By Dylan Henry, Kacie Kerigedes, and Kimberly Sachs, of Montgomery McCracken
Over the last decade, football has earned a reputation as being one of the most dangerous sports. Concussions and football are now inextricably linked, with major news outlets regularly reporting on chronic traumatic encephalopathy (CTE), the dangers of repeated blows to the head, and the long-term effects of traumatic brain injuries. Parents keeping their fingers on the pulse of concussions in football are becoming increasingly concerned about the long-term impacts of the high-risk sport, with some opting instead to steer their children to lower-risk, reduced-contact sports such as swimming, track, or baseball.
Existing literature on cumulative head impacts and tackle football seem to support this decision. A recent study, however, suggests that youth football is not as dangerous as critics once thought, at least in the short-term, for youth athletes who play football for a few consecutive seasons. The study, published on December 30, 2021, in JAMA (Journal of American Medical Association) Network Open, found that head impacts and concussions are not linked to problems with memory, attention, processing speed, or behavior in youth athletes between nine and twelve years of age.
The study, while promising, has its limitations. The study does not shed light on the long-term effects of repeated blows to the head, as it spanned only four years, nor does it measure the outcome of CTE or other neurodegenerative diseases (e.g., Alzheimer’s, dementia), the signs, symptoms, and risks of which develop over time. Its sample size is also quite small, making the statistical power of the study quite insignificant. Nevertheless, the study provides some optimism in a world fueled by media hysteria (which frequently outpaces the science) surrounding the risks and dangers of football.
The Study
The study ran from July 2016 to July 2020—a period spanning four football seasons. Researchers recruited male youth athletes from four separate football teams, and the seventy participants were between nine and twelve years old. Athletes dropped out of the study if they stopped playing football or if they did not attend pre- or post-season testing visits. In total, eighteen of the seventy participants completed all four years of the study.
The study monitored head impacts using helmet-based Riddell InSite sensors during practice and games. InSite is a helmet-based impact monitoring technology that collects and analyzes on-field head impacts. The study defined “head impact” as “any impact detected by the InSite sensor.”
Prior to the study, the researchers documented each athlete’s previous medical diagnoses (e.g., headaches, migraines, ADD/ADHD, anxiety, depression). The researchers also documented each athlete’s concussion history as well as the athletes’ participation in other contact sports, which the study defined as wrestling, ice hockey, soccer, lacrosse, or rugby.
Before and after each football season, participants completed several cognitive and behavioral assessments. These assessments included a symptom validity test, which tests for response validity. At the final post-season visit, players also reported whether they played other contact sports (defined as wrestling, ice hockey, soccer, lacrosse, or rugby).
Results
At the end of the study, the researchers found that head impacts across four years of play were not associated with poor outcomes on cognitive or neurocognitive tests in youth football players. The cognitive and behavioral assessments remained stable throughout the four-year study period, and those whose scores did change during the study period had premorbid conditions, including ADHD. Thus, the researchers concluded that cognitive performance was more impacted by premorbid medical conditions (e.g., ADHD) than cumulative blows to the head.
Takeaways
Most studies into the effects of youth tackle football have been retrospective, meaning they look backwards and examine past events and exposures to see how they relate to established outcomes. Prospective studies, on the other hand, look forward in time, and follow participants before they develop the disease or outcome in question. There are several longitudinal studies out there endeavoring to research the long-term effects of repeated injuries in sport and in the military, including the NCAA-U.S. Department of Defense Concussion Assessment, Research, and Education (CARE) Consortium, led by Steven Broglio, Ph.D. from the University of Michigan, which just recently earned a 10-year extension and $42 million in funding to continue the research. But this study is one of—if not the—longest prospective studies to measure head impacts and neurocognitive outcomes in youth contact sport athletes. Its results—that there are no ties between youth tackle football and cognitive issues—are promising.
Experts, however, caution that this study does not say that it is safe to play youth football; instead, more research is needed to fully understand the long-term effects of repeated exposures to head impacts (not only from football, but from participation in all sport or work-related activities, because the brain does not really care what impacts it, just that it was impacted). While parents and coaches can lean on this study to alleviate some anxiety, they should continue to implement the safety measures currently in place. This includes reducing exposure to cumulative head impacts, especially during preseason and in practice, teaching proper tackling techniques, implementing return-to-play protocols and procedures, and following those procedures—to a tee—in the event of an injury.
It should always be a priority for youth sports organizations to protect their athletes from head injuries. Football, or any contact sport, will never be a risk-free activity, and parents and coaches alike must be aware of the risks for injury and take all precautions necessary to protect their youth athletes from repeated blows to the head. This may entail delaying enrollment in football until age fourteen, something the Concussion Legacy Foundation recommends, limiting full-contact practices, or investing in helmet technology. Whatever method parents and coaches so choose to protect their youth athletes, the undeniable fact is that football will always carry risk.
What this risk is, at least in the short term, is still unknown. Though this study suggests that everything we once thought about football may not be entirely accurate, its results are quite limited and do not shed light on the long-term effects of repeated exposures to head impacts. It should therefore not be used as a green light for abandoning or reducing precautions.
