been many periods of change. I think we have now arrived upon another one. An age of enlightenment so to speak. An awareness of the importance of injury prevention and a culture change of what it means to be an injured athlete. I do not think that the game of football that has been played over the last decade will be the same as that played by my 4-year-old when it is his turn.
So what of my 4-year-old? I have given many lectures on concussed athletes. I have lectured to parents, athletes, coaches, doctors, athletic trainers, pretty much to anyone who is willing to listen. I speak to small groups and I speak at national meetings. I warn people of the dangers of concussions and their long-term consequences. I talk specifically about football as a collision sport and the risks of the sub-concussive events.
The pure repetitive hitting of the head that occurs with almost every block or every tackle. The micro head trauma that occurs about 4,000 times during a high school or collegiate career that no helmet or headgear can protect against. These head collisions may not cause any symptoms at the time, but we are learning that it is these very repetitive head collisions that are likely what truly leads to the cognitive decline, the dementia and the CTE. So inevitably I get asked at the end of every lecture, “If these head collisions are unavoidable, and this is the nature of the game, and we know the long-term outcome risks . . . would you let your son play football?”
So what is my answer? In my own risk vs. reward calculation I come up with a qualified yes. I believe that playing football has tremendous value but it also has tremendous risk. If not football, then my son would probably want to play some other risky sport instead like motocross, and there is no way that I am letting him get on a motorcycle. So as a parent what do I do? When that day comes that my son says, “Dad, I want to play football.” How do I respond?
I will educate my son and make sure that he is well aware of the risk vs. reward decision himself. If he decides on his own that he wants to play, then I will help him personally and I will also help his community to make sure that there is adequate injury awareness and prevention. I will also encourage him to practice risk averse behavior both in his technique as well as in his attitude. Finally, I will make him aware of the risks of the repetitive head collisions and I will encourage him to play a position that does not emphasize this.
I will hope that he doesn’t want to be a lineman or a linebacker or a running back. But ultimately the answer will be, “Yes.”
“Yes, son, I will let you play football. Now let’s go outside and practice your field goal kicking.”
Dr. Andrew Blecher is a board certified sports medicine physician at the Southern California Orthopedic Institute. He provides concussion management for both amateur and professional athletes including youth sports, high school and college, and he also has experience as a physician in the NFL as well as for the Los Angeles X-Games. Dr. Blecher is also the director of the SCORE Concussion program, which, in partnership with the Wells Fargo Play it Safe Program, provides comprehensive concussion insurance coverage for 10 Los Angeles-area high schools. You can also follow him on Twitter for the latest concussion information: @the_jockdoc