Weighing the risks of football

Medical professionals on-site and new recommended rules of play minimize the perceived risk of football

Southwest High School’s Lakers running drills during practice. Photo by Zoë Peterson.

There’s a push for a new narrative in youth and high school football: the benefits outweigh the risks, including the risk of concussion.

Uzma Samadani, an associate professor in the department of neurosurgery at the University of Minnesota and attending neurosurgeon at Hennepin County Medical Center, supports the argument that potential injury from football is preferable to the sedentary alternative.

“Many children who play football have a body that precludes them from engaging in other sports,” Samadani said. “Every single child in America needs to be playing sports, and if they want to play football we should make the sport as safe as possible.”

Samadani studies traumatic brain injury and hemorrhage. She also has ties to the NFL.

In a recent publication, Samadani reported “serving as an unaffiliated neurotrauma consultant to the National Football League for five games during the 2015–2016 football season.”

Samadani also agrees with the recommendations of the American Academy of Pediatrics issued to promote safer practices, including rugby-style tackles; no-contact practices; neck muscle strengthening; wearing protective equipment; and having athletic trainers at the sidelines during games and practices.

Athletic trainers

A grant funded by the NFL Foundation and Vikings will ensure that high school athletes at Minneapolis Public Schools will have access to medical attention on-site for the third school year.

Certified athletic trainers from TRIA Orthopedic Center are available to athletes at school, in attendance at football practices and on the sidelines at games for all contact sports. A physician also attends varsity football games.

The selling point for the program funded by the NFL is baseline testing for concussions — a traumatic brain injury. Athletic trainers are qualified to determine whether athletes are safe to continue playing after taking a hit.

Athletic trainers work in tandem with physicians to provide preventative services, emergency care, diagnosis, treatment and rehabilitation of injuries.

“I think it’s the most fantastic idea,” Samadani said. “The better the care that they’re given, the safer they are.”

Kelsey Gleich, the athletic trainer assigned to Southwest High School, said she primarily provides preventative care.

“My role is to provide medical coverage that includes hydration, prevention of injuries and helping to treat injuries,” Gleich said. “I try to teach athletes how to manage the daily aches and pains that may not be an injury, so that injuries don’t happen.”

Steven Miles, a professor of medicine and bioethics, as well as the Maas Family Endowed Chair in Bioethics at the University of Minnesota Medical School, said the program does not prevent the risk of head trauma.

Athletic trainers are able to identify symptoms of concussions, but by the time an athlete is concussed, they have sustained a traumatic brain injury. Even more concerning are the repeated blows and bonks, Miles said.

“It is very clear now that it is not the symptomatic concussions, but the repetitive subconcussive hits that are the problem,” Miles said. “Because it is subconcussive injuries that are the problem, athletic trainers can’t detect the injuries on the field of play.”

Although Minneapolis Public Schools ultimately benefit from the extra help, the risks of playing football are much more serious than the sprains and broken bones athletic trainers address most frequently, Miles said.

“Most sports that kids play are sports that have risk of various kinds of orthopedic injuries,” Miles said. “But the brain is a special kind of organ because it’s not paired, and it’s an organ that all other life opportunities depend on. Without a brain, you can’t do anything.”

Like riding a bike

Aimee Custer, a neuropsychologist part of TRIA’s sports concussion management team, said preventative measures and the proper treatment of concussions should prevent long-term brain damage.

“I think concussions are a very serious injury but they’re a very treatable injury,” Custer said. “I think the benefits of playing a sport outweigh the risk of sustaining a concussion.”

Many argue life is inherently risky, and that encouraging children to play football — to engage in regular physical activity — is therefore in the interest of public health.

“There’s risk of concussion playing sports at any level,” said Amy Hamilton, the manager of TRIA’s sports medicine program. “There’s risk of concussion riding your bike.”

However, this comparison is misleading, Miles said. Although many activities include a risk of brain injury, comparing bikes to football is like comparing apples to oranges.

“The problem is that in football the head injuries are repetitive while most people bicycle without ever experiencing head injury,” Miles said.

Brain damaging injuries often don’t have the symptoms of a concussion and are difficult to detect. These injuries — sustained from less intense hits and bonks— are likely to impair attention, memory and school performance in the short-term, Miles said.

In the long-term, repeated brain trauma can cause chronic traumatic encephalopathy (CTE), a progressive degenerative brain disease similar to Alzheimer’s.

“It doesn’t make sense to me for schools — who are in the business of educating brains — to incentivise students to bang them up,” Miles said.

‘It’s up to the parents’

Alvin Johnson, the offensive-line varsity coach for Southwest High School, has been playing football for nearly two decades, and continues to play semi-professionally for the St. Paul Pioneers.

Johnson hasn’t witnessed or experienced the long-term effects of traumatic brain injury, but knows firsthand that there are serious risks to consider before stepping on the field.

As a senior in high school, one of Johnson’s teammates was paralyzed during a game. The next season, as a freshman on the Southwest Minnesota State University team, he saw a teammate die in practice.

“He was doing a drill and his eyes just rolled back in his head,” Johnson said. “I try not to worry about it. I just go out and play.”

Johnson said life is unpredictable, and so he has decided to assume the risk associated with football.

“I love the game. It’s what I look forward to,” he said. “I guess it’s really up to the parents.”